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“SALUS POPULI 8UPREMA LEX.”
Vol. CXIX.
WEDNESDAY, JULY 5, 1899. No. 1.
(Original Communications.
A COUNTRY HERBALISTS CURE
FOR THE “ KING'S EVIL” (a)
Bv JOHN KNOTT, M.A.. M.D.. and Dip. StaC
Med. (Univ. Dub.); M.R.C.P.I.; M.R.I.A.; Ac., Ac-
The comparatively trivial nature of tbe communi¬
cation which I have had tbe temerity to bring under
the notice of the Medical Section of our Academy can,
perhaps, be beet excused by suggesting its usefulness
as an item provided for the mental relaxation of my
hearere in the interval between the periods of intel¬
lectual digestion of the more ponderous courses
which are usually supplied: The details of the remedy
in question were not, as the title of this paper might
. mislead some to think, obtained from a profound
•“ herbalist” or pharmacologist of any kind. The only
■connection which my informant had with the profes¬
sion of healing, in addition to the practice of his
*' cure,” was by forming tbe last link of tbe chain—in
the capacity of grave-digger. He exercised the func¬
tion or sexton of a parish church in my native county
■of Roscommon, close to the bordering Shannon, which
separates it from the adjacent county of Leitrim. The
■quiet, wavy, hilly-hollow, emerald-clad fields of this
locality have reflected tbe first light on some
of the most enlightened and enlightening mem¬
bers of rur profession. Within a very short
distance of the churchyard where my sexton
friend cures and buries his neighbours, was born
any friend. Dr. Michael F. Cox, one of the highest living
authorities on Irish history and antiquities, and who
will, I trust, throw some additional light on the folk¬
lore medicine of the locality. Hard by the birthplace
of the latter, our native western air was first breathed
by him whose “ bi-ief, brave, and glorious y«*mg
career ” was so recently unexpectedly terminated, and
whose place will long remain unfilled in the breasts
of those who were privileged to enjoy the intimate
friendship of Thomas Heazle Parke. Close to the
same place lived and died the maternal grandparents of
that inspired member of our profession, who, of all
that our country has produced, has secured the
•firmest hold on future immortality. Those who
know anything of Irish country life are aware how
•very usual it was for a married lady to go to her
mother s home to pass through the trying period of
her parturition ; and, in accordance with this custom,
local tradition states, and—from its nature and
•oi’igin—I believe, with absolute accuracy, that in the
-same parish where my friend practised his herbal
cure was bom one of tne brightest ornaments of the
-world’s literature and of the medical profession.
The misleading information supplied by speculative
biographers and hackney journalists will probably
not have prepared the majority of those present for
what should send a thrill through the breast of every
one of my hearere, when I mention the honoured
name of Oliver Goldsmith.
I made the acquaintance of my herbalist ” friend
as he was engaged in his customary vocation of dig¬
ging a grave—for, I was told, a girl of about nineteen,
(a) An abstract of this paper was read in the Medical Section of
lie Boy&l Academy of Medicine ia Ireland on Not. 18th, 1898.
who bad died from a gradual “ decline ” caused by the
discharge from a number of “ running evils,” which
had developed in the neck and various parts of the
limbs. I visited the place in company with the in¬
cumbent of the parish, who introduced me to his
adjutant; and who, being of a jocular disposition,
made some remarks on the accidental meeting of two
rofessore of the healing art. and quizzed the sexton
y observing that his present task might have been
indefinitely postponed—if the friends of the poor
victim of early decline had been judicious enougn to
avail themselves of his services in his other capacity.
This led to further conversation, and ultimately to
the friendly communication to me of a description of
his treatment of the “ King's Evil.” His “ cure” was
carried out in three stages: —
1. The “ sore ” was poulticed with a preparation
of the leaves of the “ cuckoo sorrel.”
2. The “ dressing " consisted of a preparation of
the root of the “ sweetmeadow.”
3. Application of a “ plaster ” compound of
Beeswax,
Sheep suet,
Yolk of egg,
First flour.
The leaves of the cuckoo-sorrel were gathered when
rich in sap, placed in a saucepan on the fire, and
-‘ stewed in their own sap," by being continuously
crushed and squeezed in various directions, and moved
about so as to prevent their sticking to the bottom or
sides of the saucepan and getting burnt. When
reduced by this process to a somewhat jelly-like mass,
tbe latter was spread “ even ” on a piece of calico or
linen cloth, and applied to the sore. The application
was always a very painful one.
When the sore was fairly ‘ cleansed ” by repeated
applications of this dressing, the first stage of the
cure was considered complete. The root of the sweet
meadow was then procured: ” the present year's
f rowth—soft and mellow ”—was always employed.
t was carefully scraped so as to free it from all
particles of adhering earth, and then thoroughly
pounded so as to bring it to a pretty uniform con¬
sistence. This was also spread on a cloth, after
having received on its surface a layer of the richest
cream; which, in turn, was varnished by a coating of
the “ scum from the chum-cup.”
The belief of the efficacy of this cure for the other¬
wise so unmanageable King’s Evil was strongly
corroborated by local testimony, and excited my
curiosity to investigate on my return home the
previous therapeutic history of the plants named—
if they had any.
Accordingly, I was greatly interested in finding this
Irish rural remedy for ‘ scrophulous ulcers” men¬
tioned byDr.Beddoes in his work “On the Medical Use
and Production of Factitious Airs,” and quoted from
him by Dr. Thomas Winterbottom, Physician to the
colony of Sierra Leone, who points out its similarity
to a “ cure for ulcers ” which he had found “ used by the
people about Bassa, on the Grain Coast.” The Irish
remedy “ is composed of leaves and stalks of wood-
sorrel (oxalis acetosella) and the root of meadow
sweet (spirtea ulmaria).” The application is thus
described by Dr. Beddoes -. “ Tbe sorrel is prepared by
wrapping it in a cabbage leaf and macerating it by its
led by
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ORIGINAL COMMUNICATIONS.
2 The Medical Press.
own juices in warm peat ashes. This pulp is applied
as a poultice to the ulcers, and left twenty-four hours ;
the application of sorrel is four times repeated; then
the roots of the meadow sweet, bruised and mixed with
the sour-head or efflorescence that appears on butter¬
milk left in the churn, and used in the same manner
till the sore heals, which always speedily happens,
often in two or three weeks.”
Dr. W inter bottom’ s' account of the corresponding
surgical remedy of the aboriginal African tribe is as
follows :—“ The leaves of the amelliky are used by
the people about Bassa, on the Grain coast, in the
cure of ulcers. The young leaves, after being moist¬
ened in water, are wrapped in a piece of plantain
leaf, and laid upon hot ashes; when thoroughly
warmed they are taken out, and their juice is pressed
out upon the sore, which is then covered with a piece
of plantain leaf made hot in the fire; the juice is of
a brownish colour, of a slightly acid and astringent
taste. I saw it effectual in a small, obstinate, ill-
looking ulcer, which had resisted every other applica¬
tion. [The italics are mine.]
Subsequent research showed me that the herbs in
question had, respectively, enjoyed high pharmacolo¬
gical reputations down to about the middle of the
present century; when, like many others of venerable
fame, they were retired to make room for junior com¬
petitors. In the interesting work of Roques, Plantes
Usuelles, Indigenes et Exotiques (Paris, 1808), I find
the foUowing notice of the common sorrell.
Oseille (Rumex AcetosaJ. —“Desbois de Rochefort
a parle avec enthousiasme des proprieties de l'Oseille.
Selon lui, les fi&vres intermittentes qui ont resiste atix
amere et au quinquina, cedent, comme par enchante-
ment, a l’usage de cette plante, surtout s'il existe des
symptomes scorbutiques.”
In Woodward’s Medical Botany (2nd edition,
London, 1810), is the following notice, which proves
that its value was then appreciated in Great Britain:—
“ The Acetosella is totally inodorous, but has a
grateful acid taste, which is more agreeable than the
common sorrel (Rumex Acetosa), and approaches
nearly to that of the juice of lemons, or the acid of
tartar, with which it also corresponds in a great
measure in its medical effects, being esteemed
refrigerant, antiscorbutic, and diuretic. It is recom¬
mended by Bergius in inflammation, bilious and putrid
fevers, and from the cases adduced by Francus, he
concludes, ‘ Acetossellam appetitum restaurai-e,vomi-
tum consopire, alvum stringere, sitim sedare, oris
smaritiem tollere, cordis vires reparare, anginam
abigere.’ The principal use, however, of the Ace¬
tosella, is to allay inordinate heat, and to quench
thirst; for this purpose a pleasant whey may be
formed by boiling the plant in milk, which, under
certain circumstances, may be preferable to the
conserve directed by the London College, though an
extremely grateful and useful medicine. Many have
employed the root of Lujula, probably on account of
its beautiful red colour rather than its superior
efficacy. An essential salt is prepared from this
E lant, known by the name of Essential Salt of
emons, and commonly used for taking ink-stains out
of linen.”
In the Medical Botany by Stephenson and Churchill
(new edition by Gilbert and Burnett, London, 1834),
we read:—“ Wood-sorrel is inodorous, but possesses
a very agreeable and refreshing acid taste. Twenty
pounds of the fresh plant yielded to Newman 6ix
pounds of juice, from which he got two ounces, two
drams, and one scruple of the bin-oxalate of potash,
and two ounces six drams of an impure saline mass.
The bin-oxalate of potash iB one of three subspecies
of oxalate of potash, and exists ready formed in
oxalis acetosella, oxalis comicvlata, and different
species of Rumex, from which it is extracted in some
parts of Europe in large quantities. Hence it is
July 5, 1899.
known by the name of salt of wood-sorrel, and in this
country is sold as essential salt of lemons, mixed
with an equal quantity of cream of tartar. It is
mentioned by Duclos in the ‘ Memoirs of the French
Academy for 1668.’ Marcgraaf proved that it con¬
tained potass, and Scheele discovered its salt to be
oxalic. It may be formed, as Scheele has shown, by
dropping potash very gradually into a saturated
solution of oxalic acid in water; as soon as the proper
quantity of alkali is added, the bin-oxalate is pre-
cipitated.But care must be taken not to add too much
alkali, otherwise no precipitation will take place at all.
“ Medical Properties and Uses. —The leaves of
this plant are among the most grateful of the vege¬
table acids. The juice of sorrel is sometimes used as
an agreeable refreshing drink in fevers, and the leaves
boiled in milk form a pleasant whey; but the other
vegetable acids are quite as useful and more available.
Beaten up with fine sugar, the leaves make a refresh¬
ing and wholesome conserve ; ‘ its flavour resembling
green tea.’ The leaves in a recent state form a good
salad for the scorbutic, and have been employed with
advantage as an external application to scrofulous
ulcers.” So that we have more than ample evidence to
demonstrate the appreciation of the therapeutic value
of the sorrel family in the first half of the nineteenth
century.
An additional interest is superadded for us Irish¬
men in the fact that it has been claimed by a high
botanical authority that the wood-sorrel is really
the genuine original shamrock of St. Patrick. On
this subject, Mr. Bichene,the secretary of the Linnsean
Society, read a paper on the appropriate date of Sfc.
Patrick’s Eve, 1830. An abstract appeared in the
Philosophical Magazine of the following June: He
stated that it would seem “ a condition at least
suitable if not necessary to a national emblem that it
should be something familiar to the people, and
familiar, too, at that season when the national feast
was celebrated. Thus the Welsh have given the
Leek to St. David, being a favourite oleraceous herb,
and the only green thing they could find on the 1st
of March; the Scotch, on the other hand, whose
feast is in autumn, have adopted the Thistle. The
white clover is not fully expanded on St. Patrick’s
Day, and wild specimens of it could hardly be
obtained at this season. Besides, it was probably,
nay, almost certainly, a plant of uncommon occur¬
rence in Ireland during its early history, having been
introduced into that country in the middle of the
seventeenth century, and made common by cultiva¬
tion. He then referred to several old authors to
prove that the Shamrock was eaten by the Irish, and
to one who went over to Ireland in the sixteenth
century, who says it was eaten and was a sour plant.
The name also of Shamrock is common to several
trefoils, both in the Irish and Gaelic languages. Now
clover could not have been eaten, and it is not sour.
Taking therefore all the conditions requisite, they are
only found in the wood-sorrel, Oxalis acetosella. Itisan
early spring plant; it was and is abundant in Ire¬
land ; it is a trefoil; it is called Sham-rog by the old
herbalists; and it is sour; while its beauty might
well entitle it to the distinction of being the national
emblem. The substitution of one for the other has
been occasioned by cultivation, which made the wood-
sorrel less plentiful, and the Dutch clover abundant.”
In passing backwards to the voluminous Herbals of
former centuries, we find copious notices of the great
therapeutic virtues and multitudinous preparations of
this plant and its numerous cousins.
In the Theatrum Botanicum (1640), Parkinson de¬
scribes no less than fifteen varieties of Acetosa, and
gives the following general account of the whole :—
“ The Names. —It is called in Greeke £(oa2s, oxalis
of the sharpe taste, many of the La tine writers keepe
that name, in Latine also Acetosa, and of some Ace-
Digitized by Google
Jult 5, 1899.
ORIGINAL COMMUNICATIONS.
The Medical Pbess, 3
dula of the sournesse thereof ; others call it Burner
hortensis, and Oalen calleth it o^u\aratov. id eat, Lupu.-
thum acid inn. sou re Docke, yet with Dioscorides,
Oxyala path um is Lapatliuin Acutuni, that kinde of
Docke whose forme of leafe is more sharpe and
pointed then others, and not for the sharpe taste to
cause that name, the Sheepes Sorrel, is called La pa-
tiohnn and Acetosella by divers. Clusius maketh
mention of the first great sort, and Lohel of
the second. Dodonunis, and Lohel gave first of
all others knowledge of the third, and Columna
of the fourth; Bauhinua of the fift sixt. and
seventh. Columna of the eight, Prosper Alpinua
in his Hooke of Egyptian plants of the ninth;
of the tenth and last none hath made any men¬
tion: now Beaterua in horto Eyatetensi speaketh
of the eleventh, by the name of Acetosa cesicaria
peregrina, which Bauhinus calleth Acetoaa Americana
foliia longisaimia pediculia donatia; but of the twelfth
sort (if it lie not the same with the second, where-
unto it is very like), no author ever made mention
before now, and scarce is it known to any but the
gentleman of Angl'sey, called Mr. Morris Lfoid. of
Prisliencorth, that found it on a mountaine in Wales,
and showed it to Dr. Bonham in his life; the thirteenth
is called by Matthiolua Tenuifilia; and so by
Lonir°rua, Geaner, Tragua, and almost all other
writere of herbes in our later age. and called Oxnlia
rervecina of Lohel and Or in a of others, and arvensis
lanceolate by Bauhinua; the fourteenth is re¬
mem bered by Montanua, Gerard, and B tuhinu*. All
of them deservedly have the nurne of Sorrell, because
howsoever, they are somewhat different in leafe or
roote yet they all agree in the sourenesse. although
some more or lesse then others. The Arabians, as
Serapio saith. call it Humaalh ; the Italians Acetosa,
the Spaniards Azederaa Azederilha and Agrethaa ; the
French Azeille or Oaeil'e, Sultette, Surelle, and Aigrette;
the Germanea Saicrampffer ; the Dutch Surckcle and
Surincke ; and we in English Sorrell.
“ The Virtuea .—Sorrell is cooling and drying in the
second degree, and is prevalent in all hot diseases
to coole any inflammation and heate of bloud in
agues pestilentiall or cbollericke, or other sicknesses
and fainting rising from heate, and to refresh the
overspent spirits with the violence of furious or fiery
fits of agues, Ac., to quench thirst, and to procure an
appetite in fainting or decaied stomackes; for it
resisteth the putrefaction of the bloud, killeth wormes,
and is a cordiall to the heart which the seede doth
more effectually, being more drying and binding,
and thereby also stayeth the hot flluxes of the men-
strues, or of humours in the bloudy flixe, or fluxe of
the stomacke; the roote also in a decoction or in
powder, is effectuall for the said purposes; both
rootes and seede, as well as the h -rbe is held power-
full to resist the poison of the scorpion, so that he
that shall eate thereof shall feele no paine being
stung ; the decoction of the rootes is taken to helpe
the jaundise, and to expel gravell. and the stone in
the mines or kidneys; the decoction of the flowers
made with wine and drunke helpeth the blacke
jaundise, as also the inward ulcers of the body or
bowells.
“ A syrupe made with the juyee of Sorrel and Fumit-
terie is a soveraine helpe to kill the force of those
sharpe humours that cause the itch: the juyee
thereof with a little Vinegar, serveth well to use out¬
wardly for the same cause, and is also profitable for
frettings and gallings of the skin in any part, and for
tetters, ringwormes, Ac. It helpeth also to discusse
the scrophules or kernells in tne throate, and the
juyee gargled in the mouth helpeth the sores therein :
the leaves wrapped up in a Colewort leafe, and
roasted under the Embers, and applied to an hard
empostume, botch, bile, or plague sore, both ripeneth
and breaketh it: the juyee of Sorrell dropped into
the eares of such as are hard of hearing helpeth
oftentimes: the distilled water of the herbe is of
much good use for all the purposes aforesaid. The
lesser Wilde Sorrell, and so all the other are of the
same qualitie, and are no lesse effectuall in all the
diseases before spoken of.’
The Wood Sorrell is treated separately in the
following chapter, which I accordingly quote in its
entirety:—
“ Oxye, Alleluja sive Trifolium Acetoaum.
“There are two sorts of Wood Sorrell, the one
familiar enough in many places of this land, the
other a stranger, as farre as I can learne, and onely
cherished in the gardens of those that are curious.
I have, as I said, brought these two sorts from their
family, where they might otherwise be ranked that
is among the Trefoiles for their propertie and name
also, in part.
“1. Trifolium Acetosum Vulgare, Common Wood
Sorrell.—The common Wood Sorrell groweth low
upon the ground without any stalke rising from it,
having a number of leaves comming from the roote
made of three leaves like a trefoile or three-leaved
grusse, but broad at the ends, end cut in the middle,
of a faint yellowish greene colour, every one standing
on a big footestalke, which at their first comming up
are close folded together to the stalke, but opening
themselves afterwards, and are of a fine sour relish,
more pleasing then many of the former Sorrells, and
yielding a juyee. which will turne red when it is
clarified, and maketh a most daintie cleare syrupe :
among these leaves rise up divers slender weake
foote stalkes, not growing above them, with every
one of them a flower at the top, consisting of five
small and pointed leaves starve fashion, of a white
colour in most places, or in some dasht over with a
shew of blush, and in some but on the backe side
onely ; of any other colour (although some have set
downe that it beareth deepe coloured flowers) I have
not seene, after the flowers are past follow small
round heads, with small yellowish seede in them : the
rootes are nothing but threads or small strings
fastened to the end of a small long piece, all of them
being of a yellowish colour not perishingeveir yeare,
but abiding with some leaves thereon in the Winter.
2. Oxys luteo flore .—Wood Sorrel with yellow
flowers. This Wood Sorrel shooteth forth diverB
slender weak reddish stalks trailing upon the ground,
and taking root at the joints as they lie, spread into
many branches, with many leaves on them, standing
singly one above another and made of 3 leaves
cut in at the ends like the former, but are much
smaller and of a paler greene colour; at the joynts
with the leaves come forth three or four small flowers
together, at the end of a long foote stalke, yet each
separate from other, consisting of small ana pointed
leaves like the other, but contained in smaller and
longer heads like cods or homes, yet not crooked
but pointed small which quickly fall away when
touclied when they are ripe, and spring up againe
all about where it grew; it abideth the Winter with¬
out perishing, if it be not too violent, else they will
rot and perish must be new sowne againe.
The Place .—The first, as I said, groweth plentifully
in many places of the land, in woods, and wood sides,
where they may be moist and shadowed, and in other
places that are not too much open tj the sun; the
other groweth in divere shadowie places about Sevile
in Spaine. and in gardens at Mompelier.
The Time .—The first flowerth early in Aprill and
May, the others after Midaommer, and so continueth
in flower until the Autume colds perish it, and the
seede is ripe in the meantime.
The Names .—It is generally taken to be the Oxya
' of Pliny, whereof he speaketh in his 27. Booke, and
4 Thx Medical PHEW
ORIGINAL COMMUNICATIONS.
July 5, 1899.
12. Chapter, but not the Oxytriphyllum, although
Tragus and Lacuna do so call it, because the name
did somewhat agree thereto, but that it is another
herbe whose sharpe pointed leaves, and not the sharpe
taste caused this name, for the Greeke word doth
signifie both sharpnesse in forme and in taste. It is
called Trifolium acetosum of divers, which is the same
in signification as I said with Oxytriphyllum, and of
some Panis Cuculi, Cucbowbreade, eyther because
the Cuckowes delight to feede thereon, or that it
beginneth to blossome when the Cuckow beginneth
to utter her voyce ; it is called by the Apothecaries in
their shoppes AUeluja and Luiula, the one because
about that time it is in flower when AUeluja inantient
times was wont to bee sung in the churches, the
other came corruptly from Juliola as they of Calabria
in Naples doe call it, as Scaliger upon Theophrastus
de causis plantarum saith, yet it is there set downe
Alleluja, but I think it rather should be Lujula. The
other is called Oxys flore luteo of Clusius, and Oxye
lutea corniculata repens of Lobel, and of Bauhinus
Trifoliuni aceto8um comiculalum. The Italians call
it Trifolio acetoso Pan cuculi and Alleluja, the French,
Pain de coqu, the Germane tiawerklee, the Dutch
Coeckcoezbroet, and we in English Wood Sorrell, Wood
Sower, Stabbewort, and Sorrell dubois.
The Virtues. —Wood Sorrell is cold and dry as the
other Sorrells are, and serveth to all the purposes
that they doe, being as effectuall if not more, espe¬
cially in hindring the putrefaction of blood and
ulcers in the mouth and body, and in cooling and
tempering distempered beats and inflammations, to
quench thirst, to strengthen a weake stomacke,
to procure an appetite, to stay vomiting, and most
singularly excellent in any contagious sicknesse or
pestitentiall Feaver, the syrupe made of the juice is
effectuall in all the causes aforesaid, and so is the
distilled water of the herbe also : Sp.unges or linnen
clothes wet in the juyce and applyed outwardly to
any hot tumours and inflammations doth exceedingly
coole and helpe them; the same juice taken into the
mouth and there gargled for some time, and after
spit forth and fresh taken, will wonderfully helpe a
stinking, foule Canker or Ulcer therein; it is also
singular good in wounds, punctures, thrusts and
stabbes into the body, to stay the bleeding and to
dense and heale the wounds speedily, and helpeth
well also to stay any hot defluxions or catairhes upon
the Throat and Lungs.”
(To be continued.)
“THE CANCER FOG.”
An Address delivered at the Inaugural
Meeting of the Cancer Society, June 7, 1899.
By HERBERT SNOW, M.D.Lond., &c.,
Surgeon to the Cancer Hospital since 1876.
Sia Charles Cameron, Ladies and Gentlemen
—The discerning student of history quickly observes
that no important reform-movement, social, political,
or religious, has ever arisen and flourished until the
time was thoroughly ripe for it: and secondly, unless
it was absolutely necessary. So in briefly consider¬
ing the reasons which invite the institution of this
society, I have to ask in the first place whether it is
really required by the community; and secondly,
whether the present is a fitting period for its in¬
auguration.
As its printed circular, on the authority of the
Registrar-General, informs you, the mortality from
cancer is steadily on the increase. In 1864, 8,117
people died from this source; in 1874, 11,011; in
1884,15,198; in 1894, 21,422. In 1897, the last year
for which the returns have been issued, the total was
no less than 24,443 (males 9,673, females 14,870).
But of course the population has also increased;
and may not these large figures be due to that fact p
The supposition is disproved bv calculating the ratio
of deaths to each million of living persons. In 1864,
this was only 385; in 1874, it had risen to 461; in
1884, to 563 ; in 1895, to 755; in 1896, to 764; in 1897,
to 787. You will please note the steadily pro¬
gressive increase of the ratio, concurrently with
that of the population. This, to my mind, suffices
to prove the point in question, though an attempt
has beeen made with some dialectical skill to mini¬
mise its force, and to show that more people die from
cancer simply 1 ecause more live to an advanced age.
Even if such were the case. I am unable to see the
pertinence of the argument, for no cancer ever
arises merely from age. and without a definite exciting
cause. Then also it has been said that the figures are
larger than in former years, because medical educa¬
tion has improved, and doctors are better able to
recognise cancer when they see it. Even if that were
so (and I, at least, can hardly regard the argument as
serious), it is plain that there has been no commen¬
surate progress in treatment. Lastly, I may fairly
ask—without any reference to statistics, which often
involve fallacy : “ Do we not all daily more and more
hear of kinsfolk and acquaintance dying on every side
from cancerous maladies ? ”
It has further been pointed out that a large propor¬
tion of the deaths are referable to cancer in such form
as, on the common consensus of opinion among all
the leading surgeons of the present day, are curable
radically and permanently by a surgical operation
under certain given conditions. If that be true, we
are confronted with one of two alternatives. Either
those conditions are difficult of attainment; or else we
doctors do our work very badly, and most imperfectly
fulfil our functions as guardians of the public health.
Last month a leading medical magazine issued a
special “ Cancer Number,” from which I will quote
one or two extracts singularly pertinent to our present
purpose:—
“ Cancer is the Darkest Africa on the map of medi¬
cine.' For all of us it has something of the gruesome
fascination of a ghost story. - ’
“ There is too much individualism in scientific
work, and the result is not only waste of power, but
actual loss of knowledge ; which is allowed to die with
it 8 discoverer because he could not get a hearing for it or
because it failed to find favour in the eyes of some
superior person.”
We could hardly find a more trenchant indictment
of existing medical organisation for scientific pur¬
poses, or a more ingenuous confession that raaical
reforms are here greatly needed. Yet one more
quotation from the same source (The Practitioner,
April, 1899)
“ With a proper organisation of research on definite
lines by a number of investigators working together
to a definite end, there would be little or no leakage,
and success (i.e., in cancer-research) would be merely
a matter of time.”
Again, I would fain ask you if it be not a sign of
the times, and a note of ominous warning, when we
find the President of the College of Surgeons—who
is regarded, and justly regarded, as a species of Pope
in our profession,_ and who may not unfairly be
described as speaking ex cathedrd when he delivers
the Hunterian Oration before H.R.H. the Prince of
Wales—but a few weeks since pointed out the scant
progress since the days of John Hunter.
Now, I greatly wish that some competent person
would take the trouble to survey, purely from a
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philosopher's point of view, the literature of cancer
during the past century. He would easily master
the special treatises. Excluding pamphlets dealing
with one or two counties in a vast empire, and of the
more or less scrappy order, only two works on the
whole field have appeared within that period, the
only two extant in our language. You will please
note here the strange contrast presented by those
branches of our art in which recent progress has been
most marked: e.g., Gynwcology, Ophthalmology,
Bacteriology. In each of these he would have a whole
library at his disposal. But in the medical journals
he will find articles and papers innumerable, often
involving laborious toil, profound thought, and con¬
tinued self sacrifice in the cause of truth.
Yet, strange to say, the truth always eludes our
grasp. The philosopher of whom I speak will find
everything moving perpetually round and round in
a vicious circle. The great region of cancerous
maladies bristles everywhere with moot points and
controversial questions, some abstract, but very many,
on the other hand, of the most practical and imme¬
diate import. Some one takes great pains to deter¬
mine one of these, and his paper convinces not only
himself but all who read it; so that we might
reasonably suppose the matter settled for good and
all. Yet a few years elapse; the question is found
to be as undetermined as ever; and the same process
is gone through over again with infinite waste of
time and force. Nothing is ever settled. All sorts
of views and opinions flourish, the false equally with
the true. All is truly “ Darkest Africa,” or densest
London fog.
I appeal confidently to those unprejudiced mem¬
bers of my own profession, whose years and acquire¬
ments place them in a position to judge, whether the
picture hero drawn is at all overwrought. Though
seeking to avoid unnecessary technicalities before the
present audience, I am constrained to quote as instan¬
cing wlat I mean—long-settled points yet remaining
matt era of dispute even among doctors—theipbrases,
*• Constitutional Origin,” “ Heredity,” “ Bacterial
Origin,” “ Geographical Distribution,” *• Cancer-
houses,'’ “ Damp Soils,” " Vegetarianism,” “ Elec¬
tricity." While of the fog outside our profession, the
ever-recurring paper questions about the harmless
necessary tomato will suffice. Even vaccination,
which surely has sins enough already to answer for,
at least in the view of its opponents, is gravely pro¬
claimed the true cause of cancer increase, by no less
eminent a High Priest of Science than Alfred Russel
Wallace!
From the point of view of the logician who has
also some smattering of pathology, all the articles in
the lay journals upon “ Cancer ” and 99 per cent, of
those m the medical are vitiated by a radical fallacy,
which brings the argument to nought. It is the
custom to speak of “ Cancer ” as though it were a
single malady ; instead of a very wide group of ex¬
tremely diverse diseases, linked together by a single
feature; in most other particulars differing toto
ccelo; and each owning a special exciting cause apart
from those which generate the rest.
Why then do these maladies, which we must per¬
force now discuss under the single word, loom so
largely on our mortality registers P And why has
Sir William MacCormac to deplore the want of pro¬
gress in their treatment since John Hunter’s epoch P
Assuredly not for want of research and of laborious
industry by the members of the medical profession ;
but simply by reason of the utter absence of co-ordi¬
nation and organisation. Hitherto the force of
numerous individual workers has been wasted to an
enormous extent, and there has been no “Cancer-
Science ” worthy of the name. And it is the aim of
this Society—(I ask you if it be not a grand and
worthy aim ?)—to create one.
In attaining that object the Society will earnestly
endeavour to sink all unworthy jealousy, avoid all
class prejudices, elude all side issues which would
divert it from its goal. I am informed that not a
few persons who received the printed circular seemed
to regard this as involving a reflection upon medical
practitioners, who are presumed guilty of not doing
their level best to grapple with a universal foe,
sparing no ranks of society, though most cruelly
gripping in its claws the poor and already suffering.
lam a88ured that nothing could be more remote
from the views with which the movement was set on
foot, and which the circular aptly expresses. It is
hoped to gain the cordial co-operation of the more
able and enlightened medical men, of all classes and
ranks within their profession in this great reform
movement. So by means of their wisdom, zeal and
experience, under the magic spell of judicious organi¬
sation, and concentration of those scattered efforts
which the authority above cited tells us are now
wasted solely for want thereof, the Society desires to
work. It will sedulously shun conflict with the legiti¬
mate authority and opinion of the medical profession
at large. It will but seek to strengthen the hands of
the members throughout the world, of that profession,
and in a quarter where they themselves universally
confess the utmost weakness. Of such a spirit and
intention the presence on the Committee of Mr.
George Brown, elected Representative on the Medical
Council of all the doctors throughout England and
Wales, may be taken as evidence.
Another objection raised concerns possible experi¬
ments on the lower animals. It is intended, I am told,
to constitute a “ Ladies’ Committee,” which, while-
supervising the numerous future details of a scheme
unhappily most pertinent to their sex, will necessarily
also preclude even the bare suspicion of cruelty to
our less evolved friends and kinsfolk.
As aptly typical of that truly scientific spirit which
will, God-willing, dominate the Society’s counsels, you
will note the name of the Rev.Dr. Dallinger, so famous
in the annals of microscropical research.
The reign of our beloved Queen will for ever Btand
pre-eminent in the world's history for two great points
among many lesser.
First: Man's remarkable progress in physical
science and increased control over the forces of
Nature.
Secondly : His conspicuous “ social evolution ” in
humanity.
We note the closing century on all sides marked
by the association of bodies of men for beneficent
and humane purposes; and it is a phenomenon of good
augury for the ship of state that so keen and discern¬
ing an interest in those schemes is evinced by the
Heir-Apparent. I earnestly hope that the few and
fragmentary remarks time permits me now to make
will tend to indicate that the present movement is
second to few thereof, in sincere intention, in practical
beneficence, in width of scope, in fulfilment of public
need. That the seed now planted will thrive apace
and grow vigorously to a huge tree is hardly open
to doubt; and though some of its fruits will appear
in our day, those most fully ripened can be witnessed
only by future generations. Slightly altering the
words of the great fable, “ Some men have climbed
on those mountains : circle above circle of bare rock
they have scaled ; and wandering there, have chanced
to pick up on the ground one white silver feather
dropped from the wing of Truth. And it shall come
to pass that when enough of those silver feathers
shall have been gathered by the hands of men, and
shall have been woven into a cord, and the cord into
a net—in that net the Truth shall indeed be
captured.”
If it be held that the man who makes two blades
of grass grow where but one was seen before has
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6 Thb Medical Press.
TRANSACTIONS OF SOCIETIES.
July 5, 1899.
<3one more to please the Deity than he who says ten
thousand prayers, what will be the meed of those who
to-day succeed in founding anew Science for vigorous
battle with the most agonising scourge of our race P
We may not gain the victory, but surely it is our
bounden duty to fight for it, and to fight our
hardest.
A NOTE ON THE EMPLOYMENT
OF EUBOPHEN IN RHINOLOGY
AND LARYNGOLOGY,
By EUGENE S. YONGE, M.D.,
Hon. Surgeon to the Chorlton-on-Mediock Hospital, Manchester.
Europhen (iso-butyl-ortho-creey 1-iodide) is a substi¬
tute for iodoform which may be employed with advantage
in all those cases which are suitable for the older remedy.
But a salient advantage is its freedom from the peculiar
odour of iodoform ; moreover, its lightness is such, that
a given weight, as compared with iodoform, will cover a
surf ace five times the area of the latter substance. (1)
Europhen is apparently non-poisonous, and clings
tenaciously to secreting surfaces, liberating iodine—of
which it contains 28 per cent.—in the process. I have
employed it with success in rhinology and laryngology ;
and it is in these departments of medical practice that the
aesthetic objections to iodoform are most apparent. The
faint saffron-like odour of europhen has not been objected
to, and its lightness, tenacity, and antiseptic powers
render it of very considerable clinical value. The drug
ha9 proved satisfactory in minor operations about the
nose and throat, and healing has in every case been
satisfactorily consummated.
Europhen has acted with specially good effect as an
antiseptic and detergent snuff after the removal of nasal
polypi. I am not prepared to say, with my present
experience of the subject, that in cases of ozsena it is
superior to the other drugs in vogue in the treatment of
that disease; but Chappel (bj has obtained most
encouraging results in such cases. Out of a total of
fifteen patients treated, three were cured, whilst the
others were much more benefited by this substance than
by other remedies.
In a case of hypersecretory rhinitis, under my care,
europhen acted more favourably than any other drug
or method, and this is in accord with the experience of
Petersen. (c)
Case of M. M., set. 16, female.—Post-nasal adenoids,
enlarged tonsils and considerable hypertrophy of the
inferior turbinates, which were in a more or less
constant state of hyper-secretion. The patient was
constantly expelling muco-purulent secretion from the
nose and suffered great discomfort on account of the
accumulation of this fluid. The adenoids and tonsils
were removed, and the inferior turbinal freely incised
with the galvano-cautery. As a result of this procedure,
some improvement of the nasal respiration accrued, but
the hyper-secretion was not diminished. Numerous
astringent and antiseptic applications were applied at
various times to the intra-nasal mucous membrane,
without much success. Europhen, however, rapidly and
decidedly diminished the muco-purulent exudation and
reduced the amount, within ten days, by about half.
The drug was blown into the cleansed nostrils by means
of a quill, and applications were made twice daily as long
as was necessary. In the treatment of tuberculous
ulcerations of the larynx and pharynx europhen proved
a valuable substitute for iodoform. Under the influence
of regular applications, the loss of tissue assumed the
appearance of a healing ulcer and steadily decreased
in size.
Case of A. K., set. 24, male.—Phthisis pulmonalis et
laryngeal. Tuberculous ulcer the size of a shilling on
posterior wall of pharynx. The ulcer was cleansed
twice daily with an alkaline spray, and europhen in
powder was then sucked into tne pharynx through a
(a) “Medical Annua],” 1809. (b) Chspell: Medical Record,
April, 1892. (c) Petersen : Munch. Med. Woch., No. SO, 1891.
tube. At the end of a week the ulcer was appreciably
smaller, had taken on a healthy appearance, and was
less painful. Although at the time of the last observa¬
tion the ulcer had not disappeared, it was still continu¬
ing to heal up.
For the local medication of syphilitic ulcerations of
the nose europhen appears more effective than such
similar preparations as iodoform, iodine-glycerine, Ac.
The principal points in favour of the employment of
europhen in laryngology and rhinejogy appears to be
(a) its apparent innocuousness, (b) itB lightness and
tenacity, (c) the absence of disagreeable odour, and (d)
it 8 marked antiseptic powers. No by-effects of any
kind have ever been noted in any of my cases.
^raitBartions of gorictus.
BRITISH GYNAECOLOGICAL SOCIETY.
Meeting held Thursday, June 8th, 1899.
The President, Dr. Macnauohton-Jones, in the chair.
DECIDUOMA HA LIGNUM.
Dr. F. W. N. Haultain (Edinburgh) showed a
specimen of this growth, together with microscopic
sections, and gave a lantern demonstration of micro¬
photographs, which we hope to publish, with illustra¬
tions, in our next.
The President said that the demonstration and
excellent illustrations of Dr. Haultain elucidated one of
the most vexed questions in gynaecology, on which autho¬
rities were not yet agreed. The most recent view
appeared to be that it must be regarded as a malignant
chorio-epithelioma, the typical or atypical nature of
which depended upon the character of the chorionic
epithelium, and its remaining in its form of early preg¬
nancy, its alliance to other malignant tumours bejng
dependent upon transitional conditions. Personally, he
believed in deciduoma malignnm as a distinctly malig¬
nant tumour, characterised by typical etiologies,
pathological, and clinical features, and this was the
view generally held on the Continent. He had not met
with a case in his own practice. The characteristic
specimen which he had Bhown at the Society was one
that he had seen removed by Professor Martin, in Berlin.
Dr. Eden said he thought there was grave doubt
whether all the ninety-one cases which had been recorded
as cases of deciduoma malignum could bear close exam¬
ination. The fact was that this new and fascinating
pathological theory had aroused the keenest interest in
Germany, and there had been some extravagance result¬
ing from the general enthusiasm. This extravagance
was evident in a case recorded by Schmore, in which a
malignant vaginal tumour was described as deciduoma
malignnm arising from inoculation of a vaginal
wound with placental tissue, no uterine growth
whatever being discovered. But there was evidence
that opinion in Germany was becoming steadier.
In the last volume of Veit's Handbook on “ Gynsecologie "
the editor expressed his conviction that the chorionic
theory was untenable, and that the disease was in reality
sarcoma modified by the occurrence of pregnancy. With
this view he was personally in full agreement. With
regard to Dr. Hamtain’s case. Dr. Haultain himself ad¬
mitted that the growth possessed the broad character¬
istic of a sarcoma. The only structures in it which were
peculiar were the large bands and loops of nucleated proto¬
plasm ; the other features might occur in any rapidly grow¬
ing sarcoma. But from the presence of these structures to
the theory of deciduoma malignum was too wide a step
for the pathological theorist. The relation of the villi to
the growth might be equally well explained by the
assumption that these were retained, and that the
disease subsequently invaded the part of the uterine wall
where they were situated. In scientific questions the
simplest explanation should always be adopted in prefer¬
ence to the more complex ones, and the chorionic theory
of deciduoma malignum formed so novel a departure from
established pathological principles that we were justified
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Jclt 5, 1899.
PRANCE.
The Medical PeE88. 7
in asking for much more conclusive evidence in its favour
than had yet been advanced.
Dr. Herbert Snow said that the eloquent exposition of
Dr. Haultain must not blind them to the complexity of
the subject. The question was whether a deciduoma
malignum was a quite different kind of thing to any
other malignant tumour. They had the broad clinical
fact that malignant disease could follow pregnancy, espe¬
cially in the cervx ; but this fact did not require a
special nomenclature. Was deciduoma malignum actu¬
ally more than a name ? The fallacies of m-croscopical
examination must be remembered. He could not help
thinking that some of Dr. Haultain’s explanations of the
appearances were a little idealistic. Probably some of the
cases described as deciduoma malignum a ere not malig¬
nant at all.
Dr. William Duncan observed that they bad all
learned something, and the pains that Dr. Haultain had
taken to make the demonstration clear deserved all
credit. But he thought that they should depre¬
cate making a special pathology for diseases of the
uterus ; this had kept gy narcology back many times in
the past. Thus he had heard of a corroding ulcer of the
os uteri, said to be quite different from any other kind of
ulcer found in the body ; it was really either malignant
disease or tuberculosis. All the cases he had seen
described appeared to him to be nothing more than
sarcoma coming on in a pregnant uterus, and he hoped
that the name “ deciduoma malignum ” would soon
disappear.
Dr. Haultain, in reply, thanked the Society for the
attention they had given to his demonstration. He
knew, of course, that it was a vexed question. The
first point to decide was, what was a sarcoma cell ? On
looking at a single cell they could not say whether it
was a sarcoma or an epithelioma. And the difficulty
was increased by the fact that the cells from which
deciduoma malignum arose were embryonic, and were
not found in adult life. He also hoped that the term
“ deciduoma malignum,” which was a bad one, would be
given up, but “ sarcoma ” was even worse, and he should
like to see the name “ chorio-epithelioma ” adopted.
BRADFORD MEDICO-CHIRURGICAL SOCIETY.
Meeting held Tuesday, June 20th, 1899.
Chairman, Dr. Bebby.
Db. Enrich gave a microscopical demonstration of a
series of tuberculous tumours, which had been removed
under the supposition that they were of a cancerous
nature. They were from the penis, scrotum, labium
majus, and skin. He also showed specimens:—(1)
Secondary carcinoma of heart; (2) the supra renal
bodies from two cases of Addison’s disease.
Dr. Angus brought forwards case of
EBY8IPELATOU8 ANTHBAX.
John W., eet.' 27, a wool sorter, had been working among
Persian wools. On April 28th, he noticed, while at work,
an itching pimple on nis left shoulder. On the night of
May 1st he felt ill, shivered and vomited; the illness
continued, and on May 3rd he was seen by Dr. Angus.
Condition: Temperature in axilla 100 t> . pulse 120, weak.
On the anterior aspect of the left shoulder was a semi¬
circular patch, 3 ins. diameter, of blistered and reddened
skin, surrounded by subcutaneous ecchymosis. The
skin over the front of the chest was reddened and
cedematous, while over the right side of the chest and
on both sides of the neck and face there was oedema, but
no redness. Heart and lungs normal. On May 4th,
temperature 99'4 in axilla, and 100*6 in rectum,
pulse not perceptible at wrist. The reddened patch
increased in size; there was slight oedema of the left
arm, left scapular region and the upper part of the abdo¬
men. On May 5th temperature in mouth 974, the
whole of the front of the abdomen was cedematous, the
hands and feet were cold. Patient died at 11 p.m.
-Verropay. — Across the front of the chest and
neck the skin was of a dark purple colour,
swollen and crepitant on pressure. The subcu¬
taneous veins showed a dark purple through the
skin. Much clear fluid escaped when the tissues were
incised. The retro-sternal cellular tissue was emphyse¬
matous. The right pleura contained about half a pint
of fluid. The pericardium showed subserous extravasa¬
tion of blood, and contained 2 ozs. of fluid. The endo¬
cardium and endothelium of the aorta were deeply
stained. There were patches of extravasation on the
peritoneal covering of the intestines. The spleen was
soft but not enlarged. Cultivations cf the bacillus
anthracis were obtained from the pericardial fluid.
Photographs of the case were shown.
Dr. Rabagliati read notes on a case of
(EDEMATOUS ANTHBAX.
The patient was a man, »t. 47. The illness was only
of five days’ duration, and the symptoms consisted in
swelling of the upper and lower lips, and subsequently
of the penis and Bcrotum. There was no rise of tem¬
perature or of the pulse rate. On one day only there was
slight shivering. The patient recovered.
Dr. J. H. Bell read notes on a series of cases of
“ Anthrax,” of the (edematous and erysipelatous varieties.
He stated that although described as occurring on the
Continent, such cases had not been previously described
in this country.
prance.
[from our own correspondent.]
Paris, July 2nd, 1899.
Congenital Phymosis.
The operation for congenital phymosis, although of
simple and easy execution, can produce certain trouble¬
some consequences as regards the sexual functions in
rendering, for instance, erection painful by the traction
exercised by the skin of the penis on the circular cica¬
trix, or by maintaining the glans curved at the moment
of erection by the presence of the cicatricial tissue at the
seat of the wound resulting from the section of the
fraenum. In order to avoid these accidents, perfect
reunion should be ensured of the skin with the
epithelial surface, and the surgeon should operate so that
the glans, far from being deprived completely of the
foreskin, should be surrounded with a small oollar of
tegument, so as to permit extension. According to
Prof. Pousson, of Bordeaux, this object can be obtained
by a combination of means, among which artificial
ischemia, obtained by Esmarch’s method, plays the most
important role as facilitating the apposition of the
mucous membrane to the skin at the point of section.
After having chloroformed the child, disinfected the
parts, and destroyed with the cannula the possible exist¬
ence of adherences between the mucus of the prepuce
and that of the glans. Professor Pousson places at the
root of the penis an elastic band, ensuring
by this means a bloodless operation. He then introduces
two self-acting forceps to within a quarter of an inch of
the groove, one in front, the other behind, preventing
thus the two layers of the prepuce from gliding one
over the other. By drawing on the forceps, the prepuce
is brought forward, while the glans is pushed behind,
and between the forceps and the glans a fenestrated
clamp of Ricord is applied. Immediately behind this
instrument 8 or 12 threads are passed and finally the
prepuce is cut with a bistoury introduced into
the slit of Bicord’s clamp. The glans is thus
exposed with the sutures lying across it; these
are cut in the middle and tied. The opera¬
tion being terminated, the elastic band is with¬
drawn, and the haemorrhage resulting from congestion is
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GERMANY.
8 The Medical Press.
July 5, 1899.
arrested by irrigation with a hot antiseptic solution,
while the wound is covered by a paste composed of salol,
iodoform, and gum adjuvant. The sutnres are removed
on the fourth or sixth day.
Professor Pousson says that he never had observed
haemorrhage of any account by this method, and only
once or twice did he remark that chronic cedema so fre¬
quent at the point of section of the prepuce.
Cervical Abscess.
M. Hirtz communicated to the meeting of the
Soci^W M6dicale, the case of a man of 21, mason, with¬
out any hereditary antecedents, who received in the
month of January violent blows of a stick on the head,
but without causing any apparent lesion. However, a
few days after he complained of violent pain in the head
and vomiting. A month subsequently the patient was
seized with paralysis of the right arm, and finally with
Jacksonian epilepsy.
In presence of these troubles the trepan was applied
over the fissure of Bolando on the left side, and the dura
mater incised. The subjacent portion of the brain was
found to be particularly prominent, and the needle of a
subcutaneous syringe was introduced, giving issue to a
drop of greenish pus. It was evident the case was one
of sub-cortical abscess, and it was incised accordingly,
emptied and drained. The patient made a good
recovery, the epileptic attacks disappeared, and the arm
recovered its functions at the end of three months.
Princess and Doctoress.
Princes who have acquired, says the ChroniqM*
MJdicale, the title of Doctor of Medicine, are not abso¬
lutely rare, but with princesses it is almost unique, and
if some of these exalted persons study anatomy and
medicine as amateurs, very few aesuredly would be
capable of writing a memoir like that pub¬
lished by the Bevue Medicalt 8uitxe, and signed
Princess Gu£droytz de Belos£roff. This memoir
made at the surgical clinic of Prof. Boux,
of Lausanne, is very remarkable, it being well docu¬
mented and profusely illustrated. The choice of the
subject, however, seems to us rather singular, as the
author, though Princess and a doctrees, is a woman.
The following is the title of the memoir, “ Excision of
the seminal vesicle and of the vas deferenB in case of
castration for primary tuberculosis."
The Centenary of the Metric System.
On the " fourth Messidor. an. vii—otherwise the
22nd of June, 1799—the Corps Legislatif of France
adopted and authorised the use of the metric system.
The Paris Inspector of Weights and Measures has sig¬
nalised the occasion by issuing a circular to all pharma¬
cists directing them to adopt the metric system without
delay and to cease from using the old measures.
&rrmani>.
[from our own correspondent.]
Berlin. July lgt, 1899.
At the Society for Innere Medizin Hr. Stadelmann
introduced the subject of
Sporadic or Epidemic Cerebbo-Spinal Meningitis.
Four kinds of acute meningitis were distinguished :—
Meningitis purulenta, meningitis cerebro-spinalis epi-
demica, meningitis tuberculosa, and meningitis serosa.
All, with the exception of the last, were astiologically
attributable to bscteria, meningitis purulenta, to a
number of organisms, the pneumocoecus Fraenkel, the
typhoid bacillus, the bacillus coli, Ac., and lastly to a
baeillas discovered by the speaker, which appeared as
thick rods. A brewer’s drayman had been injured by a
case of bottles falling on his head. He was not confined
to bed but kept on with his work. Three weeks later
he had to give up his work for a day, and sixteen days
later he was attacked with violent catarrhal symptoms,
rigors, vomiting, headache, twitching of the limbs,
backache, fulness about the head, and slowing of the
pulse to 56 beats per minute. Four days later he was
admitted into hospital. His history was good. There
was great irregularity of the pulse, high temperature
(39-6 C.), stiffneck, violent headache, no affection of sense,
no hyperesthesias. With the exception of enlargement
of the spleen all the internal organs were sound. On
lumbar puncture, a very thick, almost purulent fluid
was withdrawn under a pressure of 370 mm. It con¬
tained albumen and sugar in larger quantities than
normal, 65 cem. were removed. Morphia had to be
given as the patient became worse, and for restlessness.
Three days later lumbar puncture was again performed,
pressure 250 mm., the fluid similar to that previously
drawn off, 15 com. were removed. No improvement
followed, dulness increased followed by delirium, hyper¬
esthesia of the extremities, irregular breathing, converg¬
ing strabismus and general twitchings. Food was
refused, the evacuations were passed under the patient.
Seven days afterwards lumbar puncture was again per¬
formed, this time under a pressure of 300 mm., and 15
ccm. of fluid were removed. The condition now
improved, the intellect became clearer, but the tempera¬
ture again rose, and all the symptoms became worse,
extreme apathy came on, the breathing became very
irregular, cyanosis appeared and nystagmus. Then the
condition again improved, this time decidedly. Three
days later lumbar puncture was performed for the fourth
time under a pressure of 320 mm. The fluid withdrawn
was clearer, contained no increased albumen; 5 ccm.
were removed. Lasting reconvalescence now set in
with enormous appetite. He increased in weight, and
in three weeks was discharged.
On examination of the fluid removed no bacteria were
found, and the inoculation tubes were at first sterile.
In eight days, however, cultures developed, pure culti¬
vation of thick, very mobile roots, with whips, clubbed
ends of polymorphic form not stainable by Gram’s
method. The cultures on agar presented round, clear
colonies, the bacteria were facultatively amoebic. The
growth began after three days, grape sugar was not
split up. The mobility of the bacilli was very active in
the bouillon culture. Milk was uot curdled by them
Inoculation experiments on animals and injection into
the dural sac gave no indubitable results. AStiologically
the disease was attributable to the bacillus, which was
not present in the nasal secretions. The bacterium was
new, and hitherto undescribed, its long latency was
especially striking. The cause of the happy result,
undoubtedly lies in the robust constitution of the
patient, and in the possibly slight virulence of the germ.
The lumbar puncture did not contribute to the success,
it was only of diagnostic importance.
As regarded epidemic cerebro-spinal meningitis, either
the meningococcus intracellularis Weichselbaum, or
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July 5, 1899.
AUSTRIA.
Fraenkel’s pneumococcus could cause it. It was a disease
for notification, but a diagnosis could not 'be made until
one or the other micro-organism was discovered. He had
not notified hiB case, as neither of their organisms was
present.
Heubner had never found the meningococcus except in
epidemic cerebro-spinal meningitis. Occasionally he had
found cocci morphologically similar, so that he was in¬
clined to the hypothesis of Stadelmann, that the menin-
gococous belonged to a large group. Even in diphtheria
people had accepted various micro-organism as patho¬
genic, but later on they had agreed that the offending
organism was Loeffler’s bacillus. It might be the same
with epidemic cerebro-spinal meningitis.
Hr. Kronigbad in one case seen pure cultivations of
meningococcus cellularis with staphylococcus aureus,
the presence of the latter being probably due to
furunculosis, from which the patient was suffering. In
another case he found the meningococcus, in com¬
pany with Fraenkel’s pneumococcus ? he had also
found the latter in lumbar puncture fluid in phthisical
cases. It was known that this could be injected into the
■dural sac without causing any mischief. In several cases
of suppurative meningitis he had found Fraenkel’s
pneumococcus twice, and in others the meningococcus.
He did not consider even the latter the specific excitor of
epidemic cerebro-spinal meningitis, for it could also be
caused by the pneumococcus.
Hr. Jacob from his experimental investigations held
that there was a certain specific relationship between
the meningococcus and the epidemic disease. Other
highly virulent cocci could not set it up.
Hr. A. Fraenkel had found the meningococcus in a
■case where injury had been suffered. It was to be
assumed that the bacteria were already present, and
that they had wandered into the arachnoidal canal as
a result of the trauma. One case of colotyphus presented
the clinical features of epidemic cerebro-spinal meningitis,
but of course no bacilli (Weichselbaum) were found. He
related a third case, actually one of syphilitic meningo-
myelitis in which on lumbar puncture being made, the
pressure was only 2 mm. The cerebral membranes were
attached to the foramen magnum so that the communica¬
tion was closed between the ventricular cavities and the
arachnoidal Eac —hence the low pressure. The ventricles
were dilated to the maximum.
Hr. Kronig remarked that minimal intra-spinal
pressure was nothing new. In such cases the upper part
was always shut off, and that this was so, could always
be concluded, from the pulse oscillations. If these pulse
oscillations were absent the communication between the
cerebral and spinal cavities was closed.
Jlustria.
[from our own corresponding-.]
Viixka, Juue 30th, 18W.
STENO8I8 OF THE TRACHEA.
At the Oesellschaft der Aertze, Harmer exhibited a
male patient, cet. 24, on whom he had successfully
operated for stenosiB of the trachea. It appears from
the history that this young man had croup when he was
five years of age, for which tracheotomy was performed,
but for some reason not yet explained the canula was
never removed, which gave rise to a large cicatrix so that 1
Thi Medical Press. _9
at the age of 16 the whole pharynx and vocal cords were
involved in a thick, hard belt of fibrous tissue.
According to our plastic dicta two operations are
given for the correction of this distortion on the aerial
tract—viz., (a) that long wearisome endo-laryngeal
process of distending the passage by means of a tube ;
(ft) extra-laryngeal operation by means of re-opening the
cicatrix and guiding the union, or what is more recently
performed cutting out the cicatrix altogether and so
promote union of the healthy edges of the tracheal wall.
Harmer selected a modification of the latter method
by making an opening into the larynx in which he left
thick threads of silk as drains. Later he applied a
Schomstein cannula and dismissed the patient from hos¬
pital with it in, and it was removed a few months later.
The edges of the wound were finally pared and freshened
for reunion, which took place soon after with excellent
results. Before the operation the man was unable to
converse with hiB fellow inmates unless by signals or
movement of the lips, whereas now he can speak with a
loud voice, though a little rough, which may yet im¬
prove. With the assistance of the laryngoscope the
vocal cords are shown to be quite normal with a good
wide larynx.
Rontoen Rays and Skin Affections.
Schiff demonstrated a patient who had suffered from
sycosis, chronic eczema, and blepharitis after treatment
with the Rftntgen rsys.
For the sake of contrast, and to prove the virtue
of the rays, one side of the patient had only been treated*
leaving the other half in its original condition. After
ten sittings all the hair had fallen out of the sycosed
portion, and the ezcematous eruption had immensely
improved, while the blepharitis had been quite healed,
though the cilia, which had fallen out under the action
of the rays, were absent.
Tonometer.
Gartner next showed an instrument to the society
which he has lately improved for taking more exact
records of blood-pressure in morbid states of the body.
In the criticism that followed this demonstration
Federn put a few questions concerning it9 practicability,
among which he asked if he could confidently, say for
the general weal of the profession, that the blood pres¬
sure was decidedly reduced in neurasthenia. Gartner
replied by saying that blood pressure teas not lowered in
neurasthenia in the cases he had examined.
Celluloid Implantation for Osseous Defects.
Weinlechner, in his record of surgical cases, told the
Society that celluloid was an excellent substitute for
bone, being easily disinfected, free from absorption, and
plastic when warm. In cranial openings it was indis¬
pensable, and in many cases prevented Jackson’s epilepsy,
though not in every case, as some would allege. There
is another use recently practised in the coaptation of
nerves where the plates are furnished with cannula or
small tubules for the reunion of nerves, these are useful
in resections,
Weinlechner added that he had practised another
use of this celluloid in cases of resecting elbow-
joints where it is often desirable and necessary to obtain
pseudo-arthrosis. In such cases he places a plate of cel¬
luloid between the resected bones and prevents their
union. He next illustrated his paper by examples. The
first was a locksmith, a*t. 28, who had received a blow
from a hammer on the right temple, causing a large
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10 Thi Medical Press. CONTINENTAL HEALTH RESORTS. July 6, 1899.
swelling, which was finally removed and found by micro-I twenty minutes to one hour, as prescribed in each
scopic examination to be a tuberculum. Owing to epilep¬
tiform attacks after removal, Weinlechner laid the
cerebrum bare over a wide area, which he covered with
celluloid to prevent union of the dura mater. After
eight months the epileptio fits disappeared.
The second case was a similar injury with hernia of
the cerebral contents, in which a celluloid plate acted
as an osteoplastic barrier.
The third had been a fungoid growth of the elbow-
joint, for which he had refected and applied a celluloid
plate between the bones to prevent union. The patient
could make a wide excursion with the arm with great
freedom about the joint.
The fourth and fifth cases were operations for neu¬
ralgia of the infra-maxillary and infra-orbital nerves,
where resection and avulsion had been tried in vain.
A celluloid plate was applied before the ligament in the
former, and a celluloid wedge driven into the foramen
ovale for the latter.
Continental gralth JUsorts.
[from OCR SPECIAL CORRESPONDENT.]
MONT-DORE (PUY-DE-DOME, FRANCE).
The thermal establishment at Mont-Dore (recently
reconstructed on the plans of Monsieur Emile Camut)
belongs to the department of Puy-de-D6me. It contains
very complete hydrotherapeutic appliances, of the most
modern and approved character, and very systematica'ly
arranged. The two separate buildings are connected by
a bridge, and two handsome staircases lead to the upper
floor. The building is set apart for treatment by vapour,
containing rooms for inhalations and pulverisations.
The other building contains the springs and baths, and
has been re-arranged in recent years at a cost of .£120,000.
It has numerous galleries for baths, douches, inhalations,
pulverisations, nasal-douches, foot-baths, and hydro¬
pathic treatment generally. In the upper story is a large
central hall, with a roof supported by eight fine columns
of polished Vosges granite, each column twenty-seven
feet in height, and cut from a single block. The galleries
are artistically decorated [with antique statues, pillars,
votive-tabletB, and other objects rescued from the Gallo-
Roman ruins. The establishment itself is erected at
VAngle, at the foot of a mountain, on the spot where the
Celtic and Roman remains *ere situated; and it is over
the springs themselves, so that the waters lose neither
their heat nor efficacy by distance.
The waters are administered in four principal
methods: drinking, inhalations, douches, and baths.
They are drank in various doses of half a glass to four
glasses daily, and are most effectual taken in the morn¬
ings, fasting. Almost invariably they create appetite ;
sometimes causing diarrhoea, and occasionally constipa¬
tion. The kidney secretion is almost always speedily
increased, and the secretions from the mucous membrane
of the larynx and trachea sensibly modified. The aspira¬
tion of the vapours of the Mont-Dore mineral waters is a
mode of application growing in favour among the
local physicians, especially in cases where the invalids
are too weak for bathing or drinking. Patients remain j
in rooms filled by steam (produced by peculiar engines) ]
*rd heated from 82 degs. to 89 degs. Fahrenheit for '
individual case. (The air of these vapour-rooms is
renewed by powerful ventilators, and thus perfectly
purified. Vapour thus introduced is found to soothe the
irritation of the respiratory mucous membrane, and to
reduce congestion of the lungs ; preparing the way for
other and special treatment for asthma, bronchitis, and
phthisis. It is also found a preventive of hemoptysis,
which sometimes succeeds a course of sulphurous waters.
The inhalation of the vapours of the Mont-Dore waters,
and of the waters pulverised into fine sprays have a very
sedative effect upon the mucuous membranes, and
a most remarkable effect upon granular sore throats.
The douches are given in jets and showers, local or
general, and produce especially a stimulation of the
circulatory system. Nasal douches and irrigations of ten
or twelve minutes’ duration are found useful in diseases
of the nose, chronic coryza, ozsena, ulcerations, Ac.
Vapour douches are employed for chronic catarrhs,
sciatic and intercostal troubles, rheumatism, and where-
ever it is desirable to produce revulsive action of the skin.
Garglings with the mineral waters at various tempera¬
tures are prescribed for affections of the throat, pharyn¬
gitis, and laryngitis.
A peculiar feature of the Mont-Dore establishment is
the special hot baths in the Pavilion, built immediately
over the actual springs. They are taken as half and one-
third baths, the water running through them varying
from 108 degs. to 109 degs. Fah. These baths are the
most active of all the treatments given at Mont-Dore,
speedily producing marked effects. The bather’s skin
becomes red, his pulse gains greatly in rapidity and
strength, his respiration quickens, and he perspires most
freely. In ten minutes his skin moistens and softens
notably to the touch, and his breathing equally increases*
Dr. Bertrand attached much importance to the dia¬
phoretic action of the Pavilion baths. To the looker-on
the foot-baths are, however, the most amusing part of
Mont-Dore treatment, as mentioned in a former letter,
in my “ Notes on an August Holiday in Old Auvergue,”
it is one of the unique sensations of the district.
The establishment is open from June 1st to
September 30th. The treatment customarily continues
from fifteen to twenty-one days, and the most favourable
times are considered to be the second fortnight in June,
and the first fortnight of August. When the atmosphere
is heavy and strongly electrical, the excitability of the
patients may increase, attended with sleeplessness and
gastric derangements j in these instances the treatment
is suspended for some days, otherwise it continues daily
and consecutively. The regimen varies according to
the peculiarities of each case; stimulating food, rich
sauces, and spiced meats are forbidden; otherwise (exoept
in special instances) no fixed rules of diet are observed.
The “ cure ” at Mont-Dore operates as a tonic gene¬
rally. Usually it is strongly sedative; the pulse
quietening; sleep becoming more regular, and conges¬
tions ceasing. Appetite increases, digestion improves,
baccilli disappear, the skin recovers its normal nature,
and there is a general recovery of strength and health.
But, naturally, the age, sex, temperament, constitu¬
tion, hereditary symptoms, and other incidents of each
patient must ever be considered. These indicate the
proper method of administering and applying the waters,
and upon this method depends much, for the waters.
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1]
Jolt 6 , 1899.
according to the care and the mode of application, may
increase instead of lessening congestions, and may
become exciting instead of sedative. It cannot be too
frequently impressed upon invalids seeking relief at
Continental Health Stations that to obtain the desired
results able and locally-experienced medical advice and
supervision are intrinsically important, for the different
waters affect different people in different ways. Hence
the necessity of an experienced physician’s guidance
during the “ cue.” At Mont-Dore are a number of such
physicians, speaking various languages. The English
resident physician, Dr. E. Emond, who is well known in
London, is a member of several English, French, and
Spanish medical societies, and has had many years
successful practice at Mont-Dore.
©ptraiing
WESTMINSTER HOSPITAL.
Acutk Mastoid Abscxss. Pxefobation in the Pos¬
terior Portion of thb Mastoid (Bezold’s).— Mr
de Santi operated on a man, set. about 47, who had
been admitted under him with acute mastoid abscess.
The history was that the patient had had an attack of
facial erysipelas, after which he had profuse foetid dis¬
charge from the ear; this was followed by the formation
of a large deep-seated cervical abscess extending from
the mastoid process to the level of the thyroid cartilage.
There was a large sloughing mass in the external audi¬
tory meatus. The patient had a high temperature and
looked very ill. After the administration of an anaes¬
thetic an incision was made over the mastoid extending
right down to the abscess, which was found to be under¬
neath the deep cervical fascia, and from which a large
quantity of pus was let out. The mastoid antrum was
opened in the usual way and the pus evacuated from it.
On careful examinaition perforation of the mastoid
bone was found in its deep or posterior aspect, and this
perforation communicated with the abscess cavity in]the
neck (Bezold's perforation). The whole of the parts
were then thoroughly dried and drained. Mr. de Santi
said that Bezold’s perforation was an uncommon condi¬
tion to find, but he considered that it was most important
for the surgeon to bear in mind that such a complication
might occur, for unless the mastoid bone itself were
operated on in such cases, the deep seated cervical
abscess which resulted from the perforation would not
heal.
The patient did very well till three weeks later, when he
got a sudden attack of cutaneous erysipelas on the other i
side of the face; this caused serious constitutional
symptoms, and profuse suppuration from the old absoess
cavity. The case was treated with antistreptococcic
serum by the house physician. Dr. Bond, and the patient
made an excellent recovery.
GREAT NORTHERN HOSPITAL.
Ruptured Tubal Pregnancy. —Mr. Petton Beale
operated on a woman, set. about 30, who had been
admitted with the following history : She had been
quite well until three days previously, the last menstrual
period having been completed about one week before.
On lifting a chair she stated that Bhe felt something
give way in her right side. This was followed by a sharp
pain, which passed off in the course of a few hours. She
was seen by a medical man on the following day, and was
The M edical F uses.
then becoming rather collapsed, the abdomen getting
distended, and the pulse feeble and quick. On the next
day she was sent to the hospital, when her condition was
as follows: Abdomen enormously distended, tympanitic in
front, quite dull in both flanks, face and skin very pale,
pulse hardly perceptible and very rapid, gasping respira¬
tion. and she appeared as if dying. The abdomen was im¬
mediately opened in the middle line, and was found quite
full of very dark blood clot; this was rapidly pulled away,
and the abdomen repeatedly flushed out with hot sterile
water; it was then seen that there was a small rent in the
right Fallopian tube, which last, however, was not larger
than normal. The tube was rapidly ligatured on each
side of the rent, and the intervening portion removed
The abdominal wound was closed in the usual manner, a
small aperture being left above, through which a glass
funnel was inserted and hot salt solution was poured in,
the air being allowed to escape by the side of the funnel.
Salt solution was poured in until the abdomen was
as distended as it was prior to operation ; stitches
were then inserted on each Bide of the funnel, so
that when it was withdrawn very little fluid escaped.
The whole operation only lasted ten minutes, and no
anesthetic was administered after the primary skin
incision. Mr. Beale said the ca<e was of interest: First*
cn account of the very sliglt injury which had appa¬
rently caused the mpture of the tube, it was difficult, he
thought, to believe that pregnancy could only have been
of one week’s duration, but in cases of tubal pregnancy
menstruation commonly persists. Secondly : On account
of the large amount of saline solution which was injected
and which it might be said was absorbed within one
hour, so that one hour after operation the patient had
full pulse. There seems, he remarked, to be no reason
why the quantity of ealine solution injected Bhould not
equal the quantity of blood effused, and he stated that
he would be prepared in a similar case to inject still
more by forcing a funnel between two of the
stitches if necessary after the first lot had
been absorbed ; indeed, he considered that in
cases of hremorrhage from any part of the body, hot
saline solution should be forced into the peritoneal
cavity, as it could be so rapidly done through a cannula
and was so quickly absorbed. The ovary was not re~
moved, he said, because it would have involved the
application of more than one ligature, and time was of
the greatest importance if the patient’s life were to be
saved, and he thought that in such a case nothing but
that which was absolutely necessary at the time should
be attempted.
The woman made an uninterrupted recovery.
A New “ Food ’ Hospital.
At the ordinary general meeting, held last week, of the
shareho ders of “ Mellin’s Food Company, Limited,” the
chairman took occasion to remark that Mr. Mellin had
established a new children’s hospital, in which the
inmates would be reared on the food bearing his name,
which “ he believed would have a great effect on the
medical profession.” By this admission the public
would naturally conclude that the medical profession
was against. Mellin’s Food for infants, and that it needed
the practical demonstration of a new hospital to con¬
vince it of its unwisdom. If this is the opinion held by
the chairman, we would like to point out to him his
mistake, the profession as a whole has always considered
“ Mellins’ ” to be an admirable food for infants, pre-
pared on a sound and scientific basis.
Digitized by CjOOQIc
12 The Medical Press. LEADING ARTICLES.
July 5, 1899.
BE0I8TERED FOB TRAN8MI88IOH ABROAD.
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Letters in this Department should be addressed to the Publishers.
^hc ^tebical gress attb Circular.
SALUS POPULI SUPREMA LEX.”
WEDNESDAY, JULY 5, 1899.
COVENTRY AND ITS MEDICAL CLUBS.
For some years past the so-called “ Battle of the
Clubs ” has been actively waged in the busy manu¬
facturing town of Coventry. So far back as 1892 it
was publicly stated by the chairman of the Provident
Dispensary of the town that out of a population of
52, no less than 25,000 or 26,000 belonged to the
organisation in question. Since that date we understand
that no returns have been published, but it may be
safely assumed that any change in numbers will have
been in the direction ot increase in an institution that
admits all comers without question of income.
Within the last few days we have been informed upon
what we believe to be good authority that persons
whose income amounts in some cases to a thousand a
year are, nevertheless, on the books of the Provident
Dispensary, and thus secure for themselves medical
attendance and medicine at the paltry and miserable
pittance of one penny per week. Upon such evidence
as this, if established, any system would stand self-
condemned. Unfortunately, there is no need to
hesitate in accepting the statement as to the
membership of unfit persons, because the published
facts of the case bear out the charge in every parti¬
cular. In July, 1897, for instance, the report of the
Ethical Committee of the Birmingham and Midland
Counties’ Branch of the British Medical Association
appeared in the official organ of the Association.
After a full and exhaustive inquiry it showed that
the medical staff received a sum varying from Is. Id.
to Is. 4d. per head out of the annual payment of
4s. 4d. by each member; that the staff was wholly
under the control of a lay committee, and were not
permitted to consult with any medical man outside
their own ranks; that canvassing for members was
carried on, and that the medical profession was
exploited by the dispensary with a view of making
a pecuniary gain out of their services. In September,
1897, the Provident Committee rejected with one
exception the specific request of the medical staff for
the following additions and alterations to existing
rules:—(1) a wage limit; (2) the cancelling of the
rule requiring the appointment of a new Medical
Officer when the aggregate salaries of the staff
should equal an average of £350 respectively;
(3) all the members of the staff to sit on the
committee instead of only two; and (4) chil¬
dren's subscriptions to be raised. The fourth recom¬
mendation was the only one adopted in its entirety,
but the sum mentioned in the second clause wa B
raised from £350 to £400. In commenting upon
these proceedings the members of the staff were
pointedly advised by all the leading medical journals
to resign their appointments. Last summer, at Edin¬
burgh, a further important stage of the affair
was notified in the following announcement
“ That after a prolonged and careful inquiry,
the Council of the British Medical Associa¬
tion is of opinion that the members of the Coventry
Provident Dispensary staff are continuing a Bystem
of medical relief which is incompatible with the best
interests of the profession, and hurtful to their pro¬
fessional brethren practising in the neighbourhood.”
Since that time the Council of the British Medical
Association have remained silent upon the subject.
As readers know, the whole question of the Medica’
Aid Associations was brought before the General
Medical Council a tew week3 ago, and has
been postponed for future discussion. Mean¬
while, another annual meeting of the British
Medical Association is at hand, and it is to be hoped
that the Coventry Question will be brought once again
into prominence. After having laid their hands to
the plough the Council of the Association can hardly
refuse if called upon formally to take further action.
The staff of the Coventry Dispensary bave been
treated with the utmost patience and leniency, but
surely the time has now arrived for sharp and decisive
action. The case of Coventry is the case of the
country at large. Let the medical profession at
Portsmouth raise such a discussion as shall settle once
and for all the attitude of the main mass of practi¬
tioners with regard to the “ sweating ” and advertising
tactics adopted by the friendly and other societies
that include medical relief in their scheme of opera¬
tions. One point should be kept carefully in mind—
namely, the value of a strong and united expression
of opinion at this juncture in influencing the future
action of the General Medical Council. It is to be
hoped that the medical men of Coventry, or better
still, the Midland Counties branch of the Association
will prepare a further pointed and concise memo¬
randum of the facts of the case for the benefit and
behoof of the Portsmouth meeting.
THE DIETETIC VALUE OF DRIED FOODS.
An interesting feature of recent industrial pro¬
gress in dietetics is the revival of dried foods as a
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LEADING ARTICLES.
Thk Medical Press. 13
factor in provisioning. Of course the earliest form
of food preserving consisted in the simple process of
sun-drying; and later on artificial heat, combined
with the more or less efficiently antiseptic smokintr,
came into force. But drying, as applied to preserv¬
ing foods, has its limitations, and was not alto¬
gether satisfactory, for in the process something more
than the mere superabundance of moisture was lost.
This was peculiarly true as regards vegetables and
fruits However, systematic experimentation, chiefly
in America, then in Australia, and quite recently in
England, has resulted in great improvements. We
now have sliced dehydrated fruits—such as apples,
pears, and apricots—which in a dry form can be
■closely packed, will last long, and on being soaked in
■water regain their natural physical characters, as well
as their original flavours. This perfection is attained
by the careful selection of fruit, and judicious
drying in closed but ventilated appliances What
has been done with fruit is now being done with
vegetables. At the present time vegetable garden
produce is being preserved in England mostly by the
simple process of dehydration. This has been carried
so far and so successfully that even beetroot in
thin slices can be dried hard, yet retaining
all its characteristics, including colour, and when
these slices are soaked in pale malt vinegar,
they swell, become tender, and impart a bright
red tint to the liquor. Onions, potatoes, tur¬
nips, carrots, asparagus, seakale, and even lettuce
can be treated in the same manner. It is to be noted
that the process is merely one of systematised pre¬
paration and drying, no chemicals are used, and yet
flavour and colour are absolutely retained. It is
clear enough that this improved system of drying
has many advantages over some other methods
of preserving foods. There is reduction of
bulk, lessening of, and when properly packed,
complete safeguard against the dangers of fermenta¬
tion, and the exclusion of all added chemical anti¬
septics, which, as commonly used with fresh or
bottle fruits, must have a more or less decided
influence on digestion. Moreover, these dried
vegetables and fruits can be quickly prepared for
consumption, and can be kept for travelling, or for
storage against seasons of scarcity, with far greater
ease and sense of security than edibles put up in glass
or tin. In more than one direction, this improvement
in desiccation has been applied to flesh foods with some
amount of success. Indeed, as regards the drying
of eggs, the process proves of the highest excellence
and utility. The dried eggs, in powder or small
oval pellets, have merely to be soaked in a little
water, when they can be beaten up and used for
every description of culinary work with absolutely
satisfactory results. Considering the reliance that
one must place in eggs in invalid dietaries, and the
unreliability of their supply under various cir¬
cumstances, this victory of the manufacturers is a
veritable boon. A welcome feature in this new phase
of food preserving, is that the provisions are generally
of home growth and British manufacture, and will
thus prove a help to the farmer as well as to
the consumer. It is unnecessary to dilate upon
the advantages attaching to dried goods iu the
matter of storage, say on board ship, for travellers
for victualling armies in the field, or for stocking
8 tore looms in order to have a reserve against
sudden demands on the commissariat or unexpected
dearth in the markets. But what must be em¬
phasised is the fact, that by the scientific application
of artificial heat, the vegetables and fruits are deprived
solely of their moisture, and thus they retain al
their nourishing and health-giving qualities, in fact,
merely require to be given the chance of re-absorp¬
tion of water to become fresh vegetables and fruits
once more. This new tendency in the food market is
full of interest, and deserves to be noted by our readers,
as its practical bearing may sooner or later become
apparent to them. In conclusion, just a few prac¬
tical hints. These dried fruits, vegetables, and
meats should be soaked in water for fifteen or twenty
minutes before attempting to cook them, and if they
are to be boiled, heat gradually. When fruit is in
question, stew until poft, and do not add sugir until
the last moment. Sugar added too soon is apt to
harden the fruit and to caramelise rapidly. Onions
and potatoes, when once thoroughly soaked, may be
placed to drain in a sieve, and then be dried in a
cloth, when they will be quite ready for frying.
COMPARATIVE MEDICINE.
The anti-vivisectionistij are very fond of quoting
opinions to the effect that experiments on the lower
animals afford no safe guide to the treatment of dis¬
ease in human beings. Taken literally, no doubt
there is some truth in the assertion, but if we take a
broader view of the subject it will be seen at once
that there is no such thing as human disease, any
more than there can be any purely human physiology
or anatomy. Human anatomy is but one small
department of ethnology, and he who has limited his
studies solely to the dissection of human beings
cannot be said to have attained any real grasp
of scientific anatomy. It has only been by prolonged
observation of the body functions in animals that we
have slowly built up the present science of physiology
as applied to man. Comparative anatomy is now
generally recognised as a department of study
indispensable to the proper comprehension of
anatomy as a whole; but we are now in¬
vited to go a step further, and to formu¬
late a scheme for the study of comparative medicine.
The more we learn of the etiology of disease the more
we are fain to recognise the intimate connection that
exists between disease in man and in animals.
Animals, indeed, are responsible for a large share in
the dissemination of many of the diseases from which
human beings suffer. To study diseases such as
malaria, diphtheria, and tuberculosis exclusively from
a human point of view, is to court failure, inasmuch
as the general principles underlying the propagation
of such diseases must necessarily escape observation*
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14 ThK MxDICAL PFK88.
NOTES ON CURRENT TOPICS.
July 5, 1899.
We are gradually getting to understand that the
comparatively brief time allotted to the studies which
qualify for medical practice might more advantageously
be devoted to learning to grasp principles, for the de¬
tails can only be learned in actual practice. The study
of comparative medicine, however, is of a kind which
pre-supposes a certain and not inconsiderable standard
of knowledge of disease as it presents itself in human
beings so that it will have to be of the nature of post¬
graduate work. Harvard University is, we believe,
the first educational body to give expression to these
ideas, and a chair of comparative medicine has been
founded for the express purpose of providing facilities
for its study and for the original research which such
study implies. The departments under the new
organisation will be medical, veterinary, dental, and
post-graduate. It is hardly necessary to point to the
immense benefits likely to accrue to the community
from the study on a large scale of the therapeutical
and prophylactic problems of the day in properly
equipped laboratories and hospitals designed for ex¬
perimental research on the lower animals and the
study of their diseases. It is hoped in this way to
co-ordinate the observations which are being carried
on in special departments, and while specialism in
study is just as essential to thoroughness of work as
specialism in medicine is to dexterity in treatment, it
is felt to be desirable and possible to break down the
barriers which at present separate investigators in
the various departments and tend to minimise the
value of their observations by narrowing their
respective horizons.
$ot£B mt torrent ‘toptrB.
A Medico-Legal Problem.
A somewhat remarkable case was tried at the
Winchester Assizes last week, which opened up several
knotty questions in criminal psychology. A young
soldier was charged with having fired upon the
sentries sent to relieve him. He discharged in all
four shots, inflicting serious injury upon one of the
men. There was no suspicion of personal motives,
seeing that he did not even know the injured soldier.
It seems that the accused, who was only eighteen years
of age, was doing sentry duty on a bright moonlight
night, and he appears to have been greatly disturbed
by certain ghost stories that were current relating
to apparitions believed to haunt the barrack quarters
where he was stationed. The prisoner, how¬
ever, declared that he had no recollection what¬
ever of the affair, though immediately after
his arrest he admitted that he knew he was
firing at the relief party though he was unable
to explain why he did so. It appeared that the
prisoner’s rifle ought not to have been loaded accord¬
ing to the rules, and no explanation was forthcoming
as to how and when it was loaded. The whole story,
as given in the reports, is strongly suggestive of
auto - suggestion, a psychical condition which is
extremely probable in a nervous lad under these
circumstances. The absence of motive, and his evi¬
dently confused mental condition when arrested,
point to some abnormal mental perturbation which
gives support to his statement of inability to
recall the events. Unfortunately we are not
placed in possession of any details of the pri¬
soner’s family history, which, might possibly
have thrown considerable light on inherited ten¬
dencies. It is a relief to find that in view of
his good character, though found guilty, he was-
discharged on his own recognisances, as other¬
wise we should have experienced grave doubts
whether grave' injustice had not been done. Similar
occurrences have often been reported in persons sub¬
ject to petit mol, but in the absence of any positive-
information on this point, it is unnecessary to-
speculate on the plausibility of the diagnosis in this-
instance.
Conscientious Objectors at Oldham.
Mr. Chaplin can hardly point to Oldham as a
local proof of his assertion that the actual number of
vaccinations has increased under the new Vaccina¬
tion Act. In the course of the Parliamentary election
contest now going on in that town the question of
vaccination has come into prominence. It was
publicly claimed by an anti-vaccinationist that his-
party comprised 97J per cent, of the total population
It was further stated that no less than forty
thousand certificates of exemption have been granted-
to “conscientious objectors” by the local magistrates
The Unionist candidates are reported to have ex¬
pressed themselves as “stem believers in vaccination.”
The Radical candidates, on the other hand, declared
against compulsion. Under such circumstances the
ultimate destination of votes may be pretty safely
surmised should the compulsoriness of vaccination
be made a test question. Most medical men will
agree that the vaccination laws should not be made a
party matter, but the die has now been conclusively
cast. If Mr. Balfour and his friends expected to
gain any lasting support from the anti-vaccina¬
tionists he is likely one day to fall on a bitter
awakening. In the keen fighting of an electoral
campaign who can wonder if the Liberals adopt the
non-compulsory attitude which has been passed into-
law by their opponents. Any Conservative candi¬
date who advances at this late hour of the day his-
conscientious admiration for compulsory vaccination
should ponder well and duly Mr. Balfour’s great
legislative achievement in the contrary direction.
Diabetes Among Native Indians.
The educated Bengalee has lately been proved to
be a great sufferer from diabetes, and the causes of
the malady have been attributed to excessive
brain work, malnutrition, and early marriages-.
It is pointed out in a native paper that there are
hundreds of cases of the disease at the present time.
Moreover, many well-known Bengalees have thus
fallen victims to early marriages and university
education. We learn that the remedy lies in the-
hands of the leaders of Bengalee Society and the
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NOTES ON CURRENT TOPICS.
July 6, 1699.
The Medical Press. 15
Government which is mainly responsible for the system
of education that prevails. Quoting from our authority
it is stated “ Hindu parents who are anxious that their
sons should enjoy health and long life should not
think of marrying them before they attain at least
their twenty-fifth year, and the Government should
see that the subject of study and number of
text-books for the various examinations are fixed,
with the precaution that they may not overburden
the minds of the examiners (sic) and that greater
attention is paid to physical education in the schools
than at present.” It is a great deal, no doubt, to
have discovered, as in this instance, the cause of the
diabetes, and the advice tendered for dealing with it
is excellent. The examiners, no doubt, will appreci¬
ate the delicate reference to themselves. Of
course the examiners should be properly looked
after, otherwise diabetic coma might become
a frequent occurrence among them while . dis¬
charging their duties in the class rooms. If,
however, diabetes is largely prevalent in Bengal, as
here stated, possibly the matter will attract the
notice of the officers of the Indian Medical Service
stationed in the province, and in that case it would
be interesting to learn from them what in their
opinion is the cause of its prevalence.
The Plague in Egypt.
At the end of last week the total number of cases
of plague reported at Alexandria reached the total of
forty-seven, of which eighteen have ended fatally.
Ten of the new cases occurred within the last seven
days. The fact that no cases have occurred else¬
where in Egypt is to some extent satisfactory. At the
same time it would be idle to attempt to overlook the
extreme gravity of the present situation. The
invasion of plague of a country where general
sanitation is in so backward a state as that
of Egypt must always be a serious matter,
nor does the occurrence of one fourth of the cases
within the last week tend to reassurance; on the con¬
trary, it clearly points to a local increase in the
disease. Unless the outbreak can be kept within a
ring fence, and stamped out before the autumn at
Alexandria, there is every prospect of a rapid and
disastrous invasion of many towns along the Mediter¬
ranean littoral. Happily, in these modern days of
high standard sanitation in Great Britain, there is
little chance of this scourge of mankind ever gaining
anything more than a detached and precarious foot¬
hold in our seaports. Indeed, one need not
fear the plague nowadays any more than
cholera. Filth diseases need a filth environ¬
ment for their successful fostering. However,
it must be admitted that it is so far satis¬
factory that the plague in Egypt is confined to Alex¬
andria. According to the correspondent of the
Times, the disease is attacking the lower classes in
the native quarters only. The measures adopted—
namely, isolation of the sick, segregation of those
who have been in contact with them, and the disin¬
fection of their houses and effects—are keeping
the disease well under control. The enforcement of
these precautions, moreover, it is of interest to note,
is not resented by the population, a fact which goes
to show that the natives are beginning to see the
wisdom of the action of the sanitary authorities.
Hot-air Baths for Workhouses.
Continuity of policy is a desirable thing in most
administrations, whether they be great and central
or small and local. An ideal of that kind, however,
is rarely attainable amidst the turmoil of our modem
social machinery in motion, and the wheel that moves
in one direction to-day may drive in exactly the
reverse way to-morrow. An apt illustration of this
see-saw tendency was afforded a week or two since by
the Cheltenham Board of Guardians. It seems that
the late Medical Officer of the workhouse and his
deputy were so struck by the merits of a certain
hot-air apparatus that they forthwith induced the
guardians to make an installation. Then came a
Medical Officer who knew not Joseph, and he has sent
in a recommendation to discontinue this special
treatment. Now, there are weighty reasons for caution
in abandoning any therapeutic measure that offers
relief to these scourges of the poor, chronic rheu¬
matism and rheumatic gout. As everyone who is
familiar with Poor-law administration knows, those
two conditions cripple a large proportion of the
paupers who drift into the workhouse infirmaries
with no prospect of ever leaving them again. The
treatment of the disabled joints in those above-
mentioned conditions seemed hopeless until the local
hot-air *bath appeared upon the scene. The pro¬
gressive step of the Cheltenham Board, therefore, in
providing the necessary apparatus for carrying out
the new treatment deserved the highest considera¬
tion. Alas! that they have so soon fallen from
grace! A short sum of the total loss to the nation
yearly by reason of rheumatoid arthritis would be a
revelation to statisticians. Will not some enter¬
prising Board of Guardians apply the method syste¬
matically if necessary under special skilled medical
supervision, and publish a statement of results ?
A Public Unsympathetic towards Idiots.
The position of the class of unfortunate persons for
whom such institutions as the Royal Albert Asylum
provide accommodation, is one which excludes them
from that human aid and sympathy which they so
much deserve, owing to their unhappy condition; and,
as the chairman of the meeting held in the Town
Hall, Liverpool, a few days ago observed, of all philan¬
thropic movements, this is one which should most
strongly appeal to the public. Unfortunately, the
public develops its social instincts and sympathies in
fashionable channels, and the rather appalling
appearance and maimers of some of the unfortunate
inmates of institutions for idiots, shut them¬
selves and their fellow afflicted inmates out
from the knowledge, interest, and sympathy of the
outside world. And just because such institutions are,
therefore, not so much in the public eye. they do not
receive the practical help deserved. All this,
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16 The Medical Press.
NOTES ON CURRENT TOPICS.
July 5, 1899.
notwithstanding, there are men like Sir J. T. Hibbert
who rise to the occasion, and recognise that the work
done for an institution of this character may be
described as thrice blessed, for it confers a blessing
on the patients, on their families and their homes,
and on the nation at large. The Royal Albert
Asylum has done good work in the past, it is still
doing splendid work, and the friends of the institution
support it by their energies and their means in a
manner which is creditable to their Christian charity.
The Royal College of Surgeons, England,
and its Members.
The Supplementary Charier which is shortly to be
applied for by the Council of the Royal College of
Surgeons to enable them to confer the honorary
Fellowship upon persons of distinction who are not
members of the College, will doubtless be fully discussed
at the meeting of the “ Body Corporate” at the College
this afternoon (Wednesday). The occasion will be
made use of by the Society of Members to represent
to the Council that the opportunity would be an
exceedingly favourable one for obtaining for the mem¬
bers a share in the government of the College. By
incorporating this concession in the Supplementary
Chai'ter, it is pointed out that the Council would
settle a long-standing controversy, which, especially
during the past fifteen years, has occupied a promi¬
nent position in College politics. The Society lay
stress on the fact that at least one ex-president, many
Fellows, and some 5,000 members have expressed agree¬
ment with the suggestion that the members of the Col¬
lege should be directly represented upon the Council.
But while every effort may be made to extract this
reform from the Council, there is very little reason
for supposing that it will be granted. The adaman¬
tine position which the Council have hitherto assumed
regarding this question is not likely to undergo
any change even under the altered circumstances
of making an application for a Supplementary
Charter. The object, moreover, of the Charter
is not one which the members could honestly
oppose, and, therefore, even if it were opposed,
no risk would be incurred to its application
Under the circumstances, then, we cannot admit
that the Society of Members have chosen a
favourable opportunity for bringing their claims
before the Council, for the Council have nothing
to lose by their refusal to consider them. The case,
however, would have been vastly different if it
had been intended to apply for a charter embody¬
ing controversial matters. The members would
then be in a position to seriously imperil its
prospects by actively opposing it unless and
until their demands had been incorporated in the
document. But, in any case, the possibility is that
the proposal to admit members of the College to the
Council would meet with a great deal of opposition
from the majority of the Fellows, and, clearly, if the
Society of Members are seriously desirous of bringing
about this reform, they should first of all endeavour
to win the Fellows to their side.
The Resuscitation of the Royal London
Ophthalmic Hospital.
It is somewhat remarkable that for so many long
years the largest and most renowned ophthalmic
clinique in the world should have been so poorly
“ housed,” as has been the case with the Royal
London Ophthalmic Hospital in Moorfields. How¬
ever, we are glad to record that something has at last
been done to remove this stigma from a rich and in¬
fluential community. Last week their Royal High¬
nesses the Duke and Duchess of York opened the
new building of this hospital in the City Road
which consists of three blocks —the whole of the
ground floor being taken up with the out-patient
department. The wards afford accommodation for
fifty in-patients, and throughout everything has been
designed upon a scale in accordance with modern
requirements. The Chairman, in referring to the
work of the hospital at the opening ceremony stated
that the charity was founded as long ago as the year
1804, and that the average daily attendance during last
year was 416, on each working day. Regarding
finance it is interesting to note that the old hospital
building was sold for £78,000, while the new struc¬
ture has cost £80,000. These sums so far as they
nearly balance, seem to be satisfactory, but there is
an important difference financially between the old
and the new hospital. In the former case the building
was on freehold land, while in the latter a ground
rentof £1,210 will have to be paid every year for the 99
years during which the lease has been granted to the
hospital. It is, therefore, proposed to raise a sum of
£50,000, and so invest it that the interest arising
therefrom will provide for the ground rent. The
Duke of York made a gracious speech in declaring
the new building open, and congratulated all those
concerned upon their successful effort i in bringing
the building scheme to such a satisfactory conclusion.
The Progress of Cremation.
The last report of the Cremation Society of
England shows steady progress in this method of
disposing of the dead. In 1898 there were 173 per¬
sons cremated at the Woking Crematorium,
whereas in 1885—the first year in which the
Society commenced operations there were only
three, and in the next year ten. A point
worthy of note is that the cremations so far have
been mainly carried out upon the instructions of the
richer classes, despite the fact that the charges are
by no means prohibitive. This result would seem to
imply that the less-favoured classes are still struggling
with the sentiment that cremation is opposed to the
ordinary procedures of burial which obtain in this
country. It is probably quite true that cremation is
still regarded by the majority of the community as
too unconventional, and, therefore, undesirable. But
it is also quite possible that in the course of time this
feeling will become less and less pronounced, and
that the public will come to recognise in cremation a
desirable, economical, and scientific method of the
disposul of the dead to which it is expedient to
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Jply 5, 1899. NOTES ON CURRENT TOPICS. The Medical Press. 17
resort. Sentiment, of course, is a powerful incentive
to the retention of the time-honoured earth-burial
system with its many old associated customs and,
we might add, extravagances. But, despite all this,
we believe that the day of cremation will come—long
before the world is itself destroyed by fire in accord¬
ance with prophecy—and that the sanitary needs of
the population will render this method necessary.
Constipation in Children.
Constipation in infants is the practitioner's bug¬
bear. He recognises the unadvisability of the habitual
administration of laxative drugs to the young, but is
often driven to countenance their use by the paucity
of the resources of which he disposes. It is important
to bear in mind that constipation in infants is due in
large measure to the element casein which, if it
be present in milk in larger proportion than normal,
as compared with the fatty elements, tends to inter¬
fere with the due performance of the digestive func¬
tions. A child fed on normal casein, but with a low
proportion of fat, will probably be constipated. In
breast-fed children it does not follow that the pro¬
portions of casein and fat are normal, for the
maternal supply may be faulty in this respect.
Disturbances of health, especially in the direction of
indigestion, on the part of the mother, will neces¬
sarily be reflected in the composition of the lacteal
secretion, as can be demonstrated by analysis. The
first step, therefore, must evidently be to regulate
the habits and life of the mother. She must
be placed on a fresh meat, fresh vegetable, and
fresh cooked fruit diet with due provision for
regular exercise and restriction in the matter of
tea drinking and other dietetic irregularities. This
regime will diminish the proteid and increase the
fatty constituents of the milk, and will go far to rid
the infant of the tendency to constipation. Should
it fail the best treatment for the child is the adminis¬
tration of cream in doses of from one to two tea¬
spoonfuls in warm water from time to time just
before the periodical meal. Failing trustworthy
cream, half a teaspoonful of cod liver oil is a good
substitute. In bottle-fed children the treatment of
constipation is much simpler, for we have only to
secure a due proportion of fat and proteid. It may be
necessary in some cases to reduce the ingestion of pro¬
teid by giving cream, water, and sugar mixture vice
one or more of the ordinary meals of prepared milk.
Dr. Kerley suggests amixtureof four ounces of cream
with twelve ounces of milk, which will give four per
cent, of fat with a minimum of proteid. In older
children the same care to secure a due proportion of
fat in their dietary is equally imperative, for much
of the constipation from which such children suffer
is primarily due to a deficiency of fat. This is a
point which ought to be attended to from the earliest
period because, if allowed to continue, we get what
may be called “ fat dyspepsia.” The administration
of fat then becomes difficult, but the obstacle can
usually be got over by a little perseverance. It is
surprising how many persons at all ages declare
themselves unable to digest fat. This is in many
instances due merely to the formation of a habit;
the stomach has been allowed to become unaccus¬
tomed to the digestion of fats, and until the tendency
has been overcome the mere sight of fats excites
repulsion.
Medical Practice in a Free Country.
An inquest held last week in London is worthy of
a passing note. An East-End Jewess, rejoicing in
the euphonious name of Lipshitz, called in the ser¬
vices of a “ Dr. Barnato. of Russia,” to attend her
sick child. At the ensuing inquest medical evidence
was tendered to the effect that the physic given to
deceased by this Russian immigrant was not suitable
to the case, although, on the other hand, it did
not hasten the unfavourable termination of the
illness. Witness claimed that he was qualified
to practice in his own country. One of the
jurors observed: “ This is a free country, and I
think every one has a right to act here and
get a living.” That is the precise view of a great
proportion of the inhabitants of Great Britain, with
regard to unqualified and qualified medical practice.
They imagine that it is a mere question of liberty of
action, forgetting there are many things in which
the Government has to step in and protect the sub¬
jects of the realm. The sale of liquor, for instance,
demands strict supervision. The practice of the
legal profession is hedged in with iron-bound regula¬
tions, and although a similar remark is not applicable
to the practice of medicine and surgery, there is no
conceivable argument that could be advanced in
favour of state regulated legal practice that does not
apply with equal force to medical practice.
The Premier as a Chemist.
It is stated that Lord Salisbury has discovered and
completed an important chemical process in hie
private laboratory at Hatfield, and that the results
will be made known to the world on his behalf at a
forthcoming meeting of one of the learned Societies.
The scientific world has for long known that it had
in the English Premier a devoted student to
chemical science. Despite the arduous duties
attached to his official post, he, nevertheless, snatches
every available opportunity of prosecuting his
favourite study. No doubt scientific researches
provide for Lord Salisbury that solace and
recreation without which it would be impossible
for him to conduct the affaire of this nation with the
strength and ability which he has shown. However,
it is expected of an English Premier that he prove
himself a man of parts, apart from his high official
position, and it may be said of Lord Salisbury that
he is the first of his class who can lay claim to the
reputation of a scientist.
The Rt. Hon. Viscount Knutsfobd and Lady
Knutsford will distribute the prizes to the students
and nursing probationers of the London Hospital
Medical College in the Library, on July 18th, at
4.15 p.m.
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Jult 5, 1899
18 Tbk Uuicjl Press. NOTES ON CURRENT TOPICS.
The Leaveeden Poisoning Case.
Sentence of death has been pronounced on the
unfortunate girl who has been found guilty of the
charge of having poisoned her sister, an inmate of
Leavesden Asylum, by means of a cake forwarded
anonymously by post. The motive appears to have
been the gaining of a small sum, for which the
deceased was insured, in order to forward the
prisoner’s marriage prospects. The judge spoke in
severe terms of the miserable inadequacy of motive
and the terrible nature of the crime. To our mind it
suggests the irresponsible state of the prisoner’s
mind, especially when we recall the fact that her
sister was an admitted lunatic. It is to be hoped
that the Home Secretary will cause an exhaustive
inquiry to be made into the mental condition of this
unfortunate criminal.
Is There an “Odor Mortis” ?
A curious incident is related in the current
number of a French contemporary. A favourite cat
was the constant companion of an old lady, who in
the course of time became ill and died. A few days,
however, before the latter event, occurred, nothing
would induce the animal to remain in the room with
its mistress. The cat was passed on to a second
mistress, and soon became attached to her new owner
and her surroundings. In the course, however, of
some months later, the second witness fell ill, and
ultimately died, and again a few days before her
death took place the cat refused to remain with her.
Thus, argues our contemporary, the prognosis must
be bad in a case where the favourite cat refuses to
have anything more to do with its owner. Perhaps
the animals detect an “ odor mortis.”
Embalmers for the Military.
A curious departure has been taken by the United
States’ War Department. In deference to the feel¬
ings and relatives of such soldiers as may hereafter
die on duty in connection with the recent territorial
acquisitions, the Department has made arrangements
whereby a professional embalmer will be attached to
each army transport. The embalmers will be civilians
under the control of the Quarter-master General. A
portable crematory would appear much more appro¬
priate under the circumstances. We do not profess
the superstitious importance to post-mortem repatria¬
tion which actuates the Chinese, and armies in the
field can ill afford to encumber their transport
services with cargoes of embalmed soldiers.
A Stutterer Cured.
The New York Medical News relates the ca se of
a soldier who was afflicted with such a severe stutter
that he narrowly escaped rejection at the medical
examination. While on service in Cuba he was shot
through the mouth, the bullet passing out at the back
of the neck. He recovered from the wound and now
stutters no more, and he is reported to be busy com¬
pleting the telling of stories which he had never been
able to finish on account of his halting speech. For¬
tunately there are less drastic means of curing this
distressing infirmity than the one employed in this
instance, or cures would be rare.
The Anti-Tuberculoeis Crusade in Ireland..
A very important meeting, convened by the
Royal Academy of Medicine of Ireland, took place cn
Friday last, the occasion being especially dignified
by the presence of the Lord Lieutenant, who occu¬
pied the presidential chair. Delegates named by
almost every medical, 6anitary, and municipal body
were present. Resolutions enunciating the principles
upon which the tuberculosis crusade ought to be
conducted, with which all our readers are familiar
and are in accord, were moved by the Registrar-
General, the President of the College of Physicians,
and other distinguished persons. His Excellency, in
his usual happy vein, and with his usual facility of
expression, expressed his entire sympathy with the
movement, and his belief that it would yield great
results. But he made two reservations, first, that it
would be a mistake to attempt the formation of
a purely Irish organisation to effect that which
could be more effectually attained by establishing
a branch of the present Association in England;
second, that he considers that all proposals for imme¬
diate coercive legislation on the subject would be
premature and unwise, in which view we entirely
concur. The subject of public consumption sana¬
toria was judiciously avoided by the speaker, inas¬
much as it would have raised the question of enor¬
mous expense and coercive legislation to which His
Excellency referred.
Abortionist Prosecution.
From time to time we have commented on the
flood of pernicious advertisement let loose upon
society under the name of Madame Frain. The real
nature of the business thus carried on with
unabashed pertinacity in the heart of the metropolis
must have become evident to anyone after a
glance at the trade circulars sown broadcast by that
enterprising lady and her successors. We have long
ago protested, in the name of common-sense and law (
that it is a ridiculous travesty of justice to prosecute
the actual abortionist, while those who incite to the
act are allowed to go free. We are glad to see that
the police authorities are coming round to that view t
that is to say, if one may judge from the fact that
they have lately undertaken a criminal prosecution of
the notorious Frain group. This step should have a
wholesome deterrent effect upon others of the same
class, whose name is legion. Clearly the next logical
action of the police will be to prosecute the newspapers
that aid and abet the commission of felonious acts by
the insertion of advertisements that directly or
indirectly incite to the act of abortion.
In the Bulletin de Therapeutique Weber states
that the nausea, excitant, and other unpleasant
sequela? of chloroform narcosis may be certainly got
rid of by administering chloroform water to the
patient for as long a period as possible before the
operation.
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Jult 5, 1899. >
SCOTLAND.
The Medical Press. 19
The New “ Doctor of Pharmacy.”
Wb have long since warned the profession that the
time is coming when most respectable chemists will
dub themselves “ Doctor,” and one more sham
diploma will be added to those of the spectacle
vendors, midwives, plumbers, and all the rest. The
proposal originated, appropriately, in the land of
wooden nutmegs, faked-up eggs, and all other shams,
and it was taken up by one or two of the inferior
French universities. It is now taken up by Mason
College, Birmingham, which calculates that the
University of Birmingham (when it has one) will be
delighted to rake in that form of grist for its mill.
The curriculum to be required from the new
•‘Doctor” is a voluntary course of six or nine
months at dispensing and bottle-washing. We are
gratified but not surprised to note that the journal
of the Pharmaceutical Society throws cold water on
the scheme and points out that, as a scientific quali¬
fication, the new doctorate will be of no use, as it
will not be granted by any of the respectable
Universities of Great Britain.
Liquid Air as Physic.
The physicist has of recent years been coming to
the help of the physician and surgeon. Liquid air,
it is now claimed, can be produced so cheaply that
it may be used as a convenient and practicable
motive power for the surgeon and dentist. The
Americans are trying its local application for ulcera¬
tive conditions, and claim to have obtained results
“ positively wonderful.” Possibly this will form an
addition to our next edition of the British Pharma-
copceia. Meanwhile “fresh air " in this unusual form
must be experimented with cautiously.
The Deftinct “ Index Medicus.”
The efforts made some time since to secure support
for that invaluable compilation, the Index Medicus,
unfortunately failed in their object, and as the inevit¬
able result of this lack of support by the medical pro¬
fession, its publication has been definitively aban¬
doned. The loss will be severely felt by those who
glean in the medical literary vineyard, but there is a
ray of hope in the suggestion that the American
Medical Association, through its trustees and the
editor of its journal, may undertake anew the editing
and publishing of the Index.
The Right Hon. Lord James of Hereford,
Chancellor of the Duchy of Lancashire, will distri¬
bute the prizes to the students of Charing Cross
Hospital Medical School to-day (Wednesday) at
3.30 p.m.
Rossclare, on Lower Lough Erne, has been
purchased for the purpose of establishing a con¬
sumption sanatorium in Ireland on the Nordach or
Miffing Bystem. The situation is all that can be
be desired for such an institution.
PERSONAL.
Dr. C. W. Mansell Moullin has been elected Presi¬
dent of the Rontgen Society.
Sorqeon-Captain J. Milks Jennino, Royal Army
Medical Corps, has been made a Companion of the Dis¬
tinguished Service Order for services in the Soudan.
Dr. J. Roberts Thomson, F.R.C.P., London, has been
placed on the Commission of Peace as a Magistrate for
the Borongh of Bournemouth.
Db. Mitchell Banks, of Liverpool, and Dr. John
Sibbald, Lunacy Commissioner for Scotland, received
the honour of knighthood from Her Majesty the Queen
at Windsor on Friday last.
Dr. W. J. R. Simpson, Professor of Hygiene in King’s
College, London, has been nominated as Honorary Presi¬
dent of the International Congress of Medicine, to be
held in Paris next year.
Dr. Horton-Smith has been appointed Gulstonian
Lecturer, Dr. Cheadle, Lumleian Lecturer, and Dr.
Halliburton, Croonian Lecturer for 1900, by the Royal
College of Physicians, London.
H.R.H. the Princess of Wales, visited the Cheyne
Hospital for Incurable Children, of which she is Presi¬
dent, on Thursday last, and personally gave a present
to every child with a cheering word of sympathy.
The Society of Arts has awarded the Albert Medal to
Sir William Crookes, F.R.S., “ for his extensive and
laborious researches in chemistry and in physics, re¬
searches which have, in many instances, developed into
useful and practical applications in the arts and manu¬
factures.
Mr. Ht. Archibald Stoxhah, M.R.C.S., will have
the sympathy of the entire profession. A few days ago
he was returning from visiting a patient, when he was
savagely assaulted and robbed by two men. Fortunately
they were arrested and have been committed for trial at
the Thames police-court. Mr. Stonham was mercilessly
handled, and the shock to his system has been naturally
severe.
After a long term of service Mr. Thomas Bond, M.B.,
F.R.C.S., has severed his connection with the West¬
minster Hospital. His connection as surgeon with that
Institution has lasted from 1873 to 1899. As a lecturer
on medical jurisprudence he has obtained a wide-world
reputation at the Westminster School. Mr. A. H.
Tubby, M.S., F.R.C.S., has resigned his post of assistant-
surgeon, according to a rule of the hospital, with a view
of candidature for the vacancy left by Mr. Bond's
resignation.
Jjtotkttfc.
[from our own correspondent.]
The Rowdy Residents.— At their usual weekly meet¬
ing, held a few days ago, the managers of the Edinburgh
Royal Infirmary at length arrived at a conclusion as to
the facts relating to the horseplay which we have already
Digitized by
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20 The Medical Press
SCOTLAND,
July 6, 1899.
alluded to as having occurred in the residency of the
hospital, and delivered judgment thereanent. As the
actual cause which led to the matter being brought
under their notice was discovered to have been the work
of a few men who had but lately occupied residential
posts, but who are now ex-officials, the present members
of the staff were let off with a reprimand and the in¬
evitable intimation that measures would be taken and
new rules and regulations ordered whereby the control
exercised by the Medical Superintendent and the Board
over the conduct of residents when off duty would be Btill
further strengthened. The ex-residents who were the
culprits, and who at once came forward to bear the
blame and to apologise, were gravely reproved, and
deprived of their right to make use of their hospital
tickets for attendance at the wards or diniques for the
next six months. The crucial point lies in the
imposition of new restrictions to be laid upon the
private life of the resident medical and surgical
staff of the future. The more numerous the rules the
greater will be the inducement to evade or break them.
The less confidence reposed in the residents by the
Board, the more likely will displays of unruliness and
outbursts of animal spirits be. “ Bagging ” is a subject
of curious etiology. It seldom does any harm ; often
much good. He who cannot understand its underlying I
import, and who by "cutting up rusty” stimulates
further attentions from his colleagues, must have a dis¬
contented mind. Exuberance of youth, newly freed
from undergraduate fetters, is but seldom vented in any
unfriendly or malicious sense; it is not to be compared
to the horseplay which is far too common possibly to be
encountered by them in acts of unprofessional etiquette
in their later days.
Pending the completion of the new and palatial
City Hospital which Edinburgh is building for herself
? 'ost out of her present limit towards the south, the
Town Council’s Public Health Committee approved of a
scheme whereby a limited number of pathological
reports on specimens sent in by the town health autho¬
rities should be obtained from the Research Laboratory
of the Royal College of Physicians for a temporary
period.
Students and Belvedere Cliniques.— The Hospital
Committee of the Glasgow Corporation has had under
consideration the question of charging fees to students
who receive instruction at Belvedere Fever Hospital.
Dr. Johnston, the superintendent, having made inquiries
in various cities and towns, reports in regard to the
information obtained from these places that "the
teacher is paid by the students either directly or in¬
directly in all places except Edinburgh, and even there
it is proposed to alter the custom and come into line with
the general practice. Except in three hospitals (Edin¬
burgh, Manchester, and Liverpool), where the teaching
is done by a visiting physician, the medical superinten¬
dent of the hospital takes personal conduct of the
classes.” Dr. Johnston further reports, as well as suggests,
to the Hospital Committee, that in view of the near com¬
pletion of Buchill Hospital, that the London system
wheie three guineas (.£3 3s.) are paid for sixteen
demonstrations, and £4 4s. for twenty-four demonstra¬
tions might be adopted in Glasgow. It would perhaps
be more prudent to speak of charging an already over¬
charged set of students for clinical instruction in
infectious diseases, were such charge limited, say to
£1 Is., but the suggestion of fixing it at £3 3s. to £4 4s.
has not unnaturally raised the ire of students. And it
may be asked what do medical men receive from the
Glasgow Corporation for reporting a case of infectious
disease:' 1 Half-a-crown payable at the end of three
months! But should they neglect to report a case, the
Corporation can inflict a fine of forty shillings. Another
question arises out of the proposal. To whom do these
heavy fees belong when imposed ? Do they go into the
pocket of the teacher (superintendent) or into the coffers
of the corporation ? As the teachers of the practice of
medicine are able to give the necessary theoretical
lectures on fevers, it will not be necessary for the time
of the superintendent of a fever hospital to be taken up
in delivering lectures on cases which can be demon¬
strated at the bedside of infected patients.
Manchester.
fFROM OUR OWN CORRESPONDENT.]
Victoria University. —Saturday, July lBt, was
“Degree Day.” A large and brilliant gathering as¬
sembled to witness the interesting ceremony. Among
the recipents of Honorary Degrees was Professor T.
Clifford Allbutt, Dr. Edward Schunck, and Mrs. Henry
Sidgwick. An unusually large number of candidates
were presented as qualified for degrees, or in connection
with distinctions gained. This year large contingents
have come from University College, Liverpool, and'
Yorkshire College, Leeds. Six received the deg-ee of
M D, gold medals being granted to three.
Cremation, —The authorities of the Manchester
Crematorium, one of the most satisfactory in the
country, have just issued a circular stating that several
deaths have lately occurred among their original
shareholders, and that their friends have not resorted to-
cremation but to ordinary interment. It is suggested,,
therefore, that the supporters of cremation should dis¬
tinctly record their desire to be cremated after death,
and forma have been circulated with the request that
one be forwarded filled up to the offices, and the other
deposited with the will of the signer. This is reasonable,,
although hardly a pleasant request.
Dalton’s Tomb.— The Council of the Manchester
Literary and Philosophical Society have .issued a state¬
ment that Dalton’s tomb in one of the city cemeteries
has fallen into great neglect. The monument was
provided originally out of the Dalton Memorial subscrip¬
tions in 1853, but no existing body now seems to be
responsible for its proper preservation. It is rightly
felt that the continued neglect of the resting-place of
one of Manchester’s greatest worthies would be a scandal
and discredit, and an appeal is made for subscriptions
to provide means by which repairs may be made as
required.
Manchester Therapeutic Society. —This is the only
society in Britain devoted exclusively to the study of
matters therapeutical. At the last annual meeting the
following officers were elected for the session 1899-1900.
President, Dr. Dreschfeld ; vice-presidents. Dr. Dixon
Mann, Dr. Wilkinson ; hon. treasurer. Dr. Williamson ;
hon. secretary, Dr. Wild ; committee, Dr. A. Brown, Dr.
F. J. H. Coutts, Dr. Kelynack, Dr. Vipont Brown, Dr.
Goodfellow, Dr. J. E. Platt.
^Citcraturf.
HAYES’S INFECTIVE DISEASES OF ANIMALS, (a)
Some years ago Professor Friedberger and FrOhner, of
the German Veterinary Schools, brought out their excel¬
lent Lehrbuch der Speciellen Pathologie und Therapie der
Hausthiere, which has been so favourably received that
a translation into French by the Veterinary Professor
Cadiot and M. Ries was published in 1891, and, if we
mistake not, an English translation has also been issued
in America. Captain Hayes, who is well known as a
popular writer on horses, now gives us a portion of the
work in English, and the first volume is sent out, the
second being promised to follow before long. To those
who cannot read the book as it appeared in German or
in French, this English edition will prove of sortie service
in giving an idea of the opinions entertained among
German veterinary surgeons with regard to the more
important infective diseases of animals, though to do
justice to the original authors and the title of their
book it would have been better if the whole had
been translated as in the French edition. The
entire volume before us is not occupied with these
infective disorders, a considerable portion being
allotted to such chronic constitutional diseases as
aneemia and chlorosis, leucaemia, scurvy, gout, diabetes,
(a) “Infective Diseases of Animals." Translated from tlie
German and Edited by M. H. Hayes, F.R.C.V S. with notes on
Bacteriology, by Dr. G. Newman, D.P.H. Vol 1. London i W,
Thacker anil Co.
L,00 8'
July 5, 1899.
LITERATURE.
The Medical Press. 21
Ac. The infective maladies treated of include all those
with which we are familiar, and as some of these, such
as glanders, rabies, anthrax, tuberculosis, and the variolae
of two or three species of animals, are transmissible to
mankind, the work possesses a certain interest for
medical men, who will find some useful information with
regard to these serious disorders. Friedberger and
Frohner have treated them with that thoroughness and
ability which is so conspicuous in the work of German
veterinarians, and though we may be inclined to differ
from them to some extent on points of pathology, yet,
on the whole, their views may be accepted as based on
intelligent observation and experience. The translator
appeals to have accomplished the task he undertook in a
satisfactory manner, and has added notes here and there
throughout the work when he thinks it necessary to
correct, add to, or illustrate the statements of the authors.
In these notes there are one or two little slips which a
better acquaintance with the subject would have
prevented. For instance, at page 420, in a note
appended to rinderpest, the translator says:—•* Our
exact knowledge of the occurrence of rinderpest in
England dates from I 860 , in which year this bovine
scourge was imported from Revel by Russian cattle.”
If there is any fact better established than another it is
that this decimating disease was present in this country
for several years, and on several occasions during the last
century'—of this there is ample proof in Dr. Fleming’s
“History of Animal Plagues” (a)
An interesting appendix to the volume contains a
notice of some diseases which are not dealt with in the
German edition, such as the South African horse-sickness,
the Indian surra, and a disorder of the larger domestic
animals caused by ticks in Queensland and Jamntca, as
well as in this country ; but while alluding to these, the
Translator makes no mention of the serious losses caused
in certain parts of Africa by the tse-tse fly. The notes
on bacteriology, by Dr. Newman, of King's College, will
be found useful, as they are clear, brief, and informing
on this important subject. Altogether, the book can be
recommended to those for whom it was written, as a
pretty correct exposition of our present knowledge of,the
diseases with which it deals, presented in a convenient
and readable form.
NEW SYDENHAM SOCIETY”S ATLAS OF
PATHOLOGY. ( b)
This instalment of the above well-known Atlas deals
with a very interesting subject—” Lymphadenoma. or
Hodgkin’s malady.” It consists of three beautifully
coloured plates, reproduced from drawings by Sir R.
Carswell, of a typical case of the disease in the HApital
St. Lonis, Paris. The first plate represents a dissection
of the side of the neck and axilla, showing the chain of
enlarged glands. The second gives a surface and sec¬
tional view of the spleen, which was closely studded
with brain-like nodules. In the third plate we find a
faithful and brightly coloured representation of the
appeaiance of an enoimons mass of glands that lay
beneath the liver and raised up the duodenum, pancreas.
Ac., into dose contiguity with that viscus. As regards
the letter press that accompanies these plates it calls
for little remark being purely explanatory. The title,
“ Infective Disease of the Lymphatic System,” would,
however, seem unjustified as the most recent researches
have failed to establish the " infective ” nature of
Hodgkin’s disease—unless the word be used in the sense
in which it is sometimes applied to carcinoma. But in
that case one would have to class carcinoma as “ an
infective disease of the mammary gland ” which is
assuredly incorrect so far as our present knowledge
goes. Again, the case illustrated was not subjected to
microscopic examination, and the pathologists who did
the post-mortem regarded it as one of “ cancer,” which
in the opinion of the writer of the letter press was not
unjustified in the case of the tumour beneath the liver
at least. It is also very much to be regretted that no
(a) ” Animal Plagues: their History, Nature and Prevention.'’
Vote. I and II. By GeorRe Fleming, C.B., LL.D., F.R.C'.Y.S.
London : Bailliere, Tindall and Cox.
(b) “ New 8ydeuham Society's Atlas of Pathology.” Fasciculus
in. London : H. K. Lewis. 1899.
effort has been made to illustrate the microscopic anatomy
of the disease, and that no discussion of such important
points as the correct nomenclature and the relation
to Leukiemia has been introduced. These are grave
defects in the work from the scientific standpoint.
Whilst fully considering the artistic merit of the
drawings, we feel it our duty to express the opinion that
in order to render them of educational value something
more than mere reproduction is necessary, and that
something has been left undone by the New Sydenham
Society.
THE OXFORD ENGLISH DICTIONARY, (a)
This double section contains the central portion of the
letter H, of which letter it constitutes one-fourth. It
contains 2,439 main words, 374 combinations explained
under these, and 714 subordinate entries—3.327 in all.
These words are illustrated by no less than 13,768 quota¬
tion, a number far in excess of any other dictionary,
and a good evidence of the thoroughness with which the
work is being done.
MUTER’S ANALYTICAL CHEMISTRY. ( b )
An eighth edition is of itself equivalent to a certificate
of popularity, and in respect of the value of scientific
manuals the voxpopuli may certainly be accepted as the
mx Dei. This concisely written but very comprehensive
manual deals with the practical aspects of the organic
and inorganic chemistry with the qualitative and quanti¬
tative, on the lines adopted at the South London School
of Pharmacy. Our familiarity with the earlier edition
of this invaluable work enables us to state with assur¬
ance that, in the limits which the author has assigned
to himself it is entirely without a rival. A student who
takes this work as his guide and works through it
cannot fail to become familiar with all the chief
developments of analytical chemistry from the simplest
operations upwards, including many organic questions
usually overlooked in works of this kind. Originally
written for the use of students of pharmacy, it will
prove not less serviceable to medical students preparing
for university examinations, while as a work of reference,
it may be relied upon by physiologists and studious
practitionere. The reactions have been adapted, where
necessary, to the B.P. (1898). We note, with some
curiosity, the statement that the index has been inten¬
tionally omitted in the present edition, experience having
shown that an index to a practical book leads to such an
immense numl>er of cross references as to be bewildering.
We are hardly able to follow this reasoning, though it
may be conceded that the table of contents will a la
rigueur answer all the purposes of an index.
LEAF ON THE LYMPHATIC GLANDS, (c)
We have no hesitation in affirming that this little
work, with its numerous coloured illustrations, is a valu¬
able contribution to anatomical science and incidentally
to surgery and medicine. It is not that the painstaking
author has made any particularly original discovery in
respect of the glands under consideration, indeed, he
gives a wide berth to certaio points, such as the course
of the various lymph streams, respecting which one
would have liked to hear more. What he has done,
however, is to systematise our knowledge of these groups
of glands and to confirm and complete by actual dissec¬
tions, details already more or less adequately treated in
current text-book.
By the aid of a series of diagrams the position of the
main groups of lymphatic glands is clearly indicated,
(a) “ A New English Dictionary on Historical Principles, founded
mainh on the Materials collected by the Philolotrical Society.”
Edited by Dr. James H. H. Murray, with the assistance of many
Scholars and Men of Science. Heel-Hod. Volume V. Oxford : At
the Clarendon Press. London, Edinburgh, Glasgow, and New
York: Henry Frowde.
(M “ A Short Manual of Analytical Chemistry." By John Muter,
Ph.D., F.R S.E., &c , Analyst to the Metropolitan Asylums Board,
Ac. Eighth Edition. London : Bailliere, Tindall, and Cox. 1898.
(e) “The Imperial Anatomy of the Lymphatic Glands." By Cecil H.
Leaf. M.A., M.B., F.R C.S., Demonstrator of Anatomy nt the London
Hospital. London : Archibald Constable and Co. 1898. Price 10s. 6d.
Digitized by G00gk
22 Thb Medical Pbesb.
LITERATURE.
July 5, 1899.
and the bearings of these data on surgical practice made
plain. To some of the groups of glands the author has
ventured to give new names, a somewhat risky proceed¬
ing though they indicate with sufficient accuracy the
positions occupied by the various glandular groups.
GILLESPIE ON DIGESTION, (a)
A woek of this calibre is rather a tough morsel for
the reviewer to digest. It covers such a large field, and
comprises such a disconcerting array of facts, state¬
ments, and mere hypotheses that it defies, while it in¬
vites, criticism. The author evidently has very settled
views on diet, and these have led him to investigate the
phenomena of digestion with a perseverance and a
thoroughness which are as rare as they are admirable.
The work represents an attempt, something more than
an attempt indeed, to describe in the brief compass of
some 425 pages, the general laws governing digestive
processes in all living bodies. We are invited to regard
the organisms as an association of cells, working on trades
union principles, and grouped according to occupation
qua function. In the great question of nutrition it is
impossible to lose si gh t of th e fact that individual and racial
idiosyncrasies play an important partin determining what
from an alimentary point of view, is good, and what is
bad. Therefore, in laying down rules a margin of diver¬
gence must be conceded, and it is the role of the physician
to adapt general rules to individual cases. We • do not
propose on this occasion to follow the author in his
speculations as to the influence of diet on temperament.
We have a shrewd suspicion that the influence is the i
other way about, and that it is the temperament that
governs the choice of diet and not the other way about.
There is one point, however, to which the author calls
attention, which is worthy of notioe—viz., that too
rich a diet, yielding to the body a greater income than
suffices to balance its current expenses, may lower the
bodily functions to a point below that appertaining to
the slightly underfed, but not illfed individual.
We are first initiated into ancient theories of diges¬
tion, a subject in which our ancestors took considerable
interest, though they could hardly be said to see even
“through a glass darkly.” The influence on diseased
conditions of modifications of diet could not escape the
notice of those vigilant observers who, to some extent,
made up for their lack of scientific knowledge, by close
olinical observation. One has only to read Galen to see
to what a pitch of perfection clinical observation was
carried in what we are pleased to call the Dark Ages. The
next chapter deals with the digestive process in plants
which, the author suggests, may serve to indicate the modes
and means by w hich protoplasm in all vegetable and animal
cells can most easily and economically procure a “ living
wage ” It is but a step from the carnivorous plant
(which furnishes material for a very interesting chapter)
to the animal, and this drags us at once to the important
subject of ferments and lement action. The autnor has
adopted the standard classification into organised and
unorganised ferments, respecting which he has much of
interest to say, but recent researches on yeast, for
example, render it probable that our views will shortly
undergo profound modification, indeed the division
between the two classes of ferments may prove as unreal
as that which once existed between organic and in¬
organic chemistry.
The author deals very fully with food elements and
their digestive disintegration, and gives some very
elaborate tables to show the influence of experimental and
othei circumstances in respect of the quantity and quality
of the digestive juices. One stands aghast at the labour
which many of these investigations must have entailed,
but they confer a special value on the work, which will
remain a standard work of reference for future genera¬
tions of writers on this and germane subjects.
A carefully argued chapter on metabolism leads us
to the more practical section of the work. In the
chapters on “ Dietetics and Animal Heat,” the use of
(a i “The Natural History of Digestion.” By A. Lockhart
Oil leg) ie, M.D., F.B.C.P.Edin. Lecturer on Materia Medica and
Therapeutics in the Medical 8chool of the Royal Colleges, Edin¬
burgh, 4c. London : Walter Scott, Ltd. 1898.
stimulants and foods in general we have a large amount
of valuable information, embodying the latest views on
what we may term physiological alimentation. The
analyses of the principal groups of food stuffs is given
and their nutritive value discussed. Headers who lack
the patience or desire to study the more recondite prob¬
lem of digestion may be recommended to take cognisance
of the concluding chapters on “ Foods ” which contain
many practical deductions, expressed in a pleasant
chatty manner, well calculated to make it easy of
digestion.
MOYNIHAN ON RETRO-PERITONEAL
HERNIA, (a)
This volume is a review of the anatomy and surgery
of the various peritoneal foes®, with special reference
to the development of strangulation of abdominal
viscera in them. The author deals in addition with the
herni® through the foramen of Winslow.
In discussing the duodenal peritoneal fossae, he de¬
scribes no less than nine varieties of these pouches in
the regicn of the duodeno-jejunal flexure. After an ex¬
haustive account of the anatomy and origin of the folds
and fossae, the occurrence of duodenal herni® is treated.
This form of internal strangulation has two distinct
varieties, one where the increase of the hernial sac is to
the left of the middle line, and the other—the less com¬
mon—to the right. The author discountenances the
use of the term “ duodeno-jejunal ” hernia, prefer¬
ring that of “ left ” or •* right ” duodenal hernia, and
with this we entirely agree. It would appear that
duodenial herni® are the most frequent of all tbe herni©
into peritoneal foss®, and therefore the practical hints
given are of importance, especially that of the necessity
of dividing the neck of the sac only after two ligatures
have been applied, because of the large vessel that i6
invariably present at this situation.
The foes© about the c®cum have been to a very great
extent mystified by the variety of descriptions that have
been given of them, but Mr. Moynihan has discussed
them with distinct clearness.
Prbbably the chief importance of these peritoneal
pouches is the liability for the vermiform appendix to
become incarcerated in one of them, and the subse¬
quent possibility of inflammation being thereby induced.
This may be a not infrequent determining cause of acute
appendicitis.
The remaining fossa in the series is that known as the
intersigmoid. and the author shows that hernia into this
is of very rare occurrence, as he is only able to cite two
cases from English literature, but these are typical
ones.
The anatomy of the foramen of W inslow is well dealt
with, and the passage of bowel through it discussed.
There is an excellent bibliography of the subject of
retro-peritoneal hernia, and the book concludes with a
most interesting and beautiful series of photographs of
the various specimens of such herni© in the London and
Provincial Museums, together with one from the practice
of Dr. Louis Mitchell, of Chicago.
We warmly congratulate the author on the contribu¬
tion, and that so exhaustive a one, which he has made
to surgical literature on this most interesting class of
intestinal obstructions.
THE CHEMICAL AND BIOLOGICAL ANALYSIS
OF WATER (i).
In the pages of The Medical Pbess and Cikcdlae
some time since we reviewed at some length “ The Analysis
of Milk and Milk Products,” by Messrs. Pearmain and
Moor. The review was, on the whole, complimentary,
and we feel that we ought to state at once that, well as
that instalment was done, this second part on water
analysis is even more deserving of praise.
The authors in their introduction express a Bort of
(«) “On Retro-]>eritoneal Hernia, being the ‘Arris and Gale'
Lecture on the Anatomy and Surgery of the Peritoneal Foss®.’ 1
ByB. O. A. Moynihan, M.S., Lond., F.E.C.S., Eng.
(b) “ The Chemical and Biological Analysis of Vater,” by T. H.
Pearmain and C. O. Moor, being Part II. of " The Analyses of Food
and Drugs.” London: Bailliere, Tindall, and Cox. 1899.
July 5, 1899.
NEW BOOKS AND NEWIEDITIONS.
The Medical Press. 23
apology for including water among foods. Why l
Surely it is the food, par excellence, by which we live
and exist, and by the aid of which all other foods are
alone assimilated. As it is largely consumed per se, it
becomes necessary that we should perfect our knowledge
of its analysis, unfortunately one of the hardest problems
presented to the professional analyst.
The authors divide the analysis of water into three
divisions—(1) Chemical Analysis, (2) Biological Ana¬
lysis. and (3) Physical Analysis.
They very properly say that •• undoubtedly the chemical
examination is usually the most important.” Of late
years too much stress has been laid upon bacteriology in
connection with water analysis, but the reviewer, from
practical experience, can only endorse the views of the
authors of this work, who find that bacteriological in¬
vestigations, as regards water examination, should
generally be taken as an aid to drawing an inference.
There was some danger that too little attention
would be given to its chemical analysis, and
that, carried away by the wonderful development
of bacteriological science, we should lose sight of
those chemical indications which had been the sheet-
anchor of the analyst. This, so far, is happily at an
end, and each branch has taken again it* proper place.
The chief use that the writer can see, in our present
knowledge of the bacteriology of water, is the isolation
and identification of certain pathogenic organisms, such
as the comma bacillus, typhoid bacillus, Ac. The work,
however, should only be undertaken by the bacterio¬
logical specialist. In speaking of this the authors say :
“ An analyst, whose practice does not involve
the constant study of the organisms which are in
question, in the various phases of their life history, can do
no worse service to himself or his clients than to under¬
take work which includes their identification.” This is
perfectly true. Even in the hands of experts, the
information is of the most meagre description.
The numeration of bacteria, at first thought to be of
immense import, is, by our present state of knowledge,
of no more significance than any one of the chemical
processes, such as the determination of the albumenoid
ammonia.
Of late years the microscopic appearance of the sus¬
pended matters has been neglected. The determination
of the larger forms of microscopic life in town supplies
has l>een ignored. Great importance was formerly
attached to this, which may be properly considered as
part of the physical examination of a water. In the
days of Hassel, Ac., such examinations were considered
as of the highest significance, but with the rise of bac¬
teriological science they seemed to disappear from the
expert’s reports. Perhaps the men of half a century ago,
although excellent microscopists, did not possess sufficient
knowledge to properly apply the investigation to water
analysis. It has now taken its proper level, and analysts, if
they find this kind of life, are enabled to diagnose its
bearing upon the condition of the water. Thus, if the
microscopist finds the tieggiatoa alba, or sewage fungus,
in a water, he knows it is a sure sign of the presence of a
large amount of putrid organic matter. If l.e finds fungi
he knows they cannot exist in the water itself, but are
formed in decaying organic substances. The natural
habitat of the crustacese is solid decaying matter,
and in presence of large quantities of decomposing
organic debrig , Messrs. Pearmain and Moor dwell
upon this part of water analysis to some length, and
some excellent drawings from the pencil of Miss Ethel
Smith White are added, which make this part of the
book very practical.
The “ Chemical Examination ” part of the work is
very complete and up to date. In estimating free and
albumenoid ammonia the authors seem to have neglected
the precaution of performing these operations in an
ammonia-free atmosphere. The omission of some precau¬
tions in this direction may account for the amusing discre¬
pancies found in the results of different analysts, with the
same water; yet the process is so simple and well under¬
stood that such discrepancies should not exist. Some ana¬
lysts go so far as to erect a closet for the distillations in con¬
nection with this process. The apparatus suggested by
C. Tichbone (Sc. Proc. R.D.S., Vol. III., Pt. S) is so
simple and yet so effective in its action that it should be
more generally used.
Over 50 pages of the book before us are taken up with
the consideration of the bacteriology of water. It is
very concisely and tersely put, and the authors run on a
fairly even keel as regards the rather controversial
questions connected with bacterio'ogical water analysis.
We think they have done it full justioe, without
attaching undue value to its practical bearing. They
do not underrate the pathological value of the science
as applied to such an important food as water, but it is
quite clear that the authors have a grasp of the subject
upon which they are a riting. This pare of the work is
exceedingly well written, and will be found of immense
use to students of sanitary science.
NEW BOOKS AND NEW EDITIONS.
The following have been received for review since the
publication of our last monthly list:—
Bailliere, Tixdall, and Cox (London and Paris).
Urinary Analysis and Diagnosis. By Microscopical and Chemical
Examinations. By Prof. Louis Heitzmiuu, M.D. Pp. 254.
Price 10s. fid.
The Analysis of Food and Drugs. By T. H. Pearmain and C. O'
Moor, M.A , F.C.S., F.I.C. Second Edition. Pp. 2)6. Price
3s. fid.
Essentials of Modern Trent-nent of Disease. By K. M. Nadkarni,
editor of the ** Indian Medico-Chiruivical Review." Pp. 462.
Price 5 rui>eea.
The Quarterly Journal of Inebriety. Edited by T. D. Crotliera,
M.D. Vol. XXI. Pp. 221.
Traiti 1 de Medicine et de Thernpeutique, sous 1 • direction de
MM. Brounrdel et Gilbert 1 ome sixieme. Pp. 6V2 Price. 12
francs.
Blaeiston, Son, and Co. (Philadelphia).
The Newer Remedies, a Reference Manual. By Virgil Coblentz,
A.M., Ph.D., F.C.S. Third Edition. Pp. 147. Price 1 dol.
The Chemist and Druimjist Office (London).
Proctor s Practical Testing, revised with the British Pharma¬
copeia, 1898. Price 2s. fid. net.
J. and A. Chvrchill (London).
Selected Papers on Stone, Prostate, and other Urinary JDis-
orders. By Reginald Hamson, F.R.C.S. Pp. 190. Price 5s.
The F. A. Davis Company (Philadelphia and New York).
An Epitome of the History of Medicine. By Roswell Park, A.M.,
M.D., Pp. 3H4. Price 2 dels.
Charles Griffin and Co., Limited (London).
The Diseases of Children, a Clinical Handbook. By George
Elder. M.D., F.R.C.P.Ed,, and J. 8. Fowler, M.B., F.B.C.P.Ed.
Pp. 391. Price 10s.
A Medical Handbook. By B. S. Aitchiaon, M.D,, F.B.C.P.Ed.
Pp. 363. Price 8s. 6d.
Frederick J. Hanbcrt (London).
The Flora of Kent. Being an Account of the Flowering Plants,
Ferns, Ac., with Topographical, Meteorological, and Botanical
Notes of the County. By F. Janson Hanbury, F.L.S., and Ed.
S. Marshall, M.A., F.L.S. Pp. 4+4.
Henry Kimpton (London).
Gleet and Chronic Diseases of the Urethra. By Gerald Dalton,
M.S.A.Lond. Pp. 48. Price Is.
James Maclehose and Sons (Glasgow).
Chemical and Microscopical Aids to Clinical Diagnosis. By Car-
stairs C. Douglas, M.D., B.Sc. Pp. 258.
Kf.oan Paul, Trench, Trubner, and Co. (Lond n).
Bradshaw’s Dictionary of Bathing Places, Health Resorts, &c., for
1899. Pp. 372. Price 2s. 6d.
Evolution l y Atrophy in Biology and Sociology. By MM. Demoor,
Massart, and Vaudervelde. Translated by Mrs. Chalmers
Mitch* 11. Pp. 322. Price 5s.
Longmans, Green, axd Co. (London and Bombay).
The Serum Diagnosis of Disease. By R. C. Cabot, M.D., Mass.,
U.S.A. Pp. 134. Price 7s. 6d.
A Manual of Surgical Treatment. By Watson Clieyne, F.R.C.S.,
F.B.S., and F. F. Burghnrd, M.D., F.R.C.S. In six parts.
Part I. Pp. 286. Price 10s. fid.
Metropolitan Asylums Board,
Annual Report of the Statistical Committee for 1893 with Appen¬
dices in two volumes.
Medical Publishing Company, Limited (London)
Pyorrhoea Alveolaris and its Relations to General Medicine. Bv
John Fitzgerald, L.D.B. Pp- °-
Digitized by Google
24 The Medical Pbbss.
LABORATORY NOTES.
July 5, 1899.
Oliver and Botd (Edinburgh).
Anaemia and Some of the Diseaeea of the Blood-forming Organs
and Glands. By Byrom Bramwell, M.D., F.B.C.P.Ed. Pj>. -450.
Price 12e. 6d.
The Open Court Publishing Compant (Chicago!.
The Psychology of Reasoning. By Alfred Binet. Translated
from the French by A. G. Whyte, B.Sc. Pp. 191.
Young J. Pentland (Edinburgh and London).
The Murmurs of Mitral Disease. By E. Mansfield Brockbank,
M.D., M.R.C.8. Pp. 47.
Aseptic Surgery. By C. B. Lockwood, F.R.C.S. Second Edition.
Pp. 2<H. Price 4s.
The Edinburgh Medical Journal. Edited by G. A. Gibson, M.D.,
F.R.C.S.Ed. New Series. Vol. V.
Sampson Low, Marston a*d Co., Limited (London).
Handbook of Medical Gymnastics. By Anders Wide, M.D. Pp.
374. Price 10s. 6d.
Twentieth Century Practice, an International Encyclopaedia of
Modern Medical Science. Edited by Thos. Stedman., M.D.
Vol. XVI. Infectious Diseases.
The Botal British Nurses' Association.
Boll of Members for 1899. Pp. 132.
John Wright and Co. (Bristol).
Our Baby : for Mothers and Nurses. By Mrs. Langton Hewen •
Sixth Edition. Price Is. 6d.
An introduction to Dermatology. By Norman Walker, M.D.,
F.R.C.P.Ed. Pp. 247. Price 8s. 6d. net.
CIomBpmtOtntt
We do not hold ourselves responsible for the opinion* of our
correspondents.
COLONIAL DEGREES: REGISTRATION.
To the Editor of Tbe Medical Pbisb and Cibculab.
Sib,— On April 29th you were kind enough to publish
a letter from me, stating that the Medical Council,
acting on the advice of Mr. Muir Mackenzie, had passed
a refolution confirming the action of the Registrar in
refusing to register the diploma of F.R.C.S.I. as an addi¬
tional qualification on the Colonial List, and I stated
then that I had appealed to the Privy Council on behalf
of the applicant.
The appeal, I am glad to Bay, has been successful, and
I have just received a communication from the Privy
Council Office, informing me, by direction of the Lord
President of the Council, that the General Medical
Council have intimated to His Grace that on the 6th
inst. they resolved to accede to the application, and have
directed the Registrar, in future, to legister additional
or higher qualifications on the Colonial List.
I have not yet received any intimation from the
Registrar of tbe General Medical Council, but I see in
the report of the proceedings that Mr. Mnir Mackenzie
stated that his first opinion was given without a full
knowledge of the facts before him.
In my appeal to the Privy Council, I did not in any
way add to the application made to the General Medical
Council, which, I take it, should have been submitted to
Mr. Muir Mackenzie, when his opinion was asked, as
refusal to register a qualification might, and probably
has, inflicted injury on an applicant legally entitled to
registration.
Thanking you and the members of the General
Medical Council, who assisted in effecting this regis¬
tration.
I am, Sir, yours truly,
Chakle8 Frederick Knight, M.D.
Edinburgh, June 29th, 1899.
Surgical Appliances.
NEW UTERINE DOUBLE CURETTE.
By Dr. Alexander Duke,
Cheltenham.
For the various operations requiring curetting I think
it will be found an advantage to possess an instrument
rt \ which will do double the work effectually
‘f^i and in s much shorter time.
11 • i lij, The curette depicted, made for me
\V ] by Messrs. Evans and Wormull, Stam-
\\jlf ford Street, London, will be found
\'iin practice to act well, and with
« ordinary care can do no injury to
[ll, uterus. It consists of two curettes or
■V11 ring knives (lying inside each other while
1 ' '•/, instrument is closed) the blunt edges
1 I alone presenting The width of outer
t loop from side-to-side measures little
|jji more thsn half an inch, so that that
■ amount of dilatation of “os ” and cervix
|! j will be found sufficient to admit the
J i blades to pass into uterus while steadied
(jU by tenaculum or volsel’um. The milled
ffl \ nut on outer side being then released by
!’ fingers, the weak spring action will be
! found sufficient to open blades to
ft ||V- the extent allowed by nut and bring
1 the cutting edge or edges into close
proximity with uterine walls. (The depth
/ALk of cutting edge exposed can be giaduated
;2 ? to a nicety by mems of the milled nuts,
1,51 J the necessary number of half turns having
I?! i been counted before instrument is intro-
duced.)
The blunt edge of inner curette should
o! project slightly from outer during in' ro¬
ot duction; there will then be no danger of
z|| incising the cervix while passing instru-
jp ment into uterus. The blades can also
|i * he used by rotation while withdrawing
13 1 curette slowly from uterus, thus making
( ;JF * the complete removal of endometrium
far more certain and avoiding the neces¬
sity of having at some future time to repeat the
operation. Thq instrument can be used either as a
single or double curette by keeping the blades almost
closed or opened respectively.
laboratory ^otes.
L’EAU D’OREZZA.
We examined this water nearly a quarter of a century
ago, and found it to contain a considerable percentage of
iron, both as carbonate and protoxide, calcium carbonate,
magnesium, carbonate with traces of potassium, and
sodium chloride. We pnt it through present-day tests
writh some curiosity and found its leading characteristics
had undergone but the slightest variation during this
long interval, showing it to be what is claimed for it,
a natural ferruginous water of stable character and of
decided value in amemia, chlorosis, and general debility,
it contains more free carbonic acid, and is, therefore, more
effervescent than most others of its class, a point in its
Small pox in HulL
It appears from a statement made by the President
of the Local Government Board last week in the House,
that of the 83 cases of small-pox at Hull, as to which the
Board have received information, 62 showed evidence on
examination of having been vaccinated, and 21 appeared
to have been unvaccinated. The rate of death among
patients exhibiting evidence of vaccination has been 9 - 7
per cent., whilst amofig those exhibiting no evidence of
■vaccination it has been 57'1 per cent.
favour which invalids will readily appreciate.
It seems passing strange that a natural product of
such excellence should be comparatively so little known
in this country, while on the Continent it is so popular a
remedy with the profession. It issues from a mountain
spring nearly 2,000 feet above sea level in the island of
Corsica, whence it is bottled and conveyed to the various
depots in the usual manner. Probably it may be
destined to a fuller appreciation in the future, as Sir
Hermann Weber speaks highly of it in Clifford Allbu Ps
new “System of Medicine,” an-1 recent writers Lave
lecogniBed its therapeutical value. The shippers and
Digitized by Google
Jult 5, 1899.
MEDICAL NEWS.
Th* Medical Press. 25
agents for .this country are Messrs. Mark, Whitwill, Son
and Jndge, and it is obtainable at all chemists and
mineral water dealers.
ELIXIR PHOSPHORUS (HORN).
This preparation may be described as a clear, stable
aromatic fluid of syrupy consistence, containing, accord¬
ing to the prospectus, a fiftieth of a grain of free phos¬
phorus in each fluid drachm, an assertion which is
approximately borne out by the results of chemical
analysis, and which also shows that the preparation
contains no chloroform, ether or oil. The elixir is
miscible with water, without any turbidity, and the
mixture is free from any unpalatable taste. This is not
the place to dilate upon the therapeutical application
of free phosphorus, but when it is desired to administer
the drug, this preparation appears to offer certain
advantages. It is manufactured by Mr. O. E. Horn, D.Sc,
of Bournemouth.
CHOCOLATE-COATED MEDICINE TABLETS.
Messrs. Parke, Davis and Co. have favoured us with
samples of sundry recent additions to their list of choco¬
late-coated tablets, notably (1) tablets of calomel,
ipecacuanha, bicarbonate of s<xla and bismuth, for
infants; (2) cubeb compound tablets, for gonorrhoea;
(3) euonymin, podophyllin, and calomel tablets; and (4)
calomel and bicarbonate of soda.
These chocolate-coated tablets are characterised by
perfect uniformity in point of size and weight (for each
kind); and by their, pharmaceutically speaking, perfect
finish. They represent, indeed, “le dernier cri de la
pharmacie.” The remorseful incontinent will welcome
the tablet of cubeb compound as a pleasant change to
the nauseous pastes and mixtures with which the old-
fashioned practitioner beguiles his ailment, and children
will appreciate the “corrective” tablets as a heaven¬
sent substitute for the teaspoonful of liquid redolent of
rhubarb and other medioaments, good, no doubt, in their
way, but not popular with unreasoning childhood.
^Ubical s.
Royal Institute of Public Health.
“ Peculiar People,” have been committed for trial on a
charge of causing the death of a female child, aged 5,
by withholding medical aid. The medical evidence
showed death to have resulted from exhaustion conse¬
quent upon an attack of pleuro-pneumonia.
The General Medical Council and the Certification of
: Mid wives and Opticians.
The Corporate and Medical Reform Association request
us to point out that in reply to the memorials, the
General Medical Council has adopted resolutions imply¬
ing that for registered practitioners to take part in such-
certification is “ impropor conduct,” within the purview
of the Council (vide Lancet and June 10th, 1899).
In 1893 the Council’s Executive Committee framed for
the Obstetrical Society a form of licence for midwives
which the Council approved and the Society adopted.
As the Medical Act denies recognition of the right to
practice midwifery to persons not registered under the
Act, these proceedings of the Council, and all its pro¬
ceedings recognising such lioences, are illegal. Yet ho W
can the General Medical Council, it is asked, after sanc-
toning these licences, bring itself to convict practitioners
of “ infamous oonduct ” for issuing them P But if it will
not convict one registered practitioner for examining or
licensing mid wives, how can it convict another for
examining and passing opticians in sight-testing ? And
is not the sole escape from this embarrassing dilemma
which we can anticipate a predetermined acquittal upon
either charge P The General Medical Council has thus,
by refusing their power to rescind its illegal proceedings,
repudiated its judicial character, and destroyed its
judicial competency as to the conduct of practitioners
i in examining and certifying either midwives or opticians.
The direct representatives are in a hopeless minority,
and the Counoil has twice in three sessions refused to
recommend an increase in their number, and has also
refused to amend, in accordance with the terms of the
Medical Acts, its illegal form of return of corporate
members, which enables them to be illegally returned.
Under such circumstances vigorous measures are stated
to be urgently needed to protect the rights of the pro¬
fession and the public safety, and the remarkable success
and general approval attained by the memorials is a
guarantee of the success of more enerretic and no less
constitutor al proceedings. An address or petition to
the Privy Council to exercise its authority under the
Medical Acts will be submitted for consideration.
The annual Congress takes place this year at Black¬
pool, under the presidency of the Marquis of Lome,
K.G., the Mayor of Blackpool being honorary president,
and Dr. Jasper Anderson is honorary secretary of local
committee. A Health Exhibition in connection with the
Congress will be held from September 21st to October
14th, of appliances connected with public health, special
attention being paid to those for the abatement of smoke,
the object being the much-needed improvement of the
smoke-polluted air of our towns and cities, and the
economical consumption of fuel. There will also be a
special section for public and private means of preventing
fire, and of appliances for saving life from tire. Mr. W.
G. Larkins, who was the curator and manager of the
Exhibition at the Royal University in connection with
the Dublin Congress last year, has been appointed to the
same responsible position at Blackpool, and may be
communicated with at the Public Health Office, Black¬
pool.
Chelsea Hospital for Women.
W e are asked to announce that this institution will be
closed to in-patients from the middle of July to the end
of September in order to permit of the following neces¬
sary alterations and improvements being carried out:—
Enlargement and modernising of operating theatre, new
hot-water service, new lift, installation of electric light.
These improvements will cost nearly .£3,000, and in view
of the great pressure at which the work of the hospital
is carried on, they can be no longer delayed. An appeal
is being made for assistance towards defraying this
expenditure. The out-patient department will be closed
during August only.
More “Peculiars.”
Frederick Norman and his wife, members of the
Heath Under Chloroform.
An inquest was held last week at Sudbury, on a man,
set. 34, who had died at the St. Leonard’s Hospital
during the administration of chloroform previous to an
operation necessitated by an injury to the hand. There
was the usual struggling, which subsided, only to be
promptly followed by respiratory failure. The report
before us gives no information as to the amount of
chloroform given in the matter of administration, but it
is plain that the pernicious, so-called “ open ” method
was followed. Unfortunately, these are matters which
coroners juries are ill-fitted to d scuss and appreciate,
so the usual verdict was returned in accordance with the
medical evidence.
Recalcitrant Guardians.
The Dewsbury Board of Guardians have instructed
their vaccination officer not to take any proceedings
against defaulters under the Vaccination Act, the Local
Government Board’s instructions to that officer to the
contrary notwithstanding. It remains to be seen what
course the central authority will take to put the insub¬
ordinate guardians in order.
Diphtheria In Staffordshire.
At Longton, in Staffordshire, upwards of 560 cases
have been notified during the last few months with 102-
deaths. The Medical Officer of Health personally noti¬
fied the Sanitary Committee that unless they build an
infectious disease hospital, do some radical work to the
drains, concrete building sites, watch the places where
refuse tipping is going on, they must consider that they
are only playing at sanitary reform, making matters on
the surface to please the eye, but not to please the eye of
intelligence.
26 The Medical Press
NOTICES TO CORRESPONDENTS.
July 5, 1899.
4totice0 to
(JornoponbentB, Short ^tetters, &r.
Palpebral and Oculo-motor Apparatus of Fishes.—Prof. C. Addison
Tables and Illustrations of a Research ou the Topographical
Anatomy of the Abdominal Viscera.—Mr. H. Higgins : The Move¬
ments of the Knee-joint.
Correspondents requiring a reply in this column are par¬
ticularly requested to make use of a distinctive tigvatur ' or
initials, and avoid the practice of signing themselves “ Reader,"
“Subscriber,” “Old Subscriber,” 4c. Much confusion will be
spared by attention to this rule.
Local Reports and News. - Correspondents desirous of drawing
attention to these are requested kindly to mark the newspapers
when sending them to the Editor.
Puzzled. —Syrupus calcii lactophosphatis of the new Brit.
Phnrm. is made by dissolving 25 ports of precipitated carbonate
of calcium in 60 parts of lactic acid, adding 46 of concentrated
phosphoric acid, orange flower water, sugar and water. This drug
was greatly lauded upon its introduction for its virtue in phthisis.
That it really possessed some value is more than likely, but modem
open-nir therapeutic methods have superseded all drug cures by a
more rational comprehension of the etiology and pathology of
tubercle.
THE EFFECT OF TITLES ON THE FEMALE MIND.
A correspondent has related to us an amusing episode in connec¬
tion with the recent bestowal of a title by Her Majesty on the h ad
of a household. Some months before our confre-e could dub him¬
self with the coveted prefix, his wife was apprised of the fact that
the honour was shortly forthcoming, and her mind was immediately
in a state of perturbation. The servant - ! were summoned and put
through their paces daily. They were instructed to practise
addressing herns my lady this, my lady that; to answer the door to
imaginary callers on her ladyship, and to the delivery of orders to
tradesmen and others for lady so-and-so. until the entire household
became one of expectant excitement. Meanwhile Dr.- was an
amuse . spectator of feminine exultation.
Dr. A. T. T. is thanked for his communication ; the course pur¬
sued is quite the most dignified and proper under the circumstances.
FATALITIES FROM THE LOW FLASH OIL.
Statistics have been compiled by the editor of the Star news
paper showing that sixty-three deaths have resulted from accidents
with lamps in which the low flash oil has been used during the past
half year against thirty-six in the corresponding period of 1898.
What an outcry there would be had this serious loss of life resulted
from an epidemic. But, say the authorities, if ignorant people will
buy this common oil they must put up with the consequences.
Dr. O. S.—There are entrance scholarships at most, if not all,
medical schools, particulars whereof can be obtained by application
to the Deans of tne respective schools. In London most of these go
to university students, no restriction being imposed in respect of
the financial status of the candidate. While we quite ngree that
candidates for such scholarships ought to be required to sign a
declaration of want of funds we know of no school where it is re¬
quired. It, therefore, often happens that the rich man does not go
empty away.
Observer (Bradford-.—We shall be pleased to receive any evi¬
dence you may be enabled to place at our disposal bearing on the
case you refer to. We may mention incidentally that it is likely to
be threshed out in the Law Courts, but we trust, not at our
expense.
Dr. R. J. L. ■ Communication to hand as we were at press.
Mr. Ht. Knight.— Thanks, but scarcely suitible.
M.D.Edin.—T he work referred to has, we understand, been out of
print for some time but a new edition is promised shortly.
JfUctinijB of the gocietieo attb lecture*.
Wednesday, July 5th.
Obstetrical Society of London.—8 p.m. Specimens will be
shown by Dr. Lewers, Dr. Lediard, and Mr. Gilford (introduced by
Mr. Targett). Demonstration Prof. A. Thoms n: On the Sexual
Diflerences of the Fcetal Pelvis. Papers:—Dr. Lewers: A Case of
Persistent Mento-posterior Position of the Face in which the Child
was delivered Alive by the Axis-traction Forcep .—Dr. Savory :
Notes on a Case of Puerperal Eclampsia.
Friday, July 7th.
Ophthalmological Society of the United Kingdom.— 8 p.m.
Cases and Specimens. 8.30 p.m. Papers:—Major H. Herbert,
I. M.S.: Changes in the Conjunctiva produced by Chronic Inflam¬
mation (with lantern slide demonstration).—Mr. Rockliffe and Mr.
Hainworth: Penetrating Wound of the Orbit with Traumatic
Meningitis, Recovery. Annual General Meeting.
Saturday, July 8th.
Anatomical Society of Great Britain and Ireland (Anatomical
Schools, New Museums, Cambridge).—2 p.m. Specimens and Ex¬
hibits will be shown by Prof. J. Musgrove, Prof. T. Wardrop Griffith,
Prof. 8. Martin, Prof. A. C. Haddon, Prof. A. Birmingham, Dr. R.
J. Berry, Mr. W. L. H. Duckworth. Papers and Lantern Demon¬
strations : Prof. A. M. Paterson: On Perforations of the Parietal
Bones (with exhibition of specimens).—Dr. H. Gadow: On Interca¬
lation.—Mr. C. B. Lockwood: The Lymphatic System of the
Appendix Vermiformis.—Dr. C. J. Patten : Exhibition of Slidee
showing the Form and Position of the Abdominal and Thoracic
Viscera in the Lemur.—Prof. J. Symington : A Note on the Thymus
•f the Koala.—Dr. W. H. Gaskell: The Meaning of Giant Fibres.—
Prof. Mocalister: Cephalic Index Curves of 1,000 Egyptian Skulls.—
Dr. Barclay Smith: Scaphocephaly.—Mr. N. B. Harman; The
B&cartrits.
Belfast District Asylum.—Locum Tenens Assistant Medical Officer
| for a few months. Salary, £3 3s. per week, with residence aud
attendance.
Berrywood Asylum, Northampton.-Assistant Medical Officer.
Salary commencing at £150, with board, lodging, washing, aud
attendance.
Borough Asylum, Portsmouth.—Junior Assistant Medical Officer.
Salary £100, with board, lodging, and washing.
County Asylum, Gloucester.—Third Assistant Medical Officer, un¬
married. Salary £105 per annum, with board (no stimulants),
lodgings, and wnsliing.
County Asylum, Prestwich, Manchester. - Junior Assistant Medical
Officer, unmurried. Salary commencing at £125 per annum,
with apartments, board, at tends nee, and washing.
Es&x and Colche-ter »' ospital, Colche«ter.~House Surgeon. Salary
£100 per annum, with board, washing, and residence.
Fisherton sylum.—Assistant Me-’ical Officer. Salary commencing
at £120 per annum, with board, lodging, and wnshing. Apply
to Dr. Finch, The Asylum, Salisbury.
Manchester Ro\al Infirmary.-Resident Surgical Officer for twelve
months, unmarried. Salary £150 per annum, with board and
residence.
Staffordshire Genernl Infirmnry, Stafford. - House Surgeon for
two years. Salary £100 per annum, with board, lodging, and
washing. Also Assisttnt House Surgeon. Salary £50 per
annum, with board, lodging, and washing.
Surrey County Asylum, Brookwood, near WokiDg.—Medical Officer
for about four months. Salary at the rate of three guineas per
week, with apartments and all found.
Appointment*.
Berrill, a., L.R.C.P.Lond., M.R.C.S., Medical Officer for the
Woodford Sanitary District of the West Ham Union.
Byford, W. F., M.R.C.S., L.R.C.P.Lond.. Medical Officer and
Public Vaccinator for the N. . 1 Sanitary District of the Ruthin
Union.
Coles, Charles, M.D., D.P.H.Lond., L.R.C.P., Medical Officer of
Health to the Leicestershire and Rutlaud Combined Disrricts.
Griffith, A. H., M.D.Aberd., F.R.C.S.FJdin., Honorary Ophthal¬
mic Mirgeon to the Royal Inflrmarj , Manchester.
Knaggs, R. L. M.D.Cainb., F.R.C.S., Hon. Demonstrator of Sur¬
gical Pathology by the (,'ouucil of the Yorkshire College.
Lawrence, GT, M.R C.S., Medical Officer to the Chepstow Work-
house.
Leai', Cecil H., M.A., M.B.Cantab., F.R.C.S., Surgeon to the Out¬
patients at the Gordon Hospital for Diseases of the Rectum,
London.
Mac Vick* r, C. G, B.A., M.B.Irel., Medical Officer and Public
Vaccinator for the Fourth Sanitary District of the Wei’s Union.
Marsh, J. H., L.R.C.P.Lond., M.R.C.S., Medical Officer of Health,
Macclesfield.
Meachen, G. N., L.R.C.P Lond., M.R.C.S., Assistant Home Sur¬
geon to Guv's Hospital, London.
Pitt-Taylor, F. S., M.B., Ch.B.Vict., Assistant Medical Officer to
the Mill Road Infirmary, Liverpool.
Reynolds, E. S., M.D., F.fi.C.P.Lond., Honorary Assistant
Physician to the Royal Infirmary, Manchester.
Sinclair, A. M., M.B., C.M.Aberd., Houorary Medical Officer for
the Burnley Victoria Hospital.
girths.
Carr.- On June 30th, at 19 Cavendish Place, W., 'the wife of J.
Walter Carr, M.D., of a daughter.
Dalton.— On June 2flth, at Cranmer House, Cambridge, the wife of
J. H. C. Dalton, M.D., of a son.
Gourlay.— On June 30th, at Furiugcote, Guildford, the wife of F.
Thornbrough Gourlay, of a sou.
Newington. - On June 27th at The Grunge, Edenbridge, the wife of
Chos. W. Newington, M.R.C.S., L.R.C.P., of a sob.
Walter.— On June 25th at Lytham Road, Blackpool, the wife of
R. A. Walter, M.R.C.S., L.R.C.P., of a son.
^ttarrmges.
Auden—Bicknell.— On June 27th, at All Saints' Church, Notting
Hill, W., George Augustus Auden, M.A., M.B., B.C.Cantab., of
Bootham, York, to Constance Rosalie, daughter of the late Rev.
R. H Bicknell, M.A., Vicar of Wroxham, Norfolk.
Bower—Whitley.— On June 27th, at the parish church, Stretton
near Warrington, Harry Edward Bower, M.B., of View Field’
Stretton, to May, eldest surviving daughter of Charles Thomas’
Whitley, of Wallspit House, Stretton.
Sarjeant—Kekwick.— On June 28th, at 8t. Mary's Church, Isling
ton, John Frederick Sarjeant, L.R.C.P., M.R.C.S., eldest son of
John W. Sarjeant, of Wellington, to Jane Eleanor, elder
daughter of the lare James Watson Kekwick, of Carlisle.
Heath*.
Hughes.—O n June 24th, Philip Vernon Hughes, M.R.C.S., L.R.C.P.
eldest son of the late Philip Hughes, aged 28.
Norman. On June 29th, at 21 Sussex Gardens, Hyde Park
London, Julia Claudine, widow of William Alford Norman
M.B., F.R.C.S.
Swaby-Smith.— On July 2nd, at 124 Mill Lane, Hampstead C
Swaby-Smith, M.R.C.P.Edin., M.R.C.S., LL.A., aged 64.
SR.
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“SALUS POPULI SUPREMA LEX."
Vol. CXIX. WEDNESDAY, JULY 12, 1899. No.
(Original Communications.
DECIDUOMA MALIGNUM ?
A CRITICAL REVIEW FROM A CASE
SUCCESSFULLY TREATED BY
VAGINAL HYSTERECTOMY, (a)
F. W. N. HAULTAIN, M.D., F.R.C.P.E.,
lecturer in Obstetrics, Edinburgh School of Medicine.
Te.v years ago. Sanger described under the name
of Deciduoma Malignum, a new growth of the
uterus, which he considered owed its origin to an
immediately pre-existing pregnancy. Since then a
considerable number of cases have been recorded.
The condition in question is of much import¬
ance clinically, and interesting pathologically.
From a clinical aspect its importance lies chiefly
in its malignancy and comparative rarity. When
untreated by radical means, death in the majority of
instances occurs within 6 months of the confinement,
although in a few instances it seems to run a more
chronic course. The causes of death are haemorrhage,
septicmmia, and pulmonary embolism from metastases,
the last being most common.
Its supposed rarity is questionable. Already I
have been able to collect 90 cases published; of these
the vast majority are German. In England, curiously
enough, but six cases have been described, and in
Scotland only one. This infrequency in Britain is
probably to be explained through a want of apprecia¬
tion of the true character of the growth, many being
considered ordinary carcinomata and sarcomata,
and claiming no particular attention. This conten¬
tion is supported by the fact that up to 1896 when
the condition was comparatively unknown, only 26
cases could be found in the literature, while now,
three years later. 90 cases have been recorded.
Though important clinically, it is doubtless from a
pathological standpoint this so-called deciduoma is
of paramount interest; indeed, it is questionable if
any pathological subject within the last five years
has comparatively had bestowed upon it more inves¬
tigation or given rise to such diversity of opinion
as regards its structure, origin, and designation.
Observers may be divided into two primary groups.
1. Those who believe the growth to be an ordinary
sarcoma having no connection with pregnancy, and
2. Those who consider it to owe its origin to an imme¬
diately pro-existing gestation. The first group
embraces practically the opinion of all the Britisn
investigators, with the exception of Teacher, (b)
While the second group only agree to differ in detail.
Thus we have Siinger suggesting its decidual origin,
Gottshalk maintaining it arises from the stroma of
the chorionic villi, and Williams, from the syncytium
alone; while Marchand. Gebhard, Teacher, and
many others assert its structure embraces both the
epithelial layers of the chorionic villi. To still
further complicate matters, the question of the
origin of the syncytium forms a point of debate
as to whether the tumour is maternal, foetal, or both.
(а) Paper read and Demonstration given before the British
Grnsecological Society, June 8th, 1899. For discussion see page t>,
No. for July 5. 1899.
(б) “ Pathological Journal," 1899.
2.
Before venturing any assertion on this much-vexed
uestion, I will take the opportunity of describing in
etail a case which I had the good fortune to have
placed under my care.
On October 18th I was asked by Dr. Thomson, of
Musselburgh, to see with him a woman who was
suffering from copious uterine haemorrhage, and who
gave the foltowing history :—
On September 10th, after a period of amenorrhoea
which had lasted for ten weeks, she was seized with
a sudden and profuse haemorrhage for which the
vagina was plugged. As the bleeding continued and
the uterus was found to be enlarged it was decided
to evacuate its contents. After the introduction of a
bougie into the uterus and tight vaginal plugging,
she spontaneously expelled a myxomatous mole. Her
recovery seemed in evepr way normal and satisfactory;
but on October 6th slight bleeding reappeared, and
after a few days there was expelled a large fibrinous
mass, not unlike a carneous mole. During and after
its expulsion the bleeding was excessive and reduced
the patient to a state of profound anaemia. At this
time I now saw the patient. On local examination
the uterus felt enlarged and soft, and the cervix
sufficiently patulous to admit the finger for a con¬
siderable distance, though not entirely to the
fundus.
Fia. 1.—Uterine scrapings which show (F) nucleated
protoplasmic masses and large actively proliferating
malignant cells, (d) Fibrin. id .
Being of opinion I had to deal with subinvolution
due to retention of gestation products, I curetted
the uterus, and was at the time struck with the free
nature of the bleeding which occurred, and which
could only be stopped by very thorough
intra-uterine plugging. As I was suspicious
on this account of some malignant growth, I
preserved the scrapings, and carefully examined
them microscopically (Fig. 1). They showed the char¬
acteristic multi-nucleated protoplasmic masses and
large nucleated cells described as occurring in deci¬
duoma malignum, and, I therefore advised immediate
Digitized by Vj ooQle
28 The Medical Press.
ORIGINAL COMMUNICATIONS.
July 12. 1899.
hysterectomy. As Dr. Thomson informed me, how¬
ever, that the patient was well, the bleeding entirely
having ceased, and that she and her friends would
not hear of such radical methods being adopted, I
reluctantly abandoned the idea of immediate opera¬
tion, but strongly insisted that in the event of haemor¬
rhage recurring, such should be carried out without
delay.
On November 21st, 1898, more than a month after
curetting, a sudden profuse haemorrhage occurred,
and the patient was sent to my hospital. On arrivaJ,
after a journey of some miles in an ambulance, during
which she was bleeding profusely, I fourd her in an
extremely exhausted ana exsanguine state. So much
so indeed that I felt immediate operation to be un¬
safe. As I was aware of the terribly malignant
nature of the disease, I hesitated to delay operation
long, and on November 24th performed vaginal
hysterectomy, which was easily and rapidly accom¬
plished. The ovaries and tubes were not removed.
Her recovery was uninterrupted, and she is now in
evident health, although eight months have passed.
On examination of the uterus there was found on
section a small growth (walnut) springing from the
upper part of the anterior uterine wall, sessile in
nature and bulging into the uterine cavity. It was
covered (with the exception of a small portion) by
apparently smooth healthy mucosa, and from the
uncovered portion there protruded a mass of blood
clot. The rest of the uterine cavity was lined by an
apparently healthy mucosa.
On a complete section of the tumour the portion
which bulged into the uterine cavity appeared to be
composed mainly of fibrinous material, which indefi¬
nitely and irregularly gave way to a grey, apparently
cellular layer, which in turn encroached into the sub¬
stance of the uterine wall in an equally indefinite and
irregular manner by means of prolongations along
the blood sinuses. This infiltration was by no means
extensive, and appeared to leave a large area of
healthy uterine tissue between the growth and the
serous surface of the uterus.
Fig. 1a.— (F) Necrotic are. (C) Cellular area of activity.
(V) Villi.
Microscopically: The structure of the growth is
seen to be composed of blood clot, two varieties of
cellular elements and chorionic villi (Figs. 2, 3, 4).
The cellular elements are of two types, (1) large
polyhedral cells, which stained lightly, and whose
large nuclei show a wide intranuclear network, and
(2) multinucleated deeply staining protoplasmic
Fig. 2.—Shows large nucleated individual cells and multi-
nucleated protoplasmic masses, (P). Fibrin x 100, (F).
Protoplasmic mass. Blood sinus. Villus.
Fig. 3.—(V) Tip of villus. (BS) Blood spaces. (PE)
Proliferating epithelium x 60,
Fig. 3a. —Transverse section of chorionic villus in
tumour, showing intense proliferation of both layers ~
of epithelium. (V) Villus. (S) Protoplasmic masses
of syncytium. (M) Individual cells showing mitosis.
(BS) Blood space.
July 12, 1899.
ORIGINAL COMMUNICATIONS.
The Medical Press. 29
Fig. 4.—Higher power of cellular layer. (C) Individual
cells with intranuclear network. (P) Nucleated
protoplasm. (F) Fibrine, x 400.
venous sinuses and engraft themselves on the
interior of their walls, where they continue to pro¬
liferate.
The chorionic villi in some instances show degen¬
eration of their stroma, but others present an almost
normal appearance. In all. however, there is evidence
of great activity in their epithelial coverings. On
section of the tumour three areas might be micro¬
scopically described : 1st, the submucous or peri¬
pheral area, which forms the main bulk of the tumour
mass, and is necrotic in character, composed of fibrin
and cellular elements in all stages of degeneration ;
2nd, a cellular area or tumour proper, which is com¬
posed entirely of actively proliferating cellular
elements and chorionic villi mixed with free un¬
coagulated blood; while, 3rd, we have the area of
infiltration, in which may be seen cells and protoplas¬
mic masses isolated, and in groups insinuating them¬
selves into the blood channels (Fig. 7), and surrounded
by the degenerating muscular fibres of the uterine wall.
From what has been described, therefore, it would
appear as if the role of the cellular elements com¬
posing the growth was to penetrate the blood
channels, in which, so long as the blood circulation con-
masses of all varieties of shape, whose nuclei are ex¬
tremely rich in chromatin and show no wide intra¬
nuclear network as in the othev cells. Both varieties
of elements, however, show a marked tendency to re¬
traction of their protoplasm and vacuolation. Mitotic
figures were frequently observed in the individual
cells, but nowhere in the protoplasmic masses. The
relationship of these two types of cells varies greatly;
in some instances it appeared as if groups of indivi¬
dual cells were confined in alveoli formed by processes
of nucleated protoplasm. This is most apparent when
in close relationship with the chorionic villi. As one
proceeds further from the villi the cells and proto¬
plasmic masses are arranged indefinitely. The
individual cells, in some places, are much in excess of
the protoplasmic masses, while in others the latter only
Fio. 5.—Branching multinucleated protoplasmic pro¬
cesses in free blood spaoea.
are to be distinguished j(Fig. 5). Nowhere is there
evidence of intercellular substance, or blood-vessels,
although free blood is intimately mixed with the
cells, and is also found in the vacuoles in their sub¬
stance.
Extending into the muscle can be seen clumps of
both types of cells, apparently following the peri¬
vascular lymph spaces, while throughout, indivi.
dual cells may be seen finding their way indis.
criminately, with a special tendency to penetrate th e
Fic. 7.—Area of invasion. Both varieties of malignant
elements (C) in small vessel and surrounding tissues.
tinued, they maintained their vitality and proliferated
rapidly, but when coagulation and extravasation of the
blood took place, they rapidly degenerated. It
also appears as if the protoplasmic processes
and masses had an amoeboid character not
only in their power of movement, but more especially
in the phagocytic action on surrounding tissues; every¬
where they were surrounded by a free blood space,
and in the interior of many of the masses could be
seen degenerated blood and debris in the process of
absorption. From this action their power of rapid
infiltration is very great
In seeking for an origin of this curious variety of
growth, and at the same time recognising the fact
as pointed out by Sanger, that they always arise
after an immediately pre-existing pregnancy, one
naturally turns for a physiological prototype to the
placenta.
Here, as is well known, in the early weeks we have
extreme activity in the epithelial coverings of the
villi, especially at their tips, when they come
in contact with the decidua (Figs. 10, 11). By means
of this epithelial proliferation more villi are formed,
and at the same time through the phagocytic action
of these epithelial layers, maternal blood-vessels are
opened into and an actual encroachment made into
tne decidua itself. In due course, however (accord-
Digitized by
-o°8 lc
30 The Medical Pbess. ORIGINAL COMMUNICATIONS._ Jclt 12, 1899.
where throwing out large complex processes of a
similar structure to itself. It cannot but be con¬
sidered from the appearances thus presented, that the
origin of at least this tumour has been from the
epithelial layer of the villi.
In further investigating the origin of the so-called
deciduomata in general, one must naturally turn to an
examination of the structure of myxomatous chorion,
a condition with which it seems to be closely allied, as
shown by the fact that of the 91 cases of deciduoma
recorded, 49 followed the expulsion of this variety of
mole. And if it be kept in mind that myxoma
of the chorion i6 in itselt an infrequent condition,
occurring only once in 1,800 pregnancies, a
priori, it is to be expected that a connecting
link may be found between the normal villus
of the young placenta and the growth in question.
In this reasoning one is not disappointed, for micro¬
scopic examination of so-called myxomatous villi
demonstrates this abnormality to be due to an intense
activity in the syncytium and to a lesser extent of
Langhan's layer, by which rapid proliferation and
the formation of new villi is accounted for. (Fig.
12). It will also be noted that there is an extra¬
ordinary vacuolation o f the syncytium. As one
Fio. 12.—Myxoma of chorion. Transverse section through
f small villus x 200 showing (S) retracted stroma of
villus. (VP) Enormous hypertrophy and vacuolation
of syncytium. (C) Proliferation of Langhan’s layer.
would naturally expect, a result of this excessive
activity in the epithelial layers of the villi is an
increased aggressive action of the villi on the sur¬
rounding decidua and a deeper penetration into its
substance. In some instances, as is well known, this
may be so extreme that the villi not only travel
through the entire thickness of the decidua, but
penetrate the muscular wall of the uterus, and give
rise to spontaneous rupture or peritonitis; or in
other cases pass into the blood stream and give rise
to metastases and pulmonary embolism.
It is no mere fancy, then, to argue that, under
certain conditions, villi with actively proliferating
epithelium may penetrate the muscle wall of the
uterus, and in this situation by continued activity
of their epithelial coverings, give rise to the new
growth we are now considering. This condition is
certainly more likely to result from a myxomatous
mole pregnancy where the villi are specially active,
and more prone to overcome the resistance of a nor¬
mal decidua, but it is also possible through a weak¬
ness in the decidual defence, that the villi of a normal
pregnancy, may reach the muscular wall of the uterus
and there continue in a state of activity, and give
rise to an epithelial growth. The chain of evidence
Fio. 10 .—Normal placenta, sixth week. (CD) Chorio-
decidual space into which (A) vessel opens by dilata¬
tion, see endothelial lining. (V) Villi with intense
proliferation of Langhan’s cells. (D) Decidua. (L)
Protoplasmic multinucleated masses, from specimen
of Dr. Gulland’s.
Fig. 11.—Normal placenta, sixth week x 200. (V) Tip
of villus. (D) Decidua. (L) Proliferating cells of
Langhan’s layer. (S) Multinuoleated protoplasmic
masses. (CD) Chorio-decidual space lined by endo¬
thelium.
ing to Fothergill), the decidual cells, which are also
phagocytic in action, overcome the ingression of the
chorio-epithelium, destroy it entirely when in contact
with it, and thus prevent infiltration of the uterine
wall by villi. In other words the decidua may be
looked upon as the first line of maternal defence
against the inroads of parasitic villi. On microscopic
examination the villi are found to be covered by two
layers of epithelium, an inner composed of individual
cells (Langhan’slayer) and an outer of nucleated proto¬
plasm not differentiated into cells (syncytium), and on
comparing these layers with the cells of the tumour
in question one is struck by the similarity. If fur¬
ther proof be wanting of their identity one need
only turn to the villi found in the tumour, which, as
shown (Fig. 7), display an intense activity in both
layers of epithelium. The individual cells of Lang-
lians layer, dividing and multiplying in all manners
and ways, whilst the syncytium can be seen every¬
ORIGINAL COMMUNICATIONS.
July 12, 1899.
Thi Medical Press. 31
in favour of this new growth being of epithelial
origin has, to my mind, no weak link ; the structural
appearances, the physiological prototype of the young
villus, and the interesting association with myxoma
of the chorion which it closely resembles anatomically,
physiologically, and pathologically, all serve to prove
that the growth is of epithelial origin, at least, so far
as concerns the case under our immediate notice.
(To hi roucluded is our next.)
THE SEXUAL DIFFERENCES OF
THE FCETAL PELVIS, (a)
By ARTHUR THOMSON, M.A. Oxon, M B. Ed.,
Professor of Homan Anatomy in the University of Oxford: Lec¬
turer on Anatomy in the Government School of Art, South
Kensington.
After demonstration by the aid of numerous dia¬
grams and lantern slides of the sexual differences
in the conformation of male and female pelves during
foetal life as resulting from his researches the author
commented on the absence of any reference to the
subject in most anatomical works, and he pointed out
that to Fehling belongs the credit of discovering that
the differences in form and appearance are such as
to enable the observer to distinguish between the
pelvis of the male and female as early as the third
month of foetal life. He referred to the statement
which still finds currency that no such differences
obtain until the period of puberty, and he discussed
the explanations that had been offered of the causa¬
tion of the differences at that period. He alluded in
particular to the views held by Matthews Duncan,
who suggested that the changes were lees marked in
the male pelvis, in which the bones were thicker,
stronger, and stouter, and more early consolidated
with each other, these conditions being at once the
signB and causes of the peculiarities of a masculine
pelvis. The author’s object was to insist upon the
fact that at a comparatively early period in the deve¬
lopment of the fcetus the sexual differences are as
pronounced and characteristic as they are in the
adult. He showed a number of pelves taken from
foetuses which had been previously hardened in
spirit which had been preserved as moist
specimens, this moist oonaition being an im¬
portant point to bear in mind in drawing deduc¬
tions. He noted that in respect of the proportions of
the pelvis as a whole the breadth-height index is high
—viz., 86‘6 for the females and 82'4 for the males, in
other words the height of the foetal pelvis is great in
proportion to its width. It follows that during the
growth of the pelvis from the foetal to the adult form
there is a greater proportionate growth in width
than in height. In the foetal condition, however,
the breadth-height index in the female is higher
(85'6) than in the male (82'4), the converse whereof
holds good in the adult, so that the female pelvis
during growth appears to increase in size more
rapidly m width than in height, a circumstance no
doubt associated with the peculiarity in the form and
size of the hinder portion of the ileum. In the foetus
the splay of the lateral walls of the pelvis is
greater in the male than in the female, and it is note¬
worthy that this difference is characteristic of the
different sexes in the adult. This difference in the
splay of the pelvic sides reacts on the proportions of
the true and false pelves, so that in the female the
lower segment bears a larger proportion to the upper
segment; while in the male, owing to the greater
read at the meeting of the Obstetrical Society, July 5th,
liacussioB will be found on page 35.
splay of the pelvic wall as a whole, the proportion of
the lower segment to the upper is much less than in
the female. The author attached considerable im¬
portance to the proportion of the width of the ileum
to the total pelvic height. His results show that
during growth the increase in width of the
ileum is proportionately greater than the increase
in height of tne innominate bone. It is, however, in
the true pelvis that the appearances characteristic of
sex are principally met with, and they are as well
marked in the fcetus as in the adult. The form of
the inlet in the male is described as caudate as con¬
trasted with the more uniformly oval elliptical or
reniform aperture in the female. The proportion
which the sacrum bears to the pelvic inlet is of some
importance, and as a matter of fact the foetal sacrum
is larger in proportion to its surroundings than iD
the adult. He finds, too, that the females even in
the fcetal condition possess a sacrum which bears a
relatively larger proportion to the maximum pelvic
width in the male such as maintains in the adult. He
showed that the sacrum in the foetus exceeds the
width of the pelvic inlet, and he pointed out that the
increase in tne size of the diameters of the inlet of
the pelvis is due in large measure to the growth and
development of that part of the iliac bone which
overtops and formR the upper boundary of the great
sacro-aciatic notch. He pointed out that the narrow¬
ness of the fcetal sacrum so often alluded to in works
of reference has no existence in fact. He notes in
the male fcetus a higher sacral index than in the
female, indicating a proportionately greater width of
sacrum in that sex, tne converse of what obtains in
the adult. Passing on to the true pelvis the author
noted that apart from the differences in the outline
of the inlet the walls of the true pdlvis in the male
encroach much more on the cavity owing to their
greater obliquity. The relative width between the
ischial spines is greater in the adult than in
the foetus attributable to the fact that, unlike
most of the other spinous prominences on the
innominate bone the ischial spines are not provided
with secondary epiphyses from which it may be
assumed that their growth ceases at a much earlier
period with the consequent effect of proportionately
increasing the width between them in the adult. The
author drew attention to the marked difference
between the angle of the pubic arch in the male and
female foetuses, differences which can easily be recog¬
nised without the aid of instruments when the speci¬
mens are placed side by side. It is evident, indeed,
that although there is an increase in the angle with the
growth of the pelvis, the sexual difference is main¬
tained throughout. Another feature in which the
adult female pelvis differs from the male is the form
and size of the great sacro-sciatic notch. This
in the female is usually wider and shallower
than in the male. If the forms of the male
and female adult innominate bone be compared,
it will be seen that in the female the width
of the posterior part of the ilium is greater
than in the male, and this difference exists even
during fcetal life. From a consideration of the facts
already stated, it follows that in many of its forms
and proportions the fcetal pelvis conforms very closely
to the adult. The greatest difference is met with in
the innominate indices and in the proportion of iliac
width to pelvic height To sum up, it appears from a
consideration of the foregoing facts that during festal
life the essentially sexual characters are as well
defined as in the adult forms, and that any differences
that occur during growth between the adult and
fcetal forms, due it may be to the inflaence of pres¬
sure or muscular traction, affect both sexes alike, and
that such influences are in no wise accountable, as has
been maintained, for the characteristic features of
the pelves of females as contrasted with the male.
D
32 Thi Medical Pexss.
ORIGINAL COMMUNICATIONS.
July 12. 1899.
The patient suffered severely from shock, but
improved somewhat towards evening. Next day,
however, she was not so well ; the pulse was very
rapid and weak, and the surface bedewed with cola,
clammy sweat. During the night vomiting set in
with violent abdominal pains, and Dr. Smyly was
summoned to her early in the morning. She had
then violent abdominal pains, with evident peris¬
taltic movements of the intestines, but no flatus bad
escaped. There was constant vomiting, no radial
pulse could be felt, and her arms were cold up to the
elbows. An endeavour to reach the constriction per
anum failed. Dr. Gordon saw her in consultation at
9 a.m., but as the wound presented an unhealthy
appearance, and could not be used to form an arti¬
ficial anus, and as it was evident that to have opened
the abdomen in another position it would have proved
immediately fatal, it was decided that nothing
further could be attempted. During the day she
gradually became worse, and the vomit assumed a
faecal character. Shortly after midnight, however
she took a turn for the better, passed flatus, and
shortly after a faecal motion; pains and vomiting
ceased, and she took and retained nourishment.
Since then she has steadily improved, takes her food
well, and is putting on flesh. A considerable but
steadily decreasing quantity of faeces, however,
escapes from the abdominal wound. The specimen
under the miscroscope shows giant cells and casea¬
tion.
ON A CASE OF
TUBERCULOUS OVARY REMOVED BY
ABDOMINAL SECTION, (a)
By W. J. SMYLY, F.R.C.P., MD., T.C.D.,
Gynecologist to the Adelaide Hospital; formerly Master of the
Botunda Hospital, Dublin, Ac.
Until quite recently such a condition was un¬
known, but Martin, in his recent work on diseases of
the ovaries, states that 184 cases have been recorded
in recent years, so that the disease is not so rare as
had been supposed. As a primary affection, how¬
ever, it is extremely rare, three cases only having
been recorded by Edmonds, Jacobs, and v. Franke,
but even these are doubtful. The patient was set.
28, and had been married two years. She enjoyed
good health until shortly before marriage, when she
had influenza, from which, however, she completely
recovered. About Christmas, 1897, she began to
feel ill, and had gradually got worse. I first saw her
in April, 1899. She complained of always feeling
tired, and seldom left her bed before midday, had
5 refuse night sweats, and had steadily lost weight—
8 lbs. in the last twelve months. She was greatly
emaciated, had the appearance of a person in ad¬
vanced phthisis, and had not menstruated for seven
months. She had no cough, nor any physical signs
of pulmonary disease. The abdomen was somewhat
distended, and a small tumour could be detected in
the left inguinal region, which, upon bimanual
examination, proved to be tho uterine adnexa of that
side. The uterus and right appendages appealed to
be normal. Tuberculous disease of left uterine
adnexa was diagnosed, probably involving the tube,
and associated with tuberculous peritonitis.
Operation .—On opening the abdomen no general
tuberculous disease was round. There were, how¬
ever, dense pelvic adhesions, but no visible tubercles.
Both tubes were found diseased, the right being
about as thick as an ordinary pencil; the left, some¬
what larger, lying upon an ill-aefined mass about the
size of an orange. When freeing the right tube it
burst, and some pus escaped, but it was removed,
with the accompanying ovary, without difficulty. The
tumour on the left side had developed in the meso-
rectum, which was intimately connected with it,
passing over it from left to right, and then down
behind it. The peritoneum was opened in front of
the rectum, and about a quarter of an inch from it,
but in attempting to detach the latter, though the
greatest care and gentleness were used, the finger
penetrated the gut. Keeping the finger ends in con¬
tact with the tumour, it was enucleated without diffi¬
culty, brought up out of the pelvis, and removed with
the tube in the ordinary manner. Upon examining the
cavity left, however, it was discovered that the entire
anterior wall of the rectum was wanting as far down
as the reflexion of the peritoneum. After' consul¬
tation with Dr. Gordon, who assisted at the operation,
it was decided that an ordinary enterorrhaphy offered
small prospect of success, not only because of the
extent of tne injury, but also because of the condi¬
tion of the surrrounding structures. It was, there¬
fore, determined to resect the injured portion of bowel,
and about two inches having been removed, tw*> liga¬
tures were inserted, one on either side of the lower
end of the upper portion of the bowel, and by means
of these it was drawn down into the lower portion,
and secured there by a double row of sutures. Having
sponged out the pelvic cavity, and packed the sutured
portion around with iodoform gauze, the ends were
brought out at the lower angle of the abdominal
incision, the rest of which was closed in the usual
manner.
- I -
(a) Read before the Boyal Academy of Medicine in Ireland, May j An abstract of this paper was read in the Medical Section of
26th, 1896. the Boyal Academy of Medicine in Ireland on Nov. 18th, 1898.
A COUNTRY HERBALIST’S CURE
FOR THE “ KING’S EVIL.*’ (a)
By JOHN KNOTT, M.A.. M.D.. and Dip. Stat.
Med. (Univ. Dub.); M.R.C.P.I.; M.R.I.A.; &c., &c.
(Continued from page 4.)
The herb which forms the second ingredient'of our
remedy is thus described by the same author: —
“Ulmaria sive Regina prati. —Medowsweete or
Medesweete. Of this herb there are two sorts, the
one familiar to our country, the other a stranger to
us, and only entertained of a few, and those the
lovers of rare plants.
“1. Ulmaria Vulgaris. —Common Mede or Med-
dowsweete. The stalks of this Medesweete are reddish
and easie to breake, lising to be three foot high, and
sometimes to be four or five, having at the joynts
thereof large winged leaves, standing one above
another at distances, which are made of many some¬
what broad leaves. Bet on each side of a middle ribbe,
being hard, rough or ragged, crumpled much like to
Elme leaves, whereof it tooke the name, but having
also some smaller leaves with them, even as Agrimony
hath, somewhat deepely fluted about the edges, of a
sad greene colour on the upper side, and grayish
underneath; of a pretty sharpe sent and taste, very
like unto Burnet, and will no lesse give a fine
rellish to a cup of claret wine if a leafe be put therein
then Buraet; at the toppes of the stalke3 and
branches stand many tufts of small white flowers
thrust thicke together, which smell much sweeter
than the loaves; and in their places being fallen,
come croked and cornered seede; the roote is some¬
what wooddy and blackish on the outside, and
brownish within, within divers greater strings and
lesser fibres set thereat, of a strong sent, but
nothing so pleasant as the flowere or leaves, and
perisheth not, but abideth many years, shooting
forth anew every spring.
“2. Ulmaria major sive altera —The greater
Medesweete. This Medesweete groweth higher than
the former, with longer winged leaves set one above
Die
oogle
Jolt 12, 1899.
ORIGINAL COMMUNICATIONS
The Medical Press. 33
another upon the crested brownish stalkes, having
long footstalkes upon them, each being divided
usually into three parts, the two lowest one against
another, and every part also consisting of three to
five smaller leaves than the other. Separate each
from the other, being hard crumpled, and finely
dented about the edges: at the tops of the stalkes
grow the flowers in longer spikes, more sparsedly and
not so thick thrust together, turning downe their
heads which are white like the former, and smelling
very sweete also, more nearly resembling a goat's
beard, whereof some have given it the name than
the other; the root is more wooddy, with many
blackish strings which smell strong, and taste some¬
what harshly; the stalks and leaves dye wholly
downe every yeare, and rise againe in the spring.
“The Place. —The first groweth in moystMeddowes
that lye much wet, or neare the courses of water, and
the later is found also in shadowie woods, and places
very often.
“ The Time. —They are found in some place or
other, all the three Summer moneths, that is, June,
July, and August, and their seede is ripe quickly
after.
“The Names. —They are not found mentioned by
any of the ancient Greekes or Latines. only some
think it may bee referred to Rodora of Pliny. It is
called by the later writers Ulmaria, a foliorum Ulmi
similitudine, of the likenesse of Elme leaves, of
Dodonceus Regina prati, and Barba and Barbu la
Caprse, or Baroa Caprina of Tragus, and by him
thought also that it might be Picnocomon of
Dioscorides, as Gesner in liortis and Lonicerus doe.
Fuschius calleth it Barba capri. and Lobel Barbi
capra. Cordus Medesusium, from the Germaine
word Medesns6, that is Meddowsweete. Some, as
Lugdunensis saith, tooke the later to be Melandrium
Plinii, and some also call it Drymopogon;
Anguillara calleth them Potentilla Major Prima and
Secunda, and Thalius the greater sort Argentina
Major. Anguillaro saith the Italions call it Uhristo-
forianse, the French call it Barbe de Cheurre, and
Roine des Preis the Germanes Geisart, and the
greater Wielde Geishart; and Camerariss saith
\Vormkraut, because, as he saith, the roote is often
..'und, as it were, eaten by Wormes; but it is more
likeiy lor that it helpeth horses of the Bottes, and
"Wormes, and so he saith the country people used it;
the Dutch Reinette, and as Lobel saith Gheyten-
bladt, and Cam?cruidt, in English Medesweete or
Meddowsweete, and Queene oi the fields or Med-
dowes.
“ The Virtues.— Being neare a little in taste and
smell with Burnet, they are most lik’ly to bee neare
of the same facultie, yet Tragus accounteth them
more hot and dry; they are also used in the
same manner, and with same purposes, to stay
all manner of fluxes, bleedings, and vomit¬
ings, and women’s courses, as also their whites; it
is said to alter and take away the fits of quartaine
ague, and to make a merry heart, for which purpose
some use the flowers, and some the leaves ; it helpeth
also speedily those that are troubled with the Col-
lick, being boyled in wine and with a little honey
taken warme, it doth open the belly; but boyled in
red wine and drunke, it stayeth the flux of the belly.
Ac., it helpeth the Bottee in horses as you heard
before; being outwardly applyed it healeth old
Vlcers, that are cancrous or eating, and hollow or
fistulous, which many have used and much com¬
mended ; as also for the sores in the mouth, and
secret partH : the leaves when they are full growne
being layd upon the skinne, will after a small time
raise blisters thereon Tragus saith: the water
thereof helpeth the heate ana inflammation in the
eyes; the seede as Camerarius saith being taken,
causeth paines in the head ; and because both flowers
and herbes are of so pleasing a sweete sent, many do
much delight therein, to have it layd in their Cham¬
bers, Parlurs, Ac., and Queene Elizabeth of famous
memory did m ore desire it than any other sweet herbe
to strew her Chambers withall: a leafe or two hereof
layd in a cup of wine, will give as quick and as fine
a rellish thereto, as Burnet will, as I sayd before.”
In Salmon’s Herbal, published in London in the
year 1710. elaborate attention is paid to the uses and
preparations of Wood Sorrel, which was then, very
evidently, at the zenith of its fame.
"Of Sorrel Wood, or Sour Trefoil.
“ The Names.— It is called in Greek ’ 0 (u <, and
in Latine, “ Oxys, Oxys Pliniana,” Lib. 27, cap. 12.
Oxytriphyllum Tragi and Lacunae (but Oxytriphyl-
lum is a more proper name for the sharp pointed
Trefoil) Trifolium Acetoeum, Panis Cuculi (Cuc-
kow’s meat) also Alleluja (because it was in flower,
when in ancient times Alleluja was wont to be Sung
in Churches): and Luluja (a corrupted word from
Juliola, as in Calabria in the kingdom of Naples it
is called), in English, Wood Sorrel or Soar Trefoil.
“ The Kinds. —The chief sorts oommon with
us are 1. Oxys Plinii, Alleluja, Lujula, Oxys alba
Communis, Trifolium Acetoeum Vulgare; Our Com¬
mon Wood Sorrel. 2. Oxys flore Luteo Clusii, Oxye-
lutea comiculata repens Lobelii, Trifolium acetosum
corniculatum Bauhini, Oxys Americana, Yellow
Flower'd Wood Sorrel.
“The Descriptions.
“3. The first, or common Wood Sorrel. Its
Roots are nothing but Strings fastned to the
end of a small long Piece, all of them being of
a yellowish color, not perishing every year, but
abiding with some Leaves thereon in the Winter.
It grows low upon the ground without any Stalk,
rising from it, haying a number of Leaves coming
from the Root, which Leaves are made of three parts
like a Trefoil, but broad at the ends and cut or
dented in their middle (almost in form of a Heart)
of a faint yellowish green color, each one standing on
a long Footstalk, which at their first coming up are
close folded together to the Stalk, but opening them¬
selves afterwards, and are of a pleasing sour relish,
more grateful and pleasing than anv of the former
Son-els, and yielding a juice, which will turn red
when it is clarified, and make a most delicate clear
Syrup. Among these Leaves, rise up divers slender
weak Footstalks, not growing higner than them,
each one having a Flower at its Top, consisting of
five small and pointed Leaves, Star fashion, of a
white color in most places, or in some dasht over
with a small show of blush, and in some (but on the
backside only) of some other colors. The flowers
being past, then follow small round heads, with small
yellowish Seed in them.
“ 4. Gerard describes it thus:—Its root is very
threddy, and of a reddish color. It is a kind of
three-leav’d grass, and is a low and humble herb,
without Btalk : the leaves immediately rising from the
Root upon short stems: at their first coming forth
folded together, but afterwards spreading themselves
abroad, ot a fair, light green color, in number three,
like the rest of the Trefoils, but that each leaf has a
deep cleft in the middle. Among these leaves come
up small and weak tender stems, such as the leaves
do grow on, which bear small star-like flowers of a
white color, with some brightness of carnation dasht
over the same. The flower consists of five small
leaves, after which come little round knaps or husks,
full of yellowish seed. The whole herb is in taste
like Sorrel, but much sharper and quicker, and makes
better green sauce than any of the other Son-els.
Johnson in Gerard says, that he had some of these
Plants sent him, with very fair red flowers, which
were gathered in a Wood of Sir Thomas Walsingham ’s
Digitized by Vj
oogle
34 The Medical Pbebs.
CLINICAL RECORDS.
July 12, 1899.
called Stockwell Wood, at Cbissel-hurst, in Kent*
and in a little round Wood there adjoining.
“ 5 The Second or Yellow Flower'd Wood
Sorrel. —Re Root is a brush of Fibres, and abides all
Winter without perishing, if it be not too Violent or
Cold, the Extremity making them rot and perish, so
that the pl°nt must be raised from Seed sown again.
It shoots forth several slender, weak, reddish Stalks,
trailing upon the ground, yet growing in a heap as it
were, the Stalks take Root at the Joints as they lie,
spread into many Branches, with many Leaves on
them, standing simply one above another, and made
•of three leaves, cut in at the end like the former, but
are much smaller, and of a Pale green Color ; at the
Joints with the Leaves come forth three or four small
flowers together, at the end of a long Footstalk yet
each separate from the other, consisting of small and
pointed leaves like the former, but contained in
smaller, and larger heads, like Cods or Horns, yet not
Crooked but pointed small, which quickly fade away
<m being touched when they are ripe, and spring
up again all about where it grew.
“ 6. The Places. —The first growB very plentifully
in many places in England, in woods and by wood-
sides, where it may be moist, and shadowed from the
Sun. also in other places not too open to the Sun-
Beams, the Second grows in Spain, Italy and
Sicily ; but in a vast plenty in almost all our
worne out Plantations of Maze, in South Caro¬
lina, and other places adjacent thereto, where I have
gathered it many times: there is scarcely any Herb
which grows in greater plenty in those Countrys than
this.
“ 7. The Times. —The first Flowers early in April
and May, the other in June, July and August, ana so
continues in flower with the cold of Autumn causes
it to perish, the seed ripening in the meantime.
“8. The Qualities. —These are of the Temperature,
and properties of Common Sorrel in the former
Chapter; but more potent to all those purposes, and
are special Alexipharmicks or Antidotes against the
Plague, and all sorts of Pestilential, Malign, and
Burning Fevers.
“9. The Specification.— Wood Sorrel resists
Vomiting, strengthens the Stomach, hinders putri-
faction of the Blood, quenches Thirst, provokes
Appetite, and is effectual against the Plague, Spotted
Fever, Calentures, and other like Malign diseases.
“ 10. The Preparations. —You may make there¬
from, 1. A Juice. 2. A Decoction or rather Infusion.
3. A Syrup. 4. A Conserve. 5. A Cataplasm. 6.
A Distilled water.
“The Virtues.
“ 11. The Juice. —It has all the before specified
Virtues, cools Inflammations,takes awavall preterna¬
tural beats, whether in the Stomach, Bowels, or
habit of the Body ; resists putridity, and is most
singularly excellent against any Contagious Sickness
or Pestilential Fever. Mixt with a fit quantity of
double refined sugar, it makes most incomparable
Green Sauce.
“ 12. The Decoction or Infusion. —They have
the Virtues of the Juice, but not so effectual, and
may be given half a Pint at a Time: if they are made
in Wine (whether White or Red), they will be so
much the more effectual in some cases, more espe¬
cially where no Fever is present.
"13. The Syrup.— It is effectual in the cases
aforementioned, does exceedingly cool, and abort the
beat of Fevers; and mixed with Juice, makes an
excellent Gargarism for a sore Mouth and Throat,
being garbled therewith and spit out, and then fresh
taken in ; it wonderfully helps a stinking foul Canker
or Ulcer in those parts, and is singular good in
Wounds made by Cut or Puncture, stopping their
deeding and causing them speedily to heal.
“ 14. The Conserve. —It is cordial, refreshing in
hot Fevers, stops Vomiting, and strengthens a weak
Stomach, and is profitable against Catarrhs or hot
defluxions of Rheums upon the Stomach and Lungs.
“ 15. The Cataplasm. —It is made either of the
whole green Herb bruised: or made of the Herb,
stewed between two Pewter Dishes, and brought to a
Consistence with Crumbs of white Bread. It abates
the heat of Inflamations and other hot Tumors,
cures simple Contusions, being presently applied,
viz., whilst they are recent; applyed to simple green
wounds also, it heals them in a short time, by stop-
E ing the Haemorrhage and conglutinating their
lips.
“ 16.—The Distilled Water. —It has all the
Virtues of the Juice and Decoction or Infusion, but
very much weaker: It auenches thirst, and cools
inward heats of the Stomach, Lungs, and Liver, being
taken morning, noon, and night, half a Pint at a
time, sweetned with the Syrup aforenamed ; and so
mixed it makes a good Gargarism for Sore and
Cankerous Mouths and Throats."
And the same notable authority gives a corre¬
spondingly elaborate and appreciative account of the
qualities, uses, and preparations of the second herb
which enters into tne composition of our cure.
( To be continued.)
(Elhtical Jiccorbs.
COOSiBE LYING-IN HOSPITAL, DUBLIN.
A Successful Case of Cmsarian Section.
Under the care of F. W. Kidd, B.A., M.D.,
Master of the Hoepital.
This case presents many points of interest. The
operation was not done for contracted pelvis, but for a
large growth which sprang from the posterior portion
of the cervix. When seen at first this tumour was
drawn up to such an extent that it seemed possible to
push up the cervix ; however, this method proved quite
ineffectual. Patient was set. thirty-two. and was a
primipara; Bhe was visited at her own house on the
3rd December. The tumour was then diagnosed, and
the patient was brought into hoepital. A thorough
examination was made, and as the patient had had
labour pains it was determined to operate at 1 a.m. on
the morning of Sunday, the 4th December. Every
antiseptic precaution was taken, and on Dr. Stevens
devolved the duty of attending to the child when born,
I was assisted by Drs. Houston, Cole-Baker, and Scully.
Innsion was about 2 ins. above and 4 ins. below umbilicus,
placenta, which was huge (II ins. by 7), was on anterior
wall of uterus, and to right, and directly under incision
in wall of uterus, so that it had to be dissected off
towards left side for an inoh or two. Then there was
difficulty in getting at the lower extremities of child.
Finally one was extracted before the other, with the
result that the incision in uterine wall was
ruptured at top end for a further two inches
in an oblique direction. Membranes were unruptured at
time of operation. The uterus did not immediately
contract, and the bleeding was very considerable. Uterus
was sutured with deep, strong silk sutures, going down
to but not involving mucous membrane, with alternate
superficial sutures of a finer silk drawing peritoneum
well over line of incision, parietal peritoneum drawn
together with continuous suture of fine silk, and
abdominal incision closed with silk-worm gut sutures.
Convalescence was somewhat protracted on account of
an attack of bronchitis and the severe hemorrhage;
however, the temperature never reached 100 deg. F.,
and the patient made a remarkably good recovery. The
child, which was a male, was born partly asphyxiated,
but under the care of Dr. Stevens, who Schultzed him,
he came to, but never cried lustily. He died on the
third day; had had a slight convulsion the preceding day ;
his muscles had seemed continually to be tense, and he
Digitized by GoOglC
July 12, 1899.
TRANSACTIONS OF SOCIETIES.
Th* Medical Pbksb 35
had vomited coffee-ground vomit. There was an autopsy,
which only revealed some intussusceptions of small
intestine, probably caused during the death agony, and
some haemorrhage at lower end of oesophagus. This
gave rise to the interesting question as to whether this
could have been done by the Schultzing, even when in
experienced hands. The stitches were removed on the
eighth day, when the incision was found perfectly healed.
Before the patient left the hospital a careful examina¬
tion of the tumour was made. It had come down into the
pelvis, and seemed so near that one waa tempted to re¬
move it by morcellement through the vagina. However,
it was found that the uterus was adherent to the ante¬
rior abdominal wall, and this procedure was thrown aside
owing to the expressed opinion of Dr. Smyly that if it
were done, and htemorrhage should occur, one could not
check it by drawing down the uterus due to its adhe¬
sions. It was decided that the operation should be done
from abdomen; however, the patient refused operation.
Her present condition is excellent, she suffers in no way,
and the line of the incision is perfectly even and firm.
‘Cransattimts of gocictuo.
OBSTETRICAL 80CIETY OF LONDON.
Meeting hxld Wednesday, July 5th, 1899.
Mb. Alban Doran, F.B.C.S., President, in the Chair.
THE SEXUAL DIFFERENCES OF THE FfETAL PELVIS.
Pbofessob Arthur Thomson (Oxford) demonstrated
by means of numerous diagrams end lantern slides the
results of his researches into the sexual differences in
the conformation of male and female pelves observable
during fcetal life. We publish elsewhere an abstract of
his paper on the subject published in the Journal of
Anatomy and Physiology.
The author also Bhowed a specimen of the internal
and external genitalia of a child, set. 8, presenting
much pubic hair. The voice was bass, but she had not
menstruated Post-mortem no abnormality of the
internal genitalia waa discovered, but there was disease
of the adrenals.
In the discussion that followed, the President
referred to the French method of measuring the foetal
pelvis by skiagraphy, after having filled them with
mercury, this method gave 21 - 2 mm. as the width of the
pelvic brim in the male, and 17*7 mm. in the female.
Dr. Galabin admitted that after this admirable
demonstration thfy must give up their ideas as to the
existence of any marked differences between adult and
foetal pelves. He suggested, however, that what obste¬
tricians called the “ infantile ” pelvis was correctly so
described. Although the author had demonstrated that
the whole width of the sacrum in the foetuB was rela¬
tively greater than in the adult, yet it was true that the
wings of the sacrum were more developed in the adult
and must grow proportionally at a later period. He
asked whether that growth took place at puberty or
during childhood. If at puberty, would it not follow that
since the rest of the pelvis grew more rapidly than the
sacrum, there would be a certain si age of life at which
there would be what they were accustomed to call the
infantile pelvis, i.e., one in which the transverse diame¬
ters were not so much developed in proportion as in adult
women. He said be did not see that the facts brought to
their notice disproved Matthews Duncan's view as to the
effect of mechanical forces in determining the form of
the pelvis.
Dr. G. Herman said he was one of those authors who
had copied the statement as to the lateral massing of the
sacrum, but this was because he had been unable to
obtain the information he required as to the ossification
of the foetal pelvis. He urged that Matthews Duncan’s
views bore on the effect of mechanical forces on the for¬
mation of the pelvis, and not on the merely sexual
differences.
Mr. Stanlet Boyd commented on the explanations
hitherto offered of the differences between the male and
female pelves on the strength of the supposed influence
of ovarian activity, and he asked whether there was any
evidence of any such action. He also asked whether the
alleged differences between the larynx in the male and
female were founded on fact.
Dr. Hetwood Smith recalled the case of a child at St.
George'B Hospital in 1803, who also presented this pre¬
cocious growth of pubic hair and a bass voice, in whom
also there was a tumour of the adrenals.
Mr. Taboett mentioned that he had already directed
attention in a paper to the fact that disease of the
adrenals in young children had am influence on the
growth of the hair, coinciding in most instances with
precocious menstruation.
The President pointed out that it was quite consis¬
tent with biology that the sexual distinctions of the
pelvis should be already marked at birth, for such wss
the case for example with the genito-urinary tract. It
would be far more remarkable if the changes only
occurred at puberty.
Professor Thomson, in reply, said he in no wise wished
to discredit the views of Dr. Matthews Duncan, but it
was a fact that this authority had sought thereby to
explain the sexual differences. He had carefully avoided
discussing the changes that take place in the adult
pelvis as contrasted with the foetal condition. He said
he had not heard of this particular method of applying
skiagraphy to the measurement of the fcetal pelvis, but
from what had been said he was not disposed to attach
much importance to the results obtained.
PERSI8TENT MENT0-P06TERI0R POSITION OF THE FACE
REMEDIED BY THE USE OF AXI8 TRACTION FORCEPS.
Dr. Lewers related the case of a woman in lubour for
many hours at her first confinement, with the os fully
dilated and the membranes ruptured, where the face
presented downwards and to the right. Ordinary long
forceps slipped, but with axis traction forceps he at once
succeeded in delivering her of a living child. This, he
said, was the second case of the kind in which, after
failure with the long forceps, he had been able to pull
down the head by the aid of traction forceps, whereupon
rotation took place, and delivery was easy. He admitted
that the axis traction was superfluous, the great thing
apparently being to pull down the head to a point at
which the natural forces could act in the production of
rotation. He hoped that those who had not done so
would ijfive the axis traction forceps a trial in dealing
with this abnormality.
Surgeon-General Harvey urged that a case in which
rotation of the chin ultimately occurred could not pro¬
perly be described as persistently posterior.
Mr. Taboett said that he had often seen ordinary
forceps slip under similar circumstances necessitating
perforation. He mentioned that in persistent occipito-
poeterior position axis traction forceps gave excellent
results.
Dr. W. G. Spencer urged that the abnormality waa
not usually persistent, and in only three cases out of
forty had he found it necessary to intervene. He
showed an instrument devised by the late Dr. Luke
Robinson, of San Francisco, consisting of two blades
slipping one within the other which enabled one
to act very efficiently on the occiput. The use of
axis traction forceps under these circumstances was.
he thought, unscientific, inasmuch aa rotation put
on end to axis traction. He thought that long straight
forceps would possibly have accomplished the saipe end.
He recommend'd placing a finger on the upper jaw and
this method applied also to brow and incomplete face
presentations. They might extend the head strongly
and get an assistant to apply the forceps.
Dr. Lewers said he had used the term persistent
because labour had lasted long enough to render inter¬
vention indispensable. Failing success with the axis
traction forceps craniotomy would have been necessary.
Dr. Spencer, he said, was under a misapprehension as to
the stage at which he recommended this intervention. It
was not at a stage at which it was still possible to con¬
vert a face into a vertex presentation that interference
of the kind was necessary, for at that stage they were at
liberty to Rope that rotation would even yet take place.
Di
oogle
36 Thb Medical Press. TRAN SACTIO NS OF SOCIE TIES.__J ult_12, 1899^
Cases in which the chin would rotate forwards after the
use of the instrument shown by Dr. Spencer might well
be left alone. He pointed out that in his cases the
women had been nine hours in labour. In cases in which
he recommended this procedure there was no longer any
room for a change of position in situ.
NOTES ON A CA8E OF ECLAMP8IA.
Dr. Horace Savory contributed notes of a case of
eclampsia in a multipara in which complete and rapid
evacuation of the contents of the bowels by copious and
repeated enemata had brought about cessation of the
fits. He mentioned that the amniotic fluid was an
almost jelly - like mass consisting principally of
meconium. He commented on the peculiarly offensive
odour of the intestinal contents, and suggested that in
some cases, at any rate, the eclampsia was due to a
failure on the part of the kidneys to eliminate toxins
caused by intestinal fermentation, or from some other
source such, for instance, as the toxins resulting from
the unceasing contractions of the large mass of uterine
muscle.
ROYAL ACADEMY OF MEDICINE IN IRELAND.
Sections of Obstetrics.
Meeting heid Friday, May 26th, 1899.
The President, Dr. F. W. Kidd, in the Chair.
8PECIMEN8.
Dr. Smith showed myomatous uterus showing large
abscess cavity, removed by pan hysterectomy, from a
woman, set. 40, five years married, during which she had
given birth to two stillborn children and an instru-
mentally-delivered full term child last December. The
tumour was at that time a little larger than a four months
pregnant uterus, find had since then grown rapidly, so
that in the April of this year it filled up the entire
abdomen. It was diagnosed as a fibro-myoma of a cystic
nature He attempted to do the operation of primary
ligation of both tne ovarian and uterine arteries, and
found no difficulty in ligating the ovarian artery, but
could not do so in the case of the uterine artery,
owing to the weight of the tumour (2J stone)
fatiguing his assistant. He, therefore, decided to
split the peritoneum in front high up, and to
separate the bladder with a sponge. The bladder
was so soft that in doing this he perforated it. He then
discovered that the common iliac artery seemed to take
the place of the uterine artery, and on separating it
there was some haemorrhage, which was checked by
compression of the aorta He amputated the uterus,
and, while removing the tumour, damaged the ureter,
which he clamped temporarily. The bladder was after¬
wards stitohed with fine interrupted silk sutures, and the
ureter'treated in the same manner, the peritoneum being
finally stitched over it. A large clot of blood which had
collected in the bladder was washed out with a Bozeman’s
catheter, and the patient made a good recovery. The
cystic contents of che tumour were found to be an
abscess, which had started from the last confinement,
the woman having then had septic troubles.
In reply to some remarks by the President and Dr.
Purefoy,
Dr. Smith said the patient a few years ago had been
in a Dublin hospital, where a diagnosis was made by
making an abdominal incision, but they did not operate,
the patient then becoming pregnant again. 8o rapidly
did the tumour grow that it gave the impression of an
ovarian tumour.
REMOVAL OF TUBERCULOUS OVARY.
Dr. Smyly related a case of the above which is pub¬
lished in full elsewhere.
PAPILLOMATOUS CT6T OF OVARY.
Dr. Kidd exhibited a small ovarian papillomatous
cyst, with the following interesting history :—Patient,
T. C., unmarried, net. 35, was admitted to the Coornbe
Hospital on May 5th. She had been treated about a
fortnight previously in the country for obstruction of
the bowels and peritonitis; this had yielded to treat¬
ment. After arrival she was examined, and a small
ovarian tumour diagnosed. Operation on the 13th.
Tumour was adherent to everything—omentum, peri¬
toneum, and intestines—but the adhesions were com¬
paratively recent, and could be separated with a little
care. Part of cyst wall looked gangrenous, and when
the adhesions were all separated it was found that there
was a twist on the pedicle ; it required two half tumB to
put the tumour in its proper place. Patient made a very
rapid recovery. Temperature only on one occasion
touched 99 deg. F., and stitches were removed on the
eighth day. Union was perfect.
MYOMATOUS UTERUS REMOVED BY ABDOMINAL HYSTE¬
RECTOMY— DOYEN’8 METHOD.
Dr. Smyly said this was the first time he had resorted
to this method of operation, which, he believed, had never
before been attempted in this country. The operation
was performed for pain, and on opening the abdomen he
found adhesions to the omentum and small intestines,
in separating which there was a large number of bleed¬
ing points to control. This portion of the operation
occupied three-quarters of an hour. Doyen’s part, which
took seven minutes, commenced with pulling the tumour
out of the abdomen over the pubes. He then opened the
posterior cul-de-sac, reached hold of the cervix with a
vulsellum forceps, and decorticated it with his finger,
afterwards reflecting the peritoneum from the uterus,
and finishing the operation in the ordinary way. He
had no. hesitation in saying this was by far the best
method. Besides rapidity it had other advantages, for
in the older method they cut the arteries where they are
largest, thereby running the risk of death from embo¬
lism or haemorrhage. As a matter of fact he did not see
a big vessel at all during the operation.
The President said he had seen the cinematographic
representation of the operation in Edinburgh, and he
was amazed at the celerity with which an operation of
such magnitude could be performed.
Dr. Tweedy asked if the operation were applicable to
every form of myomatous uterus. Was it applicable
where the myoma grows behind or in intra-ligamentoua
tumours P
Dr. Smyly, in reply, said that Doyen specially recom¬
mended this operation because he believed it to be
applicable to all cases.
Dr. F. W. Kidd, Master of the Coombe Lying-in Hos¬
pital, read a note on a successful case of “ Ca-sarian
Section,” in which he was assisted by Drs. Houston,
Cole-Baker, and Scully. This cate will be found fully
reported under the head of “ Clinical Records,” page 84.
In the diBCUFsion that followed,
Dr. Smyly remarked that every step of the operation,
thouvh apparently a simple one, was the subject of con¬
troversy. Professor Murdoch Cameron, of Glasgow, has
said that the position of the child depended on the
placenta, and he would like to know if this opinion was
borne out in this case, snd if the abdomen of the child
was turned towards the placenta.
Dr. Purefoy said that, although a recent writer had
advocated the low incision in preference to the fundal
incision, his own experience had led him to think that
the high incision was certainly the better. He thought
that the careful application of the sutures and adjust¬
ment of the peritoneum had a great deal to do with the
success of a case. He had always regarded Schultzing
with misgivings, owing to the possibility of injury to
the soft parts of the child.
Dr. Tweedy did not see the necessity of avoiding
insertion of the ligatures right through the endometrium
if the uterus were aseptic, and this method gave a
firmer union in his opinion. Lusk says that an incision
is made low down in the uterus in order to avoid
haemorrhage, whereas it has been recently claimed that
an incision through the fundus, the most muscular
portion of the uterus, obviates much haemorrhage.
Dr. Kidd, in reply, said the child was very nearly in
the left occipito-anterior position, and the placenta was
more over to the right of the mother. He was not
opposed to Schultzing, and he thought that Sylvester's
method was far more likely to cause htemorrhages. With
Di
July 12, 1890.
FRANC E .
The Medical Press. 37
regard to the question of suturing, he had no guarantee
that the uterus was aseptic in this case.
The 8ection then adjourned.
EDINBURGH MEDICO-CHIRURGICAL SOCIETY-
Meeting held July 5th, 1899.
Sir John Batty Tuke, President, in the Chair.
Mb.Stile 8 showed—1. A child two months after opera¬
tion for large hydrencephalocele, involving by far the
larger part of the cranium, with stereoscopic photographs
before and after operation. 2. Child after operation for
extensive tuberculous osteomyelitis of the tibia, with
skiagrams. 3. Child after excision of the wrist for tuber¬
culous disease, with skiagrams.
Dr. Alexander Bkucx showed a patient with typical
auditory aphasia.
Mr. Stiles and Dr. Rainy showed skiagrams of tuber¬
culous ankle, of separation ef the lower epiphysis of the
humerus, and of fracture at the junction of the upper
and middle thirds of the shaft of the femur, showing
typical displacement of the upper fragment.
Dr. Alexander Bruce showed microscopical speci¬
mens of amyotrophic sclerosis of progressive muscular
atrophy. The latter showed a degeneration absolutely
limited to the anterior cornua, and not affecting the
pyramidal tracts.
Dr. Harvey Littlejohn showed—1. Specimen of
strangulation of the intestines by the omentum. 2.
Intussusception of the ileum. 3. Stomach and bowels
from a case of poisoning by hydrochloric acid; and
4. Similar visceral from a case of poisoning by zinc
chloride and hydrochloric acid.
Mr. Cottxrill showed a dermoid cyst of the ovary.
Dr. Bruce and Mr. Cotterill read a paper on a case
of
cerebellar tumour, considered from the point
OFVIEW OF LOCALISATION AND OF TREATMENT.
The patient was a man, ret. 34, a total abstainer, and
free from any sign of syphilis. Five years ago he was
seized with deafness in the left ear, which soon became
absolute, and has remained so ever since. About three
years ago he began to have difficulty in walking, and
constantly felt ae if he were about to fall over to the left
side. He could always feel the ground distinctly under
his feet. He then noted that in order to carry out any
voluntary movement with either the left arm or leg he had
to pay great attention to every part of the action, and could
not do i t with the same ease as in the case of the right limbs.
His gait then became staggering, and seven months
ago he had several attacks of vertigo, followed by left-
sided occipital headache, which has been continuous
ever since. For about the same period he has had some
dimness of vision, especially in the left eye. On exami¬
nation, the patient had a somewhat depressed look;
his temperature was subnormal, but, with the exception
of the nervous symptoms to be described, all the bodily
functions were healthy. He complained of pain in the
baok, and of left occipital and parietal headache, with
tenderness on percussion over the side of the cranium.
Common sensibility was normal, except for a degree of
anaesthesia of the left conjunctiva. The muscular
sense, as tested by weights, was normal, but when the
eyes were closed he could not touch a given part of the
body with his left arm or leg. Smell was normal.
There was total deafness in the left ear due to
nerve lesion. Taste was impaired over the anterior two-
thirds, and probably also over the posterior third of the
left side of the tongue. There was double optic neuritis,
most marked on the left side. Slight nystagmus was
present in all positions of the eyes; it became much
more rapid when the patient looked to the. right. When
he looked to the left the excursion of the eyes became
slower and more extensive. Convergence was good, the •
right visual field was normal, and the left slightly con¬
tracted. The left pupil was somewhat dilated. There
was some paresis of the left facial nerve, and difficulty
in moving the tongue to the right side. The grasp of
the hands was equal, there was tremor of both arms, but
much more distinctly on the left side; there, indeed, it
closely resembled an intention tremor, but was slower and
less rhythmical. The movements of the left leg in
walking were stamping, and at every sixth or seventh
pace the patient tended to fall to the left side. This
was most marked when he walked along a straight line;
there was, however, no Romberg’s system. The knee
S ' rks were equal. In discussing the diagnosis. Dr.
nice referred to the paper which he had previously
read to the Society, in which the connections of the
cord and cerebellum had been traced. This case was a
clinical proof of the correctness of the facts he had then
brought forward. All the fibres of the cord going to
the cerebellum end in the middle lobe, thence they
communicate with the roof nucleus, from which fibres
run to the nucleus of Deiters of the opposite Bide.
Deiters* nucleus is the nucleus for the vestibular
root of the auditory nerve, and sends fibres to the
nucleus of the sixth nerve of the same side, and to both
third nerve nuclei. It also gives off descending fibres
to the anterior cornua of the cord. The function of
Deiters* nucleus appears to be to give tone to the
muscles, and to relieve the higher centres of the neces¬
sity of controlling every detail of a voluntary movement.
All the symptoms of this case—the difficulty in per¬
forming voluntary movements, the uncontrolled and irre¬
gular movements of the eye muscles, and the staggering
gait, pointed to a lesion pressing on Deiters’ nucleus ana
the restiform body, and interfering with the arc de¬
scribed above. The question then arose as to whether
the tumour was a surface one, or whether it had begun
in the substance of the cerebellum. On account of the
early onset of the deafness it seemed most likely to
lie on the surface. The two most common tumours
in this region were tumours of the flocculus
and of the petrous temporal. The latter were usually
simple fibrous tissue growths, and were pedunculated,
so that in view of this possibility, and as the patient
was steadily getting worse, Dr. Bruce had asked Mr.
Cotterill to operate.
Mr. Cotterill said that he had never been very san¬
guine about the case, although he agreed with Dr.Bruce
as to the probable site of the tumour. In order to get
free access to the cerebellum he had removed the whole
of the lower part of the occipital bone, and was able to
push the cerebellum to the right, so as to explore the
left side with the finger. Unfortunately the patient
lost a great deal of blood during the removal of the
bone, and death (which occurred two days after the
operation) was probably hastened by this. The tumour
was found to be in the flocculus, and was beyond the
reach of interference.
Dr. Foulis read a paper entitled
SOME OBSERVATIONS ON THE DEVELOPMENT OF THE
TE8TICLE.
The paper, which was illustrated by microscopic slides
and diagrams of the developing testis of the embryo
deer, went to show that the tubuli seminiferi were
homologous with the egg ducts of Pfluger in the female
ovary.
c^rance.
[FROM OUR OWN CORRESPONDENT.]
Paris, July 8th, 1888.
Aortitis from Malaria.
At the meeting of the Academy of Medicine, M.
Lancereaux spoke on a special form of aortitis to be met
with in persons who had suffered more or less from
intermittent fever. The affection was to be observed
more particularly in men between the ages of thirty and
sixty, and was seated exclusively in the ascending
portion of the cross of the aorta, and commenced by
infiltration and thickening of the external tunic. The
middle tunic thus compressed became atrophied, and
finally disappeared; the inner tunic became hyper-
Diqiti
3 oogle
GERMANY.
38 Thb Medical Press.
July 12, 1899.
trophied and coated with wrinkled patches. The
consequences of those lesions were an inflammation of
the peri-arterial tissues, notably the cardiac plexus and
the appearance of angina pectoris. On the other hand,
the destruction of the middle coat of the vessel con¬
tributed frequently to the formation of a sacciform
aneurysm. Of thirty-seven patients observed by the
speaker, all suffered from angina pectoris, and eight pre¬
sented the signs of aneurysm. The evolution of the
affection was very slow. The prognostic was not favour¬
able, the affection frequently terminating with sudden
death. The treatment was iodide of potassium and milk
diet, with Bedatives for the angina. Injections of a solu¬
tion of serum and gelatine might be tried when the
aneurysm was well formed.
Hematocele.
M. Eegnier insisted on the danger of treating hema¬
tocele through the vagina, instead of which laparotomy
should be in all cases preferred. A short time ago he inoised
the tumour through the posterior cul-de-aac, and the
hemorrhage was so alarming that he had to perform
laparotomy to remove the cyst. In a second case he
was obliged to leave several forceps a dameure to con¬
trol the hemorrhage. Both patients recovered.
M. Poyz said that although he was a great partisan
of laparotomy, he frequently opened hematocele by the
vagina, and was always able to control the hemorrhage
by plugging.
TUBERCULO8I8 AND ALCOHOLISM.
M. Barbier declared that from statistics he had
collected on pulmonary phthisis at his hospital, he
found that 70 per cent, of cases were those of persons who
came to Paris from the provinces, and in all of them the
malady terminated rapidly by death. The speaker said
that in 98 per cent, of these cases intemperance was
admitted.
[from OUR OWN CORRESPONDENT.]
Berlin. July 8th, 1899.
At the Society for Scientific Medicine of Konigsberg,
privat docent, Dr Bosinski related a case of
Hereditary Syphilis
that was the first in which ovular transference of the
disease could be proved with certainty. A lady of good
family, married six years, with one healthy child, con¬
tracted a bad attack of syphilis, the Bource of which was
subsequently found to be a servant maid; the husband
remained healthy throughout. Several courses of inunc¬
tion were carried out, and three months after the last
the patient became pregnant again. She aborted in the
sixth week, and the foetus, 16 mm. long, already showed
rigns of syphilis of the liver. On examining the placenta,
the maternal portion was found to be a good deal dis¬
eased, whilst the chorionic villi were perfectly healthy.
The speaker concluded that the ovary was the source of
the syphilitic infection of the foetus.
At the Congress for Medicine, Dr. Von Schrotter,
Vienna, related a case of
Gas Abscess
in the abdominal wall of a man, iet. 67. By puncture,
26 ccm. of gas were removed, and by incision discoloured,
offensive pus was evacuated. Bacteriological examina¬
tion showed bacterium coli. A fistulous tract led deeply
downwards. The affection was probably periphlebitic
(perityphlitic ?). It was of importance not only patho¬
logically, but also clinically, that gas phlegmons, gas
abscesses, and abscesses with gas should be more
strongly distinguished.
Hr. von Noorden, Franfort, a/m, read a paper on
The Treatment of Chronic Kidney Disease.
He said that in chronic contracted kidney not nearly
so much importance was plaoed on absolute limitation
of albumen as in the other forms of nephritis. When
one reckoned up what was permitted of milk, eggs, meat
and vegetables, the quantity of albumen was found to be
above rather than under 10D grms. Others laid stress
on the selection of the meat, and allowed contracted
kidney cases only the white fleBh of fish, birds, veal, &o.,
whilst the brown flesh of slaughtered animals, game and
fowls was Btrictly forbidden. Many patients gradually
acquired such an objection to white meat, that its con¬
sumption was reduced to a minimum, appetite fell away,
and disturbances of nutrition came on. The chief differ¬
ence between brown and white meat lay in the colouring
matter, and this we had no ground for holding injurious.
From his own observations he was opposed to the view
of the harm fulness of brown flesh. Patients fed on
white flesh excreted rather more urea than those fed on
brown flesh containing equal quantities of nitrogenous
material.
As regarded liquids, either, nothing was said or
large quantities were recommended for flushing out the
kidneys. Ziemssen in his handbook had recommended
limitation of the liquids even when arterio-solerosis of
the kidneys was present. By observations during six
years, the speaker was convinced that cases of contracted
kidney were extraordinarily benefited by limitation o*
liquids to 5/4 or 3,2 litres per diem. Patients in whom
the heart had begun to fail did not often last over a
month. In these cases limitation of the liquids was of
the highest value. In nearly thirty cases the results were
good, the cardiac asthmatic attacks oeased, sleep
returned, ordinary diuresis returned, and the cardiac
dilatation undoubtedly improved. This favourable con¬
dition in many patients kept up for several months and
even years. Even in desperate cases where no treatment
could be any longer of use, limitation of liquids was
advantageous. The best that could be done was to keep
the patient in the statu quo.
Hr. Ewald, Berlin, had long been in favour of limit¬
ing the quantity of liquids in chronic renal cases. His
view being based on the idea that a damaged organ
should not be overburdened with work. He determined
the quantity of urine passed by Oertel’s method, and
regulated the quantity of liquids by that, if possible
remaining below the quantity excreted. He had always
acted on this principle both in contracted kidney and in
parenchymatous nephritis. By regularly estimating the
quantity of albumen, he had convinced himself of the
fact that the kind of albumen used, whether of egg,
brown or white flesh, was of no consequeuce, as far as the
excretion of albumen was concerned.
Hr. Petersen, Heidelberg, read a paper on
Surgical Procedure in Benign Diseases of the
Stomach.
About 300 cases of surgical procedures in non-malignant
diseases of the stomach had been recorded. Seventy-
seven such operations had been performed at the Heidel¬
berg Klinik. The principal indications were (1) absolute
Digitized by LjOOQIC
July 12, 1899.
AUSTRIA.
The Medical Press. 39
stenosis of the pylorus, 57 cases. The stenosis was
caused forty times by ulcer, eight times by cholelithi¬
asis, four times by cauterisation, once by tuberculosis,
Ac., two after failure of internal treatment, gastralgia,
uncontrollable vomiting, the so-called rebellious forms
of ulcer (five cases), and six times from dangerous
hemorrhage. Eight of the seventy-seven cases di*d, or
11 per cent. Advances in surgery shone out, when the
cases were divided into two periods :—before 1896 thirty-
three operations, with seven deaths = 22 per cent.; since
1895, forty-four cases, with one death - 2*3 per cent. This
striking advance was brought about by having the
patients in a better state for operation and by increas¬
ing experience in the selection of cases, and, secondly, by
improved technique, and, above all, by the introduction
of Murphy’s button. This reduced the length of an ope¬
ration from three-quarters of an hour to one-quarter ;
permitted nourishment from the first, and avoided the
so much-dreaded spur formation between the upper and
lower ends of the bowel. Trustworthy after reports were
available concerning forty patients who had been ope¬
rated on over two years. In the cases of stenosis the
reports were at first satisfactory in the better selected
method of operation. In gastroenterostomy the per¬
manent recoveries were 99 per cent. In the case of gas¬
tralgia 10 per cent, were improved, 90 were completely
cured, either by gastroenterostomy or simplv by the
separation of adhesions. In six cases of heemorrhage re¬
covery was complete, twice by excision and in the other
case by gastroenterostomy. In one case of ulcer, the
bleeding was arrested by gastroenterostomy, although
the ulcer itself was not treated. If such cases were re¬
peated it would place the treatment of ulcer of the
stomach on a new basis.
The changes in the stomach after gastroenterostomy
were important. Dilatation receded quickly, but rarely
disappeared. The motor function was normal in nearly
all cases. Lactic acid disappeared. After-operation bile
was frequently found in the stomach. Neither the
absence of gastric juioe nor the presence of bile caused
any ,visible disturbance. A functioning sphincter
gradually developed at the fistulous opening. The total
results of the period named were before 1895 :—Mortality,
25 per cent., uncured, 15 per cent., improved, 10 per cent.,
permanently cured, 50 per cent.. Since 1895, mortality,
3 per cent., uncured, 6 per cent., improved 10 per cent.,
permanently cured, 80 per cent.
JMtstria.
[from our own correspondent.]
Vie sva, July 8th, 18V0.
The Treatment of Epilepsy.
Bkchterew in his reports on epilepsy, speaks favour¬
ably of combining some cardiacs with bromide of potas¬
sium. The limple administration of bromide without
this precaution will not succeed. He has now patients
under observation treated three years ago in this way
who are still free from the attacks, which can only
be accounted for by this cardiac combination, as all
other conditions are similar to former treatment with
bromide alone, with only temporary success. For some
time past he has used an infusion of adonis vernal, 2
(30-8 grains), to 2’8 grammes (42 grains) of the solid in
180 c.c. of water (6 - 53); to this is added 13 grammes
(31 drs.), of which 6 tablespoonfuls may be taken in a
day. Where there is a depressed state of mind with
general irritability, codein is combined with this mix¬
ture. Other vegetable cardiacs are equally good, such as
digitalis, of which 05 to 9'75 grammes (7’7 to 1157
grains) of digitalis may be given as an infusion in 180 c.c.
of water (6‘53.) To this may be added sodium and potas¬
sium bromides of each to 8 grammes, with 015 to 0 2
gramme (2 3 to 3'0 grains.) Of this mixture four to eight
tableepoonfuls may be given daily without any cumula¬
tive effect, Von Bechterew is persuaded that these car¬
diacs are as beneficial in the treatment of epilepsy as
the sedatives, as they favourably influence the heart and
vascular apparatus, as well as hasten the elimination o*
unnecessary nitrogenous products, such as toxines, from
the hemic circulation.
The same combination of cardiacs and sedatives will
be equally beneficial in neurasthenic cases.
Friedreich’s Ataxia.
Cohn relaves two cases of this disease under his care
from the same family, in which the parents were addicted
to drink, one of them being tuberculous. The two brothers
when children developed progressive tendencies towards
ataxia. Cohn gives the fol owing symptoms present:
static and locomotor ataxia, absence of patellar and
Achilles reflex, cutaneous sensibility intact, though the
feeling of location was disturbed, bladder and bowel
normal, ^nystagmus, slight disturbance in speech, with
Friedreich’s symptomatic foot, and one of them had
atrophy of the optic nerve. He' differentiated the
diagnosis from chorea infantilis, multiple sclerosis,
tabes, hereditary syphilis, ataxic paraplegia, cerebral
tumour, or h6r4do-ataxie cer4belleuse. Cohn adds
the optic atrophy to the symptoms of Friedreich’s
ataxia. The head symptoms were tic-like, while the
fingers reminded one of athetosis or chorea by their
irregular movement, but partially present during repose*
as in the ataxia of tabes.
The disposition to the disease is assigned to the
drunken habits of the father and an attack of scarlet
fever which they had when young; but drinkers are
notably common origins of the disease. The thera¬
peutics he recommends are nourishing diet, massage,
and compensating exercise similar to that of Fraenkel.
Partial Immunity of the Spinal Cord.
Adamkiewicz has again instituted another hypothesis
for the immunisation of particular parts of the spinal cord
in syphilitic tabes It is well known that when all the
muscles are fatally injured by this disease the muscles of
mastication, deglutition, respiiation,and cardiac motion
are unaffected ; this is common to all other ascending
paralyses. This relative immunity to morbid changes
was undoubtedly due to the providential arrangement
of the blood supply. Injection* of coloured agents into
the arteria magna spinalis or from the arteria basilaria,
will not penetrate further than the loser margin of the
medulla oblongata. Again the transmission of blood by
the arterio-vertebro-spinalis meets with great resistance
when injecting into the cord. Another point of note in
this direction is the narrow calibre of all the vessels in
the medulla oblongata which will act as a protection on
the larger ganglion. Perhaps the most potent cause was
in the nerve system itself, which in the medulla was less
active than in other parts of the neurotic system, and this
Digitized by CjOOQle
40 Phb Medical Press.
THE OPERATING THEATRES.
combined with the hremic protection, was enough to
explain the constant exemption of this part of the cord.
Toxic Local Centres.
Bruno has announced another theory of cerebral
localisation which may be carried to an indefinite length.
It is well known that guinea pigs are very refractory to
morphia, while the intra-cerebral injection of O'OOltoO'OOfi
gramme (003 grain to 009 grain) into the anterior right
angle of the cerebrum between the coronal and saggittal
sutures, three millimetres deep, will produce rapid clonic
and tonic contractions terminating in death.
Sodium chloride, urea, sugar, and Glauber’s salts, when
similarly injected, have no action whatever. Ferro-
cyanide of soda is another harmless drug to the guinea
pig, but when injected in the same manner is fatal in
very small quantities. Subdural injections require very
large doses which produce severe tetanic symptoms from
which the animal speedily recovers. Methylen-blue is
another drug resisted by the same animal, but injected
into the brain is fatal.
At the post-mortem the colouring stuff was to be found
in the cortical part of the brain, the fluid of the ventricles
as well as in the delicate lining.
Progressive Paralysis.
Greidenberg tells us that the incidence of the disease is
now transposed in asylums of the insane for what reason
he is unable to determine. The disease was up to recent
date greatest among men, but at the present time the
larger number are females.
(Eontituntal ^otes.
(From Our Special Correspondent.)
AIX-LES-BAINS.
Aix-les-Bainb has had a successful spring season.
Every year it is attracting more and mors British
visitors; many returning from a winter residence in
Italy and on the Riviera, a ho are not invalids, find Aix
and the picturesque hills and valleys of Savoy and
Dauphiny very agreeable resting-places for April, May,
and June. Prior to the Franco-German War, the total
number of foreigners of all nationalities annually visit¬
ing Aix-les-Bains rarely amount*d to 10,000. This num¬
ber has increased steadily. In 1869, 10,000 British and
other foreign visitors; in 1879, 17,000; 1889,24,000; 1897,
32,000. This year the British visitors have remained
longer than usual; 6ome until the end of June, possibly
owing8omewhat to the weather and somewhat also to the
additional attract : ons of Aix. During the past winter
various important improvements have been made to the
Bath establishment, and to the two Casinos. The "Qrand
Casino and Cercle,” always a very attractive resort, has been
much enlarged and improved. The grounds are a picture
of landscape gardening ; the new Concert-Salon and the
new Theatre are elegantly and artistically designed
Under the able and experienced fupervision of Mr
Gandrey, all the arrangements are excellent, and the
musical and dramatic performances most satisfactory ;
so that the Concerts, Comedies, and Operas have always
a full and fashionable attendance.
The hot douchts and massages at the Baths of Aix in¬
dispose invalids for much active exercise, so that the
very agreeable “ distractions ” of the Casinos are valuable
adjuncts to “ the cure ” here, as are also the comforts and
Jult 12, 1899.
luxuries of excellent hotels, which are numerous at Aix-
les-Bains. Two other valuable adjuncts to Aix have not
yet received the attention they really merit—namely,
the waters of Saint-Simon and Marlioz. The Raphy
Spring at Saint-Simon (about twenty minutes’ walk
northerly from Aix) yields an abundant supply of an
alkaline-magnesian water, similar to that of Evian,
efficacious in chronic gastric troubles, and claimed to
lessen “the formation of uric acid in gouty and rheu¬
matic complications ” (Dr. Bonjean). The Saint-Simon
water is pleasant to drink, either with or without
admixture with wines. It is a superior table-water, and
so light that 15 to 20 glasses may be taken agreeably
daily.
At Marlioz (about thirty minutes’ walk southward
from Aix), there is a small establishment for the appli¬
cation of the waters there in baths, douches, injections,
and inhalations. The spring yields a cold sulphurous
water containing sulphuric soda, iodine, bromine, and
sulphuric-acid gas. Dr. Mace strongly recommends it
for chronic mucous affections, asthma, &c.
Yet another very valuable adjunct to the Baths of
Aix is their beautiful situation, amidst hills and vales
on the lake shore, inviting excursions, near and far, on
every side. Montaigne said :—“ He who does not bring
with him so much of cheerfulness as to enable him to
enjoy the amusements and the pleasure of the company
he may meet there, and the walks and exercises, to which
the beauty of the neighbourhood invite us, must assuredly
lose the best part of his visit to any Baths. For this
cause I choose those places most pleasantly situated, and
where are the best lodgings, provisions, and society.”
All these “ indications" of the old philosopher abound at
Aix-les-Bains!
^hc ©perathtg theatres.
ST. MARY'S HOSPITAL.
Cirsoid Aneurysm of the Scalp. —Mr. Quarry
Silcock operated on a girl, ret. 18, who had been admitted
by reason of the presence of a cirsoid aneurysm of the
right side of the scalp, involving the supra-orbital and
superficial temporal arteries, and occupying an area
three inches in diameter immediately over the eyebrow,
and extending backwards into the hairy scalp. The history
was, briefly, that the girl had a fall on her forehead when
3 years old, and since then the aneurysm had formed, and
had been gradually increasing in Rize. Efforts had been
made in other hospitals to deal with it by ligature
of the afferent arteries, but with total want of
success. It was therefore decided to excise the
tumour. This was done in the following manner:—
The scalp was shaved, together with the eyebrow, the
skin rendered aseptic, and a circuit r incision through
the skin at the periphery of the area beginning at
the inner side was made down to the pericranium
aneurysmal area. Pressure was kept up on the different
arteries as far as possible in order to control the
hremorrhage in some degree. The bleeding, however, was
very considerable, in spite of the fact that small portions
only of tissue were cut at a time, pressure forceps
being applied to each bleeding point as it arose.
Finally the whole mass was circumscribed and the
entire aneurysmal area of scalp removed, leaving a gap
about the size of the palm of the hand. At one corner
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THE OPERATING THEATRES. Tax Medical Press. 41
July 12, 1899
of the wound two sutures were inserted after freeing: the
edges of the wound a little, but the remainder of the
raw surface was left to granulate. Mr. Siloock said that
the previous methods of treatment, which may have
included others besides that of ligature of afferent
arteries, had proved entirely unsatisfactory, therefore
it was only left to him to perform excision. This he
had accomplished with the aid of about three dosen pain
of pressure forceps, so diffuse had been the haemorrhage.
He remarked that these growths were not really of the
nature of a neoplasm, but were a change affecting parti¬
cular vascular territories, giving rise to dilatation and
tortuosity of the arteries, originating possibly in some
congenital fault, as in this case in an acquired condition,
generally initiated by an injury. He pointed out that
the patient was an absolutely healthy country girl. He
said that a portion of the pericranium in the centre of
the area had to be removed since the tissues of the
affected scalp could not be separated therefrom.
Subsequently, in about a month's time, when the
whole area was granulating, it was grafted after the
method of Thiersch, the superficial granulations being
first scraped away. The wound by this time had con¬
siderably contracted, but there remained an undue
amount of deep seated pulsation just above the eye¬
brow ; the latter had not been encroached upon at the
time of the operation, by reason of the subsequent
deformity which would have resulted. This pulsation,
however, was gradually becoming less marked, and Mr.
Siloock did not think the condition called for further
interference.
KING’S COLLEGE HOSTITAL.
Amputation of Breast fob Scirrhus, followed
bt8UPRa-ClavicularExcibion of Glands.— Mr. Carlkss
operated on a single woman, ®t 60, who had noticed a lump
in her left breast for about six weeks. This was attributed
to cold. There had been no injury, and the patient had
complained of no pain. Two or three cases of carcinoma
had occurred in the family. A well-marked tumour
oould be felt in the outer and upper quadrant of the left
breast, which was larger than its fellow, whilst the
nipple was a little raised. The skin over the
tumour did not dimple on movement, but
felt thicker than elsewhere, and the sebaceous
glands were more obvious. This condition of the skin
was present for an area at least three inches in diameter,
although there was no discolouration. The axillary glands
were considerably enlarged and reached well up into
the apex of the axilla, several glands also could be felt
enlarged above the clavicle. The breast was removed
together with the sternal portion of the Pectoral is major*
the Pectoralis minor, and the axillary glands and
connective tissue through two crescentic incisions,
enclosing an ellipse of skin with its long axis
transverse, and including the affected area of skin
already mentioned; another incision was made at right
angles to the upper of the two along the border of the
Pectoralis minor. In this way the area of operation was
well exposed, and it was not difficult to remove the
whole mass in one portion. The wound was closed
with some little difficulty, so as to produce
a T - shaped cicatrix; one or two deep silver
stitches with lead buttons had to be employed. Mr.
Carless pointed out that although at first Bight this case
seemed a favourable one, in reality it was anything but of
that nature. The extensive glandular infection and the
very definite though invisible invasion of the skin, to¬
gether with the family history of malignant disease
were a sufficient warrant for the extensive operation
he had just undertaken, and which he proposed to
supplement in a few days by clearing out the supra¬
clavicular fossa. Had the patient been strong and
robust, he would have undertaken the two proceedings
at the same time, bo as to make certain that nothing
should be left between the supra and infra-clavicular
fossa; ; but, seeing that she was a somewhat feeble old
woman, he thought it better to do the operation in two
stages. There was no question in his mind as to the
value of removing the pectoral muscles in addition to the
breast and axillary oontents, but he would limit the re¬
moval to cases where the tumour is obviously fixed to the
Pectoral, or where there is much axillary trouble. His
experience did not show that the movements of the arm
were seriously crippled, especially if the patient could be
nursed with the arm at right angles to the trunk, but
in this particular instance so much skin had been taken
away that it would be necessary to keep the arm to the
side. The deep stitches would be removed in 24 hours
and the drainage tube in 48 hours.
The wound healed by first intention throughout, and
ten day8 later the supra-clavicular operation was pro¬
ceeded with. An incision was made down the posterior
border of the 8terno-mastoid and outwards along the
clavicle, the flap of skin thus marked out was dis¬
sected up, and the whole of the glandular contents and
connective tissue lining the posterior triangle were
cleared away from before backwards, the jugular vein at
its junction with tbe subclavian being first exposed, and
great care being taken not to damage the thoracio
duct. Considerable development of cancerous glands
was in this way removed. Mr. Carless alluded
to the fact that Professor Hals ted, of Baltimore,
was clearing the supra-clavicular fossa as a routine
measure in all cases of scirrhous mammae, and that
surgeon has found that in a large percentage canoer
is present, although no enlargement could be previously
detected by palpation.
It is satisfactory to note that the second wound
healed throughout by first intention, and that the
patient was enabled to leave the hospital three weeks
after the first operation.
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 the 30th ult. at
429, Strand, W.C. There were present—Dr. de Havil-
land Hall in the chair, Dr. J. B. Ball, Dr. J. W. Hunt,
Dr. F. R. Mutch, Mr. J. Brindley James, Dr. Francis J.
Allan, Mr. F. Swinford Edwards ,Dr. M. Greenwood, Dr.
Walter Smith, Mr. William Thomas, and Dr. W. Knows-
ley Sibley. At the last general meeting of the Society
held in May it was resolved that a cash bonuB of 10 per
cent, on all sickness benefit premiums paid during
the last five years should be allotted to the members.
The claim list during the first half of 1899 has been
somewhat heavy, but, nevertheless, during the six
months the income of the Societyhas been so much
greater than its outgo that the whole amount necessary
to pay this bonus has been saved and no sale of securi¬
ties will have to be made. The necessary clerical work
is nearly complete, and arrangements are being made by
which the members may receive the bonus cheques at
the end of this month. Prospectus and details may be
obtained on application to Mr. F. Addiscott, 33 Chancery
Lane, W.C.
Digitized by v^ooQle
42 The Medical Press. LEADING ARTICLES. July 12. 1899
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Letters in this Department should be addressed to the Publishers.
‘Che Jttebical Jtefi aitb Circular.
“ SALUS POPDLI SDPREMA LEX.”
WEDNESDAY, JULY 12, 1899.
THE LONDON UNIVERSITY QUESTION.
At last there seems some prospect of London
having what it has long, very long wanted, and that
is an University like those in most Continental cities,
and now in this country in some great centres. When
the University of London was started more than
half a century ago, it was by the help of those who
wanted religion excluded from the studies and
graduation of students, and that admission should
be provided to the learned professions for those who
were prevented, for certain reasons, from obtaining
distinction and degrees at Oxford or Cambridge. To
found an University, however, is a matter of diffi¬
culty. The capital required is great, and the poor
London University was not so provided that it could
develop as it should be able to do. Change after
change took place, and at last the University of
London became nothing but an Examination Hall
where no education or training was supplied, and
all that was done was to test the relative merits of
candidates for degrees. Examinations may be very
good things in their way, but it would not be
difficult to prove that the best men in after life
are not always those who have led at the beginning
of the race. The London University has become
more and move limited in its use in assisting in the
education of our younger men, and it has become
more and more apparent that what is wanted in
London is some such University as every great city
on the Continent provides for the sons of those resid¬
ing in it, and where proper education of every kind
is associated with and leads up to a Degree. Science
must be taught by competent teachers, and cannot be
learnt from books in 'the way that is possible with
classics and mathematics. What is wanted now is
technical education, and this can only be acquired by
the personal contact of student and master. The
opening up of the world can only be effected by
Practical Science, by such powers as are wielded by
the engineer, and by young men trained to go out
into the world and work where civilisation ha6 not
yet developed uncultured resources. In choosing
Kensington, where Science-Education has been at
work now for some years, a wise course has been
taken, and we think that our profession ought to aid
in every way in supporting this New University, for
we want in London some such place for those who
intend to devote themselves to the Practice of Medicine.
Between the time when a boy leaves school and joins
a hospital a year or two may well and should be
spent in the study of those sciences with which
medicine is more or less closely connected, and a
knowledge of which is certain to prove of great value
in many waysio the medical man. This is more felt
now than it was a few years ago, as Sanitary Science
has become an important matter both to the public
and to the profession, and it is not easy for our
hospitals to provide the means of educating in much
that is really outside the hospital, and is not a part
of hospital work. The education of our working
classes, and the great system of School Boards may
interest many, and is truly an important work, but
the youths of the middle class ought not to be
neglected, and good teaching is not to be obtained
without assistance. Let those, therefore, who are
interested in the training which is proper for the
medical profession, and who realise the great import¬
ance of having high-class men to carry out its work,
be generous in assisting the objects for which this
new university is intended.
THE ANNUAL ELECTION AT THE ROYAL
COLLEGE OF SURGEONS, ENGLAND.
The annual election to the Council of the Royal
College of Surgeons, England, took place last week,
and resulted in the return of Mr. Herbert W. Page
at the head of the poll with 286 votes, while Mr. T. R.
Jessop was re-elected with 233 votes. Thus Dr. Ward
Cousins, the president-elect of the British Medical
Association, failed to secure his re-election. Dr.
Cousins’s career upon the Council has been some¬
what a chequered one. Within a period of four years
he has had to seek the suffrages of the Fellows
upon three different occasions. He was first
elected to the vacancy on the Council caused by the
death of Mr. Hulke; after having filled the period of
Mr. Hulke’s term, he had again to appear at the poll;
upon that occasion the votes which he obtained only
placed him in the position of filling another death
vacancy—namely that of Mr. Rivington’s. This term
expired in the present year, so that Dr. Ward
Cousins had last week, for the third time in
four years, the necessity of seeking the support
of the Fellows for a seat on the Council. Such
a record is quite unique in the annuls of the
Council elections. Dr. Ward Cousins was originally
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Jttlt 12 , 1899 .
LEADING ARTICLES.
Th* Medical Pbbss. 43
a candidate whose claims were supported by that
reforming body—-the Association of Fellows, and as
long as the Association continued its active inter*
ference his election was practically assured. During
the past two years, however, the reforming section of
Fellows bas taken no active part in College politics,
having for various reasons, preferred to remain in this
connection in a condition of suspended animation. The
effect of this decision has beoome apparent in several
ways. First and foremost there has been a very
perceptible decline in the general interest displayed
in the annual election. The personal interest alone
is not sufficient to infuse excitement into the contest;
unless the candidates appear before the constituency
pledged to support rival interests it is only natural
that the Fellows should abstain from troubling
themselves to make use of their electoral privilege.
Nothing could better display the languid manner in
which the Fellows took part in the last election than
the meagreness of the official figures relating to the
poll. Out of a total of about 1,200 Fellows only 493
recorded their vote, namely, 477 by post, and only
16 personally. That is to say, no fewer than 40 per
cent, of the Fellows failed to consider it necessary to
fill in their voting paper. This, then, being the pre¬
sent state of affairs, the elections at the College may
now be regarded, in political language, as of the
nature of bye-elections, at which candidates are re¬
turned on side issues, that is to say, independently
of the larger and more important questions of reform,
so far as the government of the College is con¬
cerned, Just as in the political world, bye elections
are regarded as of little value as a test of the drift of
public opinion, so in the College elections, as at pre¬
sent conducted, no importance need be attached to
the personnel of those who are successful. In the
absence of candidates representing a rival platform,
it really does not matter who is returned at the
annual election; there is no burning question of
reform at present agitating the constituency, and the
organisation of the Association of Fellows for the
time being having oeased to be active, there is prac¬
tically nothing left to stimulate the Fellows into
signing their voting papers beyond the personal
interest which they may happen to take in a
friend who goes to the poll. But this dull and
decidedly tame condition of affairs will not always con¬
tinue. The generation which initiated the reforms
carried out by the Association of Fellows has done
its work, and the good work which it accomplished
from the year 1884 onwards is not likely to be over¬
looked by future historians of the College, More¬
over, several of the present members of the Council
were returned under its direct influence, and
thus the old-timed Conservatism of the Council has
now for some years been leavened by the more
opened-minded liberalism of the advocates of reform.
Still, the time is bound to come again when the con¬
servatism of the Council will be found to be out of
joint with the age, and whenever that time does
come it is certain to happen that the annual elections
will begin again to excite interest and attention.
THE IRISH “SCALE" FEE SYSTEM.
It is not very remarkable that Mr. Gerald Balfour,
being a Scotchman and naturalised Englishman, took
with him to Ireland, as Chief Secretary, the
ingrained belief in the English small fee system.
He knew that, in England and Scotland, the distri¬
bution of medical services for a few pence had,
through the agency of Medical Clubs and Aid Asso¬
ciations, come to be universal, and he thought, truly,
that a similar low fee Bystem, if not already available,
would be very useful to so poor a country as
Ireland, and he went determined to provide
such a system. Someone, who must have been
an Englishman because no one who knows
Ireland would have suffered from such a hallucina¬
tion, told him, before he started for Dublin, a very
palpable untruth, to the effect that now Poor-law
Medical Officers were bound by etiquette not to
accept less than a guinea visit, and were wont to
charge that sum to every roadside cottager who re¬
quired their services, and that, therefore, it had
become necessary to provide with gratuitous medical
services every individual who said he could not pay
the statutory guinea. One would have supposed that
a week in Ireland and a quarter of an hour’s conversa¬
tion with the medical inspectors under the Local
Government Board would have dissipated this illu¬
sion, especially as most of these inspectors had
themselves followed the plough as dispensary doc¬
tors, and had been glad to accept 5s. or less for a
visit, and knew well that others cheerfully accepted
half that sum. Whether they were afraid to tell him
anything discordant with his own view or not they
did not alter that view, and, notwithstanding numer¬
ous written and verbal assurances from deputations,
he remained “ of his own opinion still ’’ that every
Irish doctor stands out for bis solid guinea in every
case, and be set to work to force the doctor into con¬
formity with theEngliBh-Scotch system. His first course
was to refuse absolutely to do anything to mitigate
the monstrous abuse of the Irish system by which
any individual—however opulent—iB entitled to
receive medical relief as a pauper at the expense of
the ratepayers. This abuse he preserves and cherishes
as a means of forcing the Irish doctors into the Eng¬
lish penny-a-week club system. Be it understood that
we are favourable to this system under certain con¬
ditions, but the attempt of the Chief Secretary to
force Ireland to adopt it demonstrates how little he
knows of the Irish lower classes, and how
badly advised by the Local Government Board
he is. The Irish cottage peasantry and small artisans
are, at present, totally incapable of mutual organisa¬
tion for any beneficial object or for any object which
will take a penny a month out of their pocket. They
will attend a “ demonstration" on some political
subject in the chapel yard, and will contribute a few
pence when they must, but no one ever heard of one
of them insuring his life or his house. Still less
will they pay for anything which they can get just as
good for nothing, and, as successive Local Govern¬
ment Boards have trained them up in the conviction
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44 The Medical Press. NOTES ON CURRENT TOPICS. Jult 12, 1899.
that they all, even the farmer with £500 in bank, are
entitled to free medical advice and medicine from
the dispensary doctor, they are not such fools as to
pay their money into a club. Therefore, until they
find that that privilege has been taken from them
they will “ club ” not one penny.
Notwithstanding these considerations, the Chief
Secretary made a scheme which became law with the
new Local Government Bill. The doctors of every
union were to put their heads together as to what
their fees to poor persons ought to be, and to submit
a scale of such fees to their guardians, who might
adopt it and, this done, it was supposed to become
binding on doctor and patient. If the scale so approved
suggested 2s. 6d. for a visit a mile from home, the
doctor, on receiving the necessary ticket, was bound
to accept that sum, and no more, no matter who pre¬
sented it. But Mr. Balfour’s scale system went to
pieces at once; in fact, it is extraordinary that it
hung together at all. First, the doctors were not
obliged to submit a scale unless it was demanded by
the guardians, and most of them shirked doing this.
Secondly, most of the guardians, for obvious reasons,
did not wish for any fixed scale, and they carefully
forgot to ask the doctors for it. In these ,
unions nothing at all was done. Thirdly,
in a minority of unions the guardians, under
pressure of Local Government circulars, called upon
the doctors for a scale, and the doctors, under similar
pressure supplied it, but when submitted to the
guardians, it was in most instances scouted by them j
who asserted that 2s. 6d. was an altogether exorbitant
fee. In some cases the document was sent back two
or three times for amendment before adoption, and
in many the “ scale ” was repudiated altogether. The
beauty of the statesmanlike arrangement was that
the guardian who was inclined to abuse his privilege
was left in full enjoyment of that privilege. He could
give his opulent next-door neighbour an absolutely free
ticket as a “ poor person,” or in the rare case in which
he or his friend was endowed with a conscience he could
give him a half-crown ticket, which no doubt would
be a consolation for the doctor, who would receive
that sum, instead of a guinea, without the satisfac¬
tion of grumbling. This precious “ scale ” system
has pleased no one but the trafficking guardian, to
whom it has given another chance of perpetrating a
fraud on the doctor. It has done not one atom of
good to the sick poor. It has not attracted one indi¬
vidual, and it has repelled many. Let us, for the sake
of Mr. Balfour’s repute as a statesman, forget that
it ever existed, and apply ourselves to rational and
just remedies for the existing state of things.
$Qtzz on QTumnt topics.
Music and Young Girls.
The treatment, of certain diseased conditions by
means of music, as advocated by the too enthusiastic
guild of St. Cecilia, does not seem to have made
much headway; indeed, there is a sort of reaction
against the idea. Some music may possibly have a
soothing influence on the sick, but this could hardly
be said of high-class music, such as we are accustomed
to hear at fashionable concerts. This involves a
strain on the attention which the majority of people
find to be positively exhausting, akin to that engen¬
dered by too prolonged a visit to a picture gallery.
It is not, perhaps, the music per te that gives rise to
the distress, hut the unaccustomed concentration of
thought on one subject, the focussing of the percep¬
tive energies in one direction. Music, if too freely
indulged in, appears to produce a degree of physical
debility in both executant and auditor alike. In the
latter the induced fatigue is transitory, but of young
women who have adopted music as a profession a
large proportion suffer from chlorosis and “ nervous¬
ness.” The physical and mental strain entailed by
prolonged devotion to the practice of intricate exer¬
cises is admittedly very severe, and this should be
borne in mind in determining the fitness of a
person with decidedly musical tastes for taking
up music as a profession. In this, as in most
other professions, success, not to speak of eminence,
can only be purchased, other things being equal,
at the price of a robust constitution, proof
against nervous exhaustion. It goes without saying
that sitting out a concert does not produce the same
deleterious effects on everybody, Some young girls
aie obviously benefited by periodical outings of this
kind, but these are girls whose passion for music does
not carry them away and exhaust their receptivity.
While we are hardly prepared to endorse the alarming
statements which have of late found currency as to
the disturbing effeots of addiction to musical pur¬
suits, it may be conceded that girls whose nervous
system8 are in a state of unstable equilibrium are
apt to be unduly fatigued by this form of excite¬
ment, and in such cases health must be placed
before the mere indulgence of taste.
The Sexual Differences of the Foetal Pelvis.
While the existence of structural differences
between the pelves of the male and female adult has
long been recognised, the source and method of pro¬
duction of these differences are problems which have
occupied the attention of many generations of
obstetricians and anatomists. It has generally been
assumed that the characteristic features of the female
pelvis do not take shape until the period of puberty,
and an immense amount of ingenuity has been
expended in providing hypothetical explanations of
the change. Matthews Duncan,for example, heldthat
the special features of the male pelvis were due to the
bones being thicker, stronger, and stouter than in the
female, a further factor being their supposed earlier
consolidation with each other. This, however, is
more of the nature of a statement of appearances than
an explanation of their causation, and this observer’s
theory of the action of natural, i.e., muscular, forces,
falls to the ground in view of the fact that such
forces must act similarly, if not quite to the same
extent, in both sexes. The obscurity which has
hitherto surrounded the production of these differ¬
ences has to a large extent been cleared away by the
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July 12, 1S99.
painstaking investigations of Professor Thomson, of
Oxford, who, in a demonstration at the last meeting
of the Obstetrical Society, showed clearly enough,
by the aid of numerous beautiful specimens of
fcetal pelves, that the distinguishing features
which serve to identify the pelvis of the male and
female respectively are quite well marked as early as
the third month of intra-uterine life: It is highly
probable, and by no means inconsistent with biology,
that these differences exist ab initio though this
obviously cannot be affirmed owing to the fact that
at an earlier date the identification of sex is not pos¬
sible. None, however, can doubt that a foetus is male
or female from the very beginning, though evidence
thereof is not as yet available, and it follows that if
we could only check the observations the same differ¬
ences would probably be met with coincidently with the
formation of the pelvis as a definite structure. This
important contribution marks an epoch in our know¬
ledge of the development of the foetus and will greatly
simplify the proper comprehension of the subject.
A Means of Rendering Tobacco Non-Toxic.
In a recent number of the St. Louit Medical and
Surgical Journal Dr. Stern calls attention to a pro¬
cedure recommended some years ago by Professor
Gerold, of Halle, but since forgotten, whereby tobacco
is divested of the injurious effects due to the
presence of nicotine and acrid empyreumatic pro¬
ducts. Briefly described, the process is as follows:—
fifteen grammes of tannic acid boil in 1,500
grammes of water until the volume is reduced to one
kilogramme. Add thirty grammes of the essential
oil of origanum vulgare, the solution is then
removed from the fire, filtered, and allowed to cool
after which it is sprinkled on to eight kilogrammes
of tobacco leaves. Dr. Stern has made a number of
careful observations with cigars prepared from
tobacco thus treated, choosing in preference persons
known to have an idiosyncrasy in the direction
of intolerance of tobacco, and he invariably
noted a complete absence of any of the accus
tomed unpleasant symptoms, even after three
cigars had been smoked consecutively. If, as we are
assured, the tobacco thus treated does not lose its
characteristic aroma on the one hand nor gain an
unexpected flavour on the other, there ought to be a
ready sale for the product among our juvenile popu¬
lation at an age when even the now ubiquitous
cigarette is apt to give rise to distressing sensations.
We fear, however, that the toxic action of tobacco is
as essential to the hardened sinner as is alcohol in his
beer or champagne. There is nothing essentially attrac¬
tive in either the taste or odour of the weed, indeed
they are drawbacks which are put up with for the
sake of the quasi-toxic effects. People do not drink
whiskey or absinthe on account of their taste, but in
order to obtain certain definite physiological effects,
however detrimental these may have been shown to
be. There is, however, a certain proportion of non-
smokers who are such by reason of their intolerance
of tobacco “ as she is smoked,” and these possibly
Th« Medical Pbiss. 45
may be tempted by the prospect of immunity from
undesirable after-effects.
The Axis Traction Forceps in Face
Presentations.
Practitioners are familiar with the fact that
when the forceps are applied for the purpose of effect
ing delivery in complete or incomplete face presenta¬
tions they usually slip, thus, in many instances of
deficient rotation, necessitating recourse to cranio¬
tomy. Dr. Lewers has done good service by calling
attention to the value of the axis traction forceps
under these circumstances, not, of course, in all such
abnormal presentations, but when for some reason
the head gets jammed and cannot come down far
enough into the pelvis for the natural forces to
determine rotation. He is careful to point out that
it is not so much the axis traction action that
overcomes the obstacle, but the fact that it is
possible with this instrument to obtain a secure grip
of the presenting part, thus enabling the accoucheur
to pull down the head into a position where
rotation can take place in virtue of the operation of
natural forces. As these cases are among the most
troublesome with which the obstetric practitioner has
to deal he will be grateful to Dr. Lewers for a hint
which may prove the means of saving many an infant
life if judiciously employed.
The Dangers of Medical Practice in the
East-End of London.
We are not surprised to learn that medical prac¬
titioners whose lot is cast in the uninviting districts
east of the City are displaying an indisposition to
abandon the security of their hearths after dark in
view of the frequency with which these ministers of
mercy have of late been the victims of violent
and unprovoked assault. It is much simpler
to decline to expose oneself to this risk than
to go about armed because the employment of lethal
weapons, even for legitimate self-defence, is certain
to entail a large amount of worry and trouble, in
addition to much notoriety of an undesirable sort. If
the inhabitants suffer in consequence, it will be for
them to organise concerted measures to stamp out
the gangs of human brutes whose exploits vary the
monotony of life in the East End. The police are
quasi-powerless unless supported by the public, and
the drawbacks of medical practice in such quarters
are obvious enough without exposure to unnecessary
risks. It had always been understood that medica
men were known to, and respected by, these nocturnal
marauders, but either this immunity never existed or
it has fallen into abeyance.
Hospital Appointments in the Naval
Medical Department.
The Government was taken to task last week in
the House for having appointed a Deputy Inspector-
General to the charge of the Royal Hospital at Has-
lar, when the services of no less than three Inspector-
Generals were available. The reply, of course, wa6
easy enough. Mr. Goschen stated that he had been
NOTES ON CURRENT TOPICS.
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46 The Medical Pbess.
NOTES ON CURRENT TOPICS.
July 12, 1899.
guided, not by seniority or etiquette, but by the
desire to select the best man for carrying on of the
administration of what he rightly described as one of
the most important hospitals in the kingdom. This
is a sentiment which cannot fail to command general
assent, but we fear that these grandiloquent statements
of policy are but too often used as a cloak for
favouritism and jobbery. We by no means wish to
insinuate that such was the case in respect of the
appointment under discussion, though one must
sympathise with the three senior officers whose claims
to consideration have been so roughly overridden.
The Closing of Metropolitan Hospitals.
The advent of summer has again rendered it pos¬
sible for the committees of certain metropolitan
hospitals to effect some necessary alterations in their
institutions by closing them to patientB. This year,
however, the Closing will be on a colossal scale. In
the first place all but a small section of the out- i
patient department of St. Bartholomew's Hospital j
will be closed. Again, both King’s College Hospital
and St. George’s Hospital will be entirely closed to
all patients; furthermore, the out-patient depart¬
ment of St. Mary's Hospital, Paddington, and the
West London Hospital will be closed for about two
months. So far as the West London is concerned,
the Committee have for long seen the urgency of in¬
creasing the accommodation of the out-patient
department; at present it is quite inadequate
for the needs of the patients who attend,
and for the requirements of the post-graduate
students. The necessity of proceeding with the
enlargement of the departments has lately been
strongly represented to the Board of Management by
the medical staff, and the result has been that the
alterations will be forthwith begun, and will be com¬
pleted at a cost of £1,500. This will also include a
new board room, as provided for in the architect’s
original scheme of the completed enlargement of the
hospital
The Spectacle Makers’ Diploma.
A few weeks since the question was raised in these
columns as to the attitude of the Ophthalmological
Society towards those of its members who allied
themselves with the granting of questionable medical
dijfiomas to opticians. We now understand that the
learned Society mentioned has decided to take no
steps in the matter. That position is to be regretted
in a body to which medical men naturally look for an
outspoken expression of opinion in the interest both
of the profession and of the public. There may be diffi¬
culties that render the Ophthalmological Society loath
to enter into a public controversy, but that con¬
sideration can hardly be pleaded in a matter of
internal discipline. In our opinion, the medical profes¬
sion has a right to ask why a member of the Society
is allowed to remain an examiner of the Spectacle
Makers’ Guild. Curiously, the gentleman in question
seems to pose as a kind of expert examiner for lay
bodies, for we understand his name appeal's in that
.capacity on the rolls of the British Optical Associa¬
tion, a title that most of our readers will pro¬
bably find resounding but obscure. By the
way, the arms of the latter distinguished body consist
of an ophthalmoscope and two lenses, investing a
trial spectacle frame with that supreme simplicity
that marks the highest flights of heraldic art. What
have the Ophthalmological Society of the United
Kingdom to say to the name of one of their members
being appended to documents decorated with the
foregoing fantastic trades’ heraldry ? But perchance
the spirit of the coming millennium of entire toler¬
ance has descended upon the Council of the Ophthal¬
mological Society.
The “Barker” Anatomical Prizes.
The Royal College of Surgeons, Ireland, as
custodians of this prize, offer for competition a prize
of £21, which is open to any student whose name is
on the anatomical class list of any school in the
United Kingdom. The preparations must be entered
before March 31st, 1900. The prize is offered for a
dissection of the pharynx from behind, with as many
as possible of the nerves, &c., to be found in that
region. No prize will be awarded unless sufficient
merit be shown, 70 per cent, of the total marks being
the minimum. The following is the scale of marks:—
(a) For the merit of dissection, 60; (b) for excellence
of setting, 20: (c) for originality, 20; total, 100.
Those dissections for which prizes are awarded
become the property of the College. This prize is
awarded by the Curator of the College, the President
of the College, and the Professor of Anatomy of the
University of Dublin.
The Lay Press Announcement of a
“ Discovery in Cancer.”
It is stated on the authority of the Daily Mail
that Dr. Lambert Lack has made a discovery, in the
course of exhaustive investigations into the nature of
cancer, which is certain to have very far-reaching
results. The details of the discovery, we are in¬
formed, are not public property, and we are conse¬
quently not in a position to arrive ut any conclusion
as to their value. If it is a fact that the
experiments so far have been pronounced by
a select committee of the Pathological Society
to be practically conclusive ; we are not likely to
be left long in the dark. The newspaper referred to
speaks of the “ English doctor’s great achievement,”
and goes so far as to characterise it as “one of the
greatest modern discoveries." Supposing this to be
the case it strikes us as being somewhat strange that
it should be communicated through the medium
of the lay press. We learn from the Medical Direc¬
tory that Dr. Lambert Lack is an M.D. of the Uni¬
versity of London, and a Fellow of the Royal
College of Surgeons of England. We gather,
too, that he is an assistant physician to the Hospital
for Diseases of the Throat in Golden Square, but we
presume that his experiments were not made there.
The number of physiological laboratories in London
is small, and if his observations were made in one of
them we may reasonably expect to receive before
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July 12, lo&9.
NOTES ON CURRENT TOPICS.
Th* Midical Pbisb. 47
long some official confirmation of such startling news.
If Dr. Lack has really made an important dis¬
covery bearing on the etiology of cancer, we shall be
among the first to congratulate him, but if on the
other hand it turns out to be a mere newspaper puff,
we shall not be backward in commenting on the some¬
what unusual method of publication. Our minds
are perfectly open in the matter, and it is for Dr.
Lack to establish his contention and make good his
claim.
The Ansell Poisoning Case.
Some of the London newspapers have taken up the
case of the unfortunate convict, Mary Ansell, who
lies condemned to death for the murder of her sister.
For our own part we see no reason to abate the
demand we made immediately after the trial for
a careful and exhaustive inquiry into the
prisoner’s mental state. The fact that her sister
was an inmate of an asylum at the time of her death
gives a clue of great importance in the family history.
From other sources we gather that there has been
insanity on both Bides of the parental stock, and
that Mary Ansell herself has shown marked eccen¬
tricity during her childish and school days. It is to
be hoped that the Home Secretary will not allow any
extreme penalty to be inflicted until he has
convinced himself upon the most authoritative
evidence obtainable that the unfortunate girl Ansell
was fully responsible for her acta at the time of the
murder. For most medical men the paltriness of the
motive and the existence of a family taint would be
enough to suggest the exercise of the utmost caution.
In a case of this kind should there be a shadow of
doubt, we venture to say emphatically that the Crown
prerogative of mercy should be exercised without a
moment’s delay.
The Open-Air Treatment of Consumption
in London.
A popular movement is apt to reach a ridiculous
stage when it comes to be overdone, and perhaps this
criticism may be said to apply to the proposal to
carry out the open-air treatment of phthisis in con¬
nection with one of the London hospitals for
diseases of the chest. It is difficult, for example,
to comprehend bow the patients will benefit
from the inhalation during many hours in the day of
a smut-laden atmosphere, such as must be the case
wherever such treatment is attempted in London.
We do not wish, however, to say a word against the
air of the metropolis, which is surprisingly healthy
when all things are considered. But, despite its
salubrity under general circumstances, we cannot
see that to expose hapless consumptives to
the continuous inhalation of solid particles of
carbon would be especially calculated to im¬
prove their pulmonary condition. Better by
far that each chest hospital should become affi¬
liated with a sanatorium in the country, to which
the phthisical patients could be sent for the outdoor
treatment, rather than that valuable time should be
wasted in attempting to cure them by following
the treatment in London. The point is really a very
i mportant one, because it raises the question whether,
in view of the present results of the open-air treat¬
ment, provision should not be made for all phthisical
Londoners to be drafted off to sanatoria in the
country in order to undergo this new method of cure.
Death from Chloroform given for Ablation
of Tonsils.
Another fatality, of a peculiarly regrettable kind, is
reported from Winchcombe, where a lad, set. 15, died
under choloroform after removal of the tonsils. We
were under the impression that the administration of
chloroform for this purpose was generally regarded
as undesirable in view of the danger of asphyxia
supervening. The verdict of “ death from paralysis of
the respiratory centre ” does not help us much, it is
only a paraphase of “ death from want of breath.”
The question we are called upon to consider is the
cause of the respiratory paralysis, and experience,
both clinical and experimental, points to the
inhalation of too concentrated a vapour as the
source and origin of the evil. These deaths,
as we are continually pointing out, occur, well
nigh without exception, when chloroform is adminis¬
tered in the slipshod fashion still in vogue by the aid
of a towel or mask. We are led to ask when will
coroners and their juries cease to accept “slightly
flabby heart,” 41 respiratory paralysis,” and “ idio-
sjncrasy ” as affording adequate explanation of what
we are fain to regard as, for the most part, absolutely
preventive catastrophes. The occurrence of such
mishaps when a regulating inhaler is used is almost
unknown, thus testifying to the greater safety of this
more scientific method of administration. Of course*
it is possible to kill with such an apparatus, just as it
is possible to give a measured but fatal dose of
strychnine solution, but the chances of this happening
must obviously be vastly lessened.
Sentence on a Blackmailer.
Last week ah exemplary sentence was passed upon
a woman at the Lincolnshire Quarter Sessions for a
barefaced attempt to blackmail Dr. Davison, of Gos-
berton. It appears that last May the accused con¬
sulted the medical man in question, who gave her
some pills. Ten days later her brother-in-law
brought the doctor the following letter:—“Sir,—
The pills you gave me have done me no good what¬
ever. Unless you send something, and do me some
recompense for insulting me in the way you did
at your surgery, I shall inform somebody
else about it. It ought to be well worth
£10 to you for me to say nothing about
it. Unless you send the same amount to me, I
shall summon you.” In the course of evidence, it
transpired that the prisoner, in spite of the alleged
occurrence, was willing for the doctor to vaccinate
her child. The jury found her guilty, and she was sen¬
tenced to twelve calendar months’ imprisonment with
hard labour. Dr. Davison is to be congratulated for
his courage and deteimination in exposing a criminal
attempt at intimidation, a base method of attack to
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48 The Medical Press.. NOTES ON CURRENT TOPICS. Jult 12, 1899.
which medical men are peculiarly liable. A few undoubtedly one of considerable value, therefore
more salutary sentences of the kind passed at Lincoln
would make this sort of offender extremely chary of
commencing operations. By the way, why was not
Dr. Davison a member of the Medical Defence Union ?
How Infection is Spread.
During the past week several instances have been
recorded of the reckless exposure of infectious
patientB. In one case a father and mother presented
themselves at the fever hospital in Belper, Derby¬
shire, with a child seven months of age, suffering
from scarlet fever. They had been staying in a
common lodging-house in Alfreton, and apparently
resolved to go off straight to Belper without under¬
going any such trifling formalities as admission
orders and so on. They accordingly went to South
Wingfield station and took train to Belper, whither
they travelled in a compartment with other
people. At Aberdare, four cases of wilful
exposure of patients were heard before the local
magistrates. In three instances fines were imposed,
but the fourth was dismissed, as the bench held the
defendant had been misled by the nature of the
medical certificate. The practitioner in attendance,
so it was explained, had notified the child to be
Buffering from diphtheria, but had filled in the form
“ tonsillitis ” so as not to alarm the mother, who was
in weak health. Such a course can hardly be com¬
mended, and any medical man who acted in so
unwise a manner would not expect much sympathy
if serious complications ensued. It is clear that the
whole system of notification would be rendered useless
by the exposure of infectious persons.
The Cheerful Doctor.
The gravity which the public have learned to asso¬
ciate with the attitude of those engaged in practising
the healing art is not inconsistent with a certain fund
of cheerfulness and good humour. It may be neces¬
sary for some men to cultivate a depressing sobriety
of verbal and facial expression inorder to acquires
reputation of profundity, but the man who knows his
work need be under no apprehension lest cheeriness
of demeanour should be mistaken for frivolity. Of
course, there are times and seasons when a serious
demeanour is incumbent upon the doctor under penalty
of appearing flippant or heartless, but in general the
public appreciate cheerfulness and are grateful for the
bright smile and humorous word which, for a brief
space, distract the thoughts of the sufferer from the
contemplation of his woes. Cheerfulness in the
doctor begets confidence in the patient, inasmuch as
it is inconsistent with grave apprehensions, and we
have it on the authority of Galen that “ confidence
and hope do more good than physic.” The sick are
morbidly sensitive to impressions, and the grave face
and solemn manners of the melancholic practitioner
cannot but give a disastrous turn to his thoughts.
Of course it is not given to everyone to be amusing,
but we can all be cheerful, and the faculty of inte¬
resting one’s patients in such a way as to rouse them
from the apathy which enforced reclusion entails is
gaiety short of flippancy and humour apart from
triviality are qualities to be cultivated instead of
being smothered under the quasi-funereal garb which
many medical men still hold to be most appropriate
for those the success of whose ministrations is
largely dependent on their power of raising the
morale of the sick who look to them for comfort and
return to health.
The Committee of University College Hospital,
London, announce that the institution will be closed
during the month of August, with the exception of
the maternity department.
The annual general meeting of the West London
Medico-Chirurgical Society will be held at the West
London Hospital on Friday next, at 5 p.m., for the
purpose of receiving the annual report and the elec¬
tion of officers and council.
PERSONAL.
Mrs. Frederick Sassoon has sent a donation of one
thousand guineas to the Middlesex Hospital for the
Cancer Fond.
Mr. E. A. Minchen, M.A., Fellow of Merton College,
Oxford, has been elected to the Jodrell Professorship of
Zoology in University College, London.
Mr. Wilson Noble, Slisinghurst Grange, Cranbrook,
has been elected president of the Rontgen Society,
vice Mr. C. W. Mansell Moullin, whose term of office has
expired.
Mr. W. H. Netherclift, F.R.C.8.Ed., and Mr. G. M.
Hirons, L.R.C.P.,L.R.C.S.Ed., have been appointed magis¬
trates of the Boroughs of Canterbury and Bournemouth
respectively.
The position of Honorary Surgeon to H.M. the Queen,
void by the death of Surgeon-General Maclean, has been
filled by the appointment of Surgeon-General Colvin
Smith, C.B., I.M.S.
Dr. Wace Carlier, Assistant to the Professor of
Physiology in the University of Edinburgh, has been
appointed to the newly-founded Chair of Physiology at,
the Mason University, Birmingham.
Mr. Herbert W. Page, F.R.C.S., of 8t. Mary’s Hos¬
pital, Paddington, and Mr. Thos. R. Jessop, of Leeds,
were elected on Thursday last as members of the Council
of the Royal College of Surgeons, England.
Dr. James Barr, of Liverpool, has been presented
with an address and an honorarium of 160 guineas for
past services as honorary secretary of the Lancashire and
Cheshire branch of the British Medical Association.
Lord James of Hereford was unable, on account of
ill-health, to be present at the distribution of prizes to
students of Charing Cross Hospital last Wednesday.
His place was taken by the Solicitor-General, Mr. Robert
Finlay, Q.C., M.P.
i Mrs. Kanthack, widow of Dr. A. A. Kanthack, late
Digitized by
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July 12, 1899.
CORRESPONDENCE.
The Medical Press. 49
Professor of Pathology in the University of Cambridge*
has been placed on the Civil List for a pension, “in con¬
sideration of eminent services rendered to science ” by
her late husband.
Mr. Robt. S. Kixxier, L.F.P.S, Glasgow, has been
presented with a cheque for £260, a silver salver, and a
diamond brooch for his wife by the inhabitants of Salt¬
coats as a souvenir of the completion of fifty years
practice among them.
The many friends of Prof. C. A. Ewald (of Berlin), in
this country will be interested to hear that he has
recently completed thirty years as a teacher of Medicine,
and will cordially join in the congratulations offered to
him in Berlin by his friends and colleagues in celebra¬
tion of the event.
We are sorry to learn that Sir Thomas Grainger
Stewart, Professor of the Practice of Medicine and of
Clinical Medicine in the Edinburgh University, is not
making such a rapid recovery from his indisposition as
was generally hoped for, although he has made consider¬
able progress towards good health latterly.
At a meeting of the Cancer Society last week, it was
resolved to send out Mr. Arthur C. Duffey, M.B., B.Ch.,
the son of Sir Geo. Fred. Duffey, late president Royal
College Physicians, Ireland, to the United States to
investigate what is being done in the State Laboratory
at Buffalo with regard to the study of cancer.
The Council of Unmrsity College, London, has
awarded a Research Medal to Dr. S. B. Schryver, of
the Wellcome Chemical Research Laboratories, as one
of the former pupils of the College who has most dis¬
tinguished himself in research. Dr. Schryver received
the medal at the official presentation of prizes at the
College on Friday, June 23rd.
At a meeting of the Manchester City Council, last
Wednesday, it was announced that a “citizen” had
offered to build a hospital for consumption, at a cost of
£30,000, and to spend an additional £15,CG0 on the
grounds. This is the second generous offer by an anony¬
mous donor to Manchester during the past few months-
Although the name of the donor is kept secret, a shrewd
guess has been hazarded.
gortlattb.
[FROM OUR OWN CORRK8PONDENT.J
The Late Professor Rutherford. —On Saturday
last a bust of the late Professor of Physiology in the
Edinburgh University was unveiled before a crowded
assemblage of Professors and Students, in the class-room
where he lectured for so long. The bust, which was sub¬
scribed for by the medical students of his class, is the
work of Mr. John Hutchison, R.S.A., partly from a cast
of the late Professor’s features, made after death, is an
excellent likeness of its subject. Sir William Turner,
after Sir William Muir, the venerable Principal of the
University, had unveiled the bust, spoke in high
appreciation of his late colleague’s attainments and
merits.
H.R.H. the Prince of Wales in Edinburgh.—
The Medical Buildings of the University of Edinburgh
were the scene of a notable event on Thursday of last
week, when H.R.H. the Prince of Wales was presented
by the Lord Provost and Corporation of Edinburgh with
the Freedom of the City in its well-known hall, the
McEwan Hall. The day was held as a general holiday
from classes, and the function passed off with a maximum
of success.
The Assistant Phtsicianship in the Royai, Infir¬
mary, Edinburgh, rendered vacant by Professor R. L.
C. Leith’s translation to Birmingham, is to be filled up
next Monday; applications to be lodged before
12 noon, Friday, 14th. The managers have taken
a new departure in deciding to limit the number
of testimonials sent in by each candidate to six
only. The innovation is meritorious, but in this
instance rather hastily adopted, especially as so short a
time was allowed between notification of the vacancy
and application for the post. Six testimonials require
almost more care in obtainal and selection than sixty,
and delays in acquirement are frequent. It, however,
does away with the very considerable volumes which
before now have been sent in by applicants for various
of the hospital’s posts, formed chiefly of a few score
letters of credit.
0bituart>.
SIR ALEXANDER ARMSTRONG, K.C.B., M.D.
Thr news of the death of Sir Alexander Armstrong,
late Director-General of the Navy Medical Department,
will be read with much regret. He entered tne Royal
Navy in 1842, but bis fame rests chiefly on his personal
contribution to the cause of Arctic Exploration. He
spent five years in Arctic regions searching for 8ir John
Franklin’s expedition, and he was on the Investigator
when the North-West Passage was discovered. He has
since done much good work in Naval Hospitals in the
Mediterranean and in England. He has written his
experience in the North and his views on Naval Hygiene.
Aretic explorations have advanced much in late years;
and Nansen and his compeers are well aware that this
advance was only made possible by the stepping-stones
laid down by the great explorers of the past.
Sir Alex. Armstrong, who had retired from active ser¬
vice some years since, held the honorary appointment of
Hon. Physician to the Queen and H.R.H. tne Prince of
Wales. His services were further rewarded by Her
Majesty with the K.C.B. Trinity College, Dublin,
elected him to the honorary distinction of LL.D., and
the Royal 8ociety bestowed on him its Fellowship. He
also held the M.D.Ed., and the F.R.C P. of London.
We do not bold ourselves responsible foe tbe opinions of our
correspondents.
“THE CANCER FOG."
To the Editor of The Medical Press and Circular.
Sir, —Dr. Herbert Snow’s address at the inaugural
meeting of the Cancer Society, printed in your issue of
July 5th, tempts me to send you a few remarks. The whole
tone and style of the address, coupled with the fascina¬
tion which the subject has for a long time exercised on
me, are my excuse for troubling you; but another
motive drives me. I once had, in the dim and distant
reaches of the past, some ambition to be a scholar, and
in the early days, when what little intellect I had,
began to show its bent and direction I found myself
driven noticeably in the direction of philosophy
and rIbo of logic. Now I see an appeal made in
Dr. Snow's address both to the logician and to
the philosopher. ‘ I greatly wish,” he says, “ that some
competent person would take the trouble to survey,
purely from the philosopher’s point of view the litera¬
ture of cancer during the past century.” Sir, my practical
duties among the surgical and medical therapeutics of
cancer for many years past have sadly thwarted any
ambition I might once have had to be a philosophical
Digitized by LjOOQIC
50 The Medical Press.
LABORATORY NOTES.
July 12, 1899.
historian of cancer or of any other literature. But if the
philosopher’s function be to try to see principles, I have
attempted to cultivate that function in the intervals of
practical occupation, and the appeal to the logician sounded
in this short address presents to my ears a call which I
feelj myself unable to resist. For such expressions as
“ constitutional origin, heredity, bacteriological origin,
geographical distribution, cancer-houses, damp soils, vege¬
tarianism, electricity,” thrown together at haphazard by
the writer, as well as others like diathesis, constitution,
predisposition, mal-nutrition, hypertrophy, atrophy,
ulceration, and the like, have always, since I became
slightly acquainted with them, deeply impressed my
mind. Now I do not know—I may be wrong, of course
—but I rather incline to think that the lament which I
see lower down in this address as to “ the utter
absence of co-ordination and organisation ” in our
profession is a little confusing in its effect. To
appeal, as such a lament does by implication, to
co-ordination and organisation is not, I think, quite com¬
patible with the other appeal to the logician, the philoso¬
pher, and the philosophical historian which so attracted
me in reading the earlier part of the address. I wonder
if it will shock you. Sir, if I hint that in my opinion it
ds not more observations that we require in the study of
cancer, but a better use of the observations we already
have, if we are to gain any further knowledge of its
causes, and therefore of its cure, and especially of its
prevention. Snrely a total of 24,443 deaths from cancer
in 1897 (males 9,573, females 14,870) not to mention
the thousands of former years, is sufficient for any man
who is in search of materials for observation. “ Co-ordi-
Dation and organisation ” would no doubt afford further
observations, but when they had been got, what then ?
and how difficult to get them. How very difficult to get
men and women doing the practical work of life to
combine in any co-ordinated and organised way to put
-together new observations which shall promise to be any
more instructive than those we have already. I scarcely
think that more observations are required. There are
plenty already, and the problem regarding them, if by
co-ordination and organisation we had obtained them,
would still be the very problem that the writer suggests
should be grappled with now (or by implication sug¬
gests), viz., that we should compare our observations,
reflect on them, reason about them, and see if we
cannot come to some practical conclusions regarding
them. I do not think that a lack of observations is a
question with us now almost at all. It is certainly not a
burning question. Dr. Snow mentions two respects in
which our age differs from its predecessors. Let me
mention a third—viz., that the reign of our present
gracious Sovereign has been characterised by the accu¬
mulation of such a mass of careful and accurate observa¬
tions as has never been known before. It threatens in
fact to overwhelm us. No memory is so prodigious as
to be able to carry it, for one is in great danger of failing
to see the wood for the trees. It is of comparatively
little importance to know that the temperature was
101 deg. F. or 1016 deg. as compared with knowing that
it was high, that it was above normal; or that it was low
on the other hand. It is also of comparatively small
moment to inquire whether a disease is epitheliomatous
or papillomatous, as compared with the question is it
hypertrophic or atrophic ? And if atrophic, is it
directly atrophic, or indirectly atrophic P 1 am afraid
I shock you, Mr. Editor, but I am attempting to
follow the most commendable lead in the direction of
logical and philosophical inquiry and reflection pointed
out by Dr. Snow. Because our ancestors reasoned
justly from wrong premises is no reason why we should
refrain from reasoning from correct ones. But it is very
often assumed that it is. I repeat it; I think careful
and accurate observations are not so much a desideratum
•now as sound reasoning, judgment, and reflection
founded on them, and as the attempt to marshal our
facts in order and method, and to see the law or laws
•that govern them, and give them that majestic sweep of
orderly succession and methodised arrangement that fill
the beholder with awe and wonder and admiration, in
place of filling his down-stxuck imagination with no
higher idea than chance, and no nobler conception than
chaos. I do not hesitate to say that I should expect
much more benefit to accrue from a collection of obser¬
vations by Dr. Snow himself, or by any other competent
observer, and from logical and philosophical examination
of them and reflection on them than from any number
of co-ordinated and organised observations such as he
suggests. There would be no harm, I daresay, in having
both, but let us at least use the observations, alas too
numerous, which we already possess, and see what we
can learn from them.
Now if in the logical and philosophic and historic
spirit which Dr. Snow recommends, we approach the
examination of the thousands of cases of cancer in Eng¬
land occurring every year, certain reflections must occur
to us. Unfortunately for that logical spirit, and for that
philosophic attitude our very terms are not fixed. “ Here¬
dity,” what does it mean ? “ Constitutional origin ” and
constitution itself, what is that ? “ Bacteriological origin,”
nay, origin at all, are we agreed as to these ? I do not
see that we are. But for many years past definitions of
some of these expressions have been shaping themselves
in my mind, and as Dr. Snow does not enlighten us, I
must be pardoned for trying to focus and clear and define
myself; which, with your kind permission I hope to
attempt to do to some slight extent in my next letter.
I am. Sir, yours truly,
PhILOSOPHDS IONOTD8.
y-aboTatorg ^otcs.
“CAFE VIERGE.”
(Prepared by Messrs. Allen and Hanburys.)
This extract holds the first place for excellence among
the many coffee preparations we have examined. The
manufacturers have succeeded in what is no easy task,
namely, in presenting in a concentrated form the charac¬
teristic principles for which coffee is valued. In both
aroma and flavour “ Caffe Vierge ” is greatly superior to
most others, and the analytical data given below will
convince those who have examined coffee extracts that
it is of real value, and contains the soluble constituents
of genuine coffee in the true proportions in which they
exist
On analysis we have obtained the following results.—
Moisture .60-22
Mineral matter . 4-26
Caffeine . 198
Nitrogenous matter . ... 4-00
Non-nitrogenous matter (by difference) 29'55
When it is remembered that in many coffee extracts
the caffeine is below 0'4 per cent., and even lower, it
will be seen that this preparation is of the highest
quality.
THE “ ALLENBURYS ” TOILET SOAP.
(Prepared by Messsrs. Allen and Hanburys.)
This is a very high-class toilet soap carefully pre¬
pared. We have analysed it, and our results are as
follows:—
Free fat (by petroleum ether) 2‘0 per oent.
Water . 8‘8 „
Soda (as Naj O) . 33 2
Fatty acids . 46 3 „
Glyoerine, Ac. (by difference) 97 „
From these results and from the characters of the
fatty acids we are enabled to thoroughly endorse the
claim of the makers that this soap is prepared from
pure fats, and is specially suited for tender and sensitive
skins, inasmuch as it contains no free alkali, and is pre¬
pared from sweet and wholesome fats.
The percentage of water is remarkably low. That is
to say, the purchaser is getting real toap for his money,
whereas in the case of many common varieties an enor¬
mous quantity of water is incorporated by the manufac¬
turer, even though the appearance of the soap may not
disclose its presence.
ed by Google
Diqitiz.
July 12. 1896. MEDICAL NEWS. Thk Medical Press. 51
iEcbical ^etos.
Changes In the Catholic University Medical School, Dublin.
An advertisement in our issue of to-day states that
on October 19th two vacancies in the teaching staff will
be filled up. First, that created by the resignation of
Dr. James Campbell as Professor of Chemistry. For
some time he has had the assistance of Jos. P. Frengley,
M.B. Second, the Professorship of Ophthalmology,
vacated now by Dr. Louis Warner on the lapse of his
period of appointment. He is eligible for re-election.
Guy's Hospital Medical Echool.
Guy’s Hospital and grounds presented a brilliant
spectacle on Friday last, when the annual distribution
of prizes was made to the successful students. The
treasurer, Mr. Cosmo Bonsor, M P., presided, and intro¬
duced another of the governors, Mr. Robert Gordon,
who, besides presenting .£1,200 towards the funds
of the Medical School, had given a further hand¬
some donation to the hospital during the past
year. The latter gentleman then presented the
prizes and certificates to the successful competitors.
The following were the chief awardsThe Michael
Harris Prize for Anatomy: C. H. Robertson. The
Wooldridge Memorial Prize for'Physiology : J. T. Hicks
and A. E. Pakes. The Hilton Prize for Dissections
(1898) : C. Tessier. The Arthur Durham Prize for Dis¬
sections—First year’s students: A. M. Webber; Senior
students: C. H. Robertson and A. H. Wall. Dental
Prizes - Second year’s students (1898) : P. 8. Campkin;
First year’s students: C. 8. MorriB. Practical Dentistry
Prize; C. S. Morris. Senior Proficiency Prizes: C. T.
Hilton, E. B. Dowsett, G. N. Meachen. The Richard
Bredin Prize for Clinical Study: R. H. Swan. The
Golding - Bird Gold Medal and Scholarship for
Sanitary 8cience: S. Copley, fhe Treasurer’s Gold Medal
for Clinical Medicine: G. 8. Simpson-, and the Trea¬
surer’s Gold Medal for Clinical Surgery: C. T. Hilton.
This ceremony concluded, the treasurer moved a cordial
vote of thanks t* Mr. Gordon, which was seconded by
Dr. Pye Smith, F.R.S., senior physician, and supported
by Dr. Stevenson, senior lecturer in the medical school.
With Mr. Gordon's reply the proceedings in the theatre
terminated, and a garden party was then held in the
picturesque grounds of the hospital, the band of the
2nd Life Guards playing during the afternoon. The
hospital and school buildings were thrown open for in¬
spection, many of the large company present availing
themselves of the opportunity afforded.
Charing Cross Hospital Medical Echool.
In the absence of Lord James of Hereford, Sir Robert
Finlay, M.P., the Solicitor-General, distributed the
prizes and certificates awarded during the summer
session 1898, and the winter session 1898-99, to the
student*, at the above school, on Wednesday, the 5th
inst,
In his report for 1898-99 the Dean (Dr. Montague
Murray) announced that the winter session would be
opened in October with an introductory lecture by Dr.
Mitchell Bruce. He remarked that the school record
this year had been one of steady and continuous pro¬
gress. In 1897 the entries from all sources were 71.
This year they were 82, and when the new Hospital
Buildings are completed he had no doubt that the
increased clinical attractions would result in a
still larger number of entries. The New Dental Hos¬
pital ot London, in which the Charing Cross School was
much interested, had also progressed rapidly. Dr. Gallo¬
way had succeeded Dr. Arkle aa Assistant Physician to
the Hospital and Vice-Dean to the Medical School. Dr.
Hunter had been appointed Lecturer on Practical Medi¬
cine and Physician to the Electrical Department, and
Dr. Bosanquet had become Medical Tutor. Dr. Eden
had been appointed Assistant Obstetric Physician and
Tutor in Obstetrics and Gynaecology. The Council of
the Hospital had instituted the office of Bacteriologist to
the Hospital: and to this appointment, as well as that
of Lecturer on Bacteriology to the Medical School, Dr.
Eyre was unanimously chosen. At the Hospital. Mr.
Montgomery had been appointed Resident Medical
Officer, and Mr. Daniel, Surgical Registrar.
Boyal College of Burgeons of England.
The following gentlemen having passed the necessary
examinations have been admitted Licentiates in Dental
Surgery:—
Edward Faulkuer Ackery, Henry David Apperly, John Robert
Slade Ash, Liston Wheatley Dennett, Alfred Harold Bowkley,
Rol>ert Victor Britten, Edward Cardwell, and Harry Whitmore
Cntts, Percy Ernest Chandler, Samuel Sydney Doran. Frederick
English, Harold Arthur Thomas Fair bank. M.R.C.S.Eug.,
L.B C.P.Lond.; Emanuel Bower Marshall Frost, Archibald
James Gwatkin, John Walton Gibbons, Edward J. Fabian
Gillemand, Robert William Griffin and Cyril Henry Howkius,
Alfred David Hopkins, Ernest Robert Howlett and Arthur
Hughes, Harold Samuel Huggins John D. Dawson
Humbv, Alfred de Betharn Jenson, Sydney James KnVe,
John Mahoney, De la Hay Moores, Major Percival Nathan, Stephen
Holloway Olver, John Gerdes McAlpin, Herbert William Morris,
Percival H. Hayes Palmer, Frank Parlett, William de Courcy
Prideaux, Herbert Quinton, Thomas Edward Regan, Alfred Ernest
Rowlett, Thomas Francis Ryan, Richard John Rusaell, Frank Lyon
Shelton, Ernest Shrubsole, Sydney Colvin Smith, M.B.C.S.Eng.,
L. R.C.P.Lond., L.S.A.Lond., Lionel Taylor, Edgar Preston Uttley,
Frank Warlow, Eustace B. Lathbury White, John Albert Whitting¬
ton, Churles Frederick Witcomb, Thomas Herbert Vaughan,
und Herbert Gill Williams.
Twenty-eight gentlemen were referred to their professions
studies for six mouths and one for one year.
Univanity of Edinburgh.
The following candidates have passed the final profes¬
sional examination for degrees in medicine aud
surgery:—
Old Regulations.—John Brown, D. B. B. Hughes, Elsie M. Ingles,
D. J. M'Adam, Marion B. Marshall. I. J. van der Marwe, A. L.
Owen, Esther M. Stuart, Emily C. Thomson, Addie White.
New Regulations.— I vie Aird, Tina M‘Culloch Alexander (with dis¬
tinction), W. J. Baird, C. A. J. A. Balck, W. J. Barclay, B.A. (with
distinction). F. A. F. Bamardo, M.A.. E. F. Bashford, J. G. Bell,
P. J. Bodington, A. H. W. Boreham. G. A. Brogden, W. J. D. Brom¬
ley. E. A. Brown, G. H. J. Br'wn, Robert Bruce, J. M. Buist, D. A.
Callender, H. G. Carlisle, J. C. Carr, Morden Carthew, Lilian Mary
Cheen* v, C. S. Clark, H. E. Coghlan, W. J. Collinson, J. D. Comrie,
M. A., B.Sc. (with distinction). B. J. Courtney, R. M. Dalziel, Win.
Darling, M.A., S. M. Dawkins, T. A. Djedjizian, B.A., David
Ewart, WiUitm Ewart, W. R. Eyton-WiUiams (with distinction),
R. R. Fasson, H. Faulkner, David Ferrier, E. G. Ford, A. R. Fordyce,
J. J. Galbraith, A. B. George, M.A., H. A. H. Gilmer, B. K.
Goldsmith, J. H. Gordon. T. B. Gornall, F. J. Gray, St. L. H.
Gribben, A. H. Griffeth, George Haddow, P. W. Hampton, F. J.
Hathaway. G. G. Hay, A. C. Heath, P. H. Henderson, W. E.
Herbert, I. K. Hermon, H. T. Holland (with distinction! A. M.
Holmes, James Husband, Alice M. Hutchison, J.G. Jack (with dis¬
tinction), W. T. James, R. F. Jardin, John Jeffrey, W. J. Jones, J.
W. Kerr, D. B. King, M A.. G.*D. Laing, I . S. Lessing, T. H.
Livingstone, E. A. Loch, J. L. Louis, James Luckhoff, George Lyon
S with distinction), Elizabeth G. Macdonald (with distinction),
M. Macdonald, M.A., P. H. Macdonald, P. N. M. Macdonald.
W. J. M‘Farlan, John Macgregor, Kobina Macgregor, W. M.
Mockay, Maxwell MacKelvie, H. M. Mackenzie, T. C. Mackenzie,
P. A. Maclagan, L. C. Maclagan-Wedderhurn, T. D. MncLaren,
G. O. M'Leavy, L. W. Macpherson, A. G. Martin, E. W. Martin,
J. F. Martin, Ruth Massey, James Maseon, M.A., B.Sc. (with dis¬
tinction), J. W. Matthewson, B.Sc., E. T. Melhuiali, E. G. D.
Menzies, F. N. Menzies, G. H. Menzies, M.A., James Miller, B.Sc.
(with distinction), J. G. Mitchell, H. A. D. Moore, J. R Mumo,
J. A. Murray, B.Sc., W. A. Murray, B.A., A. W. Nankeivis, A C.
Neethling, T. P. Oates, James Orr, T. S. Orr, William Park, M.A..
F. M. Parry, W. M. Paul, M.A., A. S. M. Peebles. E. J.
Peill, Arthur Preston (with distinction), T. A. Price, R.
N. Pi ingle, S. C. Pritchard, J. M. Reid, William Reid,
M.A., C. M. Robertson, Thomas Rogerson, B. M. Rowe,
M.A. (with distinction), A. B. Shod, Sutherland Simpson, B.Sc.,
A. B. Sinter, V. E. Sorapure, Stephen Southall, H. B. Sproat,
Bernard Stracey, W. J. Stuart, M.A. (with distinction), W. W.
Thom, G. N. W. homas. J. A. Thompson, W. G. Thompson,
George Thomson, R. G. Thomson, A. K. Traill, R. B. Turnbull,
Alexander Tweedie, C S. Vartan, N. D. Walker, C. Heron Watson,
M.A., C. H. J. Watson (with distinction), Arthur Wbittome. Angus
Whyte, A. S. Whytock, M.A.. H. D. Wilson, A. H. Wood, and E.
M. Young.
Society of Apothecaries of London.
At the Primary Examination, Part I., held July oth
and 6th, the following candidates passed in: -
Biology.—J. Cretin, G. W. N. Stevens.
Chemistry.—J. Cretin. D. J. Lewis, D. A. Stepney, M. L. Tvler,
G. H. Watson, S. H. R. Welch.
Muterin Medics and Pharmacy.— C. C. Bernard, G. A. Crowe, A.
J. Nicholson, J. R. Pooler, D. W. Purkis, Z. Rowlands, H. M. S;.-
jeant, E. N. L. Wilson.
Preliminary Examination, Pait II., held July 3rd,
oth, and 6th. The following candidates passed in :—
Anatomy.—W. H. Cotton, G. M. Crockett, J. C. Curtis, K. A.
Dawson, W. C. D'Eath, S. R. Dudley, K. C. Edwards. C. D. E.
Forbes, B. H. Hirst, A. H. Hughes, M. E. Martin, T. 0. Miles, H.
Morrison, D. A. H. Moses, A. U. Parkliurst, C. M. Scott, L. G.
Simpson, G. B. S. Soper, C. J. Taylor, C. M. Woods.
Physiology.—C. H. G. Atkyns, J. A. Bartlett, C. W. S. Boggs,
H. R. Coomtes, G. M. Crockett, J. C. Curtis, K A. Daw on, W. C.
D'Eutli, K. C. Edwards, B. H. Hirst, A. H. Hughes, J. A. Kil-
f atrick, J. M. King, M. E. Martin, H. J. May, T. G. Miles, A. U.
arkhurst, G. Raymond, L. G. Simpson, W. A. G. Stevens, R. W.
1 Taylor.
52 The Medical Pbess
NOTICES TO CORRESPONDENTS.
July 12, 189®.
fiotitlB to
ftorregpmtbeitts, Short ^Letters, &c.
MT 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,” 4c. Much confusion will be
spared by attention to this rule.
ACCEPTED PAPERS .AND CASES.
The following are unavoidably held over the present issue, and
will appear in due course
Hematuria from Healthy Kidneys. By Thos. Myles, F.R.C.S.
The de Novo Origin of Syphilis. By John A. Shaw-Mackenzie,
M.D.Lond.
Monistic Physiology. By ffm. E. MacDermott, M.B., T.C.D.
Cases of Ptomaine Poisoning Following the Ingestion of
Meat. By G. Burbidge White, M.D., F.R.C.S I.
Sleep, Sleeplessness, and Hypnotics. Abstract of theC'Oonian
Lecture. By J. B. Bradbury, M.D.Cantab.. F.R.C.P.Lond.
The Innervation of thb Heart. By Prof, von Leyden, M.D.
Translation by Wm. Dodd.
Some Recent Medico-Legal Cases. By W. J. Johnston,
Barrister-at-Law.
Pyrexia During Convalescence from Typhoid Fever. By
Prof. Potain.
Recovery After the Injection of Antistreptococcus Serum.
By Skene Keith, M.B., F.R.C.S.Ed.
Cheltenham.— In answer to your qu ry, the hot air apparatus
mentioned in our note last week on “ Hot Air Baths in Work-
houses ’’ was Tallerman’s. So far as we can learn all other appara¬
tus upon the market are simply variations and imitations of his
original patent. The therapeutic value of thia form of heat appears
to be scientifically established.
LONG r. STOCKER.
We have received from Dr. Hugh Woods, Hon. Secretary of the
London and Counties Medical Protection Society, Limited, a
summarised report of the action for alleged malpraxis brought
agiinst the defendant. Dr. W. W. Stocker, of Kilburn, by a woman
who had been treated by him for an injury to the hand. While we
heartily congratulate Dr. Stocker on his successful defence we are
unable to discuss the matter for want of sufficiently explicit details
in respect of the case for the plaintiff.
G. P.- The taking of snuff has been highly recommended as n
valuable means of stopping a persistent hiccough, and the act of
gnrgling has also been found very useful.
P. P. B. (Leeds).—Several communications and marked copies
of newspapers have reached us referring to the subject of our
correspondent's letter, and we shall comment upon the facts in
our next issue.
A Parent.— No sterilising apparatus can be trusted to render con¬
taminated or decomposed milk a healthy article of diet. So-called
sterilisation, it is true, will Becnre the destruction of all living
germs, but it does not free the milk from the soluble toxins due to
their presence, and such milk, even after sterilisation, is a fertile
source of gastro-enteritis u infants. Sterilisation, in other words,
may keep fresh milk sweet, but it will not make bad milk good.
R. O. M.—It is much simpler and better to send your specimens
to a laboratory for examination and report. Bacteriological research
requires much time and no small amount of skill and experience.
Failing the latter your conclusions, whatever their tenour, will be
untrustworthy. In respect of infectious diseases, many local autho¬
rities now undertake to defray the cost of the bacteriological control
of the diagnosis.
fteamries.
Brighton, Hove, and Preston Dispensary (Western Branch and
Cottage Hospital), Queen’s Road, Brighton.—House Surgeon.
Salary £120 per annum, with board and residence.
Coleraine Union.—Medical Officer for the Protestant Dispensary
District. Salary £75, exclusive of vaccination and other fees.
(See Advt.)
• County Asylum, Prestwich, Manchester.—Junior Assistant Medical
Officer, unmarried. Salary commencing at £125 per annum,
with apartments, board, attendance, and washing.
Durham County Hospital, Durham.—House Surgeon for one year.
Salary £100 per annum, and board and lodging.
Fisherton Asylum.—Assistant Medical Officer. Salary commencing
at £120 per annum, with board, lodging, and washing. Apply
to Dr. Fmch, The Asylum, Salisbury.
Govan District Asylum, Crookston, near Paisley, N B.— Junior
Assistant Medical Officer. Salary £100 a year, with furnished
rooms, board, laundry, and attendance.
Great Northern Central Hospital, Holloway.—House Surgeon for
six months. Salary at the rate of £00 per annum. Board,
lodging, and washing provided in the hospital.
Great Yarmouth Hospital.—House Surgeon. Salary £90 per
annum, with board and lodging. Wines, spirits, beer. Ac., not
found.
Liverpool Dispensaries, Moorflelds, Liverpool.—Assistant Surgeon,
unmarried. Salary £100 per annum, with board and residence.
London County Asylum, Bexley, Kent.—Assistant Medical Officer
(male).—Salary £150 per annum, with board, furnished apart¬
ments, and washing. Applications to the Clerk, Asylums
Committee, 6, Waterloo Place, London.
Lunntic Hospital, The Coppice, Nottingham.—Assistant Medical
Officer, unmarried. Salary £160 a year, with apartments, board,
attendance, and washing.
Roxburgh District Asylum, Melrose.—Assistant Medical Officer.
Salary £100 per annum, with furnished quarters, board, wash¬
ing, and attendance.
Royal Cornwall Infirmary, Truro.—House Surgeon, unmarried.
Salary £120, with furnished apartments, fire, bght, and attend¬
ance.
St. Pancras and Northern Dispensary. Euston Road, London. -
Resident Medical Officer, unmarried. Salary £105 with resi¬
dence and attendance. Applications to the Hon. Sec., 23,
Gordon Street, Gordon Square.
West Sussex County Asylum, Chichester.—Junior Assistant
Medical Officer, unmarried. Salary commencing at £100 per
annum, with furnished apartments, board, attendance, and
washing. _
appointments.
Batten, R. W., M.D.Lond., F.R.C.P., Con-lilting Physician to
the General Infirmary and to the Eye Institution at Gloucester.
Bucher, J. Howard, pro. tem. Medical Officer and Public Vacci¬
nator for the No. 2 District of the Bodmin Union.
Forster, Frf.dk. C., M.R.C.S., L.R.C.P., House Surgeon to the
Royal United Hospital, Bnth.
Foster, P. t M R.C.S . L.B.C.P., Assistant Resident Medical
Officer to the National Hospital for Consumption, Ventnor.
Griffith, A., M.D.Lond., M.D. (State Med.), Medical Officer of
Health for the Borough of Hove. Brighton.
Haigh, Haroi.d, M.A.Cantab., M.R C.S., L.R.C.P., Medical Officer
to the Convalescent Home, near Huddersfield.
Hanlt, Johji Joseph, M.A.R.U.I., L.R.C P., L.R.C.S.Ed.. Medical
Officer for the Second District of the Shepton Mallet Union.
Harris, H. Elwin. M.B.Cantab., F.R.C.S.. Surgeon to Out-patients
at the Bristol Royal Hospital for Sick Children and Women.
Hutchinson, F. A. S., L.R.C.P Lond., M.R.C.S, pro. tem.
Medical Officer and Public Vaccinator to the Dnnmow Unirn.
Lrc», Richard Harman, M.A., M.B., F.R.C.S., Honorary Surgeon
to the Derbyshire Royal Infirmary.
Markbt, Herbert, M. R.C.S., L.R.C.P.Lond., House Surgeon to
the Chester General Infirmary.
Morgan. D. Naunton, L.R.C.P.Lond., M.R.C.S., Medical Officer
for the new district of Gilfach Goch, Bridgend.
Robertson, William. M.D.Glasg,, D.P.H., Medical Officer of
Health for the Burgh of Paisley.
girths.
Brock. —On July 6th, at 115, Adelaide Road, London, the wife of
J. H. E. Brock, M.D., F.R.C.S., of a daughter.
Falla. —On July 4th, at Adelaide Lodge Jersey, the wife of
Walter Falla, M.R.C.S., L.R.C.P.,of a daughter.
Smith.— At Forres on July 5th, the wife of Colvin B. M. Smith,
M.B., of a son.
Carriages.
Ballingall- Bonner.—O n July 6th, at St. Paul’s Church. St.
Leonards-on-Sea, George Anderson Ballingall, M.A., M.D., of
St. Leonards-on-Sea, and of Altamont, Blairgowrie, N.B., to
Mary Lilian Elsie, youngest daughter of the Rev. J. Tillard
Bonner, of St. Leonards-on-Sea, late Rector of Stanwick,
Northants.
C 01 field — Burn. —On July 5th, at St. Stephen’s, Clapham,
Edward Carruthers Corfleld, M.R.C.S.Eng., L.R.C.P., and
L.S.A.Lond., of Upper Tooting, to Helen Beatrice, only
daughter of William Barnett Burn, M.D.Lond., B.Sc.Lond., of
Balham.
Jennings—Toward. -On July 5th. at All Saints' Church, Margaret
Street, London, W., B. E. W. Jennings. M.R.C.S., L.B.C.P.
Lond., to Eileen, seoond daughter of the late W. E. Toward,
of Ncwcastle-on-Tyne.
Pilcher Sopthah. On July 5th, at the Abbey Church, Shrews¬
bury, Cecil Westland Pilcher, B.A.Oxon., L.R.C.P., M.R C.S.,
son of the late W. J. Pilcher. F.R.C.S., J.P., of Boston, Lin¬
colnshire, to Evelyn Mary, daughter of S. Clement Sontham,
F.S.A., F.R.G.S., of Shrewsbury.
8hepherd-Brushfield.— On July 6th, at St. Luke's Church,
Balham, Timothy Arundel Jordan Shepherd, M.R.C.S.E., L.S.A.,
of Moldgreen, Huddersfield, to Rosiua Mary, eldest daughter
of Thomas Nadauld Brushfield, M.D., F.S.A., of Budleigh
8alterton, Devon.
Wedd—Draper. -On July 1st, at St. James's Church, Blackheath,
Gilbert Wedd, M.A., M.D.Cantab., >on of John Wedd, of Man¬
chester and Wilmslow, to Bessie, daughter of George Draper,
F.R.G.S., Blackheath, London.
deaths.
Congreve.—O n July 5th. at Hampstead, Richard Congreve, M.A.,
Honorary Fellow of Wad ham College, Oxford, M.R.C.P.Lond.,
aged 80.
Davies. - On July 3rd, suddenly, at Caswell Bay Hotel. Mumbles,
8wanaea, Henry Naunton Davies, J.P., Surgeon, of Glyn
Rhondda House, Porth, Rhondda Valley. South Wales, aged 71.
Flower.— On July 1st, at his residence. Stanhope Gardens, Sir
William Henry Flower, F.R.C.S.Eng., K.C.B., nged 67 yeari.
Girdlestone.— On July 6th, suddenly, at Sunningdale. Berks, T.
Mountain Girdlestone, F.R.C.S.. late of Melbourne, aged 76.
Heard.— On July 1st, at Pentreve, Hunmanby, Yorkshire, Charles
Goodridge Heard, M.R.C.S., L.S.A., aged 47 years, eldest sur¬
viving son of Edward Goodridge Heard, J.P , of Truro.
Richards. —On July 5th, at CoUyhurst, Manchester, suddenly,
Arthur Izod Richards, M.R.C.S., aged 36, younger surviving
son of the Rev. G Richards, D D., of Ealing.
Slipper. —On July 9th. at Brighton, Thomas Clipper, M.R.C.S.,
L.S.A., of West Croydon, aged 87.
Dig
She §Wdical |hm mid Circular.
“SALUS POPULI SUPREMA LEX”
VOL. CXIX.
WEDNESDAY, JULY 19, 1899. No. 3.
Original Communications.
RECOVERY AFTER THE INJECTION
OF
ANTISTREPTOCOCCUS SERUM.
By SKENE KEITH, M.B., F.R.C.S.Ed.
The recovery of a patient after the injection of
the antistreptococcus serum is still probably of
interest to many. In March last I was consulted by
an Austrahan lady, set. 46, an old patient of my
fathers, from whom he had removed an ovarian
tumour some eighteen years ago. She said that she
had been having for some time great monthly losses.
Un examination the cervix was found to be very
hard, deeply lacerated, and slightly irregular on the
surface. Visual examination showed a large, torn
and eroded cervix. As I was afraid that the case
might be one of commencing malignant disease I
asked her to come again. In the meantime she had
a period so severe that the loss had to be checked by
the injections of hot water. After it was over the
cervix was found to be more healthy and softer, and
a scraping from the interior of the uterus, examined
microscopically, showed simply chronic catarrhal
endometritis.
I advised curetting, and Emmet’s operation, and
performed the two operations on the 2nd of May.
Hoth lips of the cervix were full of cysts, and I had
to cut far up into the angles, but did not open into
the cellular tissue.'
The patient was perfectly well the next evening,
but woke next morning feeling chilly. The tem¬
perature was 102 6 degs., pulse 120. These attacks,
never being more than feeling cold, recurred once
every day at gradually lessening intervals, until the
•“ft ™ en there were two within twelve hours.
Ihe highest temperature was on the fourth day,
viz., lOo degs. in the mouth. Between the attacks
the patient felt very well, and the pulse and tem-
Ifreture came down. The “ period ” came on on the
third day, there was no odour whatever.
,,.™ ( i evening of the sixth day the temperature
was103 degs., pulse 160, and the two drugs which had
up to that time answered best—antitoxin and stro-
pbanthus—seemed to have lost their effect. The
P*t^t was evidently going to die, if nothing were done
and the only two remaining possibilities were wash¬
ing out the uterus or injecting the antistreptococcus
serum. I was loath to wash out for fear of checking
P^od. Instead, the serum, 10 c.c. was injected.
Ihe next bad turn was delayed for eighteen hours,
it was not so serious as the previous one, 10 c.c. in¬
jected again. The patient kept well for sixty hours,
when as there was a slight chill, a third injection was
““de. A fourth injection was given after an interval
of eighty-four hours, making much improvement. This,
my brother, who had watched the case with me, and I
were not much surprised at, as we thought that
absorption was now going on from the intestine, and
a good result after a dose of calomel strengthened
this view.
The life of the patient was undoubtedly saved by
these injections, but she might also have lived if the
uterus had been washed out, for though there was no
odour while she was very ill, there was a slight offen¬
sive discharge for one day at the end of the first
fortnight.
While this leaves some doubt still it is certain that
the serum saved the patient, and that it was very
much safer treatment tnan washing out would have
been under the circumstances.
DECIDUOMA MALIGNUM?
A CRITICAL REVIEW FROM A CASE
SUCCESSFULLY TREATED BY
VAGINAL HYSTERECTOMY, (a)
F. W. N. HAULTAIN, M.D., F.R.C.P.E.,
Lecturer in Obstetrics, Edinburgh School of Medicine.
(Concluded from page 31.)
From the appearance presented by the specimen
before us it must be evident that the term deciduoma
is quite untenable. One is therefore constrained to
consider whether we have to deal with an entirely
different neoplasm from that originally described by
Siinger in 1889, the designation of which has been
adopted by many other observers, or whether we
have to deal with a similar growth whose histogenesis
is differently considered. Siinger has depicted (in
drawings) cells bearing the spindle t shaped ap¬
pearance of decidual elements, and there is also
shown a slight intercellular fibrillar stroma. At the
same time, however, he described large multi-
nucleated protoplasmic masses, which have all the
appearance of syncytial origin. If this be so we have
a tumour derived from connective tissue (decidua)
and epithelium (syncytium); in other words, a mixed
sarcoma and carcinoma, which is improbable ! Nay,
more, if the latest histological descriptions of the
origin of the syncytium be right, which I personally,
from my own investigations, have no doubt of, viz.,
that the syncytium is of fcetal origin ; according to
Siinger, we have to deal with not only a mixed tumour
as regards structure, but the individual elements are
derived from different sources, fcetal and maternal.
It is possible, therefore, that in Siinger's specimen
the so-called decidual elements are merely the cells of
Langhan'8 layer elongated and transformed by pres¬
sure, as shown by Teacher in his most able and com¬
plete description of a similar condition. Indeed, from
the appeai-ances presented by almost all succeeding
observers one cannot help but maintain that the cases
show a certain uniformity of structure which suggests a
coincidence with the appearances presented in my case,
whatever their origin may be considered to have been.
All the earlier recorded cases suffered from the
absence of chorionic villi, and naturally the origin of
the cells was more or •. less hypothetical until
Marchand was able (from a case which showed villi
with actively proliferating epithelium) to demon¬
strate the origin of the malignant elements from these
epithelial layers. The appearances he demonstrated
are identical in every detail with the case I have
described.
(o) Paper read and Demonstration jfiven before the British
Gynacolotfical Society, June 8th, 1899. For discussion see potto b.
No. for July 5, 1899.
Digitized b'
Google
54 Th* MbDICAL PrB88.
ORIGINAL COMMUNICATIONS.
July 19, 1899.
Sanger’s theory, that the new growth arose from
placental tissue, and was a decidual sarcoma, at once
gave rise to much discussion and diversity of opinion.
The essential characteristic of the neoplasm asserted
by him—viz., “ that it owed its origin to an imme¬
diately pre-existing pregnancy,” was at once assailed
by some observers who considered the growth to be
an ordinary sarcoma. In support of this opinion the
following arguments were adduced:—First, preg¬
nancy could not be proved to have pre-existed in
each recorded case; secondly, sarcomata of similar
structure with multinucleated masses were known
to occur, and were demonstrated by Eden and Kan-
thack from a tumour of the testicle; and, thirdly, the
role of the malignant cells corresponded with those
of a sarcoma in so far as they tended to be dissemi¬
nated by the blood stream. Each and all of these
arguments may be fully met. In the first place,
though it cannot be proved that all recorded cases
had immediately previously been pregnant, neither
can it be proved that they were not, in fact as yet
no deciduoma has been described as occurring with¬
out the child-bearing period.
As regards the structure of the tumour, though it
must be admitted that multinucleated masses are
frequently met with in sarcomata, as yet in no other
new growth but the deciduoma has there been shown
■branching reticulated processes of protoplasm as
seen in Fig 6.
The rfile of the malignant cells in their dissemina¬
tion by the blood stream, on first impressions dis¬
poses one to consider we have to deal with a growth
of connective tissue origin, but if it be borne in mind
that the special physiological feature of the chorionic
-epithelium is to burrow into blood spaces, an
extremely strong argument is adduced as to the
epithelial prototype of the tumour in question.
Further, as has been shown by Teacher, there is
undoubted evidence of lymphatic infiltration also.
The main upholders of the sarcoma theory have
laboured under the disadvantage of not having ob¬
served a case with proliferating villi, and have thus
bad merely the structural appearances of the malig¬
nant cells to rely upon ; and if, as is well known, it is
impossible to distinguish a given embryonic epithelial
<•611 from that of connective tissue origin, arguments
from this point of view must be of little value if not
upheld by other influences which, so far, are
wanting.
Veit, in supporting the sarcomatous origin of the
growth, suggests its modification by pregnancy, but
brings forward no arguments of weight in support of
bis theory.
Gottacbalk has described the growth as a cliorio-
sarcoma, and believes it to arise from the stroma of
the villi. So far he stands alone. His arguments on
behalf of this contention are by no means powerful,
sind when taken in connection with his drawings and
their descriptions do not lead one to seriously con¬
sider the hypotheses of much count.
Whitridge Williams has carefully described a case,
and considers the growth to be formed by syncytium
only. It is possible in his case this may nave been
•o, other observers, such as Nov^-Josserard, and
Lacroix, having described similar appearances. I
have also noted in certain sections of my tumour a
total absence of individual cells where the syncytium
lone seemed actively proliferating.
Marchand, Gebhard and others have described
tumours in every way identical with my own, and
unhesitatingly ascribe the origin of the malignant
cells from both layers of the chorionic epithelium. In
this Teacher fully coincides, though in nis case there
was no evidence of villi in the tumour.
With such an array of divided opinions as regards
the origin of the growth it is only to be expected that
a universally accepted nomenclature is impossible.
The current of opinion of the most recent observers
and authors on tne subject, with the exception of Veit,
seems to be towards its epithelial formation. But.
again, a generally accepted nomenclature is frustrated
on account of the vexed question of the origin of the
syncytium from maternal or foetal structures.
According to Gebhard, who believes in the maternal
origin of the syncytium, the growth is a mixed carci¬
noma of maternal and foetal structures; while
Marchand, who maintains that both epithelial layers
of the villus are foetal, designates the tumour as a
chorio-epithelioma. In this latter view I most un¬
hesitatingly acquiesce, and agree with the opinion ex¬
pressed by Hart and Gulland, and Peters, in their
convincing and exhaustive works on the development
of the placenta. From personal investigation I have
based my opinion on the following grounds :—
1. The absence of syncytium everywhere, except in
close relationship to villi, as, for example, its absence
on the decidua vera and the decidua lining the uterus
in ectopic gestation.
2. Its absence in toe intervillous portions of the
chorion.
3. The absence of general syncytial change in the
glandular epithelioma.
Analogies from demonstrations of its maternal
origin from the placenta of lower animals must be
considered fallacious, when one recollects not only
the absence of uterine menstruation in such, but also
the variations in similar types of animals themselves.
The designations of the growth therefore, which to
my mind seems most acceptable, are those of
Marchand and Kanthack, viz., chorio-epithelioma and
trophoblastoma, respectively ; a nomenclature which,
at least in my case, seems correct and conveys to the
mind the true character of the neoplasm.
Clinical Features.
From a clinical standpoint the disease may be said
to show itself in the majority of instances by the
appearance of extremely profuse intermittent uterine
haemorrhages, during the intervals of which there is
usually a slight sero-sanguinolent ooze. These sym¬
ptoms occur in most cases within a few weeks after
the gravid uterus has been emptied of its con¬
tents, and more particularly should the gesta¬
tion have been a myxomatous mole. In a
few cases (Lohlein, Runge, and others) the bleed¬
ing has not been noticed for many months
after labour or abortion, but it is doubtful whether in
these instances the patient had not, in the interval,
been again pregnant and cast off an early ovum. As
a rule the heemorrhage is so severe as to reduce the
patient to a condition of intense anaemia, and may
even be immediately fatal. In due course there is an
extremely foetid watery discharge, which may be
associated with toxic constitutional symptoms of a
septic nature, and give the patient a distinctly
cachectic appearance. As the disease advances
metastatic deposits may be found in the vagina,
cervix, or surrounding pelvic structures, and in
many instances death is directly due to pulmonary
embolism from the dissemination of the malignant
cells through the blood channels.
Naturally, as a disease associated with preg¬
nancy, it is met with only during the child¬
bearing period of life, a point of considerable
importance in the histogenesis of the tumour.
A case at the age of 56 is recorded by Meyer,
but here an undoubted myxomatous mole was ex¬
pelled four months previously, and, as is well known,
myxoma of the chorion is specially prone to occur in
elderly women when sexual activity is on the wane.
The youngest case recorded was in a girl of 17, the
growth arising from a tubal pregnancy (Marchand).
The average age of the cases recorded is 31 years.
In a few cases only has the growth followed a full
Die
oogle
July 19, 1899.
ORIGINAL COMMUNICATIONS.
Th* Medical Press. 55
time pregnancy, the great majority being noted after
abortion and myxomatous chorion. A clinical fact
which might be inferred from a study of the histo¬
genesis of the tumour, as it is an accepted fact that
in the later months of pregnancy there is little or
no activity in the epithelium of the chorion.
m - *■
m
PUP
jr IO 9 —Pulmonary metastasis from from Dr. Teacher's
case showing both varieties of cellular elements. (P)
Protoplasmic processes. (C) Individual cells.
Diagnosis .—In most instances, as has been shown,
there are usually sufficiently early marked symptoms
associated with the disease to warrant a suspicion of
its presence and indicate a careful investigation.
Thus the history of a pre-existing pregnancy
(specially a myxomatous mole), followed shortly by
profuse intermittent hoemorrhages and a persistent
watery discharge, should in all cases demand not only
a thorough curettage of the uterine cavity, but a
careful microscopic examination of the removed
fragments.
Should no evidence of malignant disease be found
in the scrapings, and the haemorrhages return,
thorough dilatation of the uterus must at once be
carried out, and the cavity explored by the finger.
The growth in the earlier stages may be mistaken
for an cedematous fibroid nodule but from the fact
that it has a friable, ulcerated area which bleeds
freely it can be easily distinguished. Portions of
the tumour can be detached by the finger nail,
and examined microscopically, but this is almost
unnecessary, as the presence of the growth is
sufficient to warrant a correct diagnosis. Micro¬
scopic examination of the scrapings will show
large, nucleated cells, and multinucleated proto¬
plasmic masses (Fig. 1), the latter are pathogno¬
monic.
Cases with the marked symptoms recorded offer
now no excuse for mistaken diagnosis, recurrent hae¬
morrhages after curetting must not be temporised
with, and repeated curetting is to be earnestly
deprecated. Unfortunately, however, there are
recorded a few cases in which through the
depth of the origin of the growth in the uterine
wail, hoemorrhage as a symptom is totally absent, as
in the case described by Whitridge Williams, where
the first evidence of the disease was metastatic deposits
in the vagina and lungs. Early diagnosis of these cases
seems to be impossible, there - being no uterine or
pelvic discomfort to indicate any abnormality. For¬
tunately such cases are rare, and there are but few in
which a prompt diagnosis cannot be made, which is so
essential for the efficient treatment of the disease and
upon which the patient's life hangs.
Prognosis .— Without treatment of a radical kind
the prognosis is absolutely fatal, death occurring in
the majority of instances within six months. By
reason of this rapidity it may be considered the most
malignant of all known tumours. A few cases have
been more chronic in their course, as for example in
Lohlein’s successful case in which the uterus was not
extirpated till more than a year after the symptoms
developed. The causes of death are excessive haemor¬
rhage, septic absorption and the development of
metastases, which, in the majority of instances,
are pulmonary.
vaginal metastases are also frequently present.
The presence of metastatic deposits, though seriously
affecting the chances of the patients recovery, are not
necessarily of fatal moment. Thus, in the cases of
Lonnberg-Manheimer and Freund, vaginal deposits
were present, yet the patient remained well after
hysterectomy. Cazin found a metastasis in the
right oyary, yet the patient was well three years
after removal of the uterus and ovary.
Even authentic cases have been recorded by
Chrobak and Von Franque, where, in spite of evi¬
dence of pulmonary emboli as shown by hremorrhagic
sputum and other symptoms, complete recovery
has eventually taken place. These cases are un¬
doubtedly difficult to understand, but may, I think, be
accounted for by the peculiar character of the
malignant cells, which, as examination of my tumour
clearly showed, grow only in free. circulating blood
and rapidly degenerate and die in extravasated blood.
It is possible, therefore, that the cells in the metastasis
may, from giving rise to free extravasations cut off
that free circulation which is so essential for their
continued activity, and rapidly die. In this way only
can Veit’s interesting case be accounted where a
secondary deposit developed in the right iliac fossa,
and eventually disappeared. After complete removal
of the uterus, before metastases have formed, the
prognosis is distinctly favourable. I have been able
to collect 30 recoveries out of the entire 90 cases I can
find recorded, many of which were not operated upon;
After complete hysterectomy secondary growths
have been known to form, and the patient
die six to nine months after the operation
as in Morison’s case. These have, however,
all been operated upon after a long period of tem¬
porising in the form of curetting, uterine plugging,
and cauterisation. Naturally, the earlier a case is
operated on the better the chances of success. There
can be little doubt, therefore, that through profiting
from the mistakes of others, to whom, as pioneers, we
are much indebted, the diagnosis will, as a rule
be much more easily made, and prompt radica.
me&sures earlier pursued.
Treatment .—This may be summed up in the word
hysterectomy, anything short of this is culpable.
Repeated curettings cannot be too severely deprecated
as lias already been stated when referring to the
diagnosis. Many recorded cases are a warning
against indecision and delay. These are found among
the earlier cases, and are excusable; now, however,
with the light of experience, there is no excuse for
similar records in future.
I must not conclude without expressing my deep
sense of indebtedness to the Edinburgh College of
Physicians’ Laboratory, where I have been permitted
to make these investigations, and from the officials of
which I have derived much valued help, and in
| particular to Mr. Hume Paterson for the accurate
micro-photographs he has made.
The Japanese Government has decreed com-
polsory vaccination throughout the kingdom. We
assume that the local Pooh-Bah will take care of the
Japanese conscientious objector.
D
by Google
56 The Medical Press* ORIGINAL COMMUNICATIONS. July 19, 1899.
A COUNTRY HERBALIST’S CURE
FOR THE «KING’S EVIL.*’ (a)
By JOHN KNOTT, M.A., M.D., and Dip. Stat.
Med. (Univ. Dub.); M.R.C.P.I.; M.R.I.A.; &c., & c.
(Continued from page 34.)
“ Of Medb-Sweet ; or Queen of the Meddows.
“ 1. The Names. —It is thought to be unknown to
any Ancient Greek or Latine Authors: but later
Writers calls it Ulmaria, a foliorum Ulmi Similitu-
dine, from its likeness to Elme leaves; in English,
Mede-Sweet, Meddow-Sweet, and Queen of the Med¬
dows.
“ 2. The Kinds. —There are two Species hereof,
viz., 1. Ulmaria Vulgaris ; Regina Prati Dodonaji:
Barba, vel Barbula Caprse, or Barba Caprina Tragi;
Barba Capri Fuchsii : Barbi Capra Lotelii : Meae-
susium Cordi, our common Mede-Sweet, or Meddow-
Sweet : some have thought it to be Rodora Plinii, but
this cannot be positively affirmed : Tragus thought
it might be Picnocomon Dioecoridis, as did also, Ges-
ner m hortis & Loniceris. 2. Ulmaria Major sive
altera, Potentilla Major Prima Anguillane; Argentina
major Thalii, The Greater Mede-Sweet, or Meddow-
Sweet. Lugdunensis save, some took ittobeMelan-
drum Plinii, and some call it Drymopogon. Camerarius
savs the Germans call the first Worm-Kraut, Worm-
Wort, because, says he, the Root is often found as if
it were eaten by Worms: but it is more likely, from
its curing Horses of the Botte and Worms, for which
purpose the Country people used it.
“The Descriptions.
“3. The First, or Our Common Mede-Sweet. —
It has a Root which is somewhat Woody and blackish on
the outside, and brownish within, with several greater
Strings, and lesser Fibres adjoining; of a strong
smell, but nothing so pleasant as the Flowers or
Leaves ; it perishes not in Winter, but abides many
Years, shooting forth anew every Spring. Its stalks
are reddish and easy to break, rising to be 3 Feet
high, and sometimes to 4 or 5, having at the Joints
thereof large winged leaves, standing above one
another at Distances; which are made of many some¬
what broad Leaves set on each side of a middle Rib,
being hard, rough, or rugged, and crumpled much like
to Elme Leaves, from whence it took its Name; but
having also some smaller leaves with them, like as
Agrimony has, something deeply dented about the
edges, of a sad green color, on the upper side, and
greyish underneath; of a pretty sharp smell and
taste, very like unto Burnet; and will no less give a
fine relish to a Glass of Wine, if a few leaves thereof
be put therein. At the tops of the Stalks and
Branches, stand many tufts of small white Flowers,
thrust thick together, which smell much sweeter than
the Leaves, which being fallen, in their places come
crooked and coloured Seed, crookedly turning or
winding one with another, and so making a fine
little Head.
“ 4. The Second, or Greater Mede-Sweet, or
Meddow-Sweet.— The Root of this is more woody
than the former, with many blackish strings, which
smell very strong, and taste somewhat harshly. This
Plant grows higher th:-n the former, with longer
winged Leaves, set one above another upon the
Crested brownish Stalks, having long foot Stales
supporting them ; each being usually divided into
three parts, the two lowest one against another; and
every part also consisting of three or five smaller
Leaves than the other, separate each from the other,
being hard, crumpled and firmly dented about the
edges, at the tops of the Stalks grow the Flowers in
(a) An abstract of this paper was read in the Medical Section of
the Royal Academy of Mwiicine in Irelind on Nov. 18th, 1898.
longer Spikes, more sparedly and not so thick thrust
together, turning down their Heads, which are-
white like the former, and smelling very sweet also,,
more nearly resembling a Goat’s Beard (which Name
some authors have given to it) than the first kind
here described. Gerard says it has leaves of the big¬
ness of Wild Angelica, and grows somewhat after the-
manner of Wild Angelica; that the stalks are crested
and divided into several Branches, which carry long
bending Spikes or Ears of white Flowers or Seeds,,
each single Flower and Seed being something like
the former.
“ 5. The Places. —The first grows in moist Medows-
which be much wet, or near Watercourses, as the
sides of Rivers, and watery Ditches, almost every¬
where. The second grows in Woods, Copses, and
shady places in Germany and other countries, but
here in England, only in Gardens.
“ 6. The Times.— Theyarefound in Flower through-
all the three Summer months, viz., June, July,,
and August, and their Seed is ripe in some short
time after.
' “ 7. The Qualities. —Mede-sweet is temperate in-
respect to heat or oold, but dry in the first Degree-
Abstersive, Astringent, and Traumatick or Vul¬
nerary ; Cephaliek, Neurotick, Stomatick, and
Hysterick.
“8. The Specification. —It stops Bleeding and.
cures Fluxes of the Bowels of all sorts, stops the
Whites and Terms in Women, and gives ease m the
Colick and Gripings of the Guts. And heals-
Wounds and old Ulcers.
“ 9. The Preparation —You may make fron*
either Flowers, Leaves, or Root, or from all of them-
1. A Liquid Juice. 2. An Essence. 3. A Decoction
or Infusion in Wine. 4. A Powder. 5. An Oil. 61
An Ointment or Balsam 7. A Cataplasm. 8. A
Distilled Water. 9. A Spirituous Tincture. 10. An
Acid Tincture.
“The Virtues.
“ 10. The Liquid Juice. —It stops all sorts of
Fluxes, Bleedings, and Vomitings, as also the over¬
flowings of the Terms in Women, and the Whites.
It is said to alter and take away the fits of Quartans
Agues, eases the Gripings of the Guts and moves the
Belly downwards. Outwardly applied it heals old
Ulcers, whioh are cancerous or eating, and fills up
fistulouB or hollow Ulcer* with Flesh, and cures
Sores in the Mouth and secret parts. Dose from 2
to 6 spoonfuls Morning and Night, or oftner in any
Convenient Vehicle.
“11. The Essence.— It las the Virtues of the-
Juice, and is more powerful to all the Intentions
before specified, and is only to be given from 1 to 3
or 4 Spoonfuls in any proper Liquor, Morning and
Night. It is Cordial and very much Cheers the-
Heart.
“ 12. The Decoction or Infusion in Wine.—
They have the Virtues of the Juice and Essenoe,.
but may be given from 2 to 6 or 8 Ounces, sweetened
a little with white Sugar: It is very Stomatick,
strengthens the Bowels, and causes a good Appetite-
“ 13.—The Powder.— It has the Virtues of the-
former Preparations, taken from half a Dram to a
Dram in any proper Vehicle; if mixt with Hony
and taken, it is good against Coughs-, Catarrhs..
Colds, Wheezings, Hoai-sness, Shortness of Breath,,
and difficulty of breathing. Strewed plentifully upon
old, moist, and running Sores and Ulcers,, it dry*
them, and induces a speedy healing; it is also said
to kill Worms in Children.
“ 14. The Oil by Insolation or Boiling.—I t
eases Pains being applyed, and strengthens weak
Joints, which have teen lately Set, or when the
Bones have been Broken.
“15. The Ointment ok Balsam. —It digests,.
ed by Google
July 19, 1899. ORIGINAL COMMUNICATIONS. The Medical Press. 57
SLEEP, SLEEPLESSNESS, AND
HYPNOTICS, (a)
cleanses, and induces the healing of old running
Sores, putrid Ulcers, Fistula's and the like, and
breeds Flesh when it is wanting. Apply'd to parts
or Joints pained with the Gout, it eases them.
** 16. The Cataplasm, —Made of the green Herb
and laid upon the Skin, it will in a small time (as
Tragus says) raise Blisters thereon. Apply'd imme-
mediately to the Biting of a mad Dog, or Stinging
of a Soorpion, Hornet, &c., it draws out the Poyson
and gives ease.
“ 17. The Distilled Water. —It has the Virtues
of the Juice, but nothing near so powerfull
and being dropt often into the Eves, it eases their
pain, and allays their Heat and Inflamation. It may
also serve as a Vehicle to take some of the other
Preparations in.
“ 18. The Spiritdoub Tincture. —It is Cordial,
strengthens the Stomach and the Bowels, stops
Fluxes of all kinds, causes an Appetite and good
Digestion, and is profitable against inward Bruises,
and gives present ease in the Colick.
“ 19. TheAcidTincture. —It mightily strengthens
the Stomach, and causes a good Appetite,
and stops Vomiting tho’ of long continuance.
It may be taken in all the Patient Drinks, whether
Ale, Beer, or Wine, so much at a time as to give the
Liquor a pleasing sharpness; and that as well at
Meals, as between Meals.
In the year 1735 there was published in Corke a
small volume, “ Botanologia Universalis Hibernioa,”
the work of a western Irishman, J. K’eogh, who was
bom and educated in the same Sh&nnonside district,
and who cultivated the bye-paths of Medicine in the
intervals of his professional duties as chaplain to Lord
Kingston. This alphabetically arranged treatise con¬
tains the following paragraphs
“ Ordinary Meadow Sorrell, Hib. Saugh boh. Seal-
gan, and Saveh. Lat. Acetoea, vel Oxana. It grows
in Cora Fields, and Meadows, flowering in May. The
leaves are Antiscorbutic, Cordial, and Styptic, they
Refrigerate, quench Thirst, Resist Putrefaction, and
are good in Fevers, the seed is put in astringent
Medicines.
“ FieldSorrel, Sheeps Sorrel,or spear-pointed Sorrel.
Hib. Sauha Keeor-gh or Keirogah, and Savachyragh.
Lat. Acetoea Arvensis. It is like the great Sorrel, but
much smaller. It grows in dry barren soil, flowering
in May. It has much the same virtues as the former,
but not so strong in its operation. It brings to
suppuration Impoethumee, and all kinds of Tumours,
usea inwardly it is Deobstruent, helps the Jaundise
and quencheth Thirst.
“ Round Leaved, or Roman Sorrel, Lat. Aoetoea
Romana Rotundifolia Hortens is. It grows in gardens,
and has the same Virtues and Qualities that the
Common Sorrel has.
“ Wood Sorrel, Hib. Samsogy, Shamsoge, Lat. Ace-
tosella, Lujula and Trifolium acetosum Vulgare. It
grows in Woody, and shady places, flowering in April.
It is more powerful in its medicinal operations tnan
Common Sorrel. It is Cordial, Stomatic, Hepatic,
and Hydrotic, good against the Jaundice and Dropsy.
It also modifies and heals rotten Uloers.
" Meadow-Sweet, or Queen of the Meadow, Hib.
Airgid Lovaghra or Arigudlugher, Lat. Ulmaria and
Regina Prati. It grows in moist Meadows, and by
River sides, flowering in June. It is Styptic, Alexi-
pharmic, and Diaphoretic. The Decoction or powder
of the Roots, stoppeth the Diarrhoea, Dysentery, and
all kinds of Fluxes. The flowers in White Wine
cure the Tertian Ague. It is also good in Fevers,
and malignant Disorders.”
(To be continued.)
By JOHN BUCKLEY BRADBURY. M.D.Cantab ,
Fellow of the College; Downing Profeeaor of Medicine in the Uni
reMity of Cambridge; and 8enior Physician to Addenbrooke’a
Hospital.
Theories of Sleep.
Thoss advanced up to the present time may be divided
into chemical, histological, vaso motorist, and psycholo¬
gical. These theories are not neoessarily antagonistic,
as we shall presently see, but their promulgators differ
in their mode of explanation and in the prominence
which they give to an individual character. Let rfs first
consider the cause of sleep in the abstract.
It is evident that consciousness, whatever this may
be, is due to a certain definite condition of the nerve-cells'
or neurons and any departure from complete conscious¬
ness must be due to some change from this state. At the
present time it is difficult to come to any other conclusion
than that this state and its alterations are of a chemical
nature—that consciousness is accompanied by, if not due
to, a normal metabolism of the nervous oells, and uncon--
sciousness or diminished consciousness to a chemical
alteration in this metabolism. This so-called normal
metabolism is the result not merely of the vital
requirements of the oells but of this j>lw the altera¬
tions produced by the inflow of stimuli. Diminish the
stimnii or make them constant both as to kind
and intensity (monotony) and the metabolism
may become constant though in changed condi¬
tions ; a kind of acclimatisation occurs, and with
it diminished consciousness. The same effect might be-
produced by the alteration of metabolism due to the
application of a poison. It seems to me that the funda¬
mental phenomena to be determined in dealing with 1
psychical processes are the chemical changes occurring in
the cells; molecular vibration and processes of a similar'
nature which have been speculated upon from time to
time are, with our present knowledge, in the realms of
the unknown. Even if they can be known it seems
more philosophical to determine the gross chemical
changes first, although there is not much likelihood of
these being actually demonstrated in the near future.
Admitting that chemical alterations are the causes or
proportional concomitants of states of consciousness we
shall be able to trace a connection in some of the various
theories of sleep which have been propounded. Thus, it
is very evident that the metabolism of the oerebral cell
may be, and probably will be, altered by changed
extrinsic conditions - e.g., by the blood supply—and that
it may produce gross physical changes in the oell—e^.,
retraction of the protoplasmic processes. The vaso-
motorial and histological and m part the chemical
theories are—or perhaps it would be better to say may be
—thus brought into connection. But let us examine the
theories in detail.
The Histological Theory. —The most fascinating of them
all is what Duval has termed the histological theory of
sleep. This seems to have been propounded in its most
rudimentary state by Babl-RUck hard who suggested that
an assumed amoeboid motion of the neurons, and espe¬
cially the dendritic prooesses, would account for various
psychological phenomena. Thus sleep might be ex¬
plained by a retraction of these processes and consequent
inability of nervous impulses to pass from one neuron to
another. The same theory was elaborated independently
by Lupine and Duval. Lupine thinks this isolation of
the individual neurons may be due to some chemical
modification of the cellular protoplasm and he also states
that the theory explains the extraordinary suddenness
with which a state of wakefulness passes into one of sleep.
Duval goes so far as to explain the notion of medica¬
ments on this theory and he draws comparisons between
the action of drugs on the terminal dendritio processes
and the effect of curare on motor nerve-endings. This
is surely hypothetical. Moreover, he seems to ignore
the body of the cell itself-, everything is referred to
the dendritic terminations. It is most unnecessary to
(a) Abstract of the first Croonian Lecture deliver ®d at the Royal
College of Phyriciara of London on June 20th, 1899.
58 Thb Medical Pbbsb. ORIGINAL COMMUNICATIONS. _July 19,1899.
point out that the theory of Rabl-R uck hard, Lupine,
and Duval is dependent upon the conception of
isolated neurons as independent units in the com¬
position of the nervous system and that with the
disproof of this conception their theory must fall to
the ground. Kolliker has strongly criticised this
(the amoeboid movement) theory. He says that Wider-
sheim’s observations on the movements occurring in the
nerve cells of the supra-oesophageal ganglion of leptodora
hyalina are not pertinent to the question, and he rejects
the comparison to the action of curare as irrelevant.
Widersheim did not observe movement in the processes
of the cells; and in the transparent parts of living
animals (the larva of batrachians, the head of the
amphioxus, &c.), where nerve terminations have been
observed, no movement has been perceived. Moreover,
he thinks that if amoeboid movements occur physical
conditions would tend to aot in a oontant manner and
the same mental states under varying conditions would
be impossible. Furthermore, he says that “ it cannot
be doubted that the essential function of the nervous
system— i.e., psychical processes—is bound up with the
nerve cells.” In many of his critioisms he seems to me
to lay too much stress upon the stability of the axis-
cylinder process. The structure of this can hardly be
compared with that of the more delicate dendritic pro¬
cesses; and stimuli without influence on the former
might powerfully affect the. latter. At the termination
of his paper he expounds hiB theory of psychical condi¬
tions which although it is necessary to mention is one
with which we have long been familiar. The essential
factors of mental, activity—sensibility, consciousness,
will, Ac.—he says, are the nerve cells with their neuro-
dendritic processes. These are affected by centripetal
stimuli and in turn, through their processes, they act
centrifugally on other motor, sensory, or psychical
elements. Sometimes the pathway is simple, sometimes
extremely complex, and in the latter case the degree of
mental gymnastics to which the individual has been
subjected is of considerable importance as facilitating
the transmission along unusual combinations. He is
thus an advocate of the view that facility in thought
and action is due to diminished resistance in the path¬
ways, but in what way this occurs he does not state.
Bam6n y Cajal strengthens Edlliker’s objections by
"the following. 1. The nerve terminations of the oere-
bellum, the olfactory bulb, the central auditory ganglion,
and the optic lobe constantly show the same extension,
form, ana degree of approximation to the cell bodies,
whatever may have been the mode of death of the
animal (from haemorrhage, chloroform, curare, or strych¬
nine, Ac.). 2. The nerve terminations of the retina and
-optic lobule of reptiles and batrachians (the only aninmla
on which he experimented) show the same condition,
■whether the organ was hardened after continued rest,
as after long retention in the dark, or other activity, as
when it had been kept several hours in the sun. He there¬
fore believes that the axites and dendrites possess a con¬
stant disposition. But in order to explain sleep and
other psychical phenomena he brings in another factor.
Under different conditions he found the processes of the
neuroglial oells contracted or expanded and he suggests
that a function of these cells is to act as an isolating
medium between the two neurons. During sleep the
neuroglial processes are introduced Detween the nerve
ramifications and the cells or their protoplasmic pro¬
cesses, in consequence of which the passage of impulses
is prevented or hindered. Apart from the seat of opera¬
tion, Ramdn y Cajal’s theory differs from Duval’s in that
the processes (neuroglial in the case of Ramon y Cajal)
are expanded when the brain is at rest and are con¬
tracted when in action. TEe contraction is usually auto¬
matic, but may be brought about by the action of the
will. I do not, however, propose to follow Ram<5n
y Cajal in his explanation of psychological phe¬
nomena on his theory, especially as his observa¬
tions have not been confirmed by more recent
investigators. His theory seems to me to endow
the neuroglial cells with more nervous activity than they
are capable of and to allot to them a function which,
from their position and structure, I venture to think
cannot be maintained. Moreover, if we accept the net¬
work theory of Boll, Hill, and others, or Berkley’s or
Lugaro’s modification of the usually accepted view, this
explanation loses nearly all its significance.
Before leaving the histological theories of sleep I will
briefly refer to a view recently advanced by Gotch to
explain the conditions of hypnotism. He goes further
than Duval m attributing a major influence to the peri¬
phery of the neuron, for he believes that the gaps
between the terminations of the adjoining dendritic pro¬
cesses are of primary importance in the transmission of
nerve impulses. These gape determine whether an
impulse shall pass or not; once it has passed Gotch
believes nothing can hinder its further course. The
gaps are capable of variation; in fact, he states that
“ the whole of modern physiology is inexplicable except
on the supposition that the gaps are susceptible of altera¬
tion. What this alteration is we do not know; the gap
consists of living tissue and, like all living structures, is
constantly undergoing molecular change.”
The most recent theory has been advanced by Lugaro.
According to him unconsciousness is not due to a re¬
traction of the terminal dendritic processes, but to an
expansion. As I have already said, he believes that
nerve impulses pass through the gemmules and that the
passage is facilitated or inhibited by the closer or re¬
moter relation of these to each other. During
ordinary thought but few of these are in contiguity, the
others are retracted. The latter are in a potential state
—that is, they are capable of being approximated by
any suitable stimulus. Lugaro’s theory differs from
that of Lupine and Duval in that expansion of the
gemmules is regarded as the resting phase and con¬
traction as the active one. Thus in sleep the gemmules
are believed to be expanded, the paths for impulses are
thus enormously increaeed, and this leads to confusion
of thought and loss of consciousness.
In the unsettled state of the views of neurologists on
the structure of the nervous system it would be im¬
pertinent to criticise these histological theories in detail.
Further research alone can settle the present conflict¬
ing opinions, and on the result of this depends the pro¬
bability or possibility of the minute changes which we
have considered affording an explanation of psychical
phenomena.
The vaso-motor theory of sleep is almost as popular as
the histological theories which we have considered, and
interest in it has recently been awakened by the experi¬
ments of Professor Howell of the Johns Hopkins Uni¬
versity. It has, however, been a favourite theory for
many years. Based upon direct observation of the cere¬
bral cortex by Donders, Durham, Hammond, and others,
and on the plethysmographic researches of Mosso, it
seemed to possess a firm foundation, but of late this has
been rudely shaken. The conditions of experimentation
in these researches were not normal, and further inves¬
tigations have shown the necessity of modifying our
views on the matter. Thus Dr. Leonard Hill has proved
that practically no change occurs in the cranial contents,
that the brain at nearly all points is in contact with the
cranial wall, and that the amount of cerebro-spinal fluid
in the intact cavity is very small and incapable of gravi¬
tating to any appreciable extent into the spinal canal.
Moreover, he has Bhown that the cerebro-spinal pressure
equals the venous pressure, that it does not rise
beyond it, and that the cerebro-spinal fluid does not
normally function as a compensating mechanism for
alterations in the cranial contents. “ The volume of the
blood in the brain,” he says, "is in all physiological
conditions but slightly variable.” Therefore, cerebral
aneemia, if we regard this as a diminution in the total
quantity of blood in the brain, cannot exist to any ex¬
tent. It is possible for an arterial anaemia, combined
with venous congestion, to occur, and Dr. Hughlings
Jackson’s observations on the retinal vessels during
sleep would render this net improbable. In view of Dr.
Leonard Hill’s researches it seems absolutely neoessary
to recognise the Munro-Kellie doctrine (the incompres¬
sibility of the brain and constant volume of the oerebral
contents) in dealing with the causal factors of sleep
Cappie, on purely theoretical grounds, advocated this
doctrine, ana advanced a theory of sleep in harmony with
it. The main feature of his view is that the arterial
Jclt 19, 1899.
ORIGINAL COMMUNICATIONS.
The Medical Pbess. 59
anaemia of the brain is compensated by a filling of the
pial vessels and an alteration of the normal pressure on
the cerebral surface from an expansive to a compressive
force.
Since Dr. Leonard Hill’s investigations Professor
Howell has advauced a modified form of the vaso-motor
theory based upon personal experiments. According to
him the anaemia of the cortex is counterbalanced by the
dilatation of the vessels at the base of the brain. The
causal factor of s eep is a fatigue of the vaso-motor
centre, and particularly of that part of it supplying the
skin area. This Professor Howell deduces from the
fact that the volume of the arm increases (that is, the
cutaneous blood-vessels dilate) just previously to sleep,
and it usually contracts suddenly on awaking. He
does not, however, ascribe the production of sleep solely
to the fall of blood pressure, but he regards this as pre¬
eminent. The etiological factors he gives as follows .-—
1. A diminution of irritability caused by fatigue of
1/urge portions of the cortical area. 2. Voluntary with¬
drawal of sensory and mental stimuli involved in the
preparations for sleep. 3. A diminished blood-supply
to the brain owing to a relaxation of tone in the vaso¬
motor centres and the fall of general arterial pressure
thereby produced. Recently Dr. Leonard Hill has
criticised Professor Howell’s results, or rather his deduc¬
tions from his results. Ho finds that the fall of arterial
pressure is concomitant with sleep, and he adduces con¬
firmatory experiments. Thus he found arterial pressure
“ as low when lying in bed in the waking state in the
morning as in the sleepy stave in the evening a
result evidently antagonistic to Professor Howell's
theory. Moreover, it is not difficult to explain the fall
of blood-pressure during sleep, or even previously to
sleep, by the posture, the diminution of external stimuli,
the extra clothing, &c., which we seek before endeatour¬
ing to sleep. The rapid rise of blood-pressure at the
moment of awaking Dr. Leonard Hill explains thus:—
“ As the waking state is neared the turgescence of the
limbs is lessened owing to the increased tone of the
muscles and to the restlessness of the sleeper. Each
movement or deep respiration expresses the blood an<J
produces a lessening in the volume of the arm. This is
shown to be so by an examination of Howell’s tracings.
Since each movement of the body momentarily raises
the vena-cava pressure the brain is congested thereby,
for the cerebral circulation passively follows every
change in vena-cava pressure. The flushing of the brain
is secondary to the external stimuli which provoke the
external movements of the body, accelerate the heart,
and increase the vaso-motor tone. At the same time
these stimuli may awaken the dormant consciousness.
Carefully reviewing all the above facts we must, I think,
conclude that the anaemia of the brain is caused by rest
of the body and the cessation of powerful objective and
subjective stimuli. It is the cessation of the latter that
produces sleep.”
Chemical Theories —The various chemical theories
which have been put forward seem to have been based
on insufficient data. With the older theories of Sommer
and Pfliiger and others I do not intend to deal. Hut
comparatively recently a new chemical theory has been
advanced. Errera believed that the leucomaines pro¬
duced by the normal activity of the body play a pre¬
dominant part. He has based his view mainly on the
experiments of Bouchard and his school, who found that
during the night convulsant substances were excreted
in the urine which were not present during the day.
The toxicity of the urine during sleep was found to be
much less than that of the urine passed whilst awake.
On these experiments Bouchard formulated the theory
that during the day the body formed a hypnotic sub¬
stance which by its accumulation produced sleep and
that during sleep a convuleant substance was formed
which by inducing muscular movements produced
awakening. Both Beck and Herringkam have failed to
corroborate Bouchard’s experiments, but apart from this
it is difficult from eviden je of this kind to draw con¬
clusions as to the cause of sleep. The urine is a com¬
plex body, it varies largely in composition with the kind
of food, the amount of exercise, and other physiological j
and pathological conditions, and this variation is greater
with this than with other secretion-. It does not seem
right to compare the variability of the composition of
the urine with the periodic alterations in the tempera¬
ture and pulse ; the limits of the first are much wider.
Furthermore, as in the case of blood-pressure, it does not
seem to me proved that this altered composition of the
urine is not post rather than propter. I do not mean to
imply that metabolic changes have no influence in the
reduction of sleep, b\it what I do maintain is that sleep
as not been proved to be due to any one Bubstance or
group of substances present in the urine. The chemical
theory from another point of view I shall mention
presently.
The Psychological Theory. —The fourth class of our
division of the theories of sleep is the psychological.
And here we enter upon difficult ground. We have seen
that the physiological and psychological are two separate-
spheres with independent methods of analysis, that the
elements of the two sciences are different, and that the
connection between the two can onl> be one of paral¬
lelism. It may be that we shall never get beyond this
stage—that the physical and the psychical even in their
simplest forms are not comparable, but from a physio¬
logical point of view there seems nothing improbable in
the idea that they may be correlated. Maris de Mana-
ceine, in a popular book on sleep published two years
ago, defines sleep as •' the resting time of consciousness,”
and perhaps from a psychological point of view no better
definition could be given; but to me it is a mere statement
of a psychological fact, not an explanation. We cannot
account for sleep in such an immaterial manner. We
may not be able, perhaps, to give any further explana¬
tion at present, but the acceptance of such a theoiy
would deprive us of that most valuable aid lo research,
a working hypothesis. It is not improbable that the new
schools of psychological physiology, and especially those-
which deal with it from the pharmacological side, may
help us to a truer conception of the causes of sleep.
Wundt and hiB pupils have already added something in
this direction, and it is especially to his pupil Kraepelin
that much of our knowledge in this department is due..
In a recent paper from his laboratory a new explanation
of the action of hypnotics is given. Working on tbe-
psychical influence of trional with Kraepelin’s methods
Hans Haenel found it to diminish the power of calcula¬
ting and learning by heart, to increase the time in the
choice-reaction, to diminish the erroneous reactions, to
increase faults and omissions in reading and apprehen¬
sion, and to diminish the rapidity of writing. He found
it, however, to exert no influence on association and
muscular work (ergographic curves) nor on the rapidity
of repeating things previously learnt. The hypnotic
action of the drug is explained, Haenel says, by the
depression of apprehension and the increased difficulty in
originating co-ordinate movements. He draws atten¬
tion to the fact that these, and especially diminished
power of apprehension, are present after all hypnotic
drugB have been given, and the fact that morphine is
not regarded as a hypnotic in small doses is due to the
stimulant rather than to the depressing effect which it
exerts on psychical processes. This in psychological
terms is the condition produced by the action of hyp¬
notics, but as an explanation of sleep it is not sufficient.
If, then, we feel obliged to discard psychological ex¬
planations—and with due deference we must do this—we
can only return to physical and biological science. As
we have said, the fundamental changes must be in the
neurons themselves. I am inclined to believe that these
are primarily of a chemical character. The differences
observed between rest and activity and the changes re¬
sulting from the administration of various poisons, I
think, support this view. But these differences are in no
sense crucial. Before we could consider them such it
would be necessary to know for certain what cells are
concerned in the production of mental phenomena and
what changes result from the action of hypnotic drugs
upon them. The action of poisons on nerve-cells gene¬
rally is, however, at least suggestive, as it shows that
marked changes of a more or less transient cha¬
racter may occur during life. As many years
ago as the year 1876 W. Ludwig, a pupil of Binz,
described changes in the nerve-cellB of excised and
zed by CjOO^Ic
60 The Medical Press.
TRANSACTIONS OP SOCIETIES.
July 19, 1899.
-teased cerebral tissue after the application of hypnotics,
and came to the conclusion that these, even when well
■diluted, produoe a kind of coagulation of the albumin of
the nerve-cells which is not produced by other and
closely allied bodies devoid of hypnotic powers. A year
later Binz himself described the effect of morphine on
isolated nerve-cells. After a time a kind of coagulation-
necrosis was produced, which did not occur after the
application of atropine or cocaine. Strychnine and
.quinine, however, produced the same effect, so that the
action is not limited to hypnotics. More recently the
action of poisonB has been investigated by means of
Nisei’s method, and a great number, including many
metals, alkaloids, and toxins, have been found to produce
distinct changes. Nissl believes that this action is
characteristic for the same poison and the same
kind of cell, but as yet there is a want of unanimity
on thiB point. That decided morphological changes
may be produced by the action of poisons all
are agreed, and that these changes may be rapidly
produced has been shown by Ooldscheider and
Flatau in some recent interesting researches. The
function of Nisei’s bodies is unknown, and their
existence under normal conditions has even been
doubted. From investigations by Nisei’s method, how¬
ever, there can be no doubt that visible changes, often
of a very marked kind, are produced in nerve-cells by
the action of poisons, and these we can only regard as of
a chemical nature. Changes, too, are produced in the
dendritic terminations of the cells, and usually these
appear earlier and are more marked than those in the
cell-body. But in the dendrites more than in (he cell
observers differ as to the exact conditions present.
Thus after the administration of morphine Demoor des¬
cribes nodosities on the dendrites which in extreme cases
are reduced to mere moniliform filaments, while Lugaro
observed expansion of the gemmules and very slight
-thickening of the processes. Alterations of the den¬
drites have been noticed by various observers after
hypnotic drugs, and there can be little doubt that trans¬
mission of nerve impulses through these must thereby
be markedly retarded, if not prevented.
Owing to the differences of opinion of observers
regarding the exact condition produced by hypnotic
drugs it is impossible to draw a satisfactory conclusion
regarding their mode of action or the cause of sleep. I
am inclined to believe that hypnotics act chemically
upon the neurons, both upon the cell-bodies and their
dendrites, and I think histological observations sup¬
port this view. Retraction of the terminal processes or
gemmules, if such occur, I believe to be secondary. But
what part is played by the cell-body and what by the
-terminal processes it is difficult to say. The finer den¬
drites are probably more exposed to external influences,
and any modifications in them must affect the transmis¬
sion of nerve impulses, but the cell-body is the seat of
metabolic activity, and this, too, must be readily affected
by changes in the environment. At the present time
-there is a tendency to regard the functions of the cell-
body as purely nutritive, but, although this may be the
case with such cells as those of the posterior root ganglia,
it is probably not the case with the cortical cells of the
brain or even with the cells of the spinal cord. But a
discussion of this would lead us too far afield, and in the
end we should have once more to confess our ignorance.
Lugaro’B view of the action of hypnotics and the cause of
sleep I have already noticed. Demoor, as a result of his
histological researches, desists from any attempt to
formulate a theory of sleep. Regular and periodic
sleep, like the sleep produced by chloroform and mor¬
phine, and the inactivity succeeding exaggerated work,
finds,” he thinks, “ its application in part of the facts
studied in this work,” but the cause of the appearance of
sleep he “ lays aside, like many others, without a solu-
-tion,” and as regards its intimate nature we with little
more knowledge must do likewise.
The old established firm of Weiss, the surgical
instrument makers, has been converted into -a com¬
pany, with a capital of £10,000.
<lr*n*artum0 of gorieius.
ROYAL ACADEMY OF MEDICINE IN IRELAND.
8ection of Anatomy and Physiology.
Meeting held Friday, June 2nd, 1899.
The President, Dr. D. J. Coffey, in the Chair.
DISTRIBUTION OF THE GLANDS IN THE HUMAN
(E80PHAGU8.
The President (Professor Coffey) said that the
(esophagus, after fixation and hardening, was divided
into twelve segments of equal length, and then sectioned.
The glands appeared isolated; they were large enough
to be distinctly visible to the naked eye, and lay im¬
bedded in a fairly close-textured fibrous submucosa.
Each one was formed of a dose cluster of alveoli, lying
a short distance below a well-defined continuous and
rather broad band of muscularis mucosae. Sometimes a
detached strip of this muscular layer extended below the
gland. In the transverse section, of which a com¬
plete set had not yet been made, the glands occurred in
interrupted vertical rows. The whole arrangement con¬
trasted remarkably with the thick, almost unbroken
stratum of glands which occupied the whole submucosa
in the dog. The number of glands in any one vertical
section through the whole length of the tube was about
thirteen as a rule. They were placed in the successive seg¬
ments, in the following order from above down—three in
the upper four segments, four in the next two, the succeed¬
ing two segments were devoid of glands, then followed
four glands, and lastly, two in the remaining segments.
The examination of the junction of the tube with the
stomach was as yet unfinished. The upper half of the
mucous membrane was therefore better supplied with
glands than the lower half. Other features of the
histological structure investigated showed that the on-
striped muscle in the circular coat extended almost to
the upper extremity of the tube.
THE HISTOLOGY OF THE HUMAN VERMIFORM APPENDIX.
The President said that the general arrangement and
structure of the layers of the tube corresponds with that
of the large intestine. The muscular layers are, how¬
ever, pretty thick for a tube of such dimensions, the
external or longitudinal being complete, and containing
almost as many rows of cells ae the circular layer. Most
interest attaches to the submucous coat. It is almost
wholly occupied by lymphoid nodules arranged in a
thick ring. Each one is conical in form, base outwards,
and surrounded by a capsule lined with endothelial cells,
which thus constitute a lymph sinus drained by the lym¬
phatics. The solitary follicles, which in the intestine lie
mainly in the mucosa, are here crushed out into the sub-
mucoHa altogether. This determines a condensation of the
proper areolar constituents of this layer into a band of dense
fibrous tissue, lying outside the nodules and separating
them from the muscular wall. One or two thick bands,
however, remain in the radial direction, and run inwards
from the muscular to the mucous coat. The lymphoid
nodulee vary much in size, and a few large ones appear
to be projected inwards from the ring, invading the
mucous coat and reaching to the epithelial surface.
These differ in shape from the submucous nodules, being
pyriform, with the broad end inwards. They, might be
described as a sort of second ring pushed inwards from
the crowded outer set. The want of uniformity in the
size of the nodules is apparently associated with the
irregularity of the lumen of the tube. The glands of
the mucous coat are of the normal character and are
fairly numerous. The muscularis mucosee is thin and
badly defined, it is broken into strips and lies imme¬
diately internal to the apices of the conical lymphoid
nodules.
Professor Purser said that the finding of unstriped
muscular tissue so high up in the (esophagus was very
interesting, and a new fact to him. He had often in
examining pathological specimens been struck with the
absenoe of glands in the (esophagus, but that may have
been owing to the pathological condition. The distribu¬
tion of lymphoid tissue in the vermiform appendix was
July 19, 1899.
GERMANY.
The Me dical Press. 61
Grrmanp.
-very inter eating ; in the rabbit it was the rule that two
or three layers of adenoid tissue were present lying over
each other.
Professor Birmingham said that a striking picture of
the structure of the appendix was given in Testut’s
M Anatomy,” but it represented the muscularis mucosas
as lying outside the lymphoid structures. Evidently
the true muscularis mucosas, which is very faint, was
overlooked.
THE FORM AND POSITION OF THE THORACIC AND
ABDOMINAL ORGAN8 IN THE LEMUR.
Dr. C. J. Patten read a paper on this subject. The
communication was illustrated with lantern slides, and
dealt more especially with the relations of the viscera to
the vertebral column in the lemur as compared with
some other animals. The value of the method of pre¬
serving and hardening the viscera with formalin was
indicated, and the form which most of the solid organs
assumed was brought out.
The President remarked that the methods of classi¬
fying vertebrate types came to little more than dentition,
and some few features about bones, with most meagre
facts about viscera. Regarding lemurs, which are so
doubtful in position, it was very useful to show exactly
the relations of their organs, and Dr. Patten's work was
very carefully done in this respect.
Profess' r D. J. Cunningham said that Dr. Patten's
work was most carefully done. It was another evidence
of the value of formalin. It was very unsafe to found any
classification on one or two characters. The animal must
be investigated from top to toe, and recently, even the
muscles which had been thrown into disregard for a long
time, are being utilised for this purpose.
SERIAL SECTION OF THE ADULT HUMAN BODY MADE
WITHOUT FREEZING.
Professor Frazer exhibited serial stations of the entire
head and neck, several from the thoracio region, and the
entire lower limb, from a subject which he had cut in
the transverse vertical direction, and serially at intervals
of about one inch, from the crown of ihe head to the
soles of the feet. The subject had been iniected from
the femoral artery with a modified formalin solution
under a pressure of about eight feet; it had then
remained exposed to the air without covering in the
preparation room, when it was removed to the dissecting
room, and cut serially at intervals with an ordinary
amputating knit e, and a small saw without a back, the
latter being applied to the bone wherever that be-
became necessary. The sections were perfect, both as
regards the hardening and the colour of the various tissues,
and could be used with great freedom. They could be
handed round the class, and examined by each member;
they could be left exposed to the air for days; they
could be left under water also for days, or they could be
finally mounted in a preservative fluid. It was desirable
to have an alternative method of making useful and in¬
structive serial sections of the adult to that which had
hitherto been employed, which was the ordinary mixtures
of ice and Balt, or snow and salt, in the absence of proper
refrigerating chambers, which were not, as a rule,
attached to anatomical departments in Great Britain or
Ireland. The meeting could say whether the sections
now exhibited would not bear favourable comparison
with any that had ever been made by the method of
freezing.
The President said that the sections were of great
value for teaching purposes, and showed the natural
appearances very well.
Professor Birmingham complimented Professor Frazer
on the beauty and usefulness of the specimens.
Professor Bisminghan exhibited a formalin specimen
of the abdomen, prepared to show the lines of reflection
of the peritoneum.
This was the last meeting of the Session.
Sir J. Crichton Browne, M.D., F.R.S., has pro¬
mised to deliver the introductory address at the opening
of the winter session in the medical department of
Owens College, Manchester, on Monday, October 2nd.
[from our own correspondent.]
Berlin. July 15th, 1899.
At the Society for Psychiatry, Hr. Henneberg showed
preparations illustrating a
Condition of the Spinal Cord in Chronic
Nephritis.
Two preparations were shown. In one there were
smaller and larger sclerotic patches. In one place
softening of the grey matter had taken place, which was
a rare occurrence in the spinal column. There was a
complication of patchy disease with systematic degenera¬
tion of the columns Both were dependent on the same
etiological condition, distinct disease of the vessels. In
the second case this was not so widespread There were
both ascending and descending degenerations. All the
diseases were due to disease of the vessels, which had
set up disturbances of circulation.
Hr. Oppenheim considers the significance of the
changes as correctly given, the changes in the vessels
played the leading r6U. Such conditions were met with
even in arteriosclerosis. He Pad also seen similar changes
in a case of chronic lead poisoning.
Hr. Goldsoheider confirmed the r6le of the blood vessels
n disease of the cord. The cases brought forward he
held to be contracted kidney. He had diagnosed
clinically a case of nervous disease in a case of arterio¬
sclerosis. The symmetrical disease of the long tracts
was interesting; it was doubtful if this had any connec¬
tion with the nephritis. In Bright's disease the cerebral
symptoms predominated over the spinal.
At the Medical Congress Hr. Escherisch, Gratz, read
a communication on
Bacterium Coli.
He had never seen production of gas in decomposition
of albumen by bacterium coli. The bacilli present in
stools were not an heterogeneous mixture with those
introduced into the intestines with the food. The bac¬
terium coli from even normal Btools had pronounced
toxic and infection properties. But an organism that
could harbour those numerous poison-forming bacteria
without injury had been supposed by some authors to
possess auto-immunising properties as they protected it
against ihe invasion of toxins. He considered this
hypothesis as unlikely, also on his own investigation.
He was opposed to the view that the pathogenic action
of the bacterium coli could be exercised from the intes¬
tinal canal. He believed that infection must be caused
by the entrance of virulent coli bacilli from without.
Quite lately it had been held that dysentery was caused
by a bacillus similar to the bacterum coli and the serum
reaction had been made. In a house infection it had
been observed that the nurses were attacked by dysen¬
tery-like symptoms. The word dysentery was now a
comprehensive term for a large number of diseases.
Hr. Jacobi, Berlin, reported on a case of typhoid in
Gerhardt’s klinik, in which an attack of pneumonia
came on, in the sputum of which the bacterium coli was
found.
Hr. Gans, Carlsbad, said that 2 to 4 days’ pure cultures
of bacterium coli increased the sulphuric ether con¬
siderably without any indication of indican; 4 to 7 days’
cultivation of the proteus vulgaris increased the excre¬
tion of indican. Once the sulphuric ether was nominally
62 Thu Medical Press.
AUSTRIA.
July 19, 1899.
increased, another time it was absent; 2 to 4 days’
cultures of bacterium acidi lactia sometimes increased
the ether and sometimes not. Indican was not excreted.
Ten grammes of yeast suspended in 200 of water
caused excretion of indicail without influencing the sul¬
phuric ether.
Hr. Pribram discussed the
Intermitting Albuminuria of Adolescents.
It was a striking fact that frequently in youthful and
normal individuals at some parts of the day albumen
might be found in the urine, and especially after bodily
exertions. There were variations in this tendency. Move¬
ments of the upper extremities generally had less influ¬
ence, for example, being less in violin playing excepting
"when the player stood. If such cases were observed long
enough, it would be seen that with the intermitting
growth of the youthful body the tendency diminished
and increased in the periods when growing persons
began to make awkward movements, got large hands
and feet, and gradually disappeared when the lengthen¬
ing of the body made them of adequate size. How far
the albuminuria was physiological was undecided.
Cylindruria was not observed for years. In one case
severe scarlatina was hot followed by nephritis. With
proper treatment and gradually developed movements,
no albumen was traceable even after dancing, tennis
playing, &c.
JUistria.
[from our own correspondent.]
Vienna, July I5th, I8t».
Immunitt.
This obscure subject was again the object of discus¬
sion at the annual meeting of the Bohemian “ Verein.”
Pelnar introduced it with a review of its past history.
Every advocate and partizan, he said, had ample scope
for dogmatising and speculation in this department of
medicine owing to our very great ignorance of the whole
subject, apart from a few empirical results, which had
often as many exceptions as cases that conform to any
rule. The different forms of immunity may be briefly
enumerated—hereditary, acquired, congenital, previous
attack, vaccination, toxin injections (active), and serum
injections (passive immunity). There may be added to
this list the bacterial immunity and the bacterial pro¬
duct or toxin immunity.
The hereditary or congenital immunity is clearly
demonstrated in vitro by Metechnikoff’s experiments,
where the infected body can be seen defending itself
against the invader. The bactericidal property resides
in the blood, probably in the serum, as reoently con¬
firmed by the experiments of Swatschenko.
The antidote theory assumes a natural protecting
property on the part of the organism, which we are not
yet in a position to prove beyond empiricism, but it is
believed that all vital tissues hane a self-resistance
peculiar to the organism, although different parts have
more resistance than others, as, for example, rate are
quite immune against the toxin of tetanus from external
causes, yet when injected so as to aot on the nerve
oentree the poison acts violently, according to the
testimony of Roux and Borrel.
Hereditary i mmu ni ty is supposed to be transmitted
by the blood, or milk of the mother, in the form of a
paralysing substance that has not been isolated, but the'
effect whereof has received the happy appellation of
“ passive immunity.”
The artificial methods are by means of living or dead
cultures, or extracts of the dead cultures termed “ plus-
minen.” These in recent years have been much
criticised, sometimes praised as potent agencies, at other
times totally discredited. It is admitted that a large
number of phenomena have been produced by these
artificial preparations, but none can demonstrate to our
satisfaction that the bactericidal action, “agglutina¬
tion ” power, or the bacteriolyses of Pfeiffer will prove a
potent immuniser. The same may be said of these ae
preventives, so that aero-immunisation and sero¬
therapy are not yet rational methods of treatment.
The minimal doBe theory is equally unreliable, as a
lethal dose must be given to immunise, although some
few cases on record would seem to point to good results.
He next entered into a long criticism of KruBe’s modi¬
fied “ Retention ” theory, Wasaemann’s “ Seitenketten-
Immunitat,” and Centani’s “ Stomo-oisinen-theorie,” aU.
of which he asserted were absolute failures.
Myxiedema.
At the same meeting Prochaska exhibited a young
male dwarf, set. 20, who had every appearance of infantile
myxoedema. There was no history of heredity ; he was
late in walking, his first teeth appearing when
three years of age, and is quite idiotic. His
somatic appearances before treatment was com¬
menced are described as follows:—Height 101 centi¬
metres (39 76 inches), cranium asymmetrical, sutures
irregular, features distinctly cretin-physiognomy with
macroglossia, the gums thick, pharyngeal mucous mem¬
brane swollen, and the teeth carious. By palpation the
thyroid cannot be distinguished. The body short, skin
distinctly thickened by myxomatous infiltration of
the deep cells. In the clavicular and axillary regions
were tumours about the size of the fist, and the abdomen
showed an umbilical hernia. Temperature averaged about
96’8 degs.; daily quantity of urine passed 1,000 grins. *
number of erythrocytes three millions; weight of body
28'4 kilos or 62 48 lbs. After eleven weeks treatment
with thyroid tabloids, each containing 0T0 gramme = l - 6
grains of the thyroid substance, the following
condition was observed :—Macroglossia had disappeared
along with the infiltration of the skin and the swellings
in the clavicular and axillary regions. The previously
subnormal temperature rose one degree, while the
number of pulsations and diuresis were distinctly
increased. During the period of treatment the patient
grew 3 ctm. in length, and distinctly improved in intelli¬
gence, spoke more, was active in movements, and ate
and drank heartily, while the body weight increased
6 kilogrammes—13 2 lbs.—in the same period. No bad
effects were observed tliroughout.
He concluded by reviewing the collateral changes,
and was convinced of the efficacy of the thyroid
therapy.
A mural tablet has been placed in the main reading-
room of the Edinburgh University Union. It bears the
following inscription:—“ In memory of James Robert
Hunter, M.A., who died January 24£h, 1899, during the
term of his Presidency of the Union. This brass, and
the set of volumes in the library known as the ‘ Hunter
Memorial, were subscribed for by his many friends in
the University.”
Digitized by CjOOQle
Jolt 19, 1*99
CONTINENTAL NOTES.
Continental ^otcs.
SUMMER SAUNTERINGS IN VALAISAN VALLEYS.
[From Ocr Own Correspondin'!-.]
No. I.—FROM GENEVA TO ZERMATT.
The most direct route from London or Paris to
Zermatt is by the Paris, Lyons, and Mediterranean rail¬
road, via Dijon, Pontarlier, Vallorbes, and Lansanne.
"We, however, came through Geneva. Leaving Geneva,
the Jura-Simplon Railway for about three hours skirts
the lovely Lake Leman. After passing Coppet and
Nyon, and dropping many passengers at each of these
stations for the Divonne Baths, we had at Morgues a
superb view of Mont Blanc, Coleridge’s “ Kingly spirit
throned among the hills.”
Lausanne came next, with its grand old cathedral,
and its reminiscences of Gibbon and his (as one of
Dickens’s characters phrased it) “ Decline and Fall Off
the Roman Empire.” At Lausanne we picked up a throng
of tourists who had travelled thither direct from Paris via
Dijon. Leaving Lausanne we rapidly passed Vevey, look¬
ing verdant, cool, and homelike; Montreux, sultry and
nowadays “ too much bricks and mortar; ” the celebrated
Castle of Chillon, recalling Byron and his chequered
career; and here we left the lake-shore for the Rhone
valley, and shortly entered the Canton of Valais by a
defile, passing on to Martigny, where passengers bound
for the Dranse Valley (Great St. Bernard) and Chamounix
alight. Soon 8ion looms in sight, with its curious
cathedral and formerly fortified rock. We are now in a
truly mountainous region, and, as in such places, legends
and tales of the supernatural abound. Sion has its full
share of them. The church bell is ringing, and one of
our company tells the tale of Sion’s saintly first bishop
and his cock outwitting Satan.
We change carriages and dine at Vi^ge (or as usually
called, Visp) to take the narrow gauge A lot railway for
twenty-two miles up the Vii^ge Valley to Zermatt; five
of these miles, at different intervals, are cog work.
Zermatt has an altitude of 5,315 feet, and chus we ascend
one of the loveliest railroad routes in all Switzerland.
At the end of our journey we instal ourselves at a very
comfortable resting-place at the Grand Hotel Mont-
Cervin, one of the half-dozen good hotels of the well-
known Seiler family. Zermatt is in gala attire, for its
“ season ” is now in full swing. Its hotels and shops are
brilliant with electric lights and its one long street
crowded with visitors and tourists from many
countries. Music, merriment, and cosmopolitan talk-
ings resound everywhere; dancing on various ver¬
andahs. Although 5,300 feet above sea-level, on
this bright July evening its atmosphere, pure and brao-
ing, is most enjoyable; and in the clear starlight we
behold, greatly uplifted above the village and valley, the
unique peak of the majestic Matterhorn which seems
" to pierce the heavens with its proud point.”
Zermatt itself is 6,315 ft above the level of the sea;
the Matterhorn summit is 9,390 ft. above Zermatt. In
Tauscher-Geduly’s words, “ It commands all the horizon;
the neighbouring summits seeming to voluntarily efface
themselves before it. All other hills around carry a
cvirasse or a casque of ice; not so the Matterhorn. The
The Medical Press. 63_
winds and the sun suffer no ice to gather on its superb
shoulders and sides. After a snowstorm it appears as if
only sprinkled with a powder of silver. Regarded atten¬
tively it seems not stationary, but to mount, mount ever
higher into the ether.”
It is not the highest of the summits in Valais, the
Taschhorn, Weisshorn, Lyskam, Dom, Monte-Roea excel
it in height. Yet none other so vividly appeals to us.
The name of Seiler seems inseparably linked with that
of Zermatt; for to the Seiler family Zermatt owes much
of its present prosperity, and visitors to this Vi^ge Valley
most of their comforts. Before 1839 there was neither
any accommodation nor any welcome whatever for
strangers in Zermatt. Dr. Lanber opened a very small
Inn here that year. In 1852 another was established,
the Hotel du Mont Cervin. Two years later, the
late Mr. Alexandre Seiler acquired the Lauber Inn, and
changed its name to Hotel du Mont Rose. With the
very efficient aid of his exoellent wife, this Mont Rose
House became popular, for both Mr. and Mrs. Seiler
thoroughly knew “ how to keep an hotel,” a compliment,
our American friends say, more to be valued than an
election to their Presidential chair! The Seilers had,
however, for a dozen years no easy task before them.
Zermatt was almost utterly unknown, and itB grand
Matterhorn mountain considered inaccessible. The
disaster to the Hudson-Wymper party in 1865 spread it»
fame far and near. The number of tourists began to
increase, and they who came appreciated the constant
courtesy and indefatigable attentions of the “Mont
Rose” hosts. In 1867, Mr. Seiler acquired also the
“ Mont Cervin Hotel,” and soon afterwards the
“ Riffelhaus,” over 3.000 feet above Zermatt, the earliest
inn at so high an altitude in this locality. In 1884, he
built the handsome Riffelalp Hotel (7,307 feet altitude),
which remains to-day deservedly the most popular house
in the whole of this part of Switzerland. The Seiler
reputation became world-wide, and many flocked to his
hospitable houses from all lands.
Mr. Seiler died in July, 1891, and his wife foijr years
later, rich in the esteem of all who knew them. The
hotels he established on so firm foundations continue
under the able management of his sons “prospering
and to prosper.” Zermatt has prospered and must
prosper with them. In a lovely valley, environed by
glorious hills and grand glaciers; endowed with an
atmosphere invigorating and salubrious in the highest
degree, as Professor Jung says:—“There is, in this
little corner of the earth, that which excites the curiosity
of the scientist and satisfies the aspirations of the
artist, rouses the activity of the inert, and consoles the
mind of the despondent. In this time of universal unrest
thousands flock hither year by year; sufferers from
ennui and pessimists lose here their moral lassitude;
they, whose bodies are alone feeble, recover vigour in
the vivifying air of these heights; all take away with
them a store of new energy, a capacity to feel better, to
understand better, in a word, to live better.”
Scarlet fever in a somewhat bad form is preva-
valent at Cheltenham College. The annual cricket
match between the College and Marlborough College
which should have been played on the Marlborough
ground on two days last, week, did not take place
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LEADING ARTICLES.
Jclt 19, 1899
©pirating ^heatrec.
ROYAL FREE HOSPITAL.
Operation for Undsual Condition of the Gall-
Bladder.— Mr. Battle operated on a stout man, a-t.
about 54, a stable-helper, who was suffering from severe
abdominal pain. The patient stated that he had been
quite well until two evenings before, when he was taken
with severe pain in the right side of the abdomen; this had
continued since, so that he had been unable to leave
his bed or even sleep. There had been no vomit¬
ing, and he had had no rigor. The pain had not
been paroxysmal, but had remained of the same in¬
tensity, so that he was eager to have anything done.
‘On examination he was a very stoat man, with a dusky
faoe and a tendency to bronchitis; he also had hard arteries
with a little albuminuria. Examination of the abdomen
showed it to be distended, and to contain a considera-
able amount of free fluid. Just below the right lower
ribs, below the usual situation of the gall-bladder, was
a bard, very tender swelling, which was dull on percus¬
sion ; it was not the shape of the gall-bladder, being
more irregular in outline, and not moving well
with respiration. He had never had any difficulty with
-the bowels, which had acted freely after medicine,
the morning before. He remembered that three months
before there had been pain in the same situation, but
he had not been obliged to knock off work, and it had
only lasted four or five days. An incision was made over
-the swelling through the upper part of the right rectus.
The swelling proved to be matted omentum of considera-
able size, about the gall-bladder; the condition of the
latter was very unusual. 'When the omentum had been
separated, the gall-bladder was found under the liver
<which was slightly enlarged); it was of a deep
red colour with splashes of a whitish yellow on it, very
tense and hard; it could be brought to the surfaoe
only by pushing the liver up under the ribs. A trocar
and cannula pushed into the apex after the peritoneum
had been protected with sponges and gauze, gave exit to
a large quantity of thick bile, which shot from the tube,
showing that it had been kept in at a considerable ten¬
sion. The gall-bladder was pulled up and sutured to the
wound; various small gall-stones escaped when an inci¬
sion was made to enlarge the puncture. The lower
part of the wound was sutured, whilst through the
middle portion the ends of stripe of gauze were
brought, which completely shut off the gall-bladder
from the peritoneum. A drainage tube was placed in
the opening of the gall-bladder, but little appeared to
come through it. A good deal of fluid escaped from the
peritoneal cavity, but it was not purulent nor in any way
offensive. Mr. Battle said it was difficult to account for
the patient’s symptons as they did not correspond to
the ordinary symptoms of obstruction of the cystic duct,
and although the operation had relieved the man the
exact cause of the condition of cholecystitis remained to
be proved. There had been no evidence of calculus
before operation, and those found at the time of the
operation were too small to block a normal duct. It
was considered that the blockage had not been relieved,
but the main condition did not admit of further treat¬
ment. Excision of the gall-bladder would most likely
have proved fatal.
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Published every Wednesday morning, Price 5d. Poet free, 5id.
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“ BALDS POPDLI SCPREMA LEX.”
WEDNESDAY, JULY 19, 1899.
THE TEMPERANCE QUESTION.
For some years there has been a general tone in
the medical profession of neutrality upon the question
of temperance. There is no doubt but that alcohol
was pushed too far some years ago, when Dr. Todd’s
authority had weight. When a man broke his leg
and was taken to a hospital the first thing to do was
to give him some brandy. Such was fashion, even in
the practice of medicine and surgeiy. Common
observation brought about a reaction, and doubt
began to influence the minds of many. We have now
reached a condition in regard to the temperance ques¬
tion something like that which has occurred in
politics. There are a few holding strong views on
both sides, but the great majority is in )nedio.
The evils of excess in some are not very clearly proved
to be curable by total abstinence in others. Prayer
and total abstinence may be regarded by some with
great confidence as curative or preventive agents;
but experience does not bear out the view that
maladies are much benefited by such treatment, for
alcoholism is a malady, and must be dealt with
scientifically and not sentimentally. As with the
opium question in the East, there is much to be
said on both sides. When we recall Bishop McGee’s
declaration that he would rather see England free
than sober, and compare this with the active crusade
carried on by some of the best of our clergy to en¬
force total abstinence, the doubt arises naturally in
the mind whether religion ought to have any influ¬
ence whatever in dealing with the question, if
regarded from a social or political standpoint
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Jult 19, 1899.
HEADING ARTICLES.
Th* Medical Press. 65
The moat important point which the medical
profession ought to debate is the cause or
causes to which alcoholic excess may be referred,
whether in the individual or the people. There is
a curious condition of religious emotion which
creates prejudice against science; and to this
it is we must refer the injury done by some
ministers of all religious denominations to the
advance of scientific knowledge and civilisation. It
is not the fault of those who feel this fear; it is
their misfortune, and may prove a trouble to others. If
we consider the temperance question purely from a
medical point of view, as we ought, and if we have the
■energy and character to educate those who cannot
study it in the 6ame way as the physician is entitled
to do, we may assist the politician when the difficult
question of Legislation is interesting the great
jury of our country. If we were asked the
apparently simple question, What is the value
of aloohol as a medicine P we should not find
it an easy one to answer. Alcohol may be a poison,
but “ poison heals in just proportion given and if
we find a friend asserting that he would rather die
than touch alcohol whatever its value may be if used
properly, it is of no use trying to discuss the matter
with him. If we look a little closely into the way in
which alcohol is obtained we are compelled to draw
the line very distinctly between that part of the
process which is not the work of man, namely,
fermentation, and that which is, namely, dis¬
tillation. It looks as if Nature had provided
us with the means to change certain substances
from one condition to another by which change they
are made more suitable for the human body. What
does bread owe its great value to but fermentation P
and to what extent are we acting wisely in extract¬
ing from the fermented juice of the grape or
other liquid one of the products of the singular series
of changes effected by the fermentation and which
can possibly be used so variously for good or ill P If we
are going to adopt the principle that nothing which
Nature provides us with should be used for good if
it can be possibly used for ill, where "should we be ?
Virtues may merge into vices, and vice versa. We
cannot but respect those who practise self-denial for
-the benefit of others, and though this virtue may not
possibly become a vice, its value as an agent for good
may be practically nil. If there is a virtue in eating
unleavened bread for a few days in the year, some
may think it would be a greater one to eat it always.
It looks as if one of the lessons to be learnt when we
■compare the practical use of fermentation with the
refusal of it, is the difference between knowledge and
ignorance. We can understand the view
Of Man’s first disobedience, and the fruit
Of that forbidden tree, whose mortal taste
Brought death into the world . . .
though we could not agree with it. The time has
come when this temperance question fairly falls
within the territory of sanitary science,'and if the
profession will treat it in the spirit it demands the I
public will be glad, and good will follow I
THE METROPOLITAN ASYLUMS BOARD.
It iB always a matter of some difficulty to realise
the progress of contemporary history. In recent
years, however, the task has been lightened to a con¬
siderable extent by the modern practice of issuing
systematic reports of official work. Among such
records those of the Metropolitan Asylums Board are
worthy of careful attention, marking, as they do, one
of the chief avenues of advance of the great modern art
of preventive medicine. The annual report of the
Asylums Board for the year 1898, which has just
been published, contains a mass of information of
first importance. Instead of being issued in the form
of a chairman’s report, it has this year been entrusted
by Sir Edwin Galsworthy to the Statistical Com¬
mittee, who have accordingly issued a report of the
Board in two volumes. The total expenditure
was £719,128, or an excess of about £63,000
on the previous twelve months. The increase
is strictly in keeping with the tradition of the
Board, which has steadily and without a single
exception increased every annual outgoing since its
comparatively modest start at £66, 469 in 1867. At
the same time, it is only fair to remember that during
the period mentioned the population has greatly in¬
creased, and the available accommodation has gone up
by leaps and bounds. But in spite of a higher rateable
value subject to taxation, the rate for 1898 was higher
than any yet made. The Asylums Board, however,
have never professed to cultivate the humble
virtue of thrift, and money has always been
bestowed on them by the ratepayer with unstinting
hand. The chi-rf oomplaint has been that in spite
of lavish expenditure the neoessary accommodation
has not been forthcoming for the housing of the
infectious sick of London. In the year under report
we are happy to find official evidence that the
reproach of inadequate equipment has been removed.
This satisfactory result appears to be attributable
mainly to two causes—first, a decrease in infectious
diseases; and, secondly, an increase in hospital
accommodation. With regard to the former point,
the committee report that the number of cases of
infectious disease notified under the Public Health
(London) Act, 1891, during 1898 amounted to 37,316
and showed the substantial reduction of 8,101 as
against the previous year. Bearing upon the second
point is the fact that the percentage of the total
number of legally admissible cases actually admitted
has touched 65 - 5 per cent., as against 58‘5 in 1897,
and 33‘6 in 1890, the first complete year in
which compulsory notification was in force.
Although it is, of course, impossible to found
any trustworthy conclusion upon the figures of a
single year, it is nevertheless impossible to avoid
altogether the hope that the days of general decline in
infectious diseases may be at hand. Preventive medi¬
cine by the aid of vaccination, isolation, and general
sanitation has reduced small-pox to vanishing point.
Why should not an equally happy result be attained
in the rest of the specific diseases as our knowledge
of cause and effect is carried ever deeper and deeper P
oogle
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66 The Medical Press.
LEADING ARTICLES.
The following figures are most encouraging: The
admissions from scarlet fever fell from 15,113 in 1897 to
12,125 in 1898; “fever” from 1,481 to 1,417; and
small-pox from 70 to 5. It is to be hoped that some
day the reduction of those diseases will be so great as
to furnish the Board with spare accommodation
enough to enable them to attack the terribly fatal
maladies, whooping-cough and diarrhoea. To a sani¬
tarian nothing is impossible, especially if unlimited
funds are forthcoming. Little is mentioned in the
report about the troubles that have arisen with regard
to the Brook Hospital. In the space at oommand it
is impossible to do more than glance in a brief and
general way at the leading features of this excellent
report, which will be found to repay perusal by those
interested in Public Health administration. The
mass of carefully-arranged statistics and the clear¬
ness of statement more than justify the relegation of
the task of reporting to a committee. It is too much
the tendency of a one man report to run on the
lines of the special pleader, a principle that
is hardly favourable to healthy growth in public
departments. We purpose dealing in a further
article with the extremely important question of the
housing of Poor-law children under Mr. Chaplin’s
Order. Meanwhile the Metropolitan Asylum Board
may be congratulated on the addition of one more
year to their records of solid achievement.
THE GOVERNMENT AND THE DEATH-
RATE FROM CANCER.
The Government have refused the request of the
Cancer Society to appoint a Royal Commission to
inquire into the causes of the increase o,‘ cancer.
They allege that the attention of the Local Govern¬
ment Board has been called to the large increase in
the number of deaths from the disease, and that as
opportunities had arisen, they had caused scientific
inquiiy to be made into the natural history and
causes of cancer. Moreover, they assert that
the President of the Local Government Board
has been advised that in the present state of
our knowledge on the subject, no useful purpose
would be served by the appointment of a Royal
Commission. In view of the booming which is taking
place, both officially and individually, of tuberculosis,
the refusal of the Government to have anything to
do with cancer is, perhaps, natural enough. The
tubercle bacillus has become quite an aristocratic
microbe ever since it was discussed in the royal pre¬
sence at Marlborough House, and the aristocracy as
well as the Lords, spiritual and temporal, are now
vying with each other in their efforts to show
the interest that they take in everything be¬
longing to it. All this, of course, cannot be
without benefit to the public, and upon these
grounds we have nothing to complain of, but it is
obvious that until the public interest begins to
wane in tuberculosis there cannot be much chance i
of a hearing for cancer. Nevertheless, as we have !
repeatedly pointed out in these columns of these two I
JcltJ9, 1899.
fatal maladies cancer is the one in the investigation
of the etiology and natural history of which the State-
should take some active part. It is not a sound
argument to advance that the subject of cancer
belongs at the present too much to the domain of
science to make a Royal Commission upon the sub¬
ject either necessary or expedient. In assuming
this position a morning contemporary altogether
misjudges the condition of affairs. The writer
of the article adds truly that the disease hae
for years been the subject of incessant study
and that something has been done to elucidate
its nature. But he then proceeds to discuss the
various hypotheses and opinions which have been ex¬
pressed regarding its origin and frequency, and in
the end makes out as strong a case as possible for a
State Inquiry, despite the fact that he opposes State
interference in the matter. Clearly a Royal Com¬
mission on Cancer could not fail to be productive of
good. In the first place it would be able to collect
and sift the evidence bearing upon the increase
of the disease; next, it might deal with the
disputed points relating to its geographical
distribution in England; again, much valuable infor¬
mation might be obtained, through its means r
regarding the so-called “ cancer-houses.” All these
are matters respecting which differences of opinion
exist, and concerning which there is. of course, a
great deal that can still be said. Under the circum¬
stances, therefore, it is absurd to state that the study
of cancer entirely belongs to the domain of
science; a State inquiry into its natural history r
as apart from its pathology, we again repeat, is
urgently called for. The scientific side of the disease
may be safely left to the pathologists and bacterio¬
logists, but, we maintain, that it is the duty of the
Government to ascertain the true facts regarding its-
increase, climatology, and prevalence in England.
Quite possibly, however, the subject of cancer is
never likely to command the same public attention
as that which belongs to tuberculosis, mainly,
perhaps, for the reason that it deals with a dis¬
ease the mere reference to which carries
with it to many persons the recollection of
fateful scenes of human suffering. Neverthe¬
less, painful, and in some respects repulsive,
as a national inquiry into a terrible disease like
cancer might be, it should not be shirked upon grounds
of sentiment. Sentiment should not be allowed to
weigh in the balance against expediency in such a
case. The Cancer Society is still in its infancy, and
we feel certain that it has a great future before it,
and its initial step in bringing under the notice
of the House of Commons the necessity of
having a Royal Commission appointed to inquire
into the disease was admirable in every way.
Although its advances were met with a rebuff
from the Government, no great importance
need be attached to this. We believe that this is the
firet occasion on which such a suggestion has been
made in the House; it was, therefore, hardly to be
expected that a favourable reply would have been
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The Medical Pbkss. 67
July 19, 1899 NOTES ON CURRENT TOPICS.
given. Meanwhile, by “ pegging away ” the Cancer
Society may find in a few years that the public will
join them in insisting upon a State inquiry into
cancer, the necessity of which was urged last week.
. 'ftottz on Current topics.
Photographed in Grave Clothes.
A curious professional incident is reported from
New Tort with all the gravity and detail that betoken
fact, but all the same one is accustomed to accept
stories of this stamp from the New World with some
amount of reserve. The tale is that Dr. Mary
Walker, a well-known citizen, was desirous of finding
out what her appearance would be when dead. She
accordingly had herself photographed when laid out
as she would be for the grave. This strange picture
is now being published broadcast over New York, so
says the Morning Leader. The information is added
that flowers are strewn over the dress in which she
lies, and on the lapel of her jacket is a bronze
medal, which Dr. Walker says was presented
to her by Congress shortly after the Civil War.
Of course, as everyone knows, on this side of the
Atlantic any attempts to attain publicity by
methods that savour of self-advertisement are
rigorously condemned by an unwritten code of laws.
In America, however, there are no such restrictions,
and we must confess to a certain sense of admira¬
tion for the daring originality of the idea, supposing
it to have been actually carried out with all the pomp
of gruesome circumstance described by the news¬
paper correspondent. One is reminded of the
ancient saw that whatever is worth doing at. all is
worth doing well To be photographed as a corpse is
“ going one better ” than eccentrics of the Sarah
Bernhardt type, who travel about with and occasion¬
ally sleep in a coffin.
The Rating of Hospitals.
The London County Council have decided, by a
small majority, not to recommend, for the present
at any rate, the exemption of hospitals from rates.
Sir Arthur Arnold and Dr. Collins urged the Council
to express a favourable opinion, but their eloquence
was without avail. In the course of the discussion it
transpired that churches and chapels, voluntary
schools, literary and scientific societies, Sunday and
ragged schools, and Volunteer buildings are all
exempted under various Acts of Parliament. In the
face of those facts it seems an extraordinary and
unaccountable thing that the medical charities, which
are not less directly essential to the welfare of the
mass of the community than many of the institutions
mentioned, should be grievously mulcted of the
funds subscribed to them by charitable donors. The
amount of taxation levied from the hospitals yearly
is no less than £21,000. Here is the opportunity for
the Prince of Wales’s Fund to step in and render a
solid service to the Metropolitan hospitals. Let
them bring the whole weight of their immense social
influence to bear upon Parliament to redress t*bis
grievance, for it is nothing less. The total debt of
the London medical charities reduced by £21,000, for
that would be the practical outcome of a special
exemption Act, would lessen the enormouB burden
that the Prince’s Fund has undertaken. The chief
objection raised in the County Council was that they
should do nothing towards exempting hospitals until
they had something to do with the management of
them. How does that principle apply to churches*
chapels, learned societies, Sunday-schools, and Volun¬
teer buildings ?
Fined for Non-Notification.
A medical man in practice at Kington, Hereford¬
shire, has recently been fined for failing to notify the
District Medical Officer of Health of a case of infec¬
tious disease within the meaning of the Notification
Act, 1889. From the evidence it appeared that a
child was attacked with what defendant himself
openly admitted to be scarlet fever, both to the
Inspector of Nuisances and to the Medical Officer of
Health. Notwithstanding that fact, the case was
never formally notified. A serious feature of the
affair was that a girl in the employ of the infected
household was allowed to enter the patient’s bed¬
room. She went home and communicated the disease
to five persons, among them being her mother, who
had been recently confined. The prosecution
seems to have been conducted in a most candid
and temperate way, and the only defence offered
was that there had been no attempt at concealment
on the part of the defendant. The Medical Officer
testified that the latter said in the course of con¬
versation that he preferred “ to wait for the peeling
before he notified.” Such a course must be not only
absolutely unnecessary, but full of danger in the vast
majority of cases. Here and there a doubtful attack
may come under observation, but even then it would
be wiser to run the risk of sending in a mistaken
diagnosis, rather than spread a dangerous disease
broadcast by delay and inexcusable timidity. The
defendant in this instance was fined £T and costs,
and by his unwisdom has placed himself in a most
unenviable position. It seems almost incredible that
any medical man should allow himself to incur such
an amount of vexation and notoriety by neglect of a
simple legal formality.
A Threatened Water Famine.
There seems to be some foundation for an ugly
rumour that has lately been in circulation as to the
possibility of a general water famine in the metro¬
polis. May and June were very dry months, during
which a far smaller amount than the average flowed
over Teddington Weir. While Londoners draw their
water from the Thames they will always have to ran
the risk of a scarcity of water in time of drought.
The peculiar danger of the present position, however,
arises from the fact of the connections that have been
made between the mains of the various companies.
Supposing that the East London Water Company
glide into their usual summer failure then the
Thames-fed Corporations, called upon as they
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68 The Medical Press.
NOTES ON CURRENT TOPICS.
Jult 19, 1899.
would be to make up for the shortcomings
of the Lea, would be likely to find them
selves in serious distress. While one has no wish to
meet trouble half-way, yet, on the other hand, it were
indeed foolish not to look ahead in a matter so im¬
portant as the water supply of a vast community.
Should any such complication as a general water
famine arise, Londoners, as a whole, will perhaps be
induced to consider things seriously, for a failure
affecting north, south, east, and west alike would not
be taken so complacently as one that threw its
brunt on the great labouring quarter of the Metro¬
polis. The Government can hardly be congratulated
so far on the handling of the London water question,
and a failure of supply this summer would cause a
good deal of heart searching, both inside and outside
the Rouses of Parliament.
The Relations of Public Vaccinators to
Private Practitioners under the
Vaccination Act.
The following sensible suggestions are offered by
the Bradford and West-Riding Medical Union for
the guidance of public vaccinators in their dealing
with the patients of other practitioners. If honourably
adhered to it is claimed they will not interfere with
the official duties of the public vaccinator, and will
protect the interests of private families and family
practitioners. 1. The public vaccinator before enter¬
ing a house should ascertain whether there is in fact,
as reported to him, an unvaccinated child in the
house. 2. In the event of his being informed that
there is not an unvaocinated child in the house: or
if there is, that arrangements have been made for its
private vaccination, the public vaccinator should then
at once retire. 3. Should the public vaccinator be
informed that the child is too ill to be vaccinated, he
should retire without entering the house. It is not
his duty to require a certificate of unfitness to be
supplied, that is the duty of the vaccination officer.
4. It is not the duty of the public vaccinator, nor is
it compatible with the dignity of his profession to
endeavour to persuade the parents to let him perform
the vaccination for which he is to receive a specified
fee from the public funds. 5. The public vaccinator
as such should not proceed to examine any child as
to its state of health, unless he has been requested to
vaccinate it, and unless he is bona fide under the
impression that the child is fit to be vaccinated. In
any other case his duty is to abstain from all inter¬
ference with the child. 6. Any reference as to the
superiority of his methods or his vaccine, made with
the view of being allowed to vaccinate, would be
most unworthy, and could only be exceeded in this
respect by any attempt to decry the methods or the
vaccine employed by other practitioners. 7. If he is
required to vaccinate a child belonging to a family
who are the patients of another practitioner, he is
in honour and in self-respect bound to avoid any act
or word which might tend to prejudice the profes¬
sional interests of the family medical attendant, or
which could be regarded as an attempt to induce the
family to employ him as their family doctor. 8,
The public vaccinator is not authorised to call, for
the purpose of vaccinating a child, until after the expi¬
ration of the twenty-four hours’ notice which he is-
required to give.
Medical Cromwellianism in Am erica.
A medical paper issued inPhiladelphiahas published
a most satisfactory account of the moral character
of the recent annual meeting of the members of the-
American Medical Association at Columbus. Indeed,
ever/ one in the profession in the United States-
must feel delighted that the editor of the journal in
question has found himself in the position of being
able to give such a good report of the conduct of the
members. He says that “ even in such a matter ae
personal ethics and dignity there was at Columbus a
most noteworthy absence of what has previously been
an altogether too conspicuous presence of the guzzlers
and all-nighters. There were even strange stories
of ‘Nothing stronger than lemonade, please,’ this-
year, and the banquets, even of the so-called
American medical editors, were free from stories in
which the delight in witless filth has often been
an astonishing element of attractiveness. There-
is plainly to be an end of the * dry smoker ’
and the ‘ roysterer.’ ” The members of the
British Medical Association who intend visiting
Portsmouth for the annual meeting should take
these remarks to heart, and make a point while
there of drinking nothing stronger than water, going
to bed punctually at ten o’clock at night, limiting
their conversation, except at the sections, to philan¬
thropic schemes relating to the parochial clergy, and
of observing an entire abstinence from tobacco
smoking—otherwise they might expose themselves
to the accusation of being roysterers and “ all-
nighters.” Has the spirit of Cromwell been acting
upon the feelings of the members of the American
Medical Association, or are the remarks above quoted
merely imaginative sallies of the editor of the journal
in which they appeared P
The Liverpool School of Tropical Diseases^
Mb. Chamberlain is evincing quite a paternal
interest in the progress of the Liverpool School of
Tropical Diseases. In commending the enterprise of
the authorities to send a research expedition to West
Africa, he has written to say that he has learnt with
satisfaction that the expedition of the Liverpool
School is being sent, and that he appreciates the
energy and public spirit shown by the committee of
the school in the matter. He also adds that the
authorities at Sierra Leone will be instructed to-
give every facility to the work of the expedi¬
tion. After the expedition has completed its
work at Sierra Leone it will proceed to Accra,
where further investigations will be carried out.
The Belgian Government, attracted by the excellent
organisation now existing at the Liverpool School of
Tropical Diseases, have despatched an officially
appointed delegate to visit the Institution and report
to the Government. Altogether, it would seem that-
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Jolt 19, 1899.
NOTES ON CURRENT TOPICS.
The Medical Press. 69
the Liverpool School will ultimately take the lead in
providing for the study of tropical diseases in this
country.
The London Hospitals and the Anti-
Vivisectionists.
The Honourable Sydney Holland is well known to
be one of the most zealous and successful managers
of hospital charities in London, and his reputation in
this regard has been gained by a devotion to service
on their behalf which has won for him unstinted
praise from all who are interested in the same work.
One of the hospitals upon the success of which he
has expended much energy, and which in consequence
now occupies quite a unique position among the
smaller institutions of the kind, is the Poplar
Hospital for Accidents. Owing to Mr. Holland’s
advocacy of its claims this hospital enjoys a large
measure of public support, but in a fair and open
manner Mr. Holland has shown that the charity is
worthy of the support which it has received. Despite
this, however, we feel it our duty to draw Mr.
Holland’s attention to a circular letter which has
been issued by the Honourable Stephen Coleridge in
which the latter seeks unfairly to disparage another
hospital for the purpose of alienating subscriptions in
favour of the Poplar Hospital for Aocidents. The facts
are as follows: Mr. Bird, the chairman of the West
London Hospital, wrote a letter to the Times stating
that the Pathological Laboratory which had recently
been organised by the Staff of the Hospital in con¬
nection with the West London Post-Graduate Col¬
lege, had not been licensed for the performance of
experiments upon animals. Whereupon the Honour¬
able Stephen Coleridge drafted a letter, a copy of
which was sent to every subscriber to the West
London Hospital, in which he stated that two mem¬
bers of the Staff weie licensed under the Vivisection
Act, by which they were enabled to dispense with
the obligation to kill the animals by anaesthesia after
the experiments had been performed. The inference
which the Honourable Stephen Coleridge evidently
intended should be drawn from his statement was
that the two members of the Staff in question made
use of the West London Hospital laboratory for the '
prosecution of their researches. Whereas, of course, i
nothing of the kind is the case. Despite, however,
the obvious unfairness—to use no stronger word—
of this attack upon a well-known and excellent
charity, the Honourable Stephen Coleridge used it as
a plea to urge the subscribers to the hospital to trans¬
fer their subscriptions from the West London
Hospital to the Poplar Hospital for Accidents, where,
as be states, an undertaking exists not to appoint or
retain licensed vivisectors on the staff. It is difficult
to believe, despite the interest which he takes in the
Poplar Hospital for Accidents, that the Honourable
Sydney Holland would desire to see his institution
made the means of impoverishing another hospital for
the reasons advanced by the Honourable Stephen Cole¬
ridge. Indeed, we feel sure that Mr. Holland would be
the first to repudiate such a method of raising funds
for his hospital. However, the matter is one which so
largely affects the interests of the medical charities
in London that we trust public Bteps will be taken to
disoount the efforts and statements of the Honour¬
able Stephen Coleridge upon each occasion that he
attempts—unwarrantably—in this way to interfere
with their concerns.
The Fellows’ Meetings at the Royal College'
of Surgeons, England.
After the annual election of members of Council
at the Royal College of Surgeons, on the 6th inst., the
president and two vice-presidents of the Council
attended in the theatre of the College in order to
hold the annual meeting of the Fellows. But for the-
third time in succession, at the Fellows’ meetings,-
the necessary quorum was not obtained, and conse¬
quently no business could take place. The presi¬
dent, Sir William MacCormac, in alluding to this fact,
expressed his regret that not more than twenty-one
Fellows had attended, inasmuch as the Council had
hoped that a discussion would have taken
place at the meeting upon the question of the-
proposed supplementary charter. But there iB no
disguising the fact that at the present time College-
politics are dead, so far as the Fellows are concerned,
and if the Council were to decide to abolish the
Fellows’ meetings entirely there would probably be
no one who would complain of their action. That
this state of affairs now exists does not prove a pre¬
valent apathy among the Fellows concerning the
affairs of their College; it merely is an indication
that the old body of reformers have ceased to be
active, and that the Fellows generally have for the
time being come to the conclusion that the present
government of the College does not call for their
interference. It would now seem to be the case that
if the Council are desirous of obtaining the opinion
of the Fellows upon the question of the proposed new
charter, the expedient will have to be resorted to of
calling a special meeting of the Fellows for this
express purpose. However, in view of the fact that
there cannot be two opinions as to the desirability of
applying for the new charter, there does not appear
to be any sufficient reason why the Council should
approach the Fellows upon the subject.
German Practitioners in England.
We are informed that Dr. Pagenstecker, the oph¬
thalmic surgeon of Wiesbaden, has taken time by the-
forelock and made a bid for practice in London. He~
haa established in Wimpole Street a German assist¬
ant who will represent him and see confiding British
patients on his behalf. The state of the law is such
that without an English medical diploma any Ger¬
man can establish himself in medical practice in
England, and provided that he was not called upon
to sign a death certificate no one could interfere with
him. There is but little danger of a practitioner
who confines himself to ophthalmic surgery being
required to sign a certificate of death, and thus the
assistant of the Wiesbaden surgeon may be regarded as
secure from interference by the law. Verily, the
“ law is a hass ” in this instance, and nothing could-
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70 The Medical Phes6.
NOTES ON CURRENT TOPICS.
Jolt 19, 1899.
more plainly show how ill-protected English practi¬
tioners are in their own country against the invasion
of competing aliens.
Another Case of Total Extirpation of the
Stomach.
On the 9th ult., Dr. Kocher, of Berne, Switzer¬
land, removed the whole of the stomach of a woman,
£B t. 40, for carcinoma of the pylorus. The duodenum
and oesophagus were united, and the abdominal
wound was sutured, a Bmall glass drainage-tube
having been inserted. The patient lived three days
and a half and then suddenly died. At the post¬
mortem examination qome peritonitis was found as
the result of necrosis of a email portion of the wall
of the transverse colon.
Union Analysts for Ireland.
The recent order of the Irish Local Government
Board, which defines the qualification of the Analyst
to a Board of Guardians has created a good deal of
.effervescence among pharmaceutists. It was quite
necessary that such an official definition should be pro¬
vided, inasmuch as a number of Boards of Guardians
had already availed themselves of the new ap¬
pointment to “job" in their own friend the local
chemist, but it appears to us that the definition is
unsatisfactory. It, for instance, makes Fellowship
of the Institute of Chemistry a qualification sine qua
non, and, in other ways, it indicates the appointment
of a pure chemist, not of a pharmaceutical expert.
In our opinion the Public Analyst should embody
both specialities. His chemical knowledge will be in¬
dispensable for analysis outside the region of drugs,
but, within this area, it will be insufficient for the desired
object. The purity of pill masses, compound lini¬
ments, and such-like therapeutic mixtures can be
Ascertained by laborious and prolonged analysis, but,
be it said with respect, the purchasing public would,
for this purpose, have more confidence in the
educated nose, tongue, and eye of the experienced
drug buyer than in any analyst, however eminent.
We suggest that the Local Government Board should
try to make a definition which would combine the
scientific and the pharmaceutic qualifications, and
should revise its rule accordingly.
The Liverpool Skin Hospital.
The Liverpool medicine profession can hardly be
congratulated on the latest phase of the “ scandal ”
at the Hospital and Skin Diseases in that town. After
the two members of the staff had been hurriedly dis¬
missed by faggot voting, the vacant poets were
forthwith advertised. It has since been publicly
stated that about thirteen doctors have applied for the
vacancies, in addition to three others who have been
nominated by “ a professional man of high standing.”
Supposing the latter statement to be true, most of
our readers will agree that the height of the status
of the gentleman in question is likely to undergo a
reduction to vanishing point. As matters stand,
two members of the staff have been dis¬
missed for bringing charges of a grave nature
against their senior, who has taken no steps
to establish his bona fides by bringing an action
for libel. How any committee of honourable men
can be induced to make themselves responsible for
such a proceeding must puzzle the average human
intelligence sorely. However, similar mysteries are
not unknown in the hospital world. It is not so many
years since that a notorious skin hospital in the
metropolis defied public opinion in much the same
way. Three of its medical staff resigned because of
the failure to clear the management of various
charges. Their places were at once filled up by other
medical men, some of whom hold to the present day
the posts obtained in a manner that the keenest Com¬
petition could not justify. There seems no prospect
of things being settled yet awhile at the Liverpool
Hospital.
The Case of Dr. Lamont.
Great satisfaction is expressed in Scotland by
members of the profession and others as to the
generous and kindly speech of the leader of the House
of Commons in reply to the statements made by a
number of Scottish representatives, descriptive of
hiB unjust and malicious treatment. The Lord
Advocate, of course, had to do hie best to whitewash
the officials of hie department, a work of no little
difficulty even in his hands; but it was only when
Mr. Balfour intervened that Dr. Lamont received
complete exoneration, and notice was given that he
would be compensated for out-of-pocket expenses.
The most important result of the discussion on this
case lies in the public exposure of the wrongs which
may be done, and frequently are done, by local
authorities to their medical officer’s, without these
officials having any power of appeal or of obtaining
redress through the Local Government Board for
Scotland. The virtuous indignation of members of
the Opposition at this state of affairs contrasts
peculiarly with their former attitude, which, if we
mistake not, was the converse.
Instruction in Pharmacy.
The Senate of the Royal University of Ireland
has intimated to the Pharmaceutical Society that it
will, in future, recognise instruction only in a regular
medical or pharmaceutic school, not in a chemist's
establishment. We are aware that the existence of
pharmacy departments in medical schools is owing
to the fact that when the certificates of chemists and
hospital dispensers were accepted, those documents
could be bought for a sovereign across the
oounter as readily as a seidlitz powder.
Therefore the Colleges thought it necessary to
ensure bona fides by establishing their own pharmacy
schools. Without suggesting that the school courses
in this subject are not as genuine as the assiduity of
the teacher can make them, we have no confidence
whatever in them as proofs of pharmaceutic educa¬
tion. We do not believe in the possibility of com¬
municating a sufficiency of such knowledge in a few
prelections in a lecture theatre, and we would sug-
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Jult 19, 1899.
NOTES ON CURRENT TOPICS.
Thb Medical Peess. 71
gest that the Licensing Bodies should surmount the
difficulty by abolishing the pharmacy certificate
altogether, and leaving the candidate to “get up”
the subject for examination any way he can.
“ Closed for Repairs.”
The spectacle of so many of the large hospitals,
special and general, evacuated of their suffering
contents for the purpose of “ alterations and repairs,”
excites a feeling of curiosity as to the fate of those
•who would otherwise be enjoying (?) their hospitality.
Although some sort of arrangement is usually
attempted in respect of the more serious cases there
-can be little doubt that much hardship is inflicted on
the suffering poor by the lack of concerted measures
between the various hospital authorities. It is
one of the drawbacks of the “ voluntary ” system
of hospital maintenance that the managers
of these institutions escape any sort of official
control, otherwise no hospital would be per¬
mitted to close all its wards at onoe, just in order
to give the staff a holiday. Apart from the hardship
to patients, the present system causes much heart¬
burning among the junior members of the medical
staff, who, the surgeons especially, look forward to
their seniors’ holidays to enjoy positions of responsi¬
bility and experience which they are yearning to fill.
The senior man, on the other hand, appears indisposed
to gratify his junior's aspirations, and gladly falls
in with the proposal to shut up the hospital as a
-whole. The occasions when such a course can be
justified by the magnitude of the alterations con¬
templated must be rare indeed, and obviously it must
be as easy to whitewash and disinfect wards seriatim
as altogether. This is a matter to which subscribers
to hospitals would do well to direct their attention,
for only a little judicious inquiry is required to bring
about a desirable reform.
A Reverend Quack.
A singular career was unfolded, in part, on
Saturday last, at one of the Metropolitan Police
•Courts, where one, Maguth, was brought up on
a coroner’s warrant charging him with man¬
slaughter. It appears from the evidence that
the accused started adult life in holy orders, but left
the church in 1879 to take up with “ medical
botany,” on the strength whereof he described himself
on a brass plate as “ Dr. Maguth, LL.D., Scientific
Medical Botanist and Hygienic and Dietetic Adviser
in all Ailments. Advice Gratis.” In the exercise of
his unauthorised functions Maguth attended a child,
»t. 7, who was suffering from “ ulcerated throat,”
which, however, he failed to identify as due to
diphtheria, and the child died. Obviously there is
hardly a disease in which a prompt and correct
diagnosis is of greater importance than diphtheria,
for on its recognition and early treatment the ulti¬
mate result must, in most instances depend. More¬
over, an unrecognised case of diphtheria is a standing
form of infection, the more potent for evil by reason
of its nature not being suspected. We trust due
i-o mine nee will be given to these points when the
case comes up for trial. The accused has been
liberated on bail pending further inquiry.
Infectious Diseases in London.
It is disquieting thus early in the season to be
confronted with a notable increase in the number of
infectious cases in the hospitals of the Metropolitan
Asylums Board It is, moreover, very disappointing
to find that all the money spent in notification or
isolation seems to be without effect in restricting the
spread, for instance, of scarlet fever, and in attenuat¬
ing its effects. The seasonal rise and fall recur with
tedious monotony, and the numbers, as compared
with those of previous years, invariably show a steady
increase, an increase which renders necessary the
building of another palatial edifice every year or two
for the accommodation of the sick. This result may,
to a not inconsiderable extent, be attributable to the
fact that the public are getting accustomed to the
idea of transference to hospital and offer less opposi¬
tion when removal is suggested. The laxity of the
Board in enforcing payment from those in a position
to pay may possibly explain this change of front, and
one of these days the Board's policy in this respect
will have to be taken into consideration.
A Midwife’s View of Infantile Bronchitis.
Now that the subject, mid wives' registration, is
so much before the public, it is with more than
ordinary interest one turns to cases that illustrate
their potential medical capabilities. From this point
of view the evidence of a midwife given last week
at Stroud is not without its instructive and suggestive
aspects The occasion was a coroner’s inquiry into
the death of an illegitimate infant of a farmer's
housekeeper in the district The midwife deposed that
she attended the mother who was confined of twins
One was born at four o’clock in the morning, the
other twenty minutes later. Witness did not expect
either of them to live, but everything was done for
their comfort. The second child was very weakly,
and could hardly breathe. It appeared to be suffer¬
ing from bronchitis, and died about nine or ten
hours later. She thought the child died from
bronchitis and weakness, and that no blame was to
be attached to anybody. She left no one in the
room, but the farmer's daughter was down¬
stairs. The attention of those who are agitating
for the registration of midwives should be
drawn to this incident. The gross ignoranoe that
attributes weak breathing in a newly-born infant to
bronchitis is just what may be looked for from
women untrained in medical matters. If that sort
of view were accepted a vast number of infants would
die simply for want of a little artificial respiration.
What had the coroner to say to the fact of the mother
being left alone with these ailing twins within a few
hours of their birth ?
Dr. Parry, of Pont-y-Cymmer, Wales, has re¬
covered £5 damages and costs against a local news¬
paper, a writer in which had charged him with
neglecting his patients for yachting. It subsequently
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THE ABUSE OF HOSPITALS.
72 Thb Medical Phbss.
July 19, 1899.
transpired that the newspaper had been “ hoaxed,”
and could not trace their anonymous correspondent'
Mr. Kearley's Food Products Bill, the Midwives
Bill, Mr. Boulnois’s Conscientious Objectors Bill,
and Mr. Begg’s Companies’ Act Amendment Bill
have all been dropped within the past week.
The occurrence of Carytes in various districts in
Ireland has been brought to the notice of the County
Councils by the Irish Industrial League with the
view of having it ascertained whether the deposits
will pay to work.
The present century has not produced, and is not
likely to succeed in giving to the world a second Lawson
Tait. Nevertheless, at the annual meeting of the Liver¬
pool Samaritan Hospital for Women, held last Wednes¬
day, “ Dr. Lawson Tait was elected Consulting Surgeon
to the hospital.” Would that our late distinguished
confrere were in the flesh to accept the honour. The
hospital committee evidently does not keep itself posted
in the everyday affairs of this mundane existence.
Jflcbico-'Jegal Jlotes.
By W. J. JOHNSTONE, B.L.,
Dublin.
The Royal College of Surgeons, England, and the
Inland Revenue Department.
The English Court of Appeal has been considering in
an important case the position and history of the Royal
College of Surgeons of England. The immediate object of
the case was to get a decision of the Court as to whether
the property of the Royal College^of Surgeons, England,
was subject to duty within Section 11 of the Customs and
Inland Revenue Act, 1885, but incidentally some inter¬
esting legal light was thrown on the objects and history
of the College. The facts were very simple. The section
above referred to imposes duty upon the annual value
of all property belonging to any body, corporate or in¬
corporate ; but there is an exemption from duty
in the case of “ property which, or the income
or profits whereof, shall be legally appropriated
and applied.for the promotion of
education, science, or the fine arts.” It appeared that
the annual value of the real property vested in the College
during the year ending June 24th, 1894, was £7,200. The
total value of the vested personal estate of the College
on the same date was £187,195 17s. lid., the income from
which amounted to £5,833 5s. 7d. The College was
assessed by the Commissioners at £3,161, and required
to pay as duty the sum of £158 Is. The Commissioners
allowed exemption in respect of the museum, and that
part of the property which consisted of laboratories; but
no exemption was allowed in respect of the library, the
conservator’s residence, the general offices, and the hall
used for examinations. Sir Edward Clarke argued
that the whole of the property of the College was
“ legally appropriated and applied ” for the pro¬
motion of science, and was, therefore, not liable to duty.
An alternative claim was put forward that, at any rate,
•the library of the College in Lincolns-Inn-Fields, and
the official residence of the conservator of the museum
came undoubtedly with the exception in Section 2.
The Court of Appeal, however, decided that no part of
the property in question was legally “appropriated ” for
the promotion of science, and that the duty must be
paid.
The Purposes of the Royal College of Surgeons,
England. —The judgment of Lord Justice Romer in the
case is a valuable document from ahistorical point of view.
He began by referring to the Act of 18 George III. c. 15,
which made the Burgeons and the barbers of London
two separate and distinct corporations, and he traced the
history of the College of Surgeons from its incorporation
by a charter of George III. in 1800 to the present time.
From an examination of the various Acte of Parliament and
the bye-laws of the College, he came to the conclusion
that the objects and purposes of the College have a dual
nature; firstly, the promotion of the science of surgery,
and, secondly, the promotion and encouragement of the
practice of surgery and the promotion of the interests of
surgeons. No part of the College property was “ legally
appropriated ” for the objects and purpose of the science
of surgery. That is, there was no legal obligation on
the part of the administrators of the College to apply
their property for the first purpose and object as dis¬
tinguished from the second; and, ae a consequence, it
was held lhat none of the property in question came
within the exemption of Section 2, In the judgment it
was assumed, of course, that property applied for the
purpose, of the practice of surgery, as distinguished
from the science of surgery, did not come within the
exempting clause.
The Laws as to Bakers and Bakehouses.
The decision of the Queen's Bench Division in
Schwerterhof v. Will-ins (19 Cox C. C. 22 j is an interesting
illustration of the construction of Acts of Parliament
and the administration of statute law. It was considered
necessary for public health and safety to pass the
Factory and Workshop Act in 1895, Section 27 of which
contains certain provisions as to bakehouses and bakers.
Sub-s. provides that a place underground shall not be
used as a bakehouse unless it was so used at the date of
the passing of the Act—namely, January 1st, 1896.
Certain underground premises were occupied by
Schwerzerhof as a bakehouse. A complaint was
preferred against him on behalf of the sanitary authority
of the district, when the following facts were proved.
The premises in question were fitted up as a bakehouse
in 1879, and were occupied by a baker down to December,
1894. The tenancy ended then, and the landlord had
the premises put into repair. In February, 1896, they
were let to Schweizerhof, who began to use them again
as a bakehouse, and was so using them when he was
summoned. On the facts the magistrates convicted, and
fined the appellant. The Queen’s Bench Division, how¬
ever, thought otherwise. That court was of the opinion
that one tenant going out and another going in did not
8top the premises being used as a bakehouse, even
though the premises happened, as in this case, to be un¬
tenanted on the crucial date, January 1st, 1896 : that the
place was being used as a bakehouse at the passing of
the Act, and that Schwerzerhof ought not to have been
fined. It never was the intention of the legislature that
the vested rights of any owner of a factory or manu¬
factory should be injured by the passing of the Act of
1895, and it seems that the above decision is clearly in
accordance with that intention.
THE ABUSE OF HOSPITALS.
A Special General Meeting of the Bradford and
District Medico-Ethical Society was called some months
ago for the purpose of considering the question of
Hospital Abuse, feveral meetings were subsequently
held, and the Committee now report that the following
resolutions were passed, and seem of so much value as
bearing on this important question, that we reproduce
them in full:—
1. Medical Rblief is Charity. —“That in the
opinion of this Society, it is of the first importance that
the Boards of Management of Public Hospitals, and the
public generally, should recognise the principle that
medical relief is charitable relief, and that the hospital
funds are provided in trust for the benefit only of the
sick who are unable to pay, when suffering from serious
ailments, and that it is not only dishonourable but dis¬
honest for other persons to take any part of these funds.”
2. TV ages Scale. —“That the Bradford and District
Medico-Ethical Society approve the following Wages
Scale for use in our hospitals :—For one person, when
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July 19, 1899.
CORRESPONDENCE.
The Medical Press. 73
in work, 18s. per week ; for two persons, when in work,
238. per week; for three persons, when in work, 28s.;
for four persons, when in work, 31s. per week, with 3s.
for each additional member of family. That cases of
long-continued illness or cases for serious operation
should be considered exceptional and should be recom¬
mended by their medical man.”
3. Inquiry Officer. —“That the necessary inquiries
as to the inability of applicants for medical charity to
pay for treatment at home cannot be satisfactorily
made exoept by a special inquiry officer, and that all
cases should be inquired into by such an officer."
4. Serious Cases.— “That no patient who is excluded
by the wages scale ought to be entitled to receive medi¬
cal charity unless suffering from an ai'ment of so serious
a nature that it cannot be properly treated except in
hospital.”
6. No Small Payments to be Taken. —" That the
acceptance of small payments from patients in receipt of
medical charity, whether as a contribution towards the
cost of maintenance or in return for medical treatment,
is highly undesirable. This is not intended to interfere
with voluntary contributions by grateful patients after
the treatment in hospital has been finished.”
6. Recommendations. —“That the system of giving
recommendai ions to subscribers is objectionable, is
greatly abused, and should be abolished.”
7. Casualty Patients —" That casualty patients
should receive first-aid. and then if above the wages
limit be referred to private medical men.”
8. Dental Extractions.— “ That cases of simple ex¬
traction of teeth should be inadmissible.”
9. Out - Patients. — “That out-patients shall be
admitted to the hospitals without charge, subject to
inquiry as to their monetary suitability. That patients
sent by their medical men for a second opinion, but not
for hospital treatment, shall be eligible without inquiry
by the inquiry officer.
10. In-patient Department.— “ That in-patients
shall be admitted according to the wages scale, excep¬
tions being made when operations are required, or when
other extraordinary circumstances obtain. That no pay¬
ing patients shall be admitted as such.”
11. Home-patients. —“That the home-patient de-
f artment, as carried out in connection with the Brad-
ord Royal Infirmary, is much abused, objectionable in
principle, and should be abolished.”
CxirreBpottOcnce
We do not bold ourselves responsible for tbe opinions of our
correspondents.
THE “CANCER FOG.”
To the Editor of The Medical Press and Circular.
Sir, —In pursuance of the promise in my previous
letter I proceed now, with your permission, to offer a
suggestion or two regarding the definition of a few of
our terms, which may perhaps throw some light on the
subject. Constitution, then! Is not constitution the result¬
ant at any moment of the reaction between the organism
and its environment from birth till the moment in ques¬
tion ? Is not constitution, therefore, always in a state of
flux, mobility, change, as the environment (manges? I think
so. Then heredity, on the other hand, is not that fixed
and determined? Would not a good definition of
heredity be that it was the state of the individual as
determined by ancestors? It seems to me it would.
And, therefore, the heredity remains fixed; what it was
and is, that it remains, while the constitution is always
altering and changing every moment. Constitution is
the state of the individual as determined by environ¬
ment. But to say that a constitution is altering and
changing every moment, is equivalent to saying—is it
not ?—that a constitution may be non-cancerous at one
period of its history, and cancerous at another. It seems
so. A constitution may certainly be sound at one time,
and damaged, broken, unsound at another, and this no
doubt in response to changes effected on it by the envi¬
ronment. A rheumatic fever will or may damage
sound heart. The philosopher indeed may see that i*
was not so much the rheumatic fever which damaged the
heart, as the previous course of events which led up to
the occurrence of the rheumatic fever and of the heart
damage which was one of the steps in the train of event*.
And similarly we have to inquire: May not long con¬
tinued unsuitable and improper environment render a
sound constitution epitheliomatous ? Make it take on
epithelioma ? Make it cancerous ? Why not ?
This kind of question raises, of course, that other of
predisposition. Well, what is predisposition ? Is not
predisposition at any moment very much the same) as
weakness ? You sit in a draught and get a bronchial
catarrh, but the draught was very slight and lasted for
a very short time, and it ought not to have given you
cold. But your predisposition was great; otherwise your
resistance was low. Predisposition, therefore—is this a
good definition ?—is inverse resistance. But how did|the
predisposition become great ? How did the resistance
become weak ? Not through heredity, for that is fixed
and determined, and yet at one time you would not have
taken cold from so slight a cause, while you do now.
If not through heredity then, has not the change been
effected by environment, otherwise by life history ? And
among facts of life history, what so important as rela¬
tions to work, to air, and to food ? and especially to the
last?
Then as to what is inherited. Is it not so that organi¬
sation is inherited rather than disease ? It seems to me
it is. In a wide sense organisation is inherited ; in a
narrower sense, humanity, bovinity, vulpinity, felinity,
are transmitted and inherited. Will it not depend on
how humanity, bovinity, vulpinity, felinity are respec¬
tively treated—what conditions of environment they are
subjected to—how or from what diseases they will suffer ?
Humanity will not suffer from bovine diseases nor from
vulpine, though some diseases may be common to all
forms of organisation. In fact, the possibility of using
the term organisation at all implies some common
qualities ? From which considerations emerges a
definition of the heredity of disease, viz.:—“ Like causes
acting on like organisms in succeeding generations
induce like effects." How would that do ? So that if a
woman has cancer at 56, and her mother had cancer at
56, and her grandmother had cancer at 56, it would not
at all follow that the grandmother transmitted it to
the mother, and the mother to the daughter. We
must first inquire how grandmother, mother, and
daughter respectively lived, what evironment they were
subjected to, or what environment they subjected
themselves to, before we can answer whether it was
likely that each in turn transmitted cancer to her
successor. Then as to the kinds of cancer. Is not one
form far commoner than any other ? Epithelioma, for
instance. Suppose, for a commencement, we confine
ourselves to that. Now, following the philosophic spirit
so justly commended by Dr. 8now, let us ask a question
or two here. Is not cancer, epithelioma, an overgrowth
of tissue ? It seem6 to me so. Where did it come from ?
It must have come as an exudation from the blood. It
seems so. Where did the blood get it, or the stuff out
of which it made it ? Did, or could, the blood create it ?
Can the blood or the body create anything? We have
no knowledge that it can or does. The body and the
blood can convert, indeed, but so far as we can see they
have no power to create. They must then have con¬
verted the epitheliomatous exudation or growth out of
something else? Out of what did they convert it?
What goes into the blood ? Air, no doubt, or gases, and
food. But especially food. Gases, as we know, pass in
and out, but is it likely that solid growths are made out
of air ? They may be, of course ; but is not food a far
larger and more bulky entrant into the blood than air ?
No doubt in the vegetable kingdom solid growths are
made from the air. It seems as if trees and shrubs
obtaiu the material for their large bulk, greatly from the
air and particularly from the carbon which it contains. But
do animals ? Theoretically they might, of course, but
practically animals do not live on air. They certainly
appear to obtain nearly the whole of the material which
goes to form their bulk from the food which they con'
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74 The Medical Press.
CORRESPONDENCE.
July 19, 1899.
enrae. If, for instance, a man.egests half a pound of carbon
daily with the expired air, and if he takes in a large
amount of oxygen which he inspires, does he not obtain
much more material for his body from the 2 lbs. or 3 lbs.
or 4 lbs. of food which he consumes daily, and which, or
much of which, he passes into his blood ? It seems so.
How would it do then, or would it not promise well, if
we| examined the food of those persons who form
epitheliomatouB growths, which reason and observa¬
tion alike tell us they cannot create, but which
they, no doubt, convert out of something else ?
Ab air is, no doubt, an entrant into the blood as well as
food, 1 have no wish to withdraw attention from air,
but for the present let us think of the food, and then, if
■we have not a sufficient answer, let us consider the air
as a possible source of cancer. Well, now following up
this line, we find that women suffer from cancer more
than men. Half as many more women had cancer as
men in 1897. Formerly, the proportions were greater. In
1868, the proportion of women to men suffering from
cancer was more than two to one. In 1892, the prepon¬
derance of women over men suffering from cancer was
only as five to three, not as six and. seven-
tenths to three, as in 1868; and in 1897, as Dr.
Snow says, the preponderance was still less. Now,
two or three questions arise here. First, is the prepon¬
derance of cancer in women over men due to their sex or
to their habits P If to sex, it cannot be due to sex alone,
because, though sex is not altering, the proportion of
canoer is altering. Suppose we turn then to habit. In
what respects do the habits of women differ from the
habits of men ? Would not every one say that they eat
oftener ? I think so. And that they take by preference
dainty things like cakes and bread made up in various
tempting ways, and confectioneries? It seems so. And
that while they do not eat so much as men they eat
oftener. And that looking at the habits of women in
general as regards this question of the incidence of
cancer does it not look as if pollaki-t-iteism, if
not polysiteism is, or may be, a cause of cancer among
them ? It seems so. And that while pollaki-siteism is
the principle , the property, amylo-siteism and glycho-
siteism are the detail, the accident ? It seems so. And if
in each generation of women we see these food habits
strengthening rather than weakening, is there not in
this a sufficient cause, and true cause, apparent for the
increase of cancer without betaking ourselves to the
-theory of hereditary transmission ? It seems so. Besides
-that, if heredity is the cause, should we not expect that
hereditary disease would appear early in life rather than
late in life, since the nearer we are to our ancestors the
more influence they must be supposed to exert on us ?
and the more remote we are from our ancestors the less
the influence they will be likely to exert, and the greater
the influence of our own environment? It seems so
But children scarcely suffer from cancer at all. Out of
20,358 deaths from cancer in England and Wales in 1892,
only 103 occurred among children under five years of age.
It does not seeifl as if heredity had very much to do
with it.
These seem to me to be some of the questions which
the logical and philosophic spirit, commended so justly
by Dr. Snow, raise regarding this question of the
incidence of cancer. There are more of them, many
more; but your space and my time are limited. Let me
ask one. The same logical and philosophical bent causes
one to inquire why are men now suffering from cancer
more than they did ? Why is the preponderance of the
proportion of female cancer continually diminishing ?
Why is the proportion of male cancer increa«ing ?
Well, are not the habits of men approximating to those
of women ? Are men much more in the open air now
than women ? Are they not more in offices, in factories,
on the exchange than before ? I think so. So that men’s
habits in offices and women's in houses are fairly compar¬
able and not very different in principle ? And what about
food ? Are not men’s habits in this respect altering some¬
what ? Are they also not tending to poly-siteism and to
E ollaki-sitesm like the women ? What about their
reakfast at eight their crust of bread and a glass of beer
at eleven, their dinner at one, tea at five, and supper
about nine? Is not that pollaki-siteism aS compared
with the three meals of their ancestors, who led an
active out-door life which oxidised the material off in
the fields, and in the open air much more than their
more penned-up successors? And even, when three
meals only form the diet-habit of men, is not digestion
Blower now, owing to the absence of abundant exercise
than it used to be in former times ? And is there not
in the inquiry regarding food a very promising line of
investigation regarding the causes of cancer ?
And if poly-siteism and pollaki-Biteism seem possible
causes of epithelioma, what is the direction in whioh hope
for cure is to be looked for ? In the surgeon’s knife ? Is
that likely ? Is it likely that the effects of causes acting
three, four, five, or six times a day for many years are
going to be undone by a surgical operation, however
brilliant and however extensive ? That long acting vital
causes involving changes in nutrition are going to be
undone by a few bold strokes of the mechanical and skil¬
ful knife of the surgeon? Is it compatible with tne
logical and philosophical spirit commended to us to ex¬
pect that? After the brilliant and skilful operation,
will not the same causes continue to act? and to re¬
induce similar changes in other parts of the body, even
if the bold and extensive operation has succeeded in
removing all the disease ? Is not, in fact, too much de¬
pendence on such methods the main reason why the
lament of Sir William MacCormac is so mournfully in
evidence, and why there has been so little progress in the
treatment of these affections since the days of Hunter ?
Suppose that the methods of treatment are wrong ? Does
it not seem as if they are, since the progress is bo little—
since, in fact, the disease is increasing, as Dr. Snow says,
both in incidence and mortality ? Prosecuting the logical
and philosophical method further, if we see some evidence
that poly-siteism and pollaki-siteism are a main partof the
cause of epit helioma, would it not be likely that oligo-siteism
or even asiteism for a time might have some influence
in preventing the spread, perhaps even in undoing the
process of epithelioma ? Of course the philosopher sees
that this may or may not be. The causes may have
been acting for too long a time for such a change to
happen. A knowledge of causes may or may not enable
us to cure a process. But it is essential to prevention,
and it is a very hopeful line of inquiry that oligo-siteism,
dis-siteism or mono-sitism properly quantified may per¬
haps or possibly be the means of preventing cancer.
I have said more than I meant, but not more than I
think, nor so much by a good deal. The importance of
the subject, the hopeless way in which it is regarded, a
hopelessness which I by no means share, the m ystery of
it and the fascination of it must be my excuse.
I am. Sir, yours truly,
Philobophus Ionotus.
THE IRISH “SCALE” FEE SYSTEM.
To the Editor of The Medical Press and Circular.
Sir, —The able article in your last issue bursts the
bubble of special fees for poor people as a remedy for
the abuse of the dispensary ticket system. Certainly
no person having any practical knowledge of medical
practice and medical remuneration in rural districts in
Ireland could have expected it to be a succoss. As you
clearly show, the Irish peasant argues that inasmuch as
he pays a portion of the doctor’s salary (one fourth part
only under the new regulations 1 , he is quite entitled to
demand his services without further remuneration, how¬
ever small, and in the few cases where dispensary
doctors have been weak enough to agree to a reduced
scale of fees, I fear they will soon find such fees will be
the highest obtainable.
It is a matter for congratulation that the necessity
for meetings to discuss these matters with each other
seems at last to have roused the Poor-law medical
officers to the need for combination, and in a good many
Unions they have so combined to demand an adequate
minimum remuneration for extra services. I regard
such local combinations as the first and most necessary
step towards obtaining a reform of those grievances of
which they most justly complain.
I have long been of opinion that only two remedies
Digi
July 10, 1899.'
LITERATURE.
Thk Medical Press. 75
exist for the use of dispensary medical relief. Either
pay the dispensary medical officers adequate salaries, and
give every person in their districts the right to their
gratuitous services, or else adopt the English system of
preparing lists of those persons in the union whom the
guardians should agree to be fit persons for free medical
relief.
I cannot see that such a system would entail any
hardship upon the poor, because the medical officer,
would only have a consultative voice in the selection,
and I believe it would save much heartburning and
sense of injustice.
As I am not a dispensary doctor, my opinion is quite
disinterested.
I am, Sir, yours truly,
T. H. Moorhead, M.D.
INTERNATIONAL CONFERENCE ON SYPHILIS
AND VENEREAL DISEASES AT BRUS8EL8.
To the Editor of The Medical Press and Circular.
Sir, —I have just reoeived a letter from Dr. Dubois-
Havenith, secretary of the congress on venereal diseases
to be held in Brussels from September 4th to 8th, asking
me to write to the medical journals to enlist their sym¬
pathy in making the congress a success. The medical
men who are at the head of this congress, viz..
Professor De Smit, Dr. Janssens, and Dr. Bayet, are
well known to many of your readers, and are a
guarantee that the discussions are likely to be of service.
Medical men, lawyers, and public functionaries are
invited to take part in the congress, and I have but litt'e
doubt that many British medical practitioners will be
anxious to give their opinion as to how syphilis might
be prevented.
It is hoped that all shades of opinion may be ex¬
pressed, and all difficulties candid ly discussed, for it is
lamentable that suoh an amount of preventible con¬
tagion should exist in oivilised count ries.
I am, Sir, yours truly,
Charles R. Dry8Dalx, M.D.,
Consulting Phys. Metropolitan Hospital of London, form«r'y
Physician to tne Bescue Society's Hospital.
London, July 14th, 1899.
%ittrature.
DE MERIC’S ENGLI8H-FRENCII MEDICAL
DICTIONARY, (a)
The author of this new dictionary is to be congratu¬
lated on having filled a gap in medical literature, which
has been felt for many years past on both sides of the
Channel. There must necessarily be a large number
of medical readers who require to have occasional
recourse to a technical dictionary in a foreign language -,
yet, so far as our experience goes, no one previously
has had the courage to tackle this difficult task, at
any rate, in this form, for Maxwell's “ Terminologie
Medica Polyglotta,” though very useful of its kind,
cannot well take the place of a dictionary specially
devoted to English-French medical terminology.
In criticising a work of this sort the reviewer is met
with the difficulty that the soheme of the work may or
may not meet with his approval. It may appear too
brief or, as in this instance, unduly comprehensive.
Perhaps the safer plan is to accepl the author’s scheme,
and to criticise within the lines he has traced for his own
guidance. In a dictionary proper we are only entitled to
expect the corresponding equivalent in the other lan¬
guage of the selected terms, not an explanation of the
meaning of the terms. Consequently, when we are given
an explanatory phrase instead of an equivalent term as
in the work before us we are to presume that no corres¬
ponding term exists in the French language. Fortu¬
nately, this is only needed in the case of terms little used
(a) “ Dictionary of Medical Terms. Vol. I., English-French.”
By H. de Meric, M.B.C.8., Surgeon to the French Hospital, ,
London, dec. London: Bailliere, Tindall, and Cos, 1899. P.p. 394. j
Price 5e.
and less understood, such as ratacrotisin, catacleisis ,
celiopyoiis, Ac, Ac., but even here there are sometimes
analogous French words—cataphoreeis, for example.
No one is perhaps better qualified by virtue of
parentage and natural associations to compile an
EngliBh-French medical dictionary than Mr. de Meric,
as one language is as much his mother tongue as the
other. It is doubtless owing to that fact that we have
been unable to detect orthological or orthographical
errors in either language. If it can be said to be a fault,
there is perhaps a little hyper-sensitive anxiety
regarding diphthongs, and also in describing or trans¬
lating operations introduced by French surgeons or
vice versa; but. taken as a whole, the authorJhas
performed his task conscientiously and welL We
have no fault to find with -the accuracy of the
renderings which, without being copious, are sufficiently
comprehensive. The labour which this work entailed
must have been enormous, and when Part II. (French-
English) has been published, the author will have
deserved the thanks of medical readers on both
sides of the Channel for the trouble he has taken to
minimise, in some measure, the hindrance to the dissemi¬
nation of scientific ideas created by the divergence in-
language.
ALLBUTT’S SYSTEM OF MEDICINE, (o)
This is certainly a most puzzling volume. It is derided
into three parts 1. Diseases of the Circulatory System
continued from a previous volume. 2. Diseases of
Muscles. 3. Diseases of the Nervous System, obviously
incomplete and probably to be continued in the next
instalment. Why one volume could not have been
devoted to Diseases of the Heart and Lungs and another
to Diseases of the Nervous System we do not know. A
classification pretty much on these lines was adopted in
the case of Reynold’s 8ystem of Medicine, and was a
sucoess. Many people who are neurologists care very
little about diseases of the circulatory system, and to-
have them all jumbled up in the same volume is not con¬
venient. As originally planned, the 8ystem was to have
been completed in five volumes and here we are, in the
Bixth volume, apparently almost as far off the end as
ever. Whether it will be completed in one, two, or three
more volumes we do not know. The editor is reticent
and tells ns nothing. But, although we complain, and
we think not without reason, of editorial deficiencies, we
have not a word to say against the individual articles,
most of which are of a very high order of merit.
After an article by Dr. Newton Pitt on right-sided
valvular diseases, based chiefly on the records of Guy’s 1
Hospital, we come to the subject of angina pectoris,
which has been entrusted to Sir Richard Douglas Powell.-
It is a careful, scholarly, and painstaking article, but it
is not very practical. He tells us nothing about treat¬
ment that we did not know before, and what little he
does tell us is not quite up to date ; in fact, the article
might well have been written a couple of years ago. He -
seems to be very hazy as to the relative value of the
vaso-motor dilators, and gives us no idea as to which to
select in different stages of the complaint. He mentions
erythrol tetranitrate incidentally, but says not a word
about its explosive properties, or the dangers from its
preparation or dispensing in a tabular form. More than
one accident has attended its use, and even in a system
of medicine something might well be said on the subject.
Probably the author's best point is when he speaks of
the Nauheim treatment as being so “boomed ’’ into popu¬
larity for every conceivable form of heart disease and
imaginary heart ailment as to discredit its use in appro¬
priate cases.
The articles on Thrombosis and Embolism, by Prof. W.
H. Welch, of Johns Hopkins University, are excellent,
and were, perhaps, worth waiting for, although we do not
think that the diagnosis between these two conditions
is given very clearly.
Dr. F. W. Mott deals in a characteinstally able manner
with arterial degenerations and diseases. It is certainly
<a) " A System of Medicine.” By many Writers. Edited by
Thomas Clifford Allbutt, M.D., F.B.C.8., F.B.S. Vol. VI,
London : Macmillan A Co, 1899.
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76 The Medical Press
LITERATURE.
July 19, 1899.
a very good bit of work, and is one of the best in the
volume.
The article on Aneurysm of the Aorta by Sir W. T.
Gairdner is in the author’s very best style, and is a
credit to the Glasgow University. He speaks favourably
of the Macewen method of introducing pins rendered
aseptic into the sac so as just to touch the opposite
wall, basing his opinion on an examination of his col¬
league's preparations. Professor Gairdner has evidently
no high opinion of “ Filipuncture,” and we almost regret
that he has not condemned so barbarous a method of
treatment in more vigorous language. The modern sur¬
geon who would treat an aortic aneurysm by the intro¬
duction into its sac of yards of wire or watch-spring
would deserve severe condemnation, and would justly be
accused of experimenting on his patient. A good account
is given of the Tufnell treatment, or Bellingham and
Tufnell treatment, as it is sometimes called, and the
principles of the method are admirably stated. The
claims of iodide of potassium to be regarded as some¬
thing more than a palliative in cases of aneurysm receive
full consideration, and credit is given to Dr. George
Balfour for so persistently advocating the employ¬
ment of large doses of this drug. A brief reference
is made in a note to Professor Whitla’s sug¬
gestion that chloride of calcium, from its marked
influence on the coagulability of the blood, might
be found useful in these cases. It would have
been interesting to have learnt something of 8ir
William Gairdner’s experience of the method of treating
aneurysms in general, and of aneurysm of the aorta in
particular by the subcutaneous injections of a gelatinous
solution advocated by Lancereaux and Paulesco.
"fThere is a brief account by Dr. Hale White of
Myotonia Congenita, a maladv, the chief feature of which
is that upon the execution of any voluntary movement
the muscles brought into play remain contracted for
some seconds. It is sometimes known as Thomsen’s
disease, after a Danish physician who suffered from it
and first described it. Dr. Hale White seems to have
had one case under his care, and Dr. Herschell some
time ago showed at the Medical Society two brothers
suffering from this disorder.
Dr. Beevor contributes the article on Idiopathic
Muscular Atrophy and Hypertrophy, accepting as
synonyms the terms primary progressive myopathy and
progressive muscular dystrophy. He does not accept
in this connection the name pseudo - hypertrophic
paralysis which Sir William Gowers employed in his
well-known lecture on the subject published in 1879,
but recognises three principal varieties or groups, which
he describes under the headings of (1) Pseudo-hyper¬
trophic paralysis. (2) The juvenile form of progressive
muscular atrophy. (3) The facio-scapulo-humeral form,
an arrangement which somewhat complicates matters.
It is curious that an article of such value and
originality should not have been illustrated, as children
suffering from the affection lend themselves readily
to photography, and the results are usually most
characteristic.
The article on the General Pathology of the Nervous
System by Dr. Be van Lewis, is admirable, and will be
found of the greatest possible value to readers who are
.unfamiliar with the most recent discoveries in the
physiology of the nervous system. He explains very
-fully and clearly the modern conception of the neuron,
axon, dendrons, and other matters which are essential to
a clear understanding of the pathology of the nervous
system. This article alone is a liberal education in the
study of diseases of the nervous system.
The article by Dr. Tumay, on Trophoneurosis or neuro¬
pathic affections of bones and joints deals fully with
osteopathies, arthropathies, and osteo-arthopathies, and
is a useful contribution.
The editor touches lightly on Adiposus Dolorosa, a
disorder characterised by irregular, sometimes symme¬
trical deposits of fatty masses in various portions of the
body preceded by or attended with pain. It is simply a
clinical curiosity or “ freak,” and hardly merits serious
consideration. ,,
Dr. Barlow iB a well-known authority on Raynaud a
disease or symmetrical gangrene, and his contribution
will be read with interest. The credit of having first
described this disease is usually assigned to Maurice
Raynaud, whose original thesis and a subsequent paper
were translated by Barlow and published in 1888 by the
New Sydenham Society. Cases are by no means un¬
common in this country, and one or two typical examples
are usually to be found in most of our London hospitals.
The article on Erythromelalgia has also been entrusted
to the same author, and we are glad to find that he has
taken the trouble to give the derivation of the word, an
example which might have been followed with advantage
by other contributors.
The subject of Tendon Reflexes has been dealt with by
Dr. Sharkey, who has made the most of a very interesting
and practical subject. The article on Diseases of the
Spinal Nerves by Dr. Gibson and Dr. Fleming is accom¬
panied by a useful table of the spinal segments with their
nerves and muscles. In conclusion, we can only repeat
that the individual articles are of a very high order of
nlerit.
EA8TBOURNE AS A HEALTH RESORT, (a)
This small work is well printed and got up, and can¬
not fail to interest and instruct anyone contemplating a
visit to Eastbourne. Those who dread the easterly
winds of Eastbourne must remember that these are not
dry and harsh; but coming down the Channel are tem¬
pered by passing over the warm sea water.
The water-supply of Eastbourne appears now to be
pure and wholesome, though hard, as waters from the
chalk always are.
The author clearly explains the cause of the East¬
bourne water being at one time under suspicion. He
does not slide over the matter in a way likely to leave
the reader in doubt and suspicion, but explains all in a
way that is clear and reassuring.
Tables of temperature, &o., of oourse, are to be found
in this as in all local works on climate. We often wonder
which, after all, is the place that really does enjoy most
sunshine on the South Coast.
Eastbourne, like Hastings, has a strongly marine air,
and this most certainly is in its favour as a health resort
in tuberculous disease of the lungs.
HOGG ON THE MICROSCOPE. (J)
The value of this work, the first edition of which
appeared in May, 1854, is sufficiently evidenced by the
fact that the edition now under review is the fifteenth.
The present work is divided into two parts and an
appendix.
Part I. begins with an interesting account of the early
history of the microscope. Chapter I. is devoted to the
theories of light in their application to the subject in
question; Chapter II. gives an up-to-date synopsis of the
various types of microscope, not omitting the most
modern developments of the instrument; in Chapter III.
we find excellent accounts of those most essential
microscopic accessories, such as achromatic objectives,
condensers, finders, &c., together with an account of
micro-photography, the polarisati m of light, and the
micro - spectroscope. Chapter IV. is devoted to an
account of the practical execution involved in preparing,
examining, and preserving all kinds of microscopic
objects.
Part II. is divided into six chapters, and comprises an
account of practically every possible kind of microscopic
object that can attract the attention of the student, the
medical practitioner, or the analyst. The portions
dealing with the various parasites attacking members
of both the animal and vegetable kingdom are remark¬
ably comprehensive and lucid.
The work throughout iB most lavishly illustrated both
(a) “Ea
F.K.C.S., &c. Eastbourne, J. Pulsford. 1899.
(6)" The Microscops, its History, Construction, and Application.”
By Jabez Hogg, M.R.C.S., F.B.M.S. Georye Boutledge and Sons,
Limited, London and New York. 15th edition, re-written, revised
and enlarged throughout, 7(4 pp„ with upwards of 900engraved and
coloured Illustrations.
Digitized b'
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Jult 19, 1899.
MEDICAL NEWS.
Thr Medical Frees. 77
with engraved drawings and with coloured plates, and
apart from the intrinsic value of the information
afforded, is written in so readable a manner that it
presents a powerful attraction for every intelligent
lover of nature.
A melancholy circumstance in connection with this
last is the fact that its distinguished author, who was
for many years on the staff of this journal, died
suddenly within a few days after revising the proof
sheets of the work for the press.
4(ttebical ^etos.
Royal College of Burgeons In Ireland.
The following is a list of prize winners in the school
of the Royal College of Surgeons of Ireland during the
Summer Session, 1899 :—
Carmichael Scholarship.—Miss M. J. Shire, £15.
Mayne Scholarship.—D. A. Fitzgerald, £16. Gold and
Silver Medals in Operative Surgery.—C. R. Boyce, gold
medal; C. MyleB and J. F. Peart (equal), silver medal.
Practical Histology.—E. Evatt, first prize (£3) and
medal; A. Charles, second prize (£1) and certificate.
Practical Chemistry.—E. C. Byrne and J. R. H. M'Manus
(equal), first prize (£2) and medal. Public Health and
Forensic Medicine.—J. P. Byrne, first prize (£3) and
medal; E. Evatt, second prize (£1) and certificate.
Materia Medica.—J. S. Ashe, first prize (£3) and medal;
T. A. Dillon, second prize (£1) and certificate. Practical
Pharmacy.—Miss J. C. Hargrave, first prize (£3) and
medal; W. Ormsby, second prize (£1) and certificate.
Biology,—J. R. B. Buchanan and Miss J. C. Hargrave
(equal), first prize (£2) and medal.
The preliminary examination for the commencement
of medical study will be held on Wednesday and
Thursday, September 27th and 28th.
On the list of Fellows and Licentiates of the Royal
College of Surgeons in Ireland, just issued, are living at
the present time 382 Fellows, 11 Honorary Fellows,
2,746 Licentiates, 84 Diplomates in Public Health, 7
Honorary Diplomates in Public Health, and 517 Licen¬
tiates over different parts of the world. Several hold
commissions in the Medical Department of the Royal
Navy, and in the Home and Indian Army. A consider¬
able number enjoy a European reputation. Amongst
those holding titular honours are one peer, four baronets,
two K.C.B.’s, eleven knight baohelors, thirteen military
C.B.’s, two C.M.G.’s, one K.C.V.C., eight D.S.O.'s, and
two hold the Victoria Cross, awarded for “conspicuous
bravery in the presence of the enemy,” their names are.
Major J. Crimmin, of the Indian Army; and Lieutenant
Colonel W. Temple, of the Royal Army Medical Corps.
Oral Instruction for the Deaf.
The annual meeting of this Association for the Oral
Instruction of the Deaf was held on the 11th inst. under
the presidency of Mr. Brudenell Carter, F.R.C.S. A
public examination of the pupils was given, an illustra¬
tion of the system given, and prizes distributed to the
successful students. The Association has been doing a
most useful work for the past thirty years under the
direction of Mr. Van Praagh, but its efficiency has been
much hindered by want of funds. It would appear that
because deaf and dumb children are not ill, the public do
not look on them as needing pecuniary support, hence a very
deserving charity which carries on its work in an unobtru¬
sive way is left to starve. An appeal is now earnestly made
for assistance to the extent of £1,000, and we sincerely
hope this sum may be obtained. The school is carried
at 11, Fitzroy Square, London.
Society for Relief of Widows and Orphans of Medical Men.
The Quarterly Court of the directors of this Society
was held on Wednesday last, July 12th, the Treasurer.
Dr. Potter, in the chair. Four new members were
elected and the deaths of three reported (one an
honorary member). There were no fresh applications
for grants, and it was resolved that a sum of £1,201 10s.
be distributed, as recommended at the last courts to the
forty-nine widows, ten orphans, and the six recipients
from the Copeland Fund. The expenses of the quarter
were £49 8s.
West London Medlco-Chlrurgical Society.
The following officers and members of Council of this
Society for 1899-1900 were elected on Friday last July
14thPresident: *Dr. J. Barry Ball. Vice-Presidents:
Mr. C. M. Tuke, Mr. L. A. Bid well, # Dr. Seymour Taylor,
•Mr. Neville Wood. Council: Dr. Andrew Elliot, Dr. F.
H. Low, Dr. J. Harper. Mr. C. Andrews, Dr. F. J.
McCann. Mr. F. R. Mallard, Mr. F. Savery, *Dr. L. Dob¬
son, *Mr. E. Bartlett, *Dr. D. R. Pearson. # Mr. H. W,
Chambers, *Mr. G. E. Twynam. Treasurer: Mr. T.
Gun ton Alderton. Secretaries: Dr. G. D. Robinson, *Dr.
G. P. Shuter. Librarian: M. C. B. Keetley. Editor of
Journal: Mr. H. Percy Dunn. Editorial' Secretary of
Journal: Mr. McAdam Eccles. *Did not hold similar
office last year.
The Surgical Aid Society.
This unobtrusive but very useful society continues to
extend its sphere of usefulness, and has once again
enlarged its premises in Salisbury Square. The open¬
ing of the enlarged premises was last week the occasion
of a little fete which was presided over by Lord Aber¬
deen.
Death Under Chloroform.
The death of a young collier under chloroform, while
undergoing an operation for appendicitis, is reported
from Cardiff Infirmary. Death seems to have been due
in great measure to the man’s condition, which was
exceedingly grave.
Relics of the Late Mr. Ernest Hart.
The late Mr. Ernest Hart was a bora collector, and
among other things he went in for the now fashionable
“ picture posters." His collection is announced for sale
this week. Avig aux amateurt !
The Plague at Alexandria.
The Sanitary Officials are still on the alert at
Alexandria. Up to the end of last week the total
number of cases amounted to 69, with 28 deaths. There
were, however, only three new cases during the pre¬
ceding week.
Manila Medical Statistics.
According to the official report just published regard¬
ing the medical condition of the army in Manila there
are no less than 1,388 soldiers down [with malaria,
dysentery, typhoid, and wounds. The total number of
wounded up to date is put at 1,586, exclusive of 292
dead. The total number of men in hospital is 1,889.
Our cousins will have learned ere this that colonial wars
are not all beer and skittles, and they will learn to
appreciate the importance of an efficient army medical
department.
The Paris International Medical Congress, 1900.
A meeting of the National Committee for Great
Britain and Ireland, which has been formed to further
the interests of this Congress, was held at the rooms of
the Medical Society, 11, Chandos Street, Cavendish
Square, W., on Tuesday, July 4th, 1899, Sir William
MacCormac, Bart, K.C.V.O., President of the Royal
College of Surgeons of England in the chair. The rules,
regulations and preliminary agenda of the Thirteenth
International Congress were presented, and were
ordered to be distributed among those likely
to be interested in the meeting. It was de¬
cided, after some discussion, that Messrs. Thomas
Cook and Co., tourist agents, be asked to arrange for
the conveyance of intending members of the Congress,
and, failing any satisfactory arrangements by the local
committee in Paris that the same firm be invited to find
accommodation. The honorary secretaries (Dr. A. E.
Garrod, 9, Chandos Street, Cavendish Square, W., and
Mr. D’Arcy Power, 10a, Chandos Street, Cavendish
Square, W.) were authorised to receive the fee (£1) for
membership, and they were directed to inform those
members who wished to make a communication to the
Congress that papers should be sent straight to the
( sectional secretaries in Paris.
d by Google
78 The Medical Press NOTICES TO CORRESPONDENTS. July 19,1899.
^lotices tc
ComBpmtientB, Short %tttzxs t &t.
Correspondents requiring a reply in this column are par¬
ticularly requested to make uw of i distinctive tignatur* or
nitiale, and avoid the practice of signing themselves " Header,’ ’
"Subscriber,” "Old Subscriber,” Ac. Much confusion will be
figured by attention to this rule.
Local Reports and News.—C orrespondents desirous of drawing
attention to these are requested kindly to mark the newspapers
when sending them to the Editor.
ACCEPTED PAPERS.
To the list publishe l in our last issue should be added the follow'
Chronic Follicular Pharyngitis. By Robert H. Woods,"M.B.,
F B.8.
The Outdoor Treatment op Consumption in Large Cities.
By David Somerville, B.A., M.D.
Aggrieved.— If yon will supply us with data on which we can
found an opinion we shall be pleased to give it. The purchase of a
practice is it all times a liaznrdous business, and where possible
should not be determined until a qualified accountant has checked
the books and figures. The calculations of interested agents should
never be relied on.
The Oppicial Schoolmaster Abroad.—A Government offioer i n
Burmah recently wired the Chief Vaccination Officer at Rangoon as
follows" Please send sharp a c<uk of ‘ vaccine lymph.’ ”
A MISCONCEPTION.
“ I can’t conceive,” she archly cried,
“ Wherein you men can longer pride
Yourselves from female rivals free,
For surely we have grown to be
Your peers in every human stride.
“ That is a truth that none may tride ;
So why you men will not decide
To recognise the new degree,
I can't conceive.
“ Now entre nous won’t von confide
And tell me true, all jokes aside,
What difference the world can see
Between your manly self and me ? ”
" To tell you truly,” he replied,
" I can't conceive.”
New York Msdical Journal.
Hypnotist.— The communication should be sent to the Chief
Commissioner of Police, New Scotland Yard, S.W.
Anasarca (Birmingham).—The subject was fully discussed in
our pages at the time, and no good purpose would be served by
reopening it Just at present.
M.D., M.R.C.P.—Our correspondent has failed to enclose bis
card.
WHAT THE HUMAN BODY WILL YIELD.
A French statistician has calculated that the average hutnan
body contains enough fat to produce thirteen pounds of candles;
enough carbon to make sixty-five gross of “lead” pencils, and
sufficient phosphorus to tip 820,000 matches. Perhaps he will
complete his observations by calculating how many bone-handled
knives one body would furnish, how many watch-springs could be
made from the iron in the blood, and how much mortar oould be
made from the lime contained in the tissues. When he has done
this we will suggest sundry other os yet unsolved problems.
Barrow, George A., M.R.C.8., L.R.C.P.Lond., Assistant Medical
Officer to the Manchester Hospital for Consumption.
Botd, Dr. F. D., Assistant Physician to the Edinburgh Royal Infir¬
mary, vice Prof. Leith resigned.
Blood, J. F., M.D., Surgeon-Major, I.M.S. (retired), Surgeon to
the Birkenhead Borough Hospital.
Catley, F. P., L.R.C.P.Lond., M.R.C.S., Assistant Medical Officer
for the Workhouse of the Parish of St. Pancras, London.
Drake, E.C., L.S.A.. Medical Offioer to the Tudhoe Sanitary Dis¬
trict of the Durham Union.
Du Buisson, E. W., L.R.C.P.Lond., M.R.C.S., Medical Officer for
the Dewchurch Sanitary District of the Hereford Union.
Garman, F. W., As-istant House Surgeon to the Dental Depart¬
ment at Guy's Hosp.tal.
Hall, Arthur J., B.A., M.B.Cantab., M.R.C.P., Professor of Patho¬
logy in University College, Sheffield.
Harrison, H. F. E., L.R.C.P.Lond., M.R.C.S., Medical Officer for
the No. 3 Sanitary District of the Fulham Union.
Hatdon, Hillyard, William, L.R.C.P.Lond., L.S.A., M.R.C.S.,
Medical Officer of Health for the Wade bridge Urban District.
Horne, W. Jobson, M.B., B.C.Camb., Surgeon to the Metropolitan
Ear, Nose, and Throat Hospital, Fitzroy Square, London.
Lass, Richard, F.R.C.S.Eng., Surgeon to the Metropolitan Ear,
Nose, and Throat Hospital, Fitzroy Square, London.
Lansdown, C. E., M.R.C.S., L.R.C.P.Lond., Surgeon to the Hos¬
pital for Sick Children, Cneltenham.
Lawrence, H. Gwysxe, L.R.C.P.Lond., M.R.C.S., Medical .Officer
of Health for Chepstow.
Lawson, Thomas Cornelius, M.R.C.S., L.S.A., M edic.il Officer
for the Coleford District of the Frome Union.
Leaf, Cecil H., M.A., M.B Cantab., F.R.C.S.Eng.. Assistant Sur¬
geon to the Cancer Hospital, Fulham Road. Brompton.
Morison, F. H., M.D..Edin., D.P.H.IreL, Medical Officer for West
Hartlepool.
Olvxr, S. H., L.D.S.Eng., House Surgeon to the Dental Depart¬
ment at Guy’s Hospital.
Recordon, R. B.. Assistant House Surgeon to the Dental Depart¬
ment at Guy's Hospital.
Reid, J., M.D., C.M.Glnsg., Medical Officer for the No. 1 Sanitary
District of the .Fulham Union, London.
UaxattrieB.
Borough Asylum, Portsmouth.—Junior Assistant Medical Officer.
Salary commencing at £120 per annum, with board, lodging, and
washing.
Bradford Poor-law Union.—Resident Assistant Medical Officer for
the Hospitals and 'Workhouse of the Union. 8alarv £100. with
rations, Ac. Apply to the Clerk to the Guardians, Bradford.
County Down Infirmary. Registrar, Assistant-Surgeon, and
Apothecary. Salary £63, with boird, lodging, washing, Ac.
Applications to Dr. Tate (See advert.).
Durham County Hospital, Durham.—House Surgeon for one year.
Salary £100 per annum, and board and lodging.
Galway Hospital.—House Surgeon. Honorarium £30, with apart¬
ments. board, washing, and attendance. (See advert.).
Govan District Asylum, Crookaton, near Paisley, N.B.—Junior
Assistant Medical Officer. Salary £100 a year, with furnished
rooms, board, noshing, and attendance.
Hertford Union. - District Medical Officer for Second and Third
Districts. Salary for the combined • istricta £79 16s., exclusive
of usual extras. Immediate applications on forms supplied by
the Cierk to the Board. (8ee advert.).
Lunatic Hospital, The Coppioe, Nottingham.—Assistant Medical
Officer, unmarried. Salary £160 a year, with apartments, board,
attendance, and noshing.
Metropolitan Asylums Board. -Assistant Medical Officer at the
New Grove Hospital. Tooting, 8.W., unmarried. Salary com¬
mencing at £160 per annum, with board, lodging, attendance,
and washing. Applications to the Clerk to the Board, Norfolk
Street, Strand. London.
Ramsgate and St. Lawrence Royal Dispensary, and Seamen's Infir¬
mary. Resident Medical Officer, unmarried. Salary £100 per
annum, with furnished apartments, board, ard attendance.
Roxburgh District Asylum, Melrose.—Assistant Medical Officer
Salary £100 per annum, with furnished apartments, board, wash¬
ing, and attendance.
Somerset and Bath Lunatic Asylum, Wells, Somerset.—Junior
Assistant Medical Officer, unmarried. Salary commencing at
£130, with board, washing, Ac.
Staffordshire County Asylum, Stafford. Junior Assistant Medical
Officer, unmarried. Salary commencing at £120 per annum,
with furnished apartments, board, Ac.
Surrey County Asylum, Brook wood, near Woking.—Temporary
Assistant Medical Officer for about four months. Salary at the-
rute of three guineas per week with apartments and all found.
Apply to the Medical Superintendent.
Swinford Union.—Medical Officer, for a month, for the Lowpark
Dispensary District. Applicants to state remuneration ex¬
pected. (See advert.).
West Sussex County Asylum, Chichester.—Junior Assistant
Medical Officer, unmarried. Salary commencing at £100 per
annum, with furnished apartments, board, attendance, and
washing.
girths.
Baker.— On July 12th, at 5, Bedford Sqnare, London, the wife of
John H. Baker, M.D., of a daughter.
Eloood.—O n July 14th, at Windsor, the wife of Charles Elgood,
M.D., B.Ch.Lond., of a daughter.
Houseman. —On July 14th, at Houghton-le-Spring, Durham, the
wife of J. O. Houseman. M.D., of twins.
Colclouoh—James.— At Broadhembury Church, near Honiton, W..
Frank Colclough, B.A., M.B., B.C.Cantab, Ac., Medical Officer
to the British Hospital, Oporto, Portugal, to Florence Irene,
fourth daughter of the late W. Rhodes James, of Pinhoe, near
Exeter.
Fawcett—Baxter. - On July 15th, at St. Paul's Church, Hamp¬
stead, John Fawcett, M.D., M.R.C.P., Assistant Physician to
Ouy’s Hospital, to May Fleming, younger daughter of H.
Fleming Baxter, of Hampstead.
Wallis— MiLNEs.-^On July 11th, at St. Martin's Church. Werring-
ton, Albert William Wallis, M.R.C.8.,of Brentwood) Essex, to
Ada Fannie, eldest daughter of the late William 8tert Milne*,
of Yeolmbridge, near Launceston, Cornwall.
gatthB.
Adams.— On July 14th, at the Lawn, Martock, Somerset, Annabella,.
wife of I. Dixon Adams, M.D.
Bailey.— On July 8th, at his residence. Bromley, Kent, George
Hewlett Bailey, M.R.C.S., Ac., late of 43| Queen Anne Street
W., London, aged 71 years.
Newham.— On July 12th, James Newham, M.B.C.S., of 80 Glou¬
cester P'ace, Port man Square, London, and Doddington, Combs
Digitized by GoOglC
At 3§Udiral gvm and ffiimfe.
“SALU8 POPULI SUPREMA LEX."
Vol. OXIX. WEDNESDAY, JULY 26, 1899. No. 4.
5 Clinical f cctnrc
ON
DISEASES AFFECTING THE NAILS.
Delivered at the London Hospital. '
By JONATHAN HUTCHINSON, F.R.C.S., F.R.S.,
Consulting Surgeon to the London Hospital, and to the Royal
London Ophthalmic Hospital; Senior 8urgeon to the Hospital for
Skin Diseases, Blackfriars.
Gentlemen, —I have chosen to approach this sub¬
ject from the point of view taken in my title rather
than from that of the nail disease as the starting
point, as tending to clearer views of this perplexing
subject, and because I believe that a large propor¬
tion of such diseases are merely extensions to the
nails of processes beginning in other parts of the
system and regions of the skin. And tne first rule
which I wish to lay down is that the character of
nail-lesions will depend not only upon the original
disease of which they are an extension, but also upon
the thickness and strength of the nail itself. The
thicker the nail the more distinct usually are the
lesions.
I wish first of all to call your attention to certain
marks and grooves upon the nails which mark the
date of some severe attack of illness, because here
tie problem is of the simplest and the causation un¬
questioned. These vary, as you will see by these
portraits from transverse, white lines curving across
the substance of the nail, to deep grooves and even
haemorrhagic stripes, due to the effusion of blood into
the nail-substanoe. Here is a water-colour drawing
of the hand of a young man who had a number of
similar attacks, causing the development of broad
transverse grooves across all his nails, most clearly
seen on that of the thumb, and which invariably fol¬
lowed curious “ bilious ” attacks, which came on with
headache, loss of appetite, bad tongue, and
all the symptoms of hepatic catarrh except
actual jaundice. These produced a curious
form of muscular stiffness in his limbs, almost
amounting to paraplegia in certain groups of
muscles. This would last for a week or more, and
each one be followed by these broad marks across
the nails. This is one of the first cases in which I
had observed the occurrence of actual deformation of
the nail substances from such a cause, and illustrates
admirably the profound disturbance of nutrition pro¬
duced in that portion of the nail-root which is grow¬
ing most actively at the time of the attack of illness.
Here is another drawing which illustrates the for¬
mation of white lines across the nails as a result of
illness, in this case most marked upon the little
finger. These are by no means uncommon, especially
after febrile or gouty attacks, but appear to bear no
relation to the seventy of the illness. In both these
conditions the occurrence of the lesion appears to
depend largely upon the structure of the nail, as in
most cases it is only upon thick, strong nails that
they appear at all, tnin, brittle nails seeming to be
largely exempt.
* This drawing shows a veiy striking case of pig¬
mental lines across all the nails, due to haemorrhage
into the nail substance consequent upon successive
paraplegic or extension of paralysis attacks in a
paralytic woman. These originally developed at the
root or growing portion of the nail in or near the
lunula, travel down the nail as this cross-level
“ grows out ” to the free edge, which they ultimately
reach, and are shed. This may be easily seen in
injuries or trappings of the base of the nail severe
enough to produce haemorrhage, the resulting mark
steadily travelling along the nail till it “ grows out.”
Any severe disturbance of the circulation may cause
these discolorations. Then there are certain forms
of disturbance which result in the formation of longi¬
tudinal markings or ridges down the middle of
the nails, though as to the nature and causation of
these we are quite in the dark. A red central eleva¬
tion begins at the edge of the lunula and travels
down the nail so that an elevated central ridge
results, then the nail becomes thin and brittle at
its edge and borders and begins to crack and scale off,
and ultimately is entirely destroyed. The disease
persists for years and is quite uncontrollable, and
while it causes no pain, is most annoying on account
of the hard unsigntly red tips left upon the fingers
after the destruction of the nails. I have here several
drawings illustrating this annoying condition, two
of them showing a curious variation in which the
longitudinal ridge takes a wedge or fan-shape with
the apex forward, and which I have ventured to
term on this account “pterygium ” of the nail. Both
of these occurred in young people, who also suffered
from lupus and eczema, but the disease ran its usual
course, and destroyed the nails almost completely.
The two great groups of pkin diseases which we
term psoriasis and eczema have each their characteristic
mode of affecting the nails. These may be roughly
distinguished by saying that psoriasis usually attacks
the free border and nail-bed and under surface of the
nail and spares the upper surface, while eczema
generally attacks the root and folds of the nail and
roughens and pits the upper surface.
In these drawings 3 ou see there is inflammation of
the nail bed extending under from the free or distal
margin, loosening the nail at its tip atid often accom¬
panied by an accumulation of epidermal scales
beneath the nail so that a pin or fine probe can be
pushed up easily under the nail half or threequarters
of an inch. The top of the nail remains smooth, and
its substance is little affected.
Although notan uncommon symptom in the course
' of general psoriasis, this form of nail disturbance
may be the only symptom of the disease, and its
| nature iB then proved by its yielding promptly to
arsenic. I have frequently seen this condition, the
only symptom in a patient, other members of whose
family had well-marked psoriasis of other parts of the
skin. Only recently a girl was brought to me with
this as the only lesion, and upon inquiring as to her
father’s condition, he pulled up his sleeve and showed
me well-marked scaly patches on both elbows.
In eczema, on the other hand, the disease begins at
the root or folds of the nail and affects its sub¬
stance and surface much more severely. Longi¬
tudinal thickenings and furrows are often produced,
the nail is opaque and dirty-looking, and its surface
rough, often stippled all over as with a series of
shallow pin-pricks. It is a much more serious and
Digitized by Vj
Thb Medical Press.
OBIGINAL COMMUNICATIONS.
July 26, 1899.
disfiguring disease than psoriasis of the nail, but the
two conditions not infrequently co-exist, especially
in those cases in which both eczema and psoriasis
are present upon the body, the so-called “mixed”
cases of skin-disease. Here is a drawing of the nails
of a young lady who presented this “mixed” con¬
dition. As you see, the nails are rough, thickened,
opaque and marked by longitudinal furrows. In this
disease it is again most important to estimate the
original condition of the nail, as it is a most influen¬
tial factor in determining the character of the
changes. The thick nail suffers more severely than
the thin.
There is a form of senile psoriasis of the nails,
fortunately quite lare, which is extremely severe.
Spreading from the nail-bed, it causes ulceration of
the finger-tips and even leads to gangrene. It also
affects the toes, and in two cases the degree of Bore-
ness produced was so great that patients were quite
unable to walk. Indeed so violent is it, that we
could hardly believe it to be psoriasis, were it not for
the characteristic scaly patches upon the body and
limbs which usually precede it.
In clubbed fingers the nails are greatly enlarged,
both in length and breadth, while in acromegaly the
fingers are enlarged, but the nails are unaffected.
This may be used as a diagnostic point in discrimi¬
nating between the two conditions.
Of syphilis of the nails the chief thing to be said
is that it presents an infinite variety of forms. There
is no disturbance of them which it will not imitate.
It often produces thick, fibrous ribbed nails ; again,
it imitates psoriasis and, in other cases, superficial
erosions, like the pitting of eczema develop. They
seldom permanently injure the nail substance or
deform the nail, and they yield, though slowly, to
mercury.
There is a pustular disease, of unknown origin,
which attacks the nails of children. Red spots
appear in the nail substance, form minute abscesses,
and break through the surface of the nail. These
pustules appear in crops, and are quite liable to
recur several times. Ringworm affects the nails at
times in a very similar manner, painful spots appear
in the nails, and then pustules form which break
through the surface. As a rule, only one nail is
affected at a time, and the diseases spreads slowly and
obstinately from one nail to another. This, when it
does occur, is so constantly associated with charac¬
teristic ringworm of the scalp or body, that I feel
quite sure as to its nature, although 1 have always
found the greatest difficulty in discovering or de¬
monstrating the fungus in the nail substance itself.
But this in my experience, is true of all parasitic
diseases of the nails.
Another rare, but most destructive disease of the
nails is congenital pemphigus. This leads to the
complete exfoliation of the nail and a most unsightly
deformity of the finger-tips, and may be recognised
by the presence of the characteristic bullae upon the
digits, forearms and legs; these seldom or never
extend above the elbow or the knee. I show here
drawings of the hands of a mother and son, which
could scarcely be distinguished from each other, and
the disease often rims in families, in this particular
group, the mother and three sons were all attacked.
The disease is chronie, extremely obstinate, and
treatment is of no appreciable effect.
Mr. Maguth, the ex clergyman, now medical
botanist, who stands charged with manslaughter, in
that he treated for simple sore throat a child who
proved to be suffering from diphtheria, and subse¬
quently died therefrom, has been duly committed for
trial, bail being allowed.
A COUNTRY HERBALIST’S CURE FOR
' THE “KINGS EVIL.” (a)
By JOHN KNOTT, M.A., M.D., and Dip. Stat. Med
(Univ. Dub.) ; M.R.C.P.I., M.R.I.A. ; Ac., Ac.
[(Continued from, page 57.)
I have now, I think, placed sufficient evidence before
my readers to show the high reputation which the herbs
in question possessed during many centuries in the
treatment, not enly of the dreaded King’s Evil, but of
many of the other physical ills to which human flesh is
heir. I will now digress for a time for the purpose of
displaying the reputation of other remedies— many of
which are now totally forgotten or absolutely neglected
—In the treatment of the special malady which has so
much troubled the therapeutists of all the ages. In
the "New London Dispensatory,” compiled by William
Salmon, the author of the Herbal, from which I have
already quoted so largely, we find the following —
“ Artanit®, Cyclaminis, of sow-bread, hot and dry in
3°. A plaister made thereof with hog’s lard and
Sulphur, helps the Atheromata, Scrophula, and Kings
Evil. . . .”
“Asari of Asarabacca. Hot and dry in 3°. The
root is hotter, but a safer purge than the leaves.
It dissolves Wens and hard swellings, and is eminent
against the Kings Evil, long tedious Quartan Agues,
Green Sickness, and Asthma.”
“ Bar dan ee majoris, Lapp® maj. Of the great Bur¬
dock, Temperate.In the Gout and Kings-Evil
it is a specifick.”
“ Chelidonii minoris, 8crophulari®, of Pilewort, it is
temperate. . . Outwardly in a balsam, it Cures the
Piles in the Fundament, Wens, Kings Evil, Sores and
other creeping Ulcers. . . .”
“Jalap®, Mechocann® nigr®, of Jalap. Temperate
and dry in 1". It pumpeth strongly all bad humours,
chiefly those that are watery, with great safety. . . .
I have oftentimes found it a good specifick in Struma or
the Kings Evil. . . .”
“ Mecoacann® alb®, of Mechoacan, or Rhubarb of
Peru. . . . Temperate and dry in 1°. ... It
is good in the Rickets, Scurvy, Kings evil. Catarrh’s,
Dropsies, Jaundice, Gout, and French Pox. . . .”
“ Spatul® foetid®, of stinking Gladdon, hot and dry in
3°. . . taken in the morning fasting in Rhenish
Wine, it prevails against the Cachexia, Dropsy, Kings
Evil. . . .”
" Bardana minor, Lappa minor, E avffiav, the lesser
Burdock; hot and dry in 1°. . . . Outwardly it
is of excellent use in the Kings Evil. . . .”
“ Capparis, Capers; hot in 1°., and dry in
2°. ... An extract of the Bark of the Roots.
. . . very prevalent against Quartan Agues,
hard Spleens, Kings Evil, Palsies, Convulsions,
Cramps. . . .”
“ Cotyledon, Umbilicus veneris, Acetabulum,
Koti<a«5oji', Navil-wort, or pennywort; cold and moist in
1". . . . The Essence prevails against the Sciatica
and Kings-Evil.”
“ Cyclamen, Cyclaminus, Artanita, Sow-bread; hot
and dry in 3°. The Juyce of the Leaves (or rather
their Essence) . . . or in a Balsam, waste knots,
hard tumors, and swellings of the Kings Evil.”
“ Digitalis, Alisma, 0pa\\U, Fox-glove, hot and dry in
2". ... is an extraordinary good wound-herb,
prevalent against the Kings Evil. . . .”
“ Ebulus, Chamfficte, Xa^aiasT??, Dane-wort, or Dwarf-
Elder, hot and dry in 3°. . . . The Essence
. . . kills Worms, helps dry Coughs, QuinsieB,
Asthma’s, King’s Evil and French Pox. . .
“ Eryngium trifolium, Trefoil Thistle; . . opens
obstructions of the Liver and Spleen, helps the Jaun¬
dice, Dropsie, Sciatica, French Disease, and Kings
Evil”
“ Ficaria, Scrophularia major, Figwort . . . hot
and dry in 3". . . .a good specifick in the
Kings Evil.”_
(a) An abstract of this paper was read in the Medical Section of
the Boyal Academy of Medicine in Ireland on Nov. 18th, 1898.
Digitized by CjOOglC
July 26, 1899. ORIGINAL COMMUNICATIONS. The Medical Press. 8l
“ Fumaria vulbosa, Bulbous, or Onion-Fumitory ; hot
in 2°., dry in 3". . . . It is . . .of sin¬
gular force against the Kings Evil.”
“ Genista, Spartum ~ 2 *&frov, Broom, hot and dry in
2“. It opens, attenuates, is abstersive, diuretick,
hepatick, splenetick and nephritick ... a great
Traumatick and Vulnerary, and a Specifick in the
Kings-evil.”
“ Hordeum, Distichon, Polystichon, Barly; cold
and dry in 1". ... with Tar, Wax, Oyl, and
Boys urine, it is effectual against the Kings Evil.”
“ Paronychia, Reduvia, Tafovvx^, Whitlock-grass, hot
and dry in 3". . . . experence has confirm'd it to
be a great specifick in curing of the Kings Evil.”
“ Primula? Veris, Of the Primrose. The Flowers
boyled in Vinegar and applyed, are good against the
swellings of the Throat, Uvula, and Kings Evil, especi¬
ally as a Gargarism.”
“ Rhamni, Spin® Cervina? fructus, Buckthorn Berries,
hot and dry in 2". ... they are of great force
against Cachexia, Dropsies, Jaundice, Gout, and Kings
Evil.”
The products of the Animal Kingdom were also laid
under contribution, although not so extensively. We
are, for instance, told that: “ Talpa, The whole Mole, the
Ashes of it helps. . . .” “ Coluber . . The Adder . .
the Ashes are good. . . .” “ Hoglice . . are most
admirable things, being given ICO days together or
more, for the curing of all sorts of Cancers and Scirrhous
Tumors in what part of the Body soever, the King’s Evil,
old sordid and rebellious Ulcers, Convulsions, the Rickets
in Children, and dimness of sight, yea blindness itself.
I have also seen a very good effect of them being used
for many days in the Cure of the French-Pox, for they
resolve, cleanse and purifie to a Wonder.”
Of the number of mineral preparation recommended
in the same volume for the cure of the King’s Evil, I
will mention but a few of those to which specially won¬
derful virtues were attributed.
“ Manna Mercurii. Golden Panchymagogon. . . .
This is a great specifick and Secret against the French
Pox, Gonorrhoea, and all manner of Venereal evils, it
eases pains in all parts. . . . and is made of wonder¬
ful Virtue for curing of the Kings Evil. ...”
“ Tinctura florum Reguli Antimonii. . . . It is a
Medicine of that universal purport that few can parallel
it; for it rectifies most Distempers of the Stomach, frees
the body from Excrements, it takes away Flegm, com¬
forts the Spi its, restores and augments the natural heat,
is an admirable thing against the Scurvy, Cachexy, and
the Green-sickness in Virgins: It takes away Scabs, Itch,
Scurff, and Morphew, cleanses the whole Mass of blood of
all putrefaction, and cures the Kings-Evil, Leprosy,
and French Pox.”
“ Oleum Arsenici Anodynum. . . . It is an excel¬
lent thing against all poysoned Wound, Ulcere, and
Cankers, Pocky boyls, sores, and breakings out, Kings-
Evil sores, bitings of Mad-Dogs, Fistulas in the Funda¬
ment and elsewhere.”
And there are many others recommended with
various degrees of confidence.
In the great encyclopaedic treasury of pathology and
therapeutics compiled by Theophilus Bonetus, “ Medicina
Septentrionalis Collatitia” (Geneva?, 1684), we find the
then current pathological notions of the Kings-Evil, as
well as all recorded methods of cure. I will give some
extracts from the English Translation, London, 1684:—
“ Because there is a great likeness between the Kings-
Evil and hardned glands (for they are alike both in
place and matter), therefore we must do our endeavour
to distinguish the one from the other. They differ first,
because the matter of the Glands is more subtil and thin,
of the Kings-Evil more gross and viscid, and more con¬
tumacious, and hence it is, that whenever a thin and
mbtil matter is incrassated, of Glands they become the
Kings-Evil. Which is Galen’s meaning, 1 dc lor. aff. 3,
when he sayes, that Glands sometimes turn into the
Kings-Evil. Secondly, because indurated Glands
are more separable from the adjoyning Flesh, so
that by the touch you may easily know it from
the Glands : But the King’s Evil is so propagated into
the adjoyning Flesh, that it is a very hard thing to
distinguish it. 3, Because the Kings-Evil has a Coat,
but the Glands are alwayes without one. Rogerius
the Surgeon advises to take Ivy Leaves, and Citron,
and pound them together, and lay them to the Swelling :
and if the Swelling fall in 3 dayee’ time, he says it is a
sign they are Glands, and not the Kings-Evil; but if
they grow worse with the application, so as to be red
and ake. it is a sign they are not Glands but the Kings-
Evil. ...”
With regard to treatment we are told (under the
same heading) how Mercurialis informs his readers
that: “as soon as I observe Swellings arise in the Necks
of Children, I find no more present remedy than to
exulcerate the skin of the head, for this is the most proper
diversion and evacuation. But we mutt have a care not
to draw Blisters in Children’s Heads with Cantharides.
. . . But it is better to do it with Mustard, Nettles,
Honysuckle; yet with great moderation and pru¬
dence. . . .
“ Galen ad Glauconem . . . tells him that he gave
astringent Medicines for the Kings-Evil. ... In
Rhases lit>. de Apostem it is found that Plantain is very
good in the Cure of the Kings-Evil.
■* Rondeletius affirms that he has cured several of the
King’s-Evil beginning, by laying Cypress nuts upon the
part.” In this mode of treatment he confesses that he
was merely carrying out the precept of his master
Dioscorides.
Felix Platerus is the authority for the following :—
“ As we find that Narcoticks outwardly applied have a
great dissolving faculty, so also, if applied in the Kings-
Evil, they will do much: As leaves of Mandrake, Hen¬
bane, Poppy, bruised, or roasted a little under Coals or
boiled or uped any other way by themselves. Also
Mandrake root, or powder added thereto, Ac, The
| rubbing also of the Scroffles till they grow red, does also
| conduce something to the discussion of them; And if it
1 be used before the application of Topicks, it better dis¬
poses them to receive their virtue,
j “ By a potential Cautery, which making an eschar in
the Skin without pain opens the Scroffles, I hive often
got them out; or I have laid them bare, that they might
be better suppurated by applying Medicines. But it is
dangerous to attempt this by actual Cauteries, seeing
an Inflammation might easily follow. Yet in any ignoble
place they might very well be opened in this manner. ”
The following remarkably successful form of anti-
scrofulous treatment has been transmitted to posterity
by Scultetus, of “Armamentarium” celebrityA
certain woman had the scroffles all over her Neck, and
! she was cured in a Months time. A powder of equal
parts of Sugar, Ginger, and Turp^h was given her,
which purges Phlegm particularly from the remote
parts. After ceratuin ox&deom was applied, they were
: softened with oyl of Lizards. Take green Lizards as
i many as you will, boyl them in common oyl till they be
1 burnt, and the oyl turn black : let the colature
j be put in a Glass and set in the Sun till the dreggs
subside, the oyl grow clear, and it be of a brown
| colour. Then I gave every Morning for 30 dayes of
j the Electuary, which H. Saxonia and J. Prawotius
reckoned as a most sure secret; take some common or
i green Lizards, cut off their Heads and tails and take out
the Guts, infuse them in strong white Wine Vinegar 40
dayes by themselves ; then dry them and steep them iL.
other Vinegar, and dry them again either in the shade-
or Sun,and reduce them to powder: which, being done.
| with one ounce of the powder mix 4 ounces of Honey
The Dose for Children is 2 drachms, for grown Persons,
j half an ounce, six drachms, or an ounce at most for
30 or 40 dayes.”
The practice of Galen and of Severinus shows
| that the modern surgical method of wholesale
extirpation of scrofulous glands is not so recent a.
j mode of dealing with them as some latter-day
; operators would seem to have persuaded them-
| selves. “ We forbear not to cut out Scroffles. though,!
1 they be crude and hard Tumours, but then they must
1 be moveable, and not fastened to the flesh, and we may,
C
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82 Thk Mkdical PEB88.
ORIGINAL COMMUNICATIONS.
Jult 28, 1890.
-draw them out with our Fingers, as we do steatomata
and such things, having cut them from the skin and
severed them round, with a knife broad and sharp-pointed
and crooked backwards, according to Galen 14 m.tn.,
cap. 11. I have tried this Chirurgical way of Cure with
success in hundreds."
Bonetus closes his article on the subject with the
following interesting list of
“ Medicines Especially Made Use of by Eminent
Physicians.
“ 1. Drink every day out of a man’s skull, and the
King's Evil will then vanish. The Mushrome that
grows on a Birch-tree, put in Wine and drunk, has a
singular Virtue in gradually curing and wasting the
Kings-Evil.” ( Vgricola.)
“ 2. It has been observed that Scroffles and other
Tumors fall, if the Part affected be rubbed with a dead
man’s hand, for so the swellings gradually vanish as
the dead Body rots by degrees. (Bartholinus.)
“ 3. Root of Vervain hung about the Neck of one that
has the Kings Evil gives wonderful and unexpected
relief. They say Silver-Knapweed is marvellous good ;
also red Poppy steeped in Wine, and bruised, and the
Mucilage applied to the Swelling, is a Medicine that
does good by tempering, and has those Virtues which we
require in Medicine for the Kings-Evil, over drying
things being excluded. (Baricellus.)
“4. Three Toads boyled in Oyl Olive in a glazed
Earthern Vessel, make an excellent Oyl, for the Kings-
Evil ; but the fumes of them, while the Oyl is in making
are dangerous. Therefore, keep that vessel close, and
have a care. First they apply Araenick to the Scroffles,
and blister them, then corrode the Part with sublimate,
and use the said Oyl, which will be yet better, if you
infuse the salt of Toads in it. (Borellus.)
“ 5. This Potion has been often tried, which not only
takes away the Kings-Evil, but all Mucosities of the
Throat; take of Broom-flower Water 3 ounces, drink it
warm with Sugar in the Morning. The Powder of Brown-
flowers does the Bame mixt with Honey of Roses.
(Sebast. Cortilio.)
“ 6 The lesser Celandine has 4 or 6 grains like Wheat
growing to its root, which are used to draw out the
Scroffles with great success.
“ 7. Their cure depends upon the Meazles of Hogs,
which may be calcined and sprinkled on them, and
Oyntments may be made of them, which are very good
for the Cure of these Swellings and these Unguents may
be fortified with distilled Oyl of Hogs-Lard, or distilled
Oyl of Hogs-Meazles, which is a specified against the
Kings-Evil. (Joh. Pet. Faber.)
“ 8. If the Kings-Evil must be taken away by caus-
ticks, there is no better Medicine to take them away, than
sublimated Arsenick; but you must have a care, that
the Parts near the Swellings do not Putrefie or Inflame
(Guil. Fabriciu8.)
“ 9. An excellent Electuary to take away the Kings-
Evil is thus made: Take of the Bones of a Hen, the
flesh whereof has been boyled off, dry them, and powder
them. Take of this Powder and Seed of Sesamum each
alike, as much as you will, with Honey make an Elec¬
tuary. Take a drachm at a time Morning and Evening
all tLe decrease of the Moon till the new, and then
repeat it the following decrease of the Moon. (Rod. it
Fonseca.)
“ 10. The use of the Powder of Sponge will cause it to
decrease, if you drink as much as you can take upon a
knife’s point, in Cinnamon-water. The sponge must not
be burnt, for then its Seminal Virtue is destroyed.
(Grembs.)
“11. This is admirable for the Kings-Evil, Throat
rupture, Parotides, and all hardness. Take the leaves
of Cypress, neither the tenderest nor the hardest, reduce
them to powder, Sprinkle them with strong Wine, and
turn them, till the Body of them turn to dreggs. Lay
it upon the Scroffles or Rupture and the third day take
the Medicine, you will find the Place contracted, which
must be squeezed out with the Fin ire rs. Let this Medi¬
cine be repeated, and on the Seventh or Ninth day at
farthest, the Kings-Evil will be gone to a Miracle.
(Holleriu8.)
“ 12. Take of Root of Fern, Spleenwort, Dwarf-elder
each 3 ounces, cut them and boyl them in the best
Wine, then pour away the Wine, bruise the Roots, and
add of live Sulphur 1 ounce, ashes of Cockle-shells, 2
drachms. With equal parts of Honey and Vinegar
reduce them into the Form of a Cataplasm, lay it upon
the Scroffles, it consumes them wonderfully. (Fr. Joel.)
“ 13. There is scarce any Plant of so great Power in
softning and discussing Swellings in the Kings-Evil,
Ac., as the bulb of Corn flag and Hog's-Lard outwardly
applied. (Laurembergius.)
“ 14. It has been found by experience, that burnt Allum
powdered, if half a drachm of it have been given in
Wine alone, or mixt with other discutient and drying
Powders has done much good in this Case. (Platerus.)
“ 16. Root of Figwort eaten for 10 dayes every Morn¬
ing fasting cures the Kings-Evil."
( To be continued.)
NURSES OF THE LATEST FASHION.
A.D. 1899.
PROFESSIONAL EXPERIENCES IN SHORT
STORIES.
By FREDERICK JAMES GANT. F.R.C.S.,
Consulting Surgeon to the Royal Free Hospital.
My attention has been lately drawn, very powerfully,
to the conduct of nurses engaged in private nursing.
This limitation at once excludes my retrospect of nurs¬
ing in hospital practice during a period of forty-five
years (1899).
Accumulating personal knowledge, reinforced by the
experiences of many authoritative members of my own
profession assures me that the character, as disclosed by
conduct (no less than the technical qualifications) of not
a few private nurses, is such as defames the general
body of which they are members. Mostly, if not
only, among the “untrained” and “ uncertificated’’
class of women, who style themselves nurses or nurse-
attendants, misconduct—-in various forms, prevails ; dese¬
crating the fair fame of the rightful Order of Women, and
by demoralising many a home, begets lasting misery in
personal and family life. I am not without hope, that
the portraitures presented in “ Nurses of the Latest
Fashion ” will fulfil a right good purpose, by tending to
eradicate some nurse-forms of wickedness and vice -
who as mildewed ears of nurse-womanhood are thus
blighting their wholesome sisters, and blasting their
just claims to the confidence reposed in their beneficent
vocation. In telling the “ stories ” bated on some of my
professional experiences, the illustrations given of these
false nurses, and of the other dramatis personas, with the
incidents narrated—do not pertain to individuals—they
are alike wholly impersonal characters, and yet realistic.
It behoves all women, as nurses, to bear ever in mind
that they are members of a body ; and that each should
hold herself responsible for a professional character
which she is thus bound to maintain or to retrieve.
A PLEA FOR STATE REGISTRATION OF NURSES.
The animated photographs and experiences to which I
invite attention in the following Beries, chiefly in the
form of stories, concern not only nurses, but the public
also. Few people there are who pass through life with¬
out knowing something of nurses, in their times of
needful help and care -, and many remember these
“ ministering angels ’’ with the most grateful apprecia¬
tion of the devoted attention, skill, and kindness, with
which they fulfil their duties in the spirit of a sacred
calling.
But the qualifications and the personal characters
of nurses differ widely. Nurses “trained” in hospitals
of different grade*, and for a rariable period, and nurses un¬
trained, “ certificated” and uncertificated, are alike c- m-
peting in any number to get “private practice,” as
distinguished from hospital work ; and as their relative
merits and demerits, are alike covered by the title
“ nurse” or “ nurs9-attandant ” ; all share equally the
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Jult 26. 1899.
ORIGINAL COMMUNICATIONS.
The Medical Press. 83
claim for admission into the mansions, the houses, the
homes of the class of society who can afford to remune¬
rate them, according either to their perhaps equal
demands for their services, or the scale of charges pro¬
vided by various competing institutions of nurses. All
these women dress very much alike—as roses, dipped in
the morning dew of blessing, trust, and hope—angelic
to the weary sufferer, and sorrowful relatives and
friends.
Of course the untrained eye of wife and mother, of
husband and father, cannot possibly see at first sight,
nor perhaps discover by after observation, more than the
outward appearance and manner, and conversation, of
the new friend in need, a friend indeed. A charming
attire—neat, not gaudy—decidedly religious-looking,
surmounted by a pretty capped-faced of healthy colour,
and cheerful expression, or sallow and work-worn,
perhaps saddened; hands scrupulously clean ; a quiet,
subdued, sympathetic manner; a mellow whispering
voice, like the tones of an teolian harp, fanned by
zephyr winds in Paradise. The note-words breathe
God’s humanity, with consolation and cheery hope.
Even the family doctor with his practised eye and ear,
may see and hear—no more ; glad, beyond measure, that
there is such an outward form of perfect womanhood to
represent his attendance in the morning, when oh, God,
would it were evening, and at nightfall, when oh, God,
would it were morning; and having full confidence and
trust that amid his toilsome rounds of day and night
rofessional duty, he can conscientiously feel relieved of
is cares and responsibilities by the heaven-sent one ;
never, when "pain and anguish wring the brow,’’ or in
convalescent hours, will his patient know an evil spirit,
thou!
If I were asked what, in my experience are the most
prevalent vices among so-called nurses up to date, and
which mo«t urgently need to be eradicated. I, with
friendly frankness, would say (1) untruthfulness and
slandering: (2) pilfering; (3) sensuality and intemper¬
ance ; (4) cruelty in their duty ; (5) idleness, or perfuna-
tory work, without any heart in it ; the ruling
principle of the nursing vocation (itself a sacred
calling) being to get the highest wages for the least
amount of work done, otherwise than in novel, magazine,
and newspap-r reading, letter-writing, and making
articles of dress for themselves or their relatives ; with
increasing hours off duty; for shopping, calling on
friends, corner of srreet-appointments, &c., and holidays
at pleasure. Matrons there are whose disqualifications
of character 1 am not portraying, who may be disfigured
by some such personal defects— t.g. (4), cruelty in their
“ duty ” to patients in homes and refuges.
But, if with many “ steadfast and true ” in, and to,
their vocation; there may be also many, some, or few,
commingled with their sisters, who cannot be distin¬
guished by the public, or the professional eye; an
authentic general Register of names, with unifoi m
qualifications, and approved character, should be the
credential for security alike for nurses and the public
In the second Charter for the Incorporation of the
Royal British Nurses Association, of which H R.H.
Princess Christian, is President, Her Majesty’e Privy
Council permitted only the term. List of Nurses, not a
Legal Register.
But State registration of nurses would regulate more
than the obvious inequalities of the certificate system,
with regard to the technical qualifications and personal
character of that order of nurses at present authorised
by various private Nursing Institutions, or as hospital
private staff nurses, each of which have rival interests,
and are of unequal competency, in their competitive
certification.
The full training—perhaps the over-training—of
certificated nurses has carried with it a scale of remu¬
neration for their services—in private cases, which has
opened the doors of the vast majority of householders,
and the bed-rooms of a population of lodgers in sickness,
to the ministrations of another order of nursing women,
instead of the certificated.
The service of a certificated nurse, at £2 2s. per
week, amounting in chronic (lasting) cases to 104 guineas
per annum, exclusive of good board (perhaps separate
meals) and bedroom to n ateh, or two such nurses for
day and night service - is a luxury quite beyond the
reach of most well-to-do householders and lodgers, con¬
stituting the professional and business classes - the bulk
of society.
The fact that (some) private nurses, who are attached
to institutions—worked perhaps upon the “ co-opera¬
tive ” principle—do not themselves receive the whole of
the remuneration for their services, does not lessen the
burden on the public who engage them. Thus, each
such Institutional nurse, say, co-operative, “ receives at
least .£50 a year, and considerably more if she is for¬
tunate in making herself liked, or if higher fees can be
obtained "by the business-nursing speculation ; the other
half share of her wages being retained for the maintenance
of the Institution, in consideration of providing her
a home, in the intervals of her cases, or in the event of
illness, The public still pay for the certificated nurse,
£2 2s. per week, as including her maintainance, when out
of work, or temporarily disabled.
In these circumstances, touching the financial rela¬
tion of nurses to the public needs, an uncertiflcated nurse,
of whom there are at least, hundreds as “ nurse-attend¬
ants, ’ with, or witnout adequate, or any practical know¬
ledge, and with, or without, any guarantee as to her
known personal character and antecedents, hears, or
reads by advertisement, that the is “wanted”; and
forthwith she undertakes the case, whatever its nature,
at £2 2s. (not per week, but) per month, at the rate of
£2h a year.
Surely this latter order of women—at present a social
necessity—should for the security of the public, be in¬
cluded (in a separate list) on the same legal register;
and all such nursing women, thus enrolled, should hold
a special certificate—expressly stat ng that they are
incompletely trained or untrained, and with special
regard to their personal character, the latter being a
guarantee even more requisite than with regard to
nurses whose personal qualities have been tried and proven
in the course of hospital training under supervision,
to practice in private cases from an institution or
hospital, or on their own account.
The author in presenting these papers on “ Nurses of the
Latest Fashion ”—whether by the unauthorised assump¬
tion of the nursing vocation, or who are imperfectly cer¬
tificated—would, therefore, humbly urge his plea for
“ State Registration ” of the whole body of nurses and
nurse-attendants in one common legal register; just as—
and for ana ogous reasons—all recognised members of
the medical profession are enrolled on a legal register of
professional qualifications.
I.—SATAN IN PETTICOATS.
In the stories I am about to relate wherein some
nurses will figure as the heroines, and of whom 1 would
present animated photographs, the first of these in its
completeness, is probably an exceptional species, under
cover of a nurse’s dress, &c.
Nurse Lucretia is partly 'he money-seeking, fortune-
hunting woman, but she gains admission to the house
of sickness and death simply to play a game best suited
to carry out certain diabolical purposes. There are
other ladies in the world of fashion and beauty who are
fortune-hunting of men, who themselves may be no less
engaged in the same vocation. Some such women
may be known to every reader of this journal,
who has met them in the World’s Mart They are to be
seen in Society’s salons, as living specimens of their
craft, without studying Thackeray’s “ Newcomes,” in
the person of Ethel Newcome, the heartless roquet who
would have sold herself body and soul, for wealth (and
rank) ; more beauteous she, in her tears of remorse and
loving care of her brutal brother's children, than ever
she looked in the flushed excitement of the ball-room,
with Lords Kew and Farintosh, with whom, and other
game, she would equally divide her fickle favours. There
are yet other E. N.’s, unknown to the Hogarth-Novelist;
nurses, whose representative portraiture, an humbler
artist would sketch with a pen dipped in the blood of his
thought.
Nurse Lucretia is of Borgian blood ; cold, calculating
cruel. She would vary the depravities of an ince6luou F
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84 Tbb Ubdicai Pbbss. ORIGINAL COMMLKICATIONS. July 26,1899.
nature; she would seduce busbaud, or son, even in the
room adjoining the departing spirit of wife and mother;
or she administers slow poison preferably by (accidental)
over doses of some potent medicine ; selling herself, or
with a redoubled display of nursing care; in either way
to gratify the only love she ever feels—her passionate
love of money. With an elderly gentleman patient,
nurse-poisoner smoothes the pillow, »nd caresses the
sufferer for a post obit bond, given to her as a tribute of
gratitude for her affectionate and unremitting devotion
to him ; a free gift, which shall not appear in his Will,
leet perhaps £10,000 or £20,000 should be disputed by
surviving claimants.
Bosh! there are no such women-nurses. Yes, in¬
credulous reader, and some such disguised “uncertifi¬
cated ” nurse may get into your home any day — if not
Lucretia, one of her blood-sisters, there to exercise her
hellish trade upon whomsoever may best answer her fell
purpose. She is the devil in petticoats. Here is one
such “nurse attendant,” an illustration of tbe species,
as developed up to date. She would have quite misled
anyone with less knowledge of human nature and
(feminine) character than a practised observer, who,
while he can fully appreciate the true and the beautiful
in woman, is also a judge of blacking.
This Kurse Lucretia, when out of place—a frequent
circumstance in her yet young life, daily consults the
newspapers of fashionable or church connection, as best
representing the wealthy and titled, or the saintly classes
of that society among whom she looks for the most pro¬
fitable find.
In reply to an advertisement, otherwise perhaps most
unsuitable for a trained nurse, she would do herself the
pleasure and the honour of calling, feeling sure that
her special knowledge in accordance with the advertise¬
ment, besides considerable general nursing experience,
would enable her to give entire satisfaction in the faith¬
ful performance of her duties, similar, indeed, to those
in the situation she had just left. Not a word about
character or reference, or both may be offered.
Nurse Lucretia calls within a few hours, and sees the
patient; if alone, so much the better. She is alertly in
advance of other nurse applicants, some of whom arrive
during her brief visit, and are waiting in the hall their
urn for being engaged, as she passes them to the street
Moor with a jubilant expression in her face. For Nurse
Lucretia has made such a personally favourable impres¬
sion, that none others applying have a chance. No
character or reference was needed from Lady U-,
whose service she was leaving.
A mourning brooch which Lucretia wore, was—she said
—the gift of a family in grateful memory of her
attendance upon one, whose loss to them was irreparable.
Time seemed only to mock their grief ; and nurse often
accompanied the disconsolate widower and his mother¬
less children to the cemetery, bearing floral tributes
to the power of death which had so mysteriously taken
their loved one from them. But ah, she had walked
with God “on earth.” and “ H* took her,” at last awav
The value of Lucretia’s mourning brooch was enhanced
by the additional gift of £100 two year’s full wages.
Lucretia returns in the evening to commence her
attendance on an elderly lady, who although stricken
with one-sided paralysis, is singularly acute in money
matters •. her husband, an old man, with much of the
heart of youth, is a sort of scientific religiose, and
although possessing mature professional experience
in the art of healing, is not singularly gifted as a
financier.
Lucretia, is a spare, lithe, active little woman, of grace¬
ful figure, wiili a face which might have been pretty, hut
sadly indicative of a past, within the short life of thirty
yeaTS; the features are hardly to be noticed ; for the
flushing cheeks, playful little mouth, slightly upturned
nose, and open forehead surmounted by a frizz of auburn
hair, seem lost to sight, in your rivetted view of gentle
hazel eyes, while the ear listens to a silvery voice as of
an angel in mercy sent.
“She is come, she is come,” sang in chorus the second
nurse-attendant with the servants, as tin* fascinating
little woman tripped or flitted with Ariel's wings into J
the bed-chamber, announcing her arrival to “ the dear
old lady.” Yes: and as Ariel might have said to'the
husband—“ Hell is empty, and all the devils are here.”
But for a moment, a little pecuniary difficulty occurred,
ere Lucretia could be installed to commence the duties
of her beneficent nursing vocation. The cabman had
carried her box on his stomach and safely deposited
the precious burden, full of dainty nurse apparel, Ac., in
the hall. “ That ere young lady has not paid my fare.”
This juBt cause and impediment being made known to
the fare-forgetting fair one, a silvery-bell voioe replied
from the drawing-room landing, * Oh, just give the man
one shilling, that is more than his due.” Nurse Lucretia
had come direct from Lady U-, and in the hurry of
packing her box, she had left her purse in her bed-room,
under the pillow. Lady U-would doubtless forward it
(the first-named valuable article) to her by book-poet.
The confiding and generous second nurse-attendant
at once discharged the lady-nurse’s liability by paying the
necessary coin. On seeing this friend in need, however, a
trace of momentary confusion passed over her self-
possessed countenance ; those liquid eyes which ever met
yours were downcast, and the playful little mouth, around
which ever danced a smile, refused its wonted perform¬
ance to its owner. Then the bell tinkled, “I was not
aware that there is a second nurse-attendant in this case ;
for my heart is easily won,” glancing at the old lady, “ and
as my work is done in God’s service, I like to have the
patient all to myself. At least if a helper is needed, as
seemingly in this case of paralysis for lifting the poor
dear sufferer, I must have the Bole personal charge of her,
and especially in that spiritual time during the
solemn hours of darkness.” Tbe uplifted eyes of
the helpless sufferer bespoke a gladsome response to
the sympathetic look and touch of the heavenly visitor ;
and the simple, honest, and faithful No. 2 bowed her
assent to this arrangement.
But it is necessary to mention the terms of Lucretia’s
engagement. The paralysed old lady had engaged this
handmaid of the Lord ; making ter ms with her quite
unknown to the old husband, and probably for this
purpose she had been so desirous of seeing the patient
alone. Happily a warning voice had whispered, “take
her on tiial for a month, but terminable by either paity
at that period.’’
The wages, even for an angel, could only be in their
circumstances, with heavy additional expenses, £25 per
annum, and eveiything found. Lucretia looked for a
moment, disappointed. “ perplexed but not in despair,
cast down, yet not forsaken,” as she would have expressed
her position; “£25, Ac., a year,” said she. “Well, she
had never received less than £50, or in that proportion
of remuneration, for her services rarely lasted so long a
period as one year; but in the pecuniary circumstances
mentioned, £25, or at that rate of weekly payment, she
would accept these terms; in consideration also of the
helpless invalid to whom she already felt attached ;
anxious, moreover, to meet her offer in a spirit of
Christian love ; she willingly and gladly thus concluded
the agreement. And she felt sure that she was sent by
Him, Ac., Ac.”
This agreement was, as in other similar cases, entirely
verbal; but no one had heard the terms; even the
second nurse-attendant being out of the room. The
patient, reduced by suffering and age, as well as having
had a paralytic attack, and the handmaid of the Lord,
were the only parties to the contract.
The old lady listened patiently, but with some nervous
restlessness to nurse’s previous experiences, painful yet
delightful, as she tsld them with her bewitching smile;
nursing in her skilful hands seemed to be quite a fine
art, and life-giving. She told the patient of “anti-
sceptics ” (antiseptics), for so nurse’s little mouth lisped
the word ; “ the ltontgen rays, dear madam, for examin¬
ing you internally—say your heart,” as Lucretia placed
her marble hand upon that treacherous organ in her
own bosom. “Then there’s the ‘funnygraph’ (phono¬
graph) into which if you speak, your every word is
registered, and can he re-spoken years afterwards, even
as they are recorded in heaven.” Pausing : “ but I alarm
you: yet why should not all we say—as well as do—bt*
registered then:,” with up-pointing finger; “who, say
Jolt 26, 1899.
TRANSACTIONS OF SOCIETIES.
The Medical Press. 85
nothing but what is true, honest, pure, lovely, and of
good report.”
Miss Lucretia B-, bearing her full name and prefix
by box label—quite captivated the simple, truthful-
minded dear old lady-patient (for so she is) ; indeed,
some such jargon of religion with scientific-nursing
accomplishments had at once won her heart, and some¬
what enfeebled understanding, on the occasion of nurse’s
first visit.
By similar tactics, it is more than probable that other
nurses, who by no means rival Lucretia in the special
features of her character, are prone to display their vast
experiences and technical knowledge, and may thus
gain more influence over a patient—albeit for no evil
purpose, than the most able doctor. We shall, in the
course of these stories, produce some further illustrations
of spurious nursing - methods for thus exalting the
lamentably ignorant, or the unprincipled women, who
practice these devices.
Thus captured, in her husband’s absence from the
bed-chamber, the credulous sufferer, after her first
interview with nurse, had sent a message to the old
gentleman below, that “ she had seen such a clever, and
good woman, with such delightful anner, and engaging
conversation ; one also who would read her favourite
prayer—“Thy Kingdom come,” morning and »vening;
in these happy circumstances she had ordered Robinson,
the maid, not to admit any more applicants of whatever
kind.” With this message warm in his breast, the
loving old husband seemed to be content, and thus
relived of his anxious solicitude for her comfort, a
devoted wife’s heart-to-heart union of forty years
married life would allay his own incessant suffering of
several years duration and breathe peace to him. Was
this twofold blessing—one for each of the old couple—
realised ?
The old lady upstairs, of whose soul and body the
ministering angel had now gained entire possession, ,
was beautifully passive in the hands of her nurse
attendant; grateful, as her nature is wont to be
for the smallest favour, she at once "fell in love,”
as a man would say, with Lucretia ; in the
long days and yet longer nights of Buffering or helpless¬
ness, almost bed-ridden for a wearisome period, this
faithful watcher learnt, with the adroitness of the most
skilful legal cross-examiner, all about her patient’s family
connections, her property—“ free from the debts and
control of any husband ”; and in return for all such con¬
fiding information, Nurse Lucretia became "the guide,
philosopher, and friend ” of the old wife, without at
present extending her favours to the old husband.
(To be continued.)
(Elittical piecorbs.
CANCER HOSPITAL.
Cate of Excision of the Rectum and Vagina for Cancer.
Under the care of Cttarles Ryall, P.R.C.S.,
8 urgeon to the Cancer Hospital, Brompton; Surgeon to Out-
Patients, London Lock Hospital: Surgeon to Out-Patients,
Gordon Hospital for Diteases of the Rectum.
E. W., aet. 51, married, was admitted into the Cancer
Hospital on April 4th, 1899, and gave the following his¬
tory. For the last two months she had had pain during
defsecation and continuing for some time after the act.
She had also suffered from constipation and occasionally
from a discharge of blood and mucuB. There had been no
marked loss of flesh. She had had no previous severe ill¬
ness and had always enjoyed good health. On examina¬
tion the growth was found occupying the lower three
inches of the rectum, involving the whole circumfer¬
ence of the bowel, and it was most extensive anteriorly
where the anus and the lower two inches of the posterior
vaginal wall were invaded by the disease The affected
part was movable, and there was no evidence of metas¬
tatic deposits, so the case was considered a fit one for
operation.
Operation, April 8th, 1899.—The patient being under
the influence of ether, she was placed on her left
side in the semiprone position, with the thigh
well flexed on the abdomen. A median incision
was made from the middle of the sacrum to the anus,
and the muscular and ligamentary structures and middle
sacral vessels were freed from the lower end of the sacrum
and the coccyx. The lower two pieces of the sacrum and
the coccyx were then removed by the bone forceps and
the exposed part of the rectum was separated from the
surrounding soft parts. The peritoneum of Douglas’
pouch was incised on both sides of the bowel and by
dividing a little of the mesorectum sufficient of the rectum
could be freed to meet the requirem^its of the case.
The bowel was now divided well above the disease and
the upper divided end was secured to the skin below the
remaining portion of the sacrum, or, in other words, to
the upper angle of the wound. The rest of the peri¬
toneum of Douglas’ pouch was separated from the bowel,
and then the peritoneal cavity was closed by suturing
this peritoneum to the anterior surface of the upper re •
maining part of the rectum. The lower portion of bowel
was now rapidly freed from the upper and unaffected
part of the vagina, and the lower diseased portion with
the diseased part of the rectum and anus was removed.
The orifice of the remaining part of the rectum was now
secured in the upper angle of the wound as described, in
order to form the future artificial anus.
The rest of the wound was then closed by deep and
superficial sutures which thuB formed an artificial
perineum and necessarily narrowed the vaginal orifice.
The bowels were kept confined for 48 hours, after which
an aperient was administered, but every care was taken
to prevent fsecal contamination of the wound. The
patient made an uninterrupted recovery, and the wound
healed by primary union, and she was discharged from
hospital four weeks after operation. She is now well
and able to carry out her household duties and exercises
control over her sacral anus by means of a rubber plug
and pad
transactions of gorictus.
BRITISH GYNAECOLOGICAL SOCIETY.
Meeting held Thursday, July 13th, 1899.
Dr. Macnaughton-Jonks, President, in the chair.
Specimens.
Mr. Charles Ryall showed a vagina and rectum
removed for malignant disease, notes of which will be
found in another column under the heading “ Clinical
Records.”
In the discussion that followed. Dr. Heywood Smith
asked how far down the posterior vaginal wall the
growth extended ? Was Mr. Ryall able to leave a part
of the vagina?
Dr. C. H. F. Routh asked whether the patient had
now complete control over the rectum ?
Mr. Bowreman Jesbett congratulated Mr. Ryall on
the sucoess of the case. The only question was whether
the same result might have been obtained without
removing the lower part of the sacrum. If the finger
could be got above the disease the old operation would
sometimes answer, and the sphincter action could be
retained; but in many cases the disease could not be
got completely away without a Kraske’s operation. In
one case he had the pleasure of assisting Mr. Ryall to
remove the upper part of the rectum, and the lower part
of the sigmoid ; the way in which Mr. Ryall did the
operation was deserving of the highest praise; he con¬
nected the two parts of the gut, and the patient was
now able to get about and pass the motions in the
ordinary way.
Mr. Ryall, in reply, said that the lower part of the
vagina was affected, so that this portion had to be
removed; the effect was that the anus was higher up
than usual, and the patient had not sphincter control.
By wearing a plug, she was able to get about all right.
In this case one could not have done the perineal opera
tion, because the peritoneum would have had to be
opened in any case
d by boogie
86 The Medical Press.
TRANSACTIONS OF SOCIETIES.
July 26, 1899.
Dr. Herbert Snow exhibited a uteruB removed for
multiple myomata from a patient, ®t. 47. The sym¬
ptoms were of five years’ duration. The patient was
worn out by repeated attacks of haemorrhage, latterly
almost continuous, with much pain. The uterine body
was completely buried in myomatous masses. Two
of these had not only contracted membranous adhesion
to the bladder-walls, but had become incorporated with
them in such a manner as to form two culs-de-sac, large
enough to admit two fingers. Dr. Snow had not met
with this condition before, and would be glad to learn
if any other member of the Society had seen it. He
regarded the pouches as peritoneal diverticula which
had become segregated; like the portions of the
funicular process which not seldom remained patent
and isolated, upon the spermatic cord, giving trouble
in later life. It had been suggested to him that they
were lymph- Bpaces, but he thought they were too large.
The nodular masses impinged on the bladder in such
a manner as to necessitate careful dissection, and to
make it impossible to tie the uterine arteries before divi¬
sion. In thus separating the tumour one suddenly
entered a rather large oavity, lined by a mucous-looking
membrane. Although the latter bad not the rugose
appearance of the bladder, it was necessary to pass a
bougie before one could feel sure an accident had not
taken place. This occurred twice. The Trendelenburg
posture was used, and the operation was that modifica¬
tion of Dr. Heywood Smith’s which Dr. Snow had lately
brought under the notice of the Society. It consisted in
dissecting off and suturing together thin flaps of uterine
tissue over the residual cervix. Thus all risk of wound¬
ing the ureter* was obviated, and firmer union was gained
than by merely sewing flaps of peritoneum easily torn
at the time or subsequently ruptured in attacks of
vomiting. The patient made a most favourable recovery.
Dr. Septimus Sunderland showed the following
specimens:—
Case I.— Subserous Fibroid removed by Abdominal
Myomertomy. —The patient, a nullipara, a;t. 39, was sent
to Dr. Sunderland by Dr. Arthur Thomas, of Wands¬
worth Common, complaining of constant abdominal pain
and the passage of very thick and clouded urine. She
had always suffered from dysmenorrhcea, and had
noticed enlargement of the abdomen for several
years. Relief from suffering, by any means, was
begged for by the patient and her husband; and
after a month’s trial by rest and drugs, with no result,
they wished for operation. The tumour, nodular
in places, occupied the lower part of the abdomen fitting
very closely to the iliac fossa; and extending nearly to the
umbilicus, and could be felt per vaginam pressing on
the bladder. The uterus felt retroverted and rather
bulky. A sub-peritoneal fibroid was diagnosed and, on
operation, the tumour was found growing from the
fundus uteri by a broad rounded pedicle (practically
continuous with the large fundus uteri) which, according
to the incised area seen on the tumour, would measure
6 ins. in circumference, 2J ins. broad, and 2$ ins. from
before backwards. There was a firm and broad adhesion
to the bladder on the left side which required transfixing
and tying, and a firm adhesion to the intestine at the
upper part on the right which was also tied. The
patient made a good recovery, and the bladder symptoms
and pain disappeared.
Case II.— Large Hydronephrosis, simulating Ovarian
Cyst, removed by Laparotomy. —The patient, a slightly-
built, thin girl, set. 14, was sent to Dr. Sunderland by
Dr. Aubrey with an abdominal tumour, diagnosed aB
an ovarian cyst. The patient and her mother had noticed
the abdomen increasing in size during the previous thir¬
teen months. Until the week before she came to him
there had been no pain, and Bhe then complained of
a feeling of discomfort more than actual pain. The
whole of the lower part of the abdomen from an
inch above the umbilicus, was dull on percussion except¬
ing a small space in the right flank. The tumour
evidently contained encysted fluid, and was again dia¬
gnosed as ovarian cyst, but on opening the abdomen in-
the middle line the tumour was found to be covered by
peritoneum. Dr. Sunderland removed the tumour by
enucleation, and ligaturing a pedicle containing the
vessels and situated several inches distant from the
ureter, which was tied separately. There was nobremor-
rhage, although the enucleation was not easy in some
parts. The fluid was removed by tapping, in the course
of the operation, and consisted of about seven pints of
urine. The flattened kidney substance could be seen at
the back part of the specimen, which was much shrunken
on account of its being badly preserved. The Datient
recovered rapidly after the operation.
Mr. J. Furneaux Jordan said that there was some¬
times a difficulty in diagnosing between renal and
ovarian cy&ts. He had reported a case before the Society.
The abdomen was larger than a full-time pregnancy ;
the cyst had grown in a few months without pain, and
was situated a little more to one side than the other.
Examination of the urine gave no result. He opened the
abdomen, thinkingit was an ovarian cyst; in the cyst were
found 33 calculi. He did not examine the other kidney at
the time, but the patient died in forty-eight hours of
anuria. He then found that the other kidney was
affected and contained seven large calculi. It was
remarkable that the patient had had no pain at all.
Mr. Bowreman Jessktt remarked that some few
years ago a patient came to him who was passing
blood and pus, and he diagnosed a renal calculus. She
would not be operated upon; the pus disappeared, and
she got well. After two years she returned with total
suppression. She then had a large tumour on the oppo¬
site side; he operated, and she got quite well. Two
years later she again returned with a large tumour on
the same side, and again he took away several calculi.
After two years more he operated for the third time, and
the patient died. At the autopsy both kidneys were
found atrophied, with hardly any kidney-sub6tance. It
was remarkable that the patient had been able to live so
long.
Dr. Hetwood Smith said that sixteen years ago a
young woman came to him with a large tumour reaching
above the umbilicus; she had seen Mr. Thornton, who
advised aspiration. This was done in the afternoon, and
she died two hours later. At the post-mortem both
kidneys were found much distended, and within each
was found a large oxalic acid calculus. He asked Dr.
Sunderland what method he had adopted for the
removal of the myoma.
Dr. Arthur Giles commented on the difficulty of
diagnosis in these cases. He had assisted one of his
colleagues at a cceliotomy undertaken for what was
thought to be an ovarian cyst; the tumour occupied the
middle line of the abdomen, which it filled, and reached
down to the pelvis. There were no symploms or signs
pointing to the kidney as the seat of the tumour. On
opening the abdomen the cyst was found to be retro¬
peritoneal, and its true nature was then, of course,
evident. The peritoneum was divided and the renal
cyst dissected out and removed. The patient made a
good recovery.
The President said that he had twice seen a pyone¬
phrosis mistaken for an ovarian tumour. He had also
seen a case which he diagnosed as renal; on tapping,
he drew off two pints of pus ; the patient got well.
These cases showed very well the disappearance of the
kidney-substance and its conversion into a cyst. It was
often difficult not only to diagnose between a renal and
ovarian cyst, but also to say which kidney was affected.
This was a point in favour of dealing with these cases
by the abdominal route.
Dr. F. A. Purcell remarked that other tumours
besides renal ones could be mistaken for ovarian cysts.
Be had a case in which a patient who was pregnant had
a large cystic swelling ; the abdomen was opened and
the cyst tapped, when it turned out to be a distended
bladder. The nurses had said that the bladder had
been emptied, the urine being drawn off with the
catheter. The wound in the bladder was sewn up, and
the patient recovered.
Dr. K. Hodgson pointed out a diagnostic sign between
the two kinds of cyst; with hydronephrosis there was
usually dulness in the flank, whilst with ovarian
tumours the flank was usually resonant.
Dr. Seitimus Sunderland, in reply, said that he had
notpassed a sound down the cut end of the ureter toward
Jult 26, 1899-
GERMANY.
Thb Medical Press 87
the bladder aa suggested by Mr. Jessett, to determine if a
stone were present in the ureter and lie wished he had
done so. He had found tho actual kidney substance
very low down in the abdomen, and he thought possibly
the kidney had originally been a congenital “ floating”
kidney. On the other hand, the kidney substance might
have been displaced downwards by the pressure of the
urine as it collected. To Dr. Heywood Smith and the
President, he said the urine was examined before opera¬
tion and contained no pus—it was quite clear and normal.
No, he had not used Langenbech’s incision — he had thought
the tumour was ovarian, and opened the abdomen in the
Tinea alba, and even then it wao not easy to decide whether
the cyst were renal or mesenteric. He had on two occa¬
sions seen the abdomen opened by operators when ovarian
tumours had been diagnosed, and when one case proved
to be a pyonephrosis, and the other a hydatid of the
kidney—both on the left side, but in neither case had
the tumour been as large and exactly simulating an
ovarian cyst as in this instance. He had also heard
and read of other cases. He was interested to hear
from Mr. Furneaux Jordan of a similar experience in his
own practice, and he thanked Dr. Giles and Dr. Hodg¬
son for their remarks as well as the other speakers.
In reply to Dr. Heywood Smith, Dr. Sunderland,
although at first contemplating supra-vaginal hyste¬
rectomy on account of the size of the pedicle, which was
as big as the enlarged fundus uteri, had removed the
tumour by a circular incision around and through the
thick pedicle. He then removed a wedge-shaped piece
of tissue from the base of the pedicle, arresting bleeding
by four transfixion ligatures, and brought the edges of
the stump together by silk sutures. Thus the uterus
and ovaries were left to the advantage of the patient.
[Some in teres ting cases were also shown by Dr. Keith,
Mr. Jessett, and the President; and papers by Mr.
Charles Ward, of Pietermaritzburg, and by Dr. Lapthorn
Smith, of Montreal, for all of which we hope to have
space in our next.—E d.J
-#ratuc.
[from our own correspondent.]
Paris, July SBr*l, 1899.
Retro-Uterine H.ematocele.
At the meeting of the Soci^te de Chirurgie, M. Rentier
spoke on the treatment of retro-uterine hematocele, and
said he was a partisan of opening the tumour through
the posterior cul-de-sac. M. Chaput admitted that that
mode of treatment was excellent, but sometimes the
patients lost a great deal of blood. One of his patients
operated at the Tenon Hospital succumbed in this way-
After having incised the posterior cul-de-sac and
evacuated the tumour, he plugged the wound with
iodoform gauze; in the afternoon the patient developed
all the signs of internal haemorrhage and died before
help arrived. Ever since he was careful to place only
a simple plug and to wait events; if the haemorrhage
continued he performed laparotomy.
M. Lucas said that he would never willingly incise an
haematocele per vaginam. Laparotomy was the opera¬
tion indicated in such cases, as it permitted the inspec¬
tion of all the points which might bleed. M. Pozzi never
witnessed the slightest accident following the opening of
the posterior cul-de-sac. He had seen more than once
serious hiemorrhage occur, but he could always control
it by hot injections and plugging. However, in extra-
uterine pregnancy, laparotomy was indicated.
M. Regnier considered it was always very difficult
to distinguish between extra-uterine pregnancy and
hanuatocele. It was always where the hiematocele was
recent, that the danger of profuse hiemorrhage existed-
Consequently, it would be well to postpone interference,
one way or the other, for three weeks after the first
symptoms.
Menstruation thhouoh the Ear.
M. Lermoyez related how he attended for several
years a young girl who menstruated for a very long time
by the right ear. Every month, after general prodromic
symptoms, such as lassitude, headache, a thin stream
of blood flowed from the ear. although no lesion could be
detected. The tympanum was intact, but the cutaneous
vessels of the external auditory canal were much
enlarged. At the end of three years menstruation
followed the ordinary channel.
• Gastric Oriuin of Skin Disease.
M. Robin said that for a long time clinicians suspected
that certain forms of dyspepsia played a role in the
genesis of some skin diseases. Out of 422 dyspeptic
patients studied by him, 129 presented acne, eczema,
lichen, prungo, urticaria, furunculosis, herpes, Ac-
On the other hand, he particularly studied the gastric
secretion of several patients suffering from prurigo or
simple eczema, but who did not present any dyspeptic
symptoms, and he found that they suffered, nevertheless,
from a form of dyspepsia due to lactic or butyric fermen¬
tation. Consequently, he was convinced that these
fermentations acted on the Bkin through a trouble of
nutrition (insufficiency of the general exchanges increase
of demineralisation, Ac.), or by elimination of lactic acid
in the perspiration. The treatment should naturally be
addressed to the special form of the dyspepsia. If the
fermentation be due to the presence of lactic acid, the
fluorides should be ordered, while sulphur, iodide of
sulphur, or iodide of bismuth, were the best agents
against the butyric acid form.
H.EMO8TATIC8 IN THREATENED ABORTION.
In hemorrhage resulting from threatened abortion,
the custom is, after providing the means destined to
calm the uterine contractions—opium, rest, ice to the
hypogastrium—to prescribe an hemostatic agent which
will not provoke tetanic contractions of the organ, such
as hydrastis canadensis, viburnum prunifolum, or
hamamelis virginica. According to Prof. Bossi, these
agents prescribed alone are not always to be relied
upon, on account of the difference of temperament so
frequently witnessed in patients. Much disappointment
would be obviated if these agents were prescribed to¬
gether according to the following formula :—
Fluid ext. of Hydrastis canadensis
,, Hamamelis virginica
„ Viburnum prunifolum
Tincture of Piscidia erythrina 1
Laudanum, xxx m.
A teaspoonful of this mixture to be given every eight
hours if necessary.
0» J;
(Sermanp.
[from our own correspondent.]
Berlin. July 22nd, 1898.
At the meeting of the Medical Association of Berlin
on June 27th, 1899, Hr von Leyden read a paper on
The Innervation or the Heart.
He reviewed the subject in outline, historically noting
mportant discoveries, such as that of the influence of the
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AUSTRIA.
vagus, the accelerating and depressor nerves, and the
existence of the cardiac ganglia, all of which led to clearer
views on the wonderful problem of how the heart con¬
tinued to beat the whole life through. Apparently, those
discoveries placed the theory as to the dependence of the
heart’s action on the cardiac nerves upon a firm basis.
But, soon, came observations to the effect that the heart,
freed from its nerves, and even when it was
removed from the body, continued to beat.
And in the case of cold-blooded animals the possibility of
this phenomenon persisting for days was explained by
postulating the existence of a motor centre in the heart.
The cardiac ganglia were regarded as this centre. Sub¬
sequently, it was ascertained that an organ deprived of
its ganglia still continued to beat, whence arose the
theory now advanced by Engelman and His that the
cardiac muscle can work even when not dependent on
nervous influence of any > ind. This theory is founded on
the following considerations:—
1. That the embryonic .heart beats long before the
presence of nerves can be demonstrated in it.
2. That there are muscular structures—the ureters,
for instance—in which neither nerve-cells nor ganglia
are demoi strable. and which, n* vertheless, exhibit the
phenomenon of contraction.
3. That, according to His junior, the cardiac
nerves originate in the sympathetic system and in the
process of their development grow into the heart. The
heart’s ganglia originate in the spinal ganglia, which
must be considered as purely sensory.
Accordingly the cardiac nerves are sensory, and as
each are, of course, incapable of engendering or emitting
motor impulses.
4. Finally, nowhere among the terminals of the cardiac
nerves are fourd the endings peculiar to motor nerves.
5. Leyden declared himself not competent to pro¬
nounce on the question, but the new theory seemed to
him a plausible one. However, he felt bound to add
that Waldeyer opposed it, maintaining the existence of
motor cardiac nerves; so, too, did Kronecker and his
•school.
Hr. Blum, Frankfort a/m, read a paper on
Thtrojd Pathology and Therapeutics.
He urged that the thyroid should be removed from the
list of glandular organs. It elaborated no physiologically ,
active secretion, but seized upon a poison continually |
secreted in the system by means of some capturing sub¬
stance. The tissue of the thyroid thus served for the
arrest of some poisonous material produced by the
action of the vital processes. The activity of the
fettered virus was different from that of the free
toxins. By the iodising process taking place in the
thyroid the harmful agent deposited there as a tox-
albumen was weakened. By perfect saturation with
iod ne it lost its poisonous properties. The free poison
caused severe and frequent epileptiform convulsions, very
frequently cachexia, and sometimes distinct psychical
disturbances. Examination of a dog destroyed by
thyroidectomy showed changes in the ganglionic cells
■of the cord and brain which could be identified by Nissl’s
method. The disturbances when the poison was passed
into the system by inunction were of another kind.
'' hey consisted chiefly in alteration in tissue changes
<emaciation, decomposition of albumen and nuclei, and
liquefaction of the fat), restlessness and palpitation of the
July 26, 1899.
heart. Convulsive conditions had never been observed.
The quantity of thyroid substance absorbed could be
determined by the administration of iodine. The iodine
of the iodine—containing substance was estimated
quantitatively. In many days the toxic effect of the
thyroid substance administered still acted alternatively
on the tissue change when all the iodine given bad been
again passed off. Such an animal when given thyroid,
besides the symptoms mentioned, always had a long con¬
tinuing glycosuria, and when cane sugar was given it
exoreted lsevulose. The same animal when phlorizin
was given with the same diet excreted dextrose.
As regarded the so-called thyroid therapeutics in
myxoedema thyroid extract might act in two different
ways in the one it could relieve the organs of
abnormal deposits; further, the capturing substance
contained in the thyroid body could fix the freely
circulating toxin in the myxocdematous individual and
at last in part render it harmless. In struma and
obesity the administration of thyroid was best abstained
from, because while the substance was incorporated, which
must be determined by the excretion of iodine in the
urine, symptoms of poisoning could not be excluded. In
cases of goitre other preparations of iodine, especially
the non-poisonous iodine albumen (iodalbacid), should
be first tried. In obesity the proper dietetic measures
should have the preference.
JUtstria.
[from our own correspondent.]
Vienna, July 22nd, 18».
Throat and Ear Disease.
The annual reports from the different kingdoms of
the Empire are rapidly coming in, and it is not unin¬
teresting to observe the enthusiasm and activity in the
different schools of medicine in which the Polish shinee-
Pieniazck records the history of a rhinosclerma which
he had under treatment since 1895, causing stenosis of
the larynx, trachea and upper part of the bronchi. By
repeated scraping and dilating the patient has greatly
improved.
Seven cases of stenosis after croup, and one caused
from granulating opening after tracheotomy were treated
with success in a similar manner, though tampons were
frequently applied.
Bronchial 3tenoseB were treated generally by com¬
pression, iodides or drugs suitable to the cause. Among
the cases were stenosis from mediastinal glandular
swelling after pleurisy, tuberculous enlargement of glands
and syphilis. In the latter laryngo-fissure and excision
of the infiltrated glands were practised. One case sud¬
denly collapsed while feeding with tube in oesophagus.
The necropsy revealed yellow atrophy of the cardiac
muscle and liver.
There are four cases of laryngeal cancer which were
hard to diagnose. One arose out of perichondritis
laryngea, phlegmona colli, with swelling in the pharynx.
Another arose from keratoides polyposum on the left
vocal cord, which was excised, but soon recurred, extend¬
ing deeper into the surroundings. Another instruc¬
tive tumour that turned out to be carcino¬
matous, was that of a female with a tumour
about the size of a hen's egg attached to the
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CONTINENTAL NOTES.
The Medical Prkbb. 89
left side of the soft palate. The fine pedicle which
supported it being cut or torn, the tumour fell back into
the throat and was swallowed by the patient. The
remnant of pedicle left was removed and micro¬
scopically examined, but no trace of any adenoid tissue
was to be found. Six months after another appeared
with typical carcinomatous tissue.
Peritonsillar Abscess.
The same author records the history of six cases of
peritonsillar abscess treated with gargle and hot fomen¬
tations. Several extended aditus ad laryngeni, in one
case paralysis of the recurrent nerve followed excision
of tuberculous glands in consequent infiltration.
ThiB case is interesting from a physiological point of
view, showing the effect on the soft palate of one side of
the mouth after cutting the tragus.
Sedziak in his diagnosis of this disease, records the
history of 8,500 cases of inflammatory condition of the
fauoes, root of the tongue, and pharynx, resulting in
purulent accumulation, and concludes that 235 are
peritonsillar in character, or 2 76 per cent. They are
also affected by season, mostly occurring in the spring
and autumn.
The greatest incidence is on males at ihe age of twenty
to thirty years. It is difficult to say how far the abuse
of nicotine and alcohol affect the origin. The immediate
cause is the pyogenic bacteria which may be retained ou
the roof of the moutn till a retention of the tonsillar
secretion occurs to admit germination. He has frequently
seen follicular tonsillitis after influenza and muscular
rheumatism, but more frequently with hypertrophy of
the tonsils. Those of a lymphatic constitution are more
prone to the disease. Death may occur from erosion of
carotis interna, tedema of larynx, or bursting of large
abscess during sleep, and suffocation.
Struma.
Thirty-one cases of struma are given—seventeen by
compression on trachea, one by displacement towards
the left, swelling of posterior surface and oedema of right
arytenoid cartilage.
Nasal Sarcoma.
Among Sedziak’s cases; two of nasal sarcoma of five
years’ standing are noticed without any effect on the sur¬
roundings, while an empytema firbri-High more of
secondary origin receded spontaneously.
The happy results obtaine 1 in these cases have con¬
vinced Sedziak to pause before commencing a major
operation on the nose. He admitted the danger of this
intra-nasa treatment in the case of sarcomatous tumours,
as the constant irritation may finally lead to a cystic
-development.
Continental fioits.
[From Our Own Correspondent.]
URIAGE-LES-BAINS (near Grenoble, France).
Uriaqk-le8-Bains is in the Department of Is^re,
formerly part of the ancient Province of Dauphiny. It
is connected by two good steam tramways with the
flourishing City of Grenoble; a city chiefly noted now¬
adays for its glove-making and its cherry-brandy!
Grenoble is an important junction-station on the Paris-
Lyons-Mediterranean Railway, and is readily accessible
from Paris, Lyons, and Marseilles by several
different lines belonging to the great P. L. M. Railway
system. Uriage is also near Aix-les-Bains, and is
a convenient and excellent spot for those who have
undergone “ a cure ” at Aix to visit for a change
of scene and for recuperation. For Uriage lies in
the Vaulnaveys Valley, one of the charming valleys of
the Dauphiny Alps; with very interesting environs,
historic, botanic, geologic, and artistic; affording easy
promenades and excursions on foot, cycle, and by car¬
riage, and with mountainous ascensions for those more
energetically inclined. The steam tramways conveni¬
ently connect it with Bourg d'Oisans and its glaciers,
the central point of Alpine climbing in Dauphiny.
The Uriage baths have been well described as really
“ sea-baths, sulphurous, and in a pine forest and moun¬
tain atmosphere ; ” Uriage being some 1,400 ft. of eleva¬
tion. The springs here were much frequented in ancient
and mediaeval days, as is shown by the many remains of
the old baths and buildings. For some centuries, dur¬
ing the troublous times of the Reformation, and of war¬
fare between Savoy and Dauphiny, the Uriage waters
were neglected; in 1820 the property came into the
possession of the Saint-Ferriol family, who yet own it>
and have again brought it into prominence as a health-
resort, valuable both for its mineral waters and for its
salubrious pine-wood, mountain atmosphere as an “ air-
cure.” Near a large garrisoned city, with its libraries,
museums, military music, good shops, Ac., and in a most
picturesque position, Uriage is a very desirable summer
home for the invalid, the rest-seeker, and the artist. Its
mineral springs are unique in France, and almost in
Europe, in uniting in themselves chemical principles
usually found elsewhere widely separated. It is diffi¬
cult to define them by the customary classifications;
they are at once strongly sodic-sulphuretted-sulphurous,
and sulphated-purgative. “ To naae Uriage,” says one
medical writer, “ is to speak of an efficient remedy with
a two-fold correlative peculiarity—peculiarity of mixture
and peculiarity of indication. The water of Uriage is a
powerfully mineralised one; in which ha3 been vigor¬
ously determined the place of its efficacious medicinal
elements.” These waters obtained their reputa¬
tion chiefly for skin-diseases acne, eczema, prurigo,
tuberculosis (external), psoriasis, Ac., and are found to
be particu’arly efficacious where there exist antemic, lym¬
phatic, or arthritic predispositioi s. Their sulphurous-
saline elements are also highly beneficial for the elimina¬
tion of uric acid.
Uriage is strongly recommended for children, espe¬
cially those residing most of the year in large cities,
where colds and bronchitis are frequent, nutrition often
imperfect, and growth hindered from various causes ;
also for hereditary tuberculosis, when not pronounced.
In syphilis it is claimed to be a valuable auxiliary cura¬
tive, and important in developing latent cases.
The Thermal Establishment at Uriage is open from
May 25th to October 15th. It is fully equipped for all
applications of the waters by the most approved scien¬
tific methods and apparatus. The water is used for drink¬
ing, baths, douches, vapour-baths, pulverisations, gar-
garisms, irrigations, and lotions. The pulverisations are
particularly efficient in diseases of the face eyes, pharynx,
ear cavities, and chronic otorrheea.
Uriage has numerous good hotels, pensions, furnished
villas, chiilets, and apaitments, restaurants, livery
stables, Alpine guides, and all other requisites for a com-
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LEADING ARTICLES.
July 36, 1899.
90 The M kdioal Pbkbk.
fortable Bojourn, transient, or for the whole season. The
houses in connection with the Bath establishment are
“ The Grand Hotel,” “ Hotel du Cercle,” “ H6tel des
BainB,” “Grand Chalet,” and the villas Juliette, Jeanne-
Marguerite, Bose, Wurbee, and des Chines; all with
electric lighting. At Uriage are also the H6tel de
TEorope (a branch of Grand Hotel, Thibaud, Grenoble).
H6tel Monnet (a branch of the HdtelMonnet, Grenoble),
Hotel du Midi (a branch of the Hotel Chateaubriand,
Hyeres), Hotel du Louvre, and several others of various
grades and terms, so as to amply accommodate all
classes of visitors.
‘SEhe (Dpentting theatres.
CANCER HOSPITAL.
Pan-Hysterectomy foe Carcinoma of the Body of
the Uterus Complicated with Fibroids. — Mr.
Bowheman Jessett operated on a single woman, let. 56.
suffering from carcinoma of the body of the uterus secon¬
dary to fibroids of the organ. She had been suffering
from off-and-on hiemorrhago for about two and a-half
years, and had been seen by several specialists who had
recognised the fibroids of the uterus, and had held out
hopes that at the menopause the hemorrhage would
stop. Just previous to admission to the Cancer Hospital
she noticed the discharge to be. however, most offensive.
Examination under ether and curetting the uterine cavity
showed the deb'is to be of malignant; nature. Mr.
Jessett, therefore, recommended an operation for removal
of the whole organ, but on account of the size of the
fibroids, it was deemed inexpedient to attempt to remove
the uterus by the vaginal route. Mr. Jessett proceeded
to open the abdomen and ligature the broad ligaments,
and remove the whole of the uterus by the abdomen.
Iodoform gauze drainage was passed down through the
vagina, and the peritoneum stitched carefully across the
front of the pelvis. Mr. Jessett said that the interest
of the case was that the patient had undoubtedly
suffered from uterine fibroids for some considerable
time, and it was considered that this was
sufficient to account for the whole of her symptoms
and, no doubt, this was the case; but in the present
instance, as he has so often pointed out, fibroids occur¬
ring in a woman about the climacteric are very apt to
take on malignant action. He had within the last
twelve months operated in many similar cases on several
occasions. The bearing of this fact in mind was, he
thought, of the utmost importance, and he would urge
on practitioners generally the necessity in all cases of
v omen suffering from uterine haemorrhage, either con.
nected with the uterus or otherwise, to make a thorough
vaginal examination, also, if necessary, to dilate the
uterine canal, and curette the cavity of the organ, and
have the dibris carefully examined by a competent
pathologist in the event of the debris being pro¬
nounced malignant to at once advise the patient to
submit to have the organ removed, as in these cases,
when the diagnosis is made early the operation may be
performed with comparative ease, and the prospect of a
radical cure is most encouraging, he having at the present
time several patients on whom he had operated fox similar
affections, alive and free from recurrence from some months
to four or five years. In examining these cases he pointed
out the great advantage of making a rectal examination
whilst the patient is under ether, as on several occasions
the broad ligament, which, by vaginal examination,
appeared to be thickened and possibly infiltrated by the
disease, by rectal examination this thickening had.
been discovered to be caused by the presence of inter-
ligamentous fibroids or by a hydrosalpinx, the presence
of which, whilst somewhat complicating the operation ,
by no means negatives the desirability of operating or in
any way jeopardises the prospects of the patient's
recovery.
The patient made an excellent recovery, and when
seen some months after the operation there were no signs
of recurrence.
Registered eor Transmission Abroad,
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Letters in this Department should be addressed to the Publishers.
^he Jttebiotl Jtes anb Circular.
“ SALUS POPULI SUPREMA LEX.”
WEDNESDAY, JULY 26, 1899.
THE STERILISATION OF MILK.
Theoretically the milk of a cow proved to be
free from tuberculosis and otherwise healthy ought
to be a salutary and nutritious food, but in practice
asepsis is impossible, and certain precautions are
indispensable if milk is not to become the vehicle of
pathogenic contaminations. This fact gives import¬
ance to the plan of sterilising milk, that is to say,
of freeing it from all living germs capable of giving
rise to disease. At the outset it is necessary to dis¬
tinguish between two groups of symptoms to which
milk may give rise. It may, as already stated, con¬
tain the bacteria of this or that disease, which it thus
helps to spread. Boiling under certain conditions will
kill the germs, but may not kill the spores, and, apart
from the latter, boiling does not neutralise the
effects of toxins elaborated in milk by previously
existing living organisms. Milk may be kept sweet
by being periodically boiled, but milk that is no
longer fresh and has therefore undergone partial
decomposition cannot by any known process be
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Jcly 26, 1899
LEADING ARTICLES.
The Medical Press. 9t
rendered harmless. The gastroenteritis of infants
which so often follows the ingestion of milk, especi¬
ally in hot weather, may. it is true, be due to the
presence of bacteria, but, seeing that it may follow
the ingestion even of milk that has recently been
l>oiled. it is probably in many instances due to the
toxins therein contained. It follows and this is a
practical point worthy of attention, that milk con¬
sumers in towns far removed from the dairy
of origin, who cannot therefore receive their milk
until many hours after it has left the cow.
cannot rely upon domestic boiling as an effec¬
tual protection against diseases due to this
cause. They must consequently fall back upon milk
which has l>een sterilised cn bloc immediately after it
has been drawn. In other words, they must rely upon
the so-called sterilised milk. The technical details
of effectual sterilisation are far too complicated to
admit of their being carried out at home, apart from
the fact just alluded to, that it is useless, or, at any
rate, insufficient to attempt to sterilise milk of many
hours' standing. Condensed milk, with or without
added sugar, of course fulfills this desideratum so far
as the freedom of the product from germs is con¬
cerned, but condensed milk is not well borne by all
infants, and there are indisputable disadvantages
attending the use of such products, which, when
diluted, do not in all respects correspond to
the formula for fresh cows’ milk. There is conse¬
quently a wide field of usefulness for milk sterilised
at the dairy under skilled scientific supervision since
this process, if properly carried out, in no wise
impairs the digestibility of the product and affects
the taste and composition of the milk in a minimum
degree. The conditions of efficient sterilisation may
be briefly summarised as follows : The milk must be
subjected either to a temperature above boiling
point for a period of time extending over not less
than half-an-hour, or the process must be repeated
at intervals at a somewhat lower temperature.
Other things being equal, a milk sterilised by re¬
peated exposure to a temperature rather below boil¬
ing point undergoes less physical change than one
which has been summarily heated under pressure,
the emulsification of the fat is not impaired and the
conversion of part of the casein into peptones is less
apt to take place. A point to which sufficient atten¬
tion has perhaps not been called, whether in sterili¬
sation on a large scale or at home, is the absolute
necessity for rapidly cooling the boiled milk. This is
necessary because the temperatures intermediate
between the boiling point and the normal are favour¬
able to the rapid development of any germs which
may be in, or may subsequently find their way into,
the milk. Under any circumstances such milk should
be consumed as soon as possible after exposure to
heat. Boiling may afford a tolerably effectual pro¬
tection against tuberculosis, scarlet fever, and diph¬
theria, but gHstro-enteritis, consequent upon the
ingestion of stale milk, which has already undergone
partial decomposition, destroys more infant lives in
one year than all the other diseases of milk origin do
in a century, hence the importance of securing fresh
milk, or. failing that, of employing milk which has
been efficiently sterilised en bloc. There are plenty of
such milks on the market, and with ordinary care
these afford a trustworthy and salutary food for
infants.
THE METROPOLITAN ASYLUMS BOARD.—II.
In accordance with a former intimation we propose
to consider in the present article the attitude of the
Metropolitan Asylums Board with regard to the
housing of certain physically unfit classes of Poor-
law children. As everyone knows, Mr. Chaplin’s
famous Order was issued in April, 1897. On behalf
of the Local Government Board he directed the
Asylums Board to provide accommodation for
children suffering from contagious diseases of the
eye, skin, and scalp; convalescents and children re¬
quiring sea air, and others of defective intellect,
cripples and those remanded by magistrates. Two
years and a quarter have now elapsed and it is
with some interest that one turns to the Annual
Report of the Asylums Board for 1898, to see what
has been done. It has been estimated that accom¬
modation will have to be provided lor 2,070 children.
Tjvo sites have been purchased for ophthalmic
patients, one at Swanley and the other at Brentwood ;
buildings have been acquired at Herne Bay and at
Margate for convalescents, besides a house at Fenton*
ville for defective children. With regard to the St.
Anne’s Home, Herne Bay, we believe we are
right in stating that the building was originally
an hotel, and that it has been already officially
condemned for structural reasons. It seems
likely, therefore, that in addition to the £17,000
already spent in purchase money, a very
large additional sum will be sooner or later
demanded for rebuilding. If these surmises be true
the confidence of the public will be to some extent
shaken in the wisdom of the Asylums Board. Men
of business capacity would have settled the whole
business off-hand, instead of dealing with it piece¬
meal in a leisurely and extravagant fashion. Let us
take the specific case of the ophthalmic patients, who
make up 800 of the 2.070 for whom accommodation
must be provided. Sites have been acquired
and plans adopted for the erection of schools
upon the cottage house system at a cost
for building and administration that can fairly
be characterised as enormous. The Metropolitan
Asylums Board has always spent money like water,
but in this particular' instance of the Ophthalmic
Schools it has established a record of extravagance
that is calculated to rouse even the apathetic London
ratepayer into indignant protest. So far as the pro¬
posed administrative staff is concerned, the estimate
seems to have been based on the fallacious view that
ophthalmic patients require as liberal a proportion of
nurses as ordinary “ fever" patients. The total
accommodation to be provided is for 712 ophthalmic
patients, equally divided between two schools.
Before the ratepayers are saddled with this heavy
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LEADING ARTICLES.
92 Thb Medical Press.
burden for foundation and up keep it seems reason¬
able that the bearings of the scheme should be
publicly and cautiously considered. First we would
ask, how is the ophthalmic population to be kept up
as the patients are gradually cured and drafted back
to their own places of settlement ! J At Hanwel]
practically all the patients of the original contributing
district school have been cured, and the isolation
ophthalmic school has since been filled by children
from other metropolitan unions. If the supply to the
new Asylums Board special hospital is to depend on the
voluntary action of Guardians and Poor-law me dical
officers, then the scheme will be likely to languish
Medical officers may or may not recognise ophthalmia,
and they may or may not be unwilling to run counter
to the unwillingness of the Boards of Guardians to
transfer children to another authority. It seems to
us that if Mr. Chaplin’s scheme is to attain lasting
success the transmission of infectious children to the
new special hospitals will have to be made com¬
pulsory. To that consideration another equally
plain proposition must be appended. In order to
keep the Poor-law schools free from such cases there
must be some plan of systematic skilled inspection.
The necessity of those two measures was advanced
in this journal on the first appearance of Mr.
Chaplin’s order. It is to be hoped that the Board
which sanctions lavish expenditure in so many direc¬
tions will not draw the line at the comparatively
small sum needed for an expert whose services
will go far towards securing the ultimate suc¬
cess of what constitutes a most salutary social
movement. The recommendation was made by
Mr. Sydney Stephenson in his admirable report upon
the Ophthalmic State of the Metropolitan Poor-
law Children in 1897. Of course it may be possible
that some satisfactory method of collecting the
affected children other than by the aid of Govern¬
ment Inspectors may have been officially adopted,
and, if so, we shall be glad to hear its details. One
point seems clear, namely, that if such Inspectors be
appointed, in order to carry official standing
and authority they will have to be officers
of the Local Government Board. In conclu¬
sion, it may be remarked generally that the
criticisms contained in this article are not advanced
in any captious or discontented spirit. If money be
needed to carry out any great public administration
let it be spent generously, but at the same time with
some regard to prudence. Mr. Chaplin by his ener¬
getic action has provided the London community
with the germ of a long-needed reform. We trust
that it will not be allowed to fall short of perfection
merely by the neglect of a few obvious precautions.
GUARDIANS AND VACCINATION OFFICERS.
It must be admitted that the position of Boards
of Guardians vis-a-vis their Vaccination Officers under
the last Act is somewhat anomalous, but guardians
have only themselves to thank for this curtailment of
their discretionary powers. In many parts of the
July 26, 1899.
country, guardians have shown themselves determined
and refractory adversaries of the law, and have not
scrupled to stultify the law by a policy of passive resist¬
ance. The Government, having gone the length of its
tether in the matter of concessions, evidently
appreciated the importance of providing an
organisation which might be trusted auto¬
matically to enforce the attenuated compulsion
which has been left part of the law. Such com¬
pulsion as remains is aimed at the careless and the
indifferent only, for all those who feel strongly enough
on the question to decline the protection afforded by
vaccination, have ample opportunity of giving expres¬
sion thereto. It remained to overcome the inertia
which characterises the behaviour of the uneducated
classes in respect of things and matters not having
for object the immediate gratification of the appetites
of the flesh. These reflections are suggested by the
meeting of Poor-law delegates which took place in
London early last week, By dint of active canvassing
some forty - two boards had been induced to
send delegates. The chairman was careful
to point out that they had not met to discuss
the question of the advisability of vaccination as a
protection against small-pox, but merely to voice the
indignation of Guardians at finding that their ser¬
vants, the vaccination officers, were expected to act
proprio motu in the matter of initiating proceedings
against defaulters under the Act. The action of the
Local Government Board was declared to be insulting
to public authorities, anda resolution in favour of bring*
ing pressure to bear on the Board was agreed to with
only six dissentients. The chairman’s introductory
remarks are in themselves a sufficient justification for
the course adopted by the Local Government Board-
They (the guardians), he observed, did not wish to
set their faces against the law, but as responsible to
the ratepayers, and representing the principle of
local self-government, they were entitled to considera¬
tion. These observations embody an exceedingly
vicious principle, one against which we cannot too
strongly protest As worked out in practice, it
amounts to an assertion that local self-government
entails the right of individuals to set the
dictates of Parliament at defiance. It is all
very well for the guardians to say that it
is not their intention to defy the law. Expe¬
rience in the past has shown that in certain parts of
the country guardians are ready and willing enough
to render the law nugatory, and guardians, like
magistrates, have to learn that their functions
consist in carrying the law into effect irres¬
pective of their own views or the opinions
of a certain section of their constituents. We
trust the Local Government Board will not recede
from the position which has been taken up,
seeing that reversion to the former regime, which
left the guardians masters of the situation, would un¬
doubtedly remove the last incentive to vaccination
among the poorer classes of the community. We are
threatened with a Vaccination Amendment Bill next
i session, but we need not now discuss its bearings.
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July 26, 1899. NOTES ON CURRENT TOPICS_ Thb Medical Pbkbs. 93
By this time next year we shall be in a better posi¬
tion to form a trustworthy opinion of the effects of
the concessions wrung from the Government in oppo¬
sition to the almost unanimous voice of those whose
opinions are worth having on such a complicated
question.
-♦-
*e on torrent ‘topics.
Legislation for Midwives.
The reception accorded by the Lord President of
the Privy Council last week to the delegation of
supporters of legislation for midwives was charac¬
terised by diplomatic sympathy and extreme caution. I
Obviously no government would, if it could do other¬
wise, take upon its shoulders legislation of a kind
bristling with controversial points and certain, if
carried, to alienate the good wishes of a large and
influential class of the community. Nevertheless,
it cannot be denied that there is a large body of
public opinion favourable to a measure having for
object to improve the education and status of mid¬
wives. The crudeness and quasi-impracticability of
the proposals hitherto brought liefore Parliament,
have rendered it a comparatively easy task to defeat
the intentions of their advocates, but the more
these proposals conform to the provisions stipulated
by the General Medical Council, the more difficult
will it be to resist their assuming legislative form.
No Government is likely to undertake the ungrateful
task of forcing through Parliament a Bill on any
other lines in the teeth of determined organised
opposition at the hands of the medical profession,
whose interests, be it remarked, are on all fours with
those of the public. From every point of view the
matter is one which would beet be dealt with as a
private bill, for this obliges its supporters to
disarm opposition by timely and reasonable
concessions. This is evidently what the Duke
of Devonshire had in mind when he urged tlie
delegates not to be discouraged, and advised them
to prepare a measure in consultation with their
critics, embodying therein all representations which
they might consider reasonable. The advocates of
midwives legislation may congratulate themselves on
having made a decided step in advance in that they
have secured an expression of sympathy on the part
of the Government, but this they could have secured
much earlier in the day had they shown themselves
less intractable when called upon to safeguard the
interests of duly qualified medical practitioners
and to take precautions against the introduction of a
new and imperfectly trained body of women for
obstetric purposes.
The Self-Constituted Expert.
An "expert ’’ is always more or less an unknown
quantity. He may be, indeed he usually is, a recog¬
nised authority on the subject respecting which his
opinion has been solicited, but it is necessary to dis¬
tinguish between the expert whose claims to special
knowledge are based on tangible evidence of special
study and the sot disant expert whose claims to
distinction fail to command assent among his fellow
professionals, to whose reputation, such as it is, is due
to cleverness in manipulating the lay press.
We are all familiar with the names of
certain people, popularly described as experts, who
somehow never miss an opportunity of bringing
themselves to the fore in the cauaes celebrea of the
hour. They do not wait for their opinions to be
asked; they buttonhole the editor or one of the
junior members on the staff of a London daily, and
on the morrow their views are blazoned forth to
the multitudes, framed in a motley array of adjectives
and irresponsible encomiums, the better to justify
their publication. It goes without saying that
the popular experts’ views must always be
diametrically opposed to the professional and
official views. He deliberately puts himself
forward as the exponent of the views of tbe
thoughtless, but possibly earnest, minority of the
public. His name is used as a lever for bringing
pressure to bear in high quarters, and so he acquires
a spurious fame, “ unto which he was not born.” As
the great public are unable to distinguish between
the genuine and the spurious article, writers for the
lay press are enabled to expatiate on the untrust¬
worthiness of expert testimony, and to give examples
in proof thereof. In well-informed circles, it is true,
opinions are valued, not by number or by energy of
expression, but by the professional status of the
donors A great deal of harm is done, nevertheless,
by these irrepressible individuals, because the public
are very apt to mistake notoriety for fame, und to
attach an overweening importance to what a cele¬
brated politician once called the “ harebrained utter¬
ances of irresponsible frivolity.”
“Vol au Chloroforme.”
Does any anaesthetist or medical expert believe
any of the thrilling narratives produced by the Press
of persons—almost always women—being rendered
unconscious by the momentary inspiration of chloro¬
form or any other anaesthetic ? From time to time
we read dramatic stories of women robbed—in rail¬
way carriages or elsewhere—of their money and
jewels, or of their virtue, by an instantaneous whiff of
chloroform, even by throwing into the carriage a hand¬
kerchief saturated with that anaesthetic. The possibility
of this has come to be so popular a belief in France
that the supposed crime is designated by a special
name. “ Vol au Chloroforme,” and we have had within
the last fortnight the report by a lady that she had
been robbed of 70,000 francs in a railway carriage
by this means. We believe we are in a position to
assure the public that the production of unconscious¬
ness by such means without preliminary violence or
without consent is the next thing to absolutely im¬
possible. We have, of course, seen young children who
succumbed to the ana?sthetic in a very short time—
say a minute—and we can also believe that a
woman assaulted in a railway carriage might from
the combined influences of excitement and terror
and the amesthetic, lose consciousness in a couple
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94 The Medical Pbebb.
NOTES ON CURRENT TOPICS.
July 26, 1899.
of minutes, but this could not happen without a sub¬
sequent recollection of the precedent circumstances.
The public should know that to induce anaesthetic
unconsciousness in an adult under the most favour¬
able circumstances almost never takes less than three
or four minutes—usually ten to fifteen minutes.
The theory of the lone, unprotected female over¬
come by a five-Becond smell of chloroform adminis¬
tered by a man whom she cannot remember, will
do for sensation newspapers, but not for the medical
profession.
The Determination of Sound Direction.
The function attributed to the semicircular canals
in respect of the determination of the direction of
sound has been gradually undermined, and is now
more or lees discredited. The nature of the mecha¬
nism by which the source of origin of a given sound
is perceived, therefore, still remains to be explained.
There is reason to believe that the appreciation of
direction is mutatis mutandis very analogous to the
phenomenon of stereoscopic vision, that is to say, it
is in virtue of certain subtle modifications of sound as
perceived by both ears that we learn to diagnose direc¬
tion, just, as the slightly inaccurate superposition of
two visual images gives the sensation of projection. In
the course of a long series of observations carried out |
at the Yale laboratory it was found that as a matter of ,
fact the sense of direction is remarkably accurate, a
blindfolded subject making only 113 out of 656possible <
errors. It was noted that the sounds of the right
hemisphere were more accurately perceived than
those of the left, those from the front more than
those from the rear, and those from below more than
those from above, variations which are probably due
to the shape and direction of the pinna, and to the
difference in the functional acuity of the two ears.
Distance is estimated merely by the absolute
intensity of the sound, but direction is gauged,
according to Matsumato, by the relative difference
between the intensities of the component sounds
as heard by the two ears. This is such a delicate
process that ventriloquists can, by directing the atten¬
tion of his audience to a given spot other than the
actual source of ‘the sound, and by certain studied
modifications of the sound emitted, mislead the
judgment into overruling the impressions on the
sensorium of the observer and give rise to an abso¬
lutely false perception. There remains the fact that
in certain atmospheric conditions, notably in fog,
the sense of direction is greatly modified, and even
lost, as sailors know to their cost. This fact would
tend to show that senses other than hearing are con¬
cerned in completing the impression or at any rate in
confirming or disproving the deductions based there¬
upon.
Unsound Fruit.
From a medical standpoint there can be no doubt
that a great deal of nonsense is talked about unsound
fruit. If we accept the popular view, many, if not
most, of the acute summer diseases are due tobadfruit.
Only last week, a correspondent signing as a medical
man,wrote to a leading metropolitan newspaper to the
effect that unsound fruit was one of the chief causes of
summer diarrhcea. As a matter of fact, it is nothing
of the kind. The malady in question is a symptom
of invasion of the body by micro-organisms of many
different kinds. It is perfectly true that those hurt¬
ful microbes may be conveyed on fruit, as they may
be in any other article of food. Fruit, however,
is in itself vastly less likely to carry the
seeds of the infection than contaminated milk,
meat, or water. Indeed, it may be fairly
asserted that to attribute the incidence of this disastrous
seasonal disorder to the agency of fruit is to cast
round the real source of the mischief an ample
cloak of ignorance. We have yet to learn that the
organisms found in over-ripe or fermenting fruit
have any serious disease-producing action. The
point has a very serious economic aspect. Quite
recently a South London sanitary inspector named
Thomas has secured the destruction of enormous
quantities of fruit consigned for the purpose of jam-
making. It is well known that the sterilising pro¬
cess of prolonged boiling renders fermenting fruit
harmless. In any case we should have preferred
the evidence of the Medical Officer of Health offered
in court upon this important point, instead of that of
a subordinate official untrained in bacteriology.
Messrs. Lipton and Co. would do well to have an
inquiry made into the question by a bacteriological
expert.
Scarborough as a Health Resort for
Tuberculosis.
Since the open-air treatment of phihisis has come
to engage so much of the professional and public
mind, the health authorities of various favoured
resorts have been active in claiming for their locali¬
ties the advantages to be derived from following out
the treatment. Under these, perhaps, natural cir¬
cumstances it is not surprising that much diversity
should prevail in the climates of those places which
have been vaunted as suitable for the purpose. In
this connection it has not been pointed out what is
the best climate in which to carry out the open-
air treatment. So far sanatoria are being opened
or have been decided upon in all parts of
the country under the most diverse conditions
as to subsoil, climate, and environment gene¬
rally. Nevertheless among the localities whose
natural surroundings eloquently plead in its favour
as a resort for consumptives desirous of undergoing
the open-air treatment, mention should be made of
Scarborough. There can be no question 60 far as our
knowledge goes that this North-Eastern health re¬
sold. is eminently adapted for the purpose. We
believe that at present no special facilities exist for
carrying out the treatment, but the matter probably
only requires to be brought under the notice of the
municipal authorities of the town, in order to prompt
them to embark upon an enterprise which could not
fail to be followed by excellent results. Naturally
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Ph* Medical Press. 95
July 26 , 1899 . NOTES ON CURRENT TOPICS.
favoured as Scarborough undoubtedly is for this
special form of treatment, there is every reason for
supposing that if the authorities were to erect a sana*
torium the enterprise would soon prove a very pro¬
fitable one for the ratepayers. A sanatorium under
municipal control, erected and conducted in accord¬
ance with all the requirements of modern times,
could not fail to prove a magnificent success. We
commend the suggestion to the Corporation of Scar¬
borough, believing that they will not lightly over¬
look this opportunity of again proving their ability
to conduct the affairs of the town with commendable
enterprise and foresight.
The Rating of Hospitals.
The question of the rating of the hospitals is by
no means so simple as it looks, and its settlement
involves many principles, both legal and ethical. If
the medical charities were all conducted in such a
way that persons who could afford to pay private
practitioners were not allowed to partake of the
charitable funds, one great objection to rate-relief
would be removed. Then, again, the pay system by
which great charities like St. Thomas's, Guy s. and
the London Hospitals in general practically trade on
funds subscribed for the benefit of the sick poor.
Apart from those two points, it is hard to see why
anyone should object to the removal of taxa¬
tion from the medical charities. However, any
rate-relief must come out of the pocket of the
ratepayer, and he may well object to relieving
hospitals that compete with general practitioners,
that give advice and medicine to the well-to-do, and
that make money out of paying patients. Why
should a struggling ratepayer contribute to the pro¬
vision of medical necessities for folk who ought to
pay for them Y Government is giving a huge dole to
the clergy of the established Church in the shape of
a Tithes’ Relief Bill. The church that nets this
substantial contribution is the richest in the world,
and ministers to a section only of the community.
It is hard to see why a similar money relief should
not be granted to the medical chanties, which relieve
Government of a vast mass of sickness, suffering,
and disease that the State would otherwise be called
upon to provide for.
Official Vaccination.
The Vaccination Bill of last year has raised an
apparently endless crop of anomalies and complica¬
tions. It has been our pleasure from time to time to
point out the enormous indirect compulsion that lies
in the hands of the Government through the civil,
military, and naval, the poor law, and the educational
services. By simply announcing that the unvacci¬
nated need not apply, the necessity of vaccination is
practically enforced upon a vast section of the com¬
munity. Nor could we imagine any Government
that could refuse to enforce vaccination upon those
engaged in the public services, an opinion we adhere
to in spite of the rude shock of Mr. Bal¬
four’s surrender of the compulsory principle in
the teeth of medical authority. But the anti-vacci¬
nators will not be content with their victory, which
will simply give them a sharper zest for future doles.
They are raising a great outcry against the condi¬
tions imposed by the Education Department whereby
vaccination of teachers is rendered an indispensable
essential. Their attitude has been summed up thus
by a writer in a contemporary journal, “ A benevo¬
lent legislature provides that children need not be
vaccinated, while the Education Department rules
that their teachers must be. The inconsistency is
as grotesque as the tyranny of the thing is out¬
rageous.” Meanwhile small-pox is practically extinct
in London, and the burden of proving that vaccina¬
tion has not been the chief factor in arriving at that
happy result lies with the anti-vaccinators.”
The “ Ophthalmic Optician.”
The fin de siecle tradesman, the so-called “ ophthal¬
mic optician,” has not by any means been backward
since the Spectacle Makers’ Company decided to give
them the chance of gaining a diploma. In pioof of
this we must again revert to the advertisement
columns of a contemporary. Upon this occasion it
is the British and Colonial Druggist to which we may
draw attention. In the issue of that journal for
last week the following advertisement appeared:—
“ Classes are now being formed in Retinoscopy,
Ophthalmoscopy and Ocular Physiology. Candidates
prepared for the optic, dioptric and ophthalmo-
metric grades of the British Optical Association.
For terms and particulars apply to T. H. Sutcliffe,
O.B.O.A., F.S.M.C., Blackpool.” This announce¬
ment shows very plainly that if the diplomates of the
Spectacle Makers' Company are compelled by the
company to keep within certain lines in their sight¬
testing businesn, they are not bound by any restric¬
tions by the British Optical Association. It will
probably be news to the majority of our readers
that opticians are now taking up retinoscopy
and learning the ophthalmoscope. Practitioners
may well ask, in view of these facts, what will be the
end of this matter. Hazarding a guess, we believe
that trouble is in store for the Spectacle Makers’
Company. In the course of time the body of
“ Diplomates ” whom they have created will be
strong enough to dictate terms to them. For
example, the restriction as to advertising is not one
to which the “ Diplomates ” are likely to submit for
long, for to a tradesman business can scarcely
come without advertising Again these diplomates
are forbidden to use atropine, but we gather
from the advertisement above quoted that reti¬
noscopy is now one of the branches of study
of the optician, and this almost implies the
employment of atropine. Altogether, it is quite pos¬
sible that the Spectacle Makers' Company, or, at all
events, those of the Company who have made them¬
selves responsible for this new diploma, will subse¬
quently find themselves in a veritable hornets’ nest,
and compelled to retire from the position which they
have assumed. Meanwhile the Medical Acts ai - e in
such a delightfully chaotic condition that there is no
NOTES ON CURRENT TOPICS.
Jplt 26, 1899
96 Thb Medic al Pbkbs.
law which can prevent opticians using atropine or
practising as ophthalmic surgeons if the public choose
to employ them as such.
A Nursing Home Case.
Obstinacy, like experience, has generally to be
paid for, as a lady in Manchester has just found to
her cost. She made an allegation against the pro¬
prietress of a nursing home in that town, to the effect
that the latter was in an alcoholic condition on a par¬
ticular morning when the lady paid a visit to the
home for the purpose of seeing her daughter. But
the allegation, however, being persisted in, there was
nothing left to do for the proprietress of the
home, who was a nurse, than to bring an
action in order to clear her character. The
case came on for trial last week, and the judge
at the outset did his utmost to settle it out of court
in the interest of both parties. The plaintiff, through
her counsel, expressed her willingness to accept the
judge’s suggestion provided that an apology was
tendered and the costs of the action paid. But the
defendant, with an obstinacy which she probably now
sincerely regrets, would not agree to this course, and
the case, therefore, was heard. After the evidence had
been given on both sides and the judge had summed
up, the jury found for the plaintiff, and awarded
damages to the extent of £50. We congratulate the
plaintiff upon the result, for not only was she able to
prove that the allegation was unfounded, but she hae
been awarded damages, the claim for which, had the
case not been tried, she had expressed her willingness
to forego. On the other hand the defendant has
been taught a lesson which she will have good reason
to remember. No possible sympathy can be felt for
her, inasmuch as the evidence showed that she made
the allegation in anger, and even when a favourable
opportunity occurred for adjusting the matter, she
obstinately refused to avail herself of it. This point
was made much of by the judge in his address to
the jury.
Footsoreness in the Army.
During the manoeuvres on Salisbury Plain last year
a large number of men were placed on the sick list
owing to the prevalence of footsoreness. This con¬
dition was brought about as the result of the long
marching, which formed part of the training to which
the troops were subjected. However, active steps
have since been taken, in order, if possible, to pre¬
vent the recurrence of this untoward result, and the
Royal Army Medical Corps have dealt with the
matter in a manner which will probably prove effec¬
tual. In the course of the end of last year at Aldershot*
a class of non-commissioned officers was formed an-,
instruction given in the art and science of chiropody.
Tbi6 plan has so far succeeded exceedingly well in
attaining the object in view, so much so that the
military authorities are contemplating adopting it
extensively. By its means the men are taught to
look after their own feet, while at the same time any
local ailments of the feet from which they may be
suffering are taken in hand and cured. As might be [
anticipated corns, bunions, ingrowing toe nails, chil¬
blains, blisters, are not uncommon among the troops,
and anyone of these, if allowed to remain unrelieved,
would soon incapacitate a man for much marching
duty. The idea of establishing a permanent system
of efficient regimental chiropodists for service in
infantry battalions is now under the careful con¬
sideration of the military authorities.
A New Theory of the Cause of Appendicitis.
We would seem up to the present to have been
living in a fool's paradise regarding the pathology of
appendicitis. It has been usual to attribute the
onset of the disease to some local disturbance of the
nutrition of the appendix, generally caused by a
foreign body of some sort, and frequently, when the
surgeon has been called upon to interfere, and explore
the seat of inflammation, a large foreign body in the
appendix has been found. But a Daniel has come to
judgment in this matter. Dr. Alexander Haig
has affirmed that the pathology of appendicitis
allows of a most simple explanation. He states
that in a large number of cases inflammation
in the region of the cajcum and appendix is merely
a gout of the fibrous tissues of the intestines and
that like gout of other fibrous tissues, it is promptly
relieved by salicylate of soda or other salicylates.
This is, of course, a physician’s view of the matter,
and physicians are rather apt to be unorthodox as to
the expediency of surgical treatment in cases like
those of appendicitis which really belong to the
domain of surgery. In waiting for cases of appendi¬
citis, however, to recover under salicylate of sodium
valuable time might be lost, so much so that instead of
gout the surgeon might find at the operation general
suppurative peritonitis, caused by the rupture into the
peritoneal cavity of an appendicular abscess. It is ob¬
viously risky matter to have theories upon such a pro¬
foundly active disease as appendicitis. In truth, there
is no room for them; a cherry stone may become im¬
pacted in the appendix as the result of a gouty attack,
but it is obvious that the patient, gout or no gout,
cannot be regarded as safe until that cherry stone
haB been removed. Hence it would Beem to be best
to find out the cause of the trouble first, and then
consider the possibility of gout afterwards.
Criminal Responsibility.
As a mere matter of homespun justice, it is likely
that the voice of the majority of our countrymen
would be raised for or against the carrying out of a
death-sentence on the merits of each particular caee.
A cold-blooded murder, without any suggestion of
mental unsoundness on the part of the pei-petrator,
would arouse little or no popular protest. Where
there is an element of reasonable doubt, however, as
in a recent case lrefore the public, a vast agitation at
once surges through the country, and the Home
Secretary is urged to exercise his prerogative of
mercy by the Press, by monster petitions, and even
by a large and solid phalanx of the House of*
Commons. When doubts of so weighty and multifai i-
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July 26, 1899.
PERSONAL.
ou8 a nature are raised, it would seem to be a safer
course to stay the avenging hand of justice. In
the case mentioned the question of the prisoners
sanity was not laid before the consideration of the
jury at the trial. Almost at the same time another
prisoner was at once acquitted of a terrible murder on
the ground of insanity. The lady in question
imagined a schoolmaster had violated a scholar, and
she accordingly shot him dead. The practical point
that seems to be suggested by recent events is that
there should be a court of criminal appeal, which in
the poisoning case, would have permitted the plea of
insanity to have been adequately considered.
Secondly, the need of a board of experts in lunacy to
inquire into the mental responsibility of criminals
of all sorts, in conditions whenever and wherever the
question of insanity is raised—whether before, after,
or during their trial.
Medical Millinery in Edinburgh.
The Edinburgh College of Surgeons has yielded
to the importunity of a number of its Fellows who
are anxious to be allowed to advertise themselves on
public occasions by assuming a gown and cap of office.
The College has intimated that any Fellow can have
such paraphernalia “designed and faced in con¬
formity with the armorial bearings of the College ”
for £3 lbs. 6d., and it “ recommends that it be worn
on all ceremonial occasions where the College is
represented.” This last limitation would be useful if
it were observed by Fellows who yearn for
special clothing, for it would prevent them
from bedizening themselves for garden parties,
charity dinners and such functions; but we
predict that it will not be observed. Practitioners
stricken with the millinery mania will probably not
wait for the occasions when their college is ceremo¬
nially invited and present. Considering that up to a
recent period the fellowship was purcliaseable for
£2o, without examination, and even in absentia, the
canonicals now adopted cannot be regarded as a
badge of very superior attainments.
Mr. Stephen Coleridge and the West
London Hospital.
Mr. Stephen Coleridge, who, as we stated last
week, endeavoured, by an appeal, to induce the sub¬
scribers to the West London Hospital to divert
their contributions to the Poplar Hospital, has been
placed in an ignominious position. The chairman of
the Poplar Hospital has stated that if any subscrip¬
tions are so diverted, his committee are sure not to
accept them. In other words, it is now quite evident
that Mr. Coleridge has signally failed to do any
harm to the West London Hospital by informing
the subscribers to the institution that two members
of the staff are licensed vivisectors. Again, it is of
interest to note that Mr. Holland utterly repudiates
Mr. Coleridge’s efforts on behalf of the Poplar Hos¬
pital. All this is entirely as it should be, and the
^National Anti-vivisection Society, of which Mr.
Coleridge is the mouthpiece, have thus been
administered a well-deserved snub.
The Med ical P ress. 97
Unqualified Assistants and Registration.
Our Edinburgh correspondent informs us that one
of the present features of the examinations for the
licence of the Scottish Medical and Surgical Colleges
is afforded by the number of candidates appearing
who have filled unqualified assistant’s posts during
the past yea rs, some of them for several years,'but
who are now compelled to become registered. Some
of them exhibit certificates of attendance on classes
obtained as many aB ten or twelve years back. Their
reappearance in the character of medical students
often has an elemen* of sadness in it, but their ac¬
quaintance with the subjects for which they come up
is frequently very defective, even in such practical
points as their experience of practice would lead one
to expect familiarity with.
A serious case of wholesale poisoning of school-
children occurred at Black heath on Saturday last.
After partaking of tea at an outing, some sixty of
them were seized with vomiting and diarrhoea, the
majority being taken to the Seamen's Hospital at
Greenwich. All were considered sufficiently recovered
before midnight, and were discharged, but the edibles
and milk were taken for analysis by Dr. Hartt, the
Health Officer for Greenwich.
PERSONAL.
Mr. H. W. Atkinson, ot Caius College, Cambridge,
has been elected to the Shuter Scholarship at St. Bartho¬
lomew’s Hospital.
W. H. Symons, M.D. (b), D.P.H. (o), F.I.C., has been
appointed Medical Officer of Health for the City and
County of Bath, at a salary of £435 per annum.
Sir Wm. Stokes, M.D., F.R.C.S.I., Surgeon-in-Ordinary
to the Queen in Ireland, has been appointed an Honorary
President of the International Medical Congress, to be
held in Paris next year.
The appointment of surgeon to in-patients at the
Westminster Hospital, void by the retirement of Mr.
Thos. Bond, F.R.C S., has been filled by the election of
Mr. Alfred Tubby, F.R.C.S., and Mr. E. Percy Paton,
F.R.C.8., has been appointed assistant-surgeon.
Dr. Max Breder, a German subject, formerly surgeon
on the s 8. Russia, has just been made a Knight of the
Legion of Honour, for having eight years ago rendered
surgical assistance to a French sailor on an English
petroleum ship, on the high seas, under peculiarly trying
circumstances. Mieur vaut tard que jamais!
We are glad to be able to report that Sir Thomas
Grainger Stewart, Professor of Clinical Medicine in
Edinburgh University, has made considerable progress
towards recovery within the last few days, although it
will necessarily be some time before he is able to fulfil
any engagements of any description. It is to be hoped
that the long vacation will afford him the rest he is so
much in need of, and enable him to undertake the work
of next winter with his health completely restored.
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98 Thb Medical Press.
CORRESPONDENCE.
Jolt 26, 1899.
It is proposed to build at Aix-le-Bains a hospital for
the poor as a memorial to the late Dr. Brachet. The
French Government has promised its assistance. English
friends of Dr. Brachet who may desire to subscribe are
requested to send their contributions to Mr. F. D.
Mocatta, of Connaught Place, W.
(EomepoitOenc*
We do not hold ourselves responsible for the opinions of our
correspondent*.
THE NATURE AND TREATMENT OF WHOOPING-
COUGH.
To the Editor of The Medical Press and Circular.
Sir, —In your article on the Metropolitan Asylums
Board in this week’s number of The Medical Press
and Circular, the words “the terribly fatal maladies,
whooping-cough and diarrhoea,” occur in reference to the
possibilities of some day dealing with them as infectious
diseases.
Now, it lias always appeared to me difficult to under¬
stand why it has taken so many years to make our pro¬
fession perceive the nature of whooping-cough. My old
friend. Dr. Octavius Sturges, thought I had some reason
for my views, but as Dr. Sturges did not go through
fifteen years of out-patient work in those crowded rooms
at the Great Ormond 8treet Children's Hospital. I made
allowance for his sceptical attitude. But I cannot
reflect on this subject without recalling an amusing
incident that occurred in the family of one of the most,
if not the most, distinguished anatomists in London.
His children had whooping-cough, and the advice of Dr.
Niemeyer that the treatment of a birch rod might prove
of effect was suggested, not by myself, but by another
friend well-known as a children’s doctor. A few weeks
passed when the mother of the family caught the
whooping-cough, and her eldest son recalled to her mind
the advice of Dr. Niemeyer. That eldest now is a well-
qualified practitioner, and an interval of between fifteen
and twenty years has, I am glad to Bee, cleared up the
great ignorance that prevailed in our profession on the
nature of whooping-cough, and which, I hope, will lead
as your article suggests, to some steps being taken to
prevent itB spread. To see thirty or forty children in
the Ormond Street waiting-rooms mixed up with others
was not pleasant.
I am, Sir, yours truly,
Robert Lee.
39, Gunterstone Road, West Kensington, W.,
July 21st, 1899.
THE CANCER “FOG.”
To the Editor of The Medical Press and Circular.
Sir,—B arnum tells in his “Autobiography” the
story of a clever young lawyer who was pleading in his
first cause, and had made a long and eloquent speech
greatly to his own satisfaction. That was somewhat
damped, however, when the judge asked him for which
side he appeared- plaintiff or defendant?
I was reminded of thiB anecdote when I read the first
letter of your correspondent, “ Philosophus Ignotns ”;
for his opening remarks coincided so exactly with my
own views, expressed or implied, that I could not see
where the prospective censure was to come in. Such
phrases as—“ The philosopher’s function to try to see,”
“ principles.” " I think careful and accurate observa¬
tions are not so much a desideratum now as sound
reasoning, judgment, and reflection founded on them.”
* It is not more observations that we require in the study of
cancer, but a better use of the observations we already
have,” “ No memory is so prodigious as to be able to
carry it (the mass of recent medical observations) ; for
one is in great danger of failing to see the wood for the
trees,” are aptly expressed propositions, perfectly after
my own heart, and with which, making one slight reser¬
vation, I fully concur.
That reservation concerns the words I have above
italicised. For however enormous the aggregate of
details and of more or less isolated facts with which we
have to deal, it is idle to pretend that we really have
more than a child’s empirical knowledge about any single
medical, physiological, or pathological point that can be
instanced. Sir Isaac Newton described himself as “ a
child picking up pebbles on the sea-shore.” That is a
simile we should all do well to bear in view, especially
in the existing state of medical education. The student’s
brain is crammed to repletion with facte, or what pass for
such. He is never supplied with any general law or
principle which binds these together, by which their
truth may be tested, and which enables them to be put
to practical use. It is not even suggested to him to look
for such a principle, which must needs be underneath
them some where ; or that, if he would become other than
a mere empiric, he must search until he find it. So long
as he can commit to memory a sufficient number of par¬
ticulars, and reel them off to order at an examination,
that is all which the present system requires. Hence, a
frightful waste of force in the process of manufacture; a
standard of quality far below what should be found in
the finished article.
In the department of cancerous diseases there have
been, of course, as my paper pointed out, very numerous
and valuable observations. Were these, as your corre¬
spondent justly hints, carried into practical effect, the
progressive mortality would soon be very appreciably
diminished. But it is futile to pretend that we have
enough for the purpose, and that no more are needed.
We know perfectly well, the immediate antecedents—in
other words, the exciting causes—of cancerous disease,
whatever the variety. No cancer erer arises without a
definite and ascertainable excitant tn each individual
inst -nee. Only it is not permissible to discuss “ cancer ”
as a single malady. It is a ve-y large group of maladies,
each widely differing from the rest, in mode of causation,
to say nothing of clinical and pathological phenomena.
The recognition of this maxim is the first step towards
reform in medical literature and towards the foundation
of any true cancer-science.
Your correspondent implies, and the lay press take for
granted, that the causes of “cancer” are obscure and
unknown. That is entirely erroneous. There is nothing
i mysterious about them. There is, indeed, a mystery,
but it is purely teleological, relating to the qualities of
protoplasm and the relation of individual cells to the
nervous Bystem Here observations are wholly wanting.
I doubt whether there can be material scientific progress
I until this wholly unknown country has been explored.
The physiology and pathology of unicellular organisms,
such as the Amoeba and its congeners, will some day be
found of profound significance in elucidating those
phenomena characterising malignancy in all its forms,
which I have ventured to designate collectively “ The
Cancer Process ”
Another most important matter on which independent
investigations are urgently needed, is the behaviour of
the lymph-glands towards cancer-protoplasm. In the
Medical Press of November 9th last, I pointed out that
in the early stages of all, or nearly all, malignant
lesions, extensive destruction of the infective cell-
particles takes place, either in these organs or in the
lymph-current; most probably the former. Of this I
feel perfectly certain, no other explanation will account
for tne clinical phenomena.
It seems to me that the fact might reasonably be
turned to therapentic use; nay, that we might even
discover something in the nature of a remedy. But a
long series of careful observations and experiments is an
indispensable preliminary to any valid work.
I fail to pee that any object would be gained by dis¬
cussing the long string of interrogatories in your corres¬
pondent's second letter; even if I could discern their
bearing upon the questions at issue, which is not the
case. But he blames me for not stating facts, and giving
the result of my own observations. If he will only do
me the honour of referring to any one of my publica;
tions, the result of a life’s work, I think he will discover
a reasonable supply of facts. And if he would condes¬
cend to explore a little further, he would find every
Google
July 20, 1899.
CORRESPONDENCE.
The Medical Pbisb. 99
question answered somewhere or other; without occasion
to invoke “ pollaki-siteism ” or “ polysiteiam.” and so
to 8end us on a tedious Bearch after the long-
disused Greek lexicon. The series of 1075 cases
analysed in reference to the question of heredity, would
offer support to his own views on the non-validity of
that factor as a source of canoer-development.
But alas! I am here reminded of a shrewd remark Sir
Walter Besant somewhere makes about clever magazine
articles. They are read, people talk about them perhaps,
for a couple of days. Then the world goes on as though
that article had never been written. So it is with any
work or paper not involving a mare’s nest on cancer.
The only difference is that nobody takes the trouble to
read the latter.
I am, Sir, your truly,
Herbert Snow.
Gloucester Place, Portman Square,
July 22nd, 1899.
THE TEMPERANCE QUESTION.
To the Editor of The Medical Press and Circular.
Sib. —May I ask for space to reply to the extraordi¬
nary article on “The Temperance Question" in your
last issue ? It so (apparently without the least inten¬
tion) caricatures the total abstinence movement that
one cannot but wonder that in these enlightened days
anyone should have such notions about it. What, for
instance, can be the meaning of the sentence, “ The
evils of excess in some are not very clearly proved to be
curable by total abstinence in others ”? I never beard
of anyone who prescribed such vicarious treatment. It
goes without saying that if a man abstains he cannot
be drunk. If A. is the drunkard A. must abstain, and
all the good B. can do A. by abstaining too is to en¬
courage him and make it easier. But B. abstains,
not simply because A. drinks, but (1) because it
is better for himself physiologically; (2) beoause
he does not want to be like A, and believes that total
abstinence is the only absolute guarantee; (3) because
he helps to break through and break down the drinking
customs which have led A and so many others to become
a drunkard.
Then the writer sneers at “ religion ” in connection
with the cure and prevention of drunkenness. One fails
to see why. For (1) the crusade againBt drink and
drinking has been chiefly carried on by men from or with
religious motives; and (2) why refuse the help of the
strong motives which religion supplies in euring the
drunkard ? They certainly have their plaoe and power.
One must pass over much that iB irrelevant in the
article, even if true, but the writer calmly defies logic in
stating that Nature, by fermentation, provides us with
the means of changing certain substances from one con¬
dition to another to make them more suitable to the
human body. To prove that fermented drink must be
beneficial, he instances the advantages of fermented
bread! Surely he must know that the object of
fermenting dough is to produce the bubbles of CO,,
which render the brrad light, and that the production of
alcohol is not the object, this product being expelled in
baking. Will he maintain that alcohol is more suitable
to the human body than sugar, or than starch ? The
absurdity of it precludes serious argument.
Then, again, he credits abstainers with the notion that
“ nothing whioh Nature provides us with should be used
for good if it can possibly be used for ill.” One might
ask, and ask in vain, for the alcoholic beverage which
Nature provides without human interference. Everyone
knows that if Nature starts the process of fermentation,
and is not let or hindered, the ultimate product is
vinegar, &a, and not an intoxicating beverage. We do
not object to any good thing, but we require proof that
alcohol is good (for internal use), and we are convinced
that even if there were some good to be obtained from
taking it (pleasure, Ac.) the evils which accompany are
so inevitably and inextricably mixed with tne good
that “ the game is not worth the candle.”
Where can he have got the idea that we regard total
abstinence as a virtue ? We disclaim it altogether. We
regard it as nothing more than common-sense to abstain
from a drug (alcohol, and the drinks which contain it)
which renders the practice of the virtue temperance
(i.e., self-control) more difficult, and which curtails or
abolishes it in hundreds of thousands of cases, every day,
to the manifest injury both of those who take it and those
who have to do with them.
By all means treat this question as one of sanitary
science, and in the same manner that other sanitary
questions are treated Sanitarians advocate that food
and drink should be as pure, nutritious, and free from
poison as possible. No one in his senses will advise the
use of slightly impure water when an abundant Bupply
of pure is available. Should we say “ A little wont do
much harm, but don't take too much? ” We are con¬
sistent in advising total abstinence from all poisons, and
especially from alcohol, which by its insidious power has
done and is doing more harm than all other poisons put
together.
The profession know that this is all true, and as soon
as they are prepared to speak out the truth, the public
will follow and have a better opinion of them.
I am. Sir, yours truly,
J. J. Ridok,
Hon. Sec. British Medical Temperance Association.
Enfield, July 22nd, 1899.
THE ANSELL POISONING CASE.
To the Editor of The Medical Pre6b and'Circular.
Sir, —Although it is impracticable to attempt to draw
a line of demarcation between insanity and criminal
responsibility, it appears to me, prima fade, that the
Home Secretary was ill-advised by the experts who
examined the condemned in this case; otherwise the
capital sentence would have been commuted. It is true
a premeditated and diabolical murder was committed for
the purposes of trivial gain. On the other hand, the
pronounced family history of insanity, the early eccen¬
tricities of the condemned (as you remark) and terrible
family history, coupled with the inadequacy of motive,
clearly point to an abnormal mental condition, apart
from the individuality of the case, and which according
to the present tone of English society and public opinion
should have absolved the condemned from criminal
responsibility.
I am. Sir, yours truly,
Clement H. 8ebs.
Queen’s Road, Peckham, July 21st. 1899.
HOSPITALS AND THE ANTI-V1VISECTIONI8T8.
To the Editor of The Medical Press and Circular.
8ir. —With reference to your article entitled “ The
London Hospitals and the Anti-Vivisectionists ” I never
suggested, nor did I use any words that could imply a
suggestion, that Dra. W. A. Turner and G. L Cheatle
“ made ubo of the West London Hospital Laboratory for
the prosecution of their (vivisectional) researches.”
I made a plain statement that those two gentlemen
were licensed vivisectors and were on the staff of the
hospital. Mr. Bird, the chairman of the hospital, wrote
to the papers claiming the support of the humane, and
fortifying his claim by asserting that vivisection did not
go on at his hospital. If he may claim support on that
specific ground, why may I not point out that there are
vivisectors on the staff ?
And there being another hospital that is without that
stigma in the eyes of anti-viviseotionists, why may I not
name it ?
If vivisection is a proper adjunct to a hospital, let those
hospitals that foster it appeal to the public on that very
ground for their support.
If it be not a proper adjunct to a hospital let those hos¬
pitals that have nothing to do with it at least have the
advantage that may accrue from such disconnection.
The National Anti-Vivisection Society has a perfect
right to use its influence openly and fairly to direct the
subscriptions of the benevolent towards hospitals discon¬
nected with vivisection, and it will certainly continue to
do so.
The suggestion that you seem to make, that in fulfilling
oogle
Digitized by
100 The Medical Press
MEDTCAL NEWS.
July 26, 1899.
this obvious duty to its supporters, the Society, and myself
‘as its representative, are doing something discreditable
is perfectly ridiculous.
I am, Sir, yours truly,
Stephen Coleridge.
20, Victoria Street, London, S.W.,
July 21st, 1899.
-♦- .
THE MEDICAL DEFENCE UNION AND MEDICAL
AID ASSOCIATIONS.
To the Editor of The Medical Pbbss and Cihculab -
Sir,— In consequence of the resolution passed by the
General Medical Council on June 6th, in re medical aid
and other associations the council of the Medical Defence
Union has decided in future to require intending candidates
for membership of the Union to sign the enclosed declara¬
tion in addition to the usual application form. As a
matter of interest to the profession, may I aBk you to
kindly afford space in your columns both for this letter
and the declaration itself ?
I am. Sir. yours truly.
A. G. Bateman.
Medical Defence Union, 4 Trafalgar Square, W.C.
July 21st, 1899.
The declaration reads as follows :—
“ I hereby declare that I do not at the present time
hold any office in connection with any medical aid or
other institution in which systematic canvassing is
practised as a means of procuring patients, and that in
the event of my being elected a member of tbe Medical
Defence Union I will not during the continuation of my
membership thereof accept any offices whatsoever in or
be otherwise associated with any society, association,
piovident dispensary, or medical institution where can
v*s8ing for tbe purpose of procuring patients is prac¬
tised ; and I further declare that I will not engage in
any practice either as principal, partner, or assistant in
which canvassing for the purpose of procuring patients is
adopted.”
THE PROPOSED BOARD OF CONCILIATION.
To the Editor of the Mbdical Press and Circular.
Sir, —We may not be all of one mind with reference
to the proposal of the General Medical Council to form a
Board of Conciliation, but we shall all be agreed that
the proposal is worth the careful consideration of the
medical officers of the Friendly Societies of this country.
May I suggest that the annual meeting of the
British Medical Association affords a very fitting
opportunity of discussing this important subject
I am, Sir, yours truly,
T. Garrett Horder.
Cardiff, July 21, 1899.
Jftebual
Dental Hospital of London.
On Wednesday last a conversazione was held by the
Dental Hospital of London at the Royal Institute
Galleries, Piccadilly, when tbe prizes of the School of
Dental Surgery were distributed to the successful
students of the year by Sir Richard Douglas Powell, the
most successful students being Mr. J. T. Carter. Mr. W.
J. Duncalf, Mr. A. Rice, Mr. E. Rhodes, and Mr. G. C.
Bawday. Mr. Morton Smale, the Dean, remarked that
the school had attracted a large number of students,
including some from Italy, and their students had
carried away several important prizes at the general
hospitals. The new premises in Leicester Square were
progressing, and the hospital would be in full working
order in October. Sir Richard Douglas Powell said
that through the efforts of the staff during forty years
the hospital had advanced to a great state of perfection
both in its teaching and in the administration of relief.
When adequate room was obtained in the new building,
with the museums and teaching power that now
existed, the institution should be Beoond to none in the
world, and he believed that the students and prize¬
winners would carry on the good work of theirj pre¬
decessors.
The Sixth International Otologics! Congress.
An interesting programme has been issued for this
Congress, which will be held at the Examination Hall,
Victoria Embankment, W.C., from August 8th to 12th.
Over seventy papers are announced for reading, besides
a general discussion on " Indications for Opening the
Mastoid in Chronic Suppurative Otitis Media,” to be-
opened by Profs. MacEwen and Politzer, and Drs. Knapp
and Luc. The museum, to be held in connection with
the Congress in the same building, promises to be of
great interest. There will be a large collection of speci¬
mens relating to diseases of the e«r andnoee, not only from
this country, but iilr-o from France, Germany, Austria,
Holland, and other countries. Among others, Prof. Politzer
(Vienna) is bringing over many valuable specimens.
Members of the profession will be admitted to the
museum, on presentation of their visiting cards, on
Wednesday, August 9th, and on Thursday, August 10th,
from 2 to 4 p.m., and on Saturday, August 12th, from
10 a.m. to 6 p.m. Further particulars of the Congress
may be obtained from the Hon. Sec.-Gen. Mr. CressweH
Baber, 40 Brunswick Square, Brighton
Irish Medical Schools' and Graduates' Association.
The summer general meeting of the association wiH
be held on Wednesday, August -2, 1899, at the Town
Hall, Portsmouth, in Committee Room No. 1 at two p.m.
the president. Sir William Thomison, M.A., F.R.C.S.I.,.
in the chair. Dr. George Stokes has given notice that
he will move the following resolution, viz.: " That the
last sentence but one of the first paragraph of Rule
VIII. be altered to read as follows:—“Of the elected
members of council twelve only shall be eligible for re-
election.” The Chairman of Council wiil report the
decision of council as to the “ coming of age ” celebra¬
tion to take place in London at the commencement of the
winter session.
Westminster Hcspi'al Medical School.
The following were the principal awards at the dis¬
tribution of the prizes at this Institution for the Winter
and Summer Sessions:—Scholarships in Arts, each of
the value of £50, to C. Fletcher and G. W. Heron.
Oxford and Cambridge Scholarships, each of the value
of .£40, to A- R. Roche, F. P. Edwards, and B. J. Dudley.
Science Scholarships, each of the value of £30, to C.
Roper and M. J. Cromie. Dental Scholarship, value
£20, to L. W. Townsend. The Chadwick prize, value
20 guineas to A. J. V. Betts. The President’s prize,
value 20 guineas, to E. C. Whitehead. The “Bird”
medal and piize, value£14,to H. D. Brice. Histology prize,
E. C. Whitehead. Pi nci ical Chemistry prize, E. C. Johnson.
Prize for Materia Medica, W. Payne and H. D. Brice.
Midwifery prize, E. R. Carling. Medicine prize, W. Payne.
The prizes having been presented. Sir John Wolfe Barry
delivered an address, in which reference was made to the
value of examinations as a guarantee to those entering a
profession of their being au courant with all that is
known in scientific research. But practical knowledge
could never be met by any system of examinations, and
in the medical profession must be acquired by clinical'
Btudy in the hospital. The position taken by the school
in the public examinations was referred to as comparing
favourably with that of the larger medical schools. The
records of old students were mentioned. Sir George
Robertson, the hero of Chitral, had been a student at
Westminster Hospital, and Messrs. Walker, ‘White, and
Jerman were now in Uganda upholding the high quality
of the Westminster Hospital Medical School training.
London Hospital Medical College.
Occasion was taken of the presentation of prizes and'
certificates gained by the students during the past
year to formally open the new buildings of vhe medical
school by Lord Knutsford, on July 18tn. The following
is a list of thi prizes:—Price Entrance Scholarship in
Science: £120, Mr. F. W. Jones. Price Entranoe
Scholarship in Anatomy and Physiology: £60, Mr. L.
Bousfield. Entrance Science Scholarships : £60, Mr. J-
Digitized by CjOO^Ic
July 26, 1899.
MEDICAL NEWS.
Tmt Msdical Press. 101
"W. Fox ; £85, Mr. J. J. Rainforth. Buxton Scholarships
(Arts): .£30, Mr. M. Greenwood. Epsom Scholarship
•(for Students of Epsom College): £126, Mr. C. Colmer.
Scholarship in Clinical Medicine: £20, Mr J. Sherren.
Scholarship in Clinical Surgery: £20, Mr. A. Killick.
Scholarship in Clinical Obstetrics: £20, Mr. R.
J. Howard. Duckworth Nelson Prize: £10, Mr. R. J.
Howard. Letheby Prizes in Chemistry: Senior (£20),
Mr. H. E. Ridewood ; Junior (£10), Mr. G. O’N. Wadding-
ton. Sutton Scholarship in Pathology : £20, Mr. R. N.
Salaman. Scholarship in Anatomy and Physiology:
£25, Mr. H. E. Ridewood. Scholarship in Anatomy
and Biology: £20, Mr. F. W. Jones. Minor Surgery
Prises: £15 prize, Mr. A. J. Couzens ; £10 prizes, Mr E.
J. H. Rudge and Mr. T. Y. Simpson -, £5 prizes, Mr. H.
R. Cran, Mr. W. G. H. Cable, and Mr. M R. Johnson ;
£3 08. 8d. prizes, Mr. G. Birch, Mr. G. M. Clowes, and
Mr. T. W. Jeffery. Practical. Anatomy • £0 prize, Mr.
R. A. Dolbey ; £4 prize. Mr. H. M. Churchill. Anderson
prizes: £2, Mr. W. H. Davidsonand Mr. R. F. Williams ;
£1, Mr. B. Warren, Mr. D. S. >kelton, Mr. H. Balean,
Mr. F. Challan, and Mr. A. B. Soltau.
St. Bartholomew's Hospital Medical School.
The following Scholarships and Prizes for the past
winter and summer sessions have been awarded:—
Entrance Scholarships.—£76, in Biology and Physiology,
L. J. Picton; £150, in Chemistry, Physics, and Biology,
-C. C. Robinson and J. Burfield, equal; £50, preliminary
Scientific Exhibition, A. F. Forster; £20, Jeaffreson
Exhibition, T. Jeff Faulder; £50, Shuter Scholarship.
H. W. Atkinson ; £50, Junior Scholarships in Anatomy
and Biology, A. Hamilton, T H. Harker, and C. C. Robin¬
son, equal; £40, Junior Scholarships in Chemistry,
Physics, and Histology, H. V. Wenham and E. C.
Williams; £6, Treasurer’s Prize in Practical Anatomy,
C. C. Robinson. Certificates—A. Hamilton, J. Bur-
field, W. S. Aldred, T. W. Chaff, J. W. Cleveland
A. J. Foster, T. H. Harker, and H. V. Wenham;
£60, Senior Scholarships in Anatomy, Physics, and
Chemistry, F. Grone; £6, Foster Prize in Practical
Anatomy, N. E. Waterfield. Certificates—W. P. Yetts,
H. E. Stanger-Leathes, H. R. Kidner, J. Corbin, F. H.
Noke, T. C. Melville, E. B. Smith; £6 6s., Harvey Prize,
in Practical Physiology, N. E. Waterfield; Prox. Aoc.,
H. R. Kidner; £5, Wix Prize, for an Essay on the Life
and Works of Matthew Baillie,IE. C. Williams; £6 10 b.,
Hitchins Prize in Butler’s Analogy, S. G. Mostyn;
£10 10s., Sir George Burrow’s Prize in Pathology, G. V.
Bull. £13 13s., Skynner Prize, in Regional and Morbid
Anatomy, including their reference to Scarlet Fever, &c.,
Bowell.Davies; £20, Matthews Duncan Prize in Obstetric
Medicine, C. J. Thomas; £30, and Gold Medal Kirkes
Scholarship, and Gold Medal in Clinical Medicine, C. J.
Thomas ; £39, Brackenbury Scholarship in Medicine, C.
J. Thomas; £39, Brackenbury Scholarship in Surgery,
F. C. Borrow.
School of Medicine for Women.
The science laboratories at the London (Royal Free
Hospital) School of Medicine for Women will be com¬
pleted and fitted up in time for the opening of the
winter session. This will allow of classes being held for
the preliminary scientific examination of the University
of London, which has been impossible hitherto owing to
lack of space.
University of London.
At the Intermediate Honours Examination in Medicine
during July, 1899, the following candidates passed: —
Anatomy.—First Class : ’William Percv Gowland (Gold Medal),
Owens College ; Charles Seymour Parker (Exhibition and Gold
Medal), University College.
Second-Class : — James Alone Coupland, Yorkshire College ;
Reginald Cheyne Elmslie, St. Bartholomew's Hospital ; Greer
Edmund Malcolmson, Owens College.
Third Class:—William Henry Bow.n, Guy’s Hospital; James
Cameron, Edin. Univ. & Sch. of Royal Colls ; William Thomson
Crawford, University College; Ernest Nicholson Cunliffe, Owens
College: Charles Edward Ham, London Hospital; Anna Maude
Smith, London School of Med. for Women.
Physiology and Histology.—Second Class :—Myer Coplans, Guy’s
Hospital; Harold Edward Ridewood, London Hospital.
l bird Class.—William Henry Bowen, Guy's Hospital: William
Henry Harwood-Yarred, B.Sc., St. Thomas's Hospital, Albert
Ernest H. Pokes, B.Sc., Guy’s Hospital: Louis E. Stamm, B.A.,
B Sc., Guv's Hospital; James Ernest Stratton. University College;
George Ernest Waugh, Cambridge Univ. and University Coll. ;
Owen Thomas Williams, University College, Liverpool.
Organic Chemistry.—First Class:—Reginald Cheyne Elmslie (Ex¬
hibition and Gold Medal, 8t. Bartholomew’s Hospital; ’William
Henry Harwood-Yarred, St. Thomas’s Hospital; "Harold Edward
Ridewood, London Hospital.
Third Class: ■ Agnes Catherine Scott, London School of Med. for
Women.
Materia, Medica, and Pharmaceutical Chemistry.—First Class
Ernest Bock Carling (Exhibition and Gold Medal), Westminster
Hospital, King’s College, and Birkbeck Institute ; Regina! Cheyne
Elmslie, St. Bartholomew’s Hospital.
Seoond Class: Ernest Nicholson Cunliffe, Owens College; Greer
Edmund Malcolmson, Owens College ; Ernest Eric Young, St.
Bartholomew's Hospital.
Third 31ass: Alexander Clarke Begg, Edinburgh University and
School of Medicine ; William Henry Bowen, Guy's Hospital; James
Cameron, Edinburgh University and School of Royal Colleges j
Charles Edward Ham, London Hospital; Anna Mande Smith,
London School of Medicine for Women.
• Obtained the number of marks qualifying for the Exhibition.
Royal College of Physicians, Edinburgh; Royal College of
surgeons, Edinburgh; and Faculty of Physicians and
Burgeons, Glasgow.
The Quarterly Examinations for the Triple Qualifica¬
tion in Edinburgh were concluded on the 20th inst., with
the following results:—
First Examination, 4 Years’ Course.—Of 6 candidates
entered, the following 4 passed the examination:—
Gilbert Elliot Aitken, Nicholas Philipson, William Henry Burn-
hill, and John Wilson ; and 1 passed in Elementary Anatomy, and
1 in Chemistry.
First Examination, 5 Years’ Course.—Of 32 candidates
entered, the following 13 passed the examination:—
Minnie Green, John Searle Burton, Leo Levi, Reginald Herbert
Brierley, Evelyn Morris Franklin, Tom Bragg, John MulvihUl
Gerety. Robert Walter Joseph Pearson, John Dick, John David
Jones, Michael Bernard Conroy, William Pearson Cowper, and
Samuel Ethelbert Mangenie; and 8 passed in Physics, 8 in Biology,
and 1 in Chemistry.
Second Examination 4 years’ Course.—Of 8 candidates
entered the following 6 passed the examination : —
Nicholas Philipson, Selby Wood house Morton, William Smith,
Thomas Edward Frazer Toovey, and Theodore William Rhoades;
and 1 passed in physiology and 1 in materia medica.
Second Examination 5 years’ Course. Of 31 candidates
entered, the f J lowing 21 passed the examination :—
Thomas Longmore Ashforth, Martin Francis Cusack, Frederic
John 8crimgeour, Robert Douglas Argyll Douglas, Edwin Wrigley
Kemp, Thomas Sergeant Pearse, Anne Low Venters, Andrew
Young (with distinction), May Thomson, Robert Chisholm,
Charles Wilfred Coghlan, Thomas Huston, Percy Howe, John
Walker Wood, Charles Stewart Hunter, Robert Bathgate Johnston
(with distinction), William James Noble Todd, Robert Stratford
Stephens, Peter Carruthers Watt. Robert Sutherland Mackintosh,
and John O'Connor, and 2 passed in Anatomy and 1 in
physiology.
Third Examination, 5 years’ Course. Of 25 candidates
entered, the following 20 passed the examination:—
Edith Maria Lydia Scull, William Charles Bentall, Alfred Augus¬
tus Beeks, Frederick Alexander Georgeson, M.A.; Raoul Ferdinand
de Boissiere (with distinction), Frederick Charles Willmot, William
Btephen Cowin, David Patrick Johnstone, Bernard Flood, Norman
Lang Stevenson, Agnes McLean Holland MoNab, Neil Murphy
Gavin, Archibald Macqueen, Arthur Ernest Whitehead, Mary Brice
Carr, James Campbell Nicholson, Thomas Arthur Ball Harris.
Walter Goldsworthy Edwards, John Hogan Rooney, and Kallyanl
Pado Chntterjee, and 2 passed in Materia Medica.
Final Examination.— Of 87 candidates entered,
the following 43 passed the examination, and were
admitted L.R.C.P.E., L.R C.8.E., and L.F.P. and S.G,:—
Anne Mercer Watson (with honours), George Frederick Stooke,
Herbert Alfred Hillman, John 8earr, Lewis Augustus Clutterbuck,
Robert Mugh Russell McKean, John Bran gun, George William
Hardie, Frank Randolph Seager, Joseph Freeman, Rowland William
Devey, Horace Gordon Lewer, John Colin Campbell Ford, Robert
Boles Sandiford, Guv Verney Fletcher, David Coffey, Patrick
Coffey, Henry Heber McWilliams, James Patrick Lavery, Ernest
Augustus Boxer, James Gerald Shealian, Winifred Muirhead,
Euphemia Stoker, Patrick Heffernan, Joseph Eugene, Horace Gen-
til, Mary Birrell Davies, John Noonan Meade, Nicholas Philipson,
Jeannie Hamilton Traill, Joseph Dalrymple, John George Grant,
Edmund Patrick Kelly, Abraham Johannes Benjamin Albertyn,
Rosalie Berthon, Robert Paterson, Dhnnaindranatlia Mittra, Parch
Ronyon Roy, Martin Joseph Lobo, Gregorio Manoel Horatio de
Souza, Thomas Edward Frazer Toovey, Bhagvant Sakhoram Patkar,
James McMurry, and William Frederick Campbell, and 5 passed in
the division of Medicine and Therapeutics, 1 passed in the division
of Surgery and Surgical Anatomy, 11 in the division of Midwifery
' and 11 in the division of Medical Jurisprudence.
Royal College of Surgeons, Edinburgh.
The following candidateb having pasbed the requisite
examinations were, on the 20th inst., duly elected
ordinary Fellows of the College :—
John Charles White Hallidav, M.B., C.M., Univ. 8vd., L.R.C.8.E.;
Thomas Ranken Macdonald, L.R.C.S.E., M.B., C.M.Edin. ■ Hugh
Robertson, M.B., C.M.Glasg. ; Walter Archdale Shnrpin, M.R C.8.
Eng., L.R.C.P.Lond.; John William Steven, M.B., C.M.Edin.,
L.B.C.S.E.; John Stevenson, MB., C.M.Edin.; William Macrae
Taylor, M.B., C.M.Edin.; Francis Ponsonby French, M.B.. C.M.
Edim: Philip George Williams, M.B.C.S.Eng., L.R.C.P.Lond. ;
and William Gordon Hanna, was admitted a licentiate. ) t ’*
102 The Medical Pbms
NOTICES TO OORKESPONDENTS.
July 26, 189ft.
<|l0tiCW to
(JtorrtBponiitntB, Short ‘jCctterB, -fo.
*&- .Correspondents requiring a reply in this column are par-
ticukrT^ requested to make use of a distinctive tignature or
nttiati', and avoid the practice of signing themselves “ Header,'
“Subscriber,” "Old Subscriber,” Ac. Much confusion will be
spared by attention to this rule.
THOSE DEVILISH VIVISECTOBS.”
. li^ye received the following communication from a gentleman
vrhoft6 illume we were unable to find in the Medical Hegxs'er, and
who,appeared to be connected in some way with a hospital equally
obscure.
To the Editor of the Medical Press and Circular.
-t . Sia,—I am afraid you are not enterprising. If you want to know
; F0OtX*m look in the Clerical Directories and you will see. And as
to this Institution, it is not a place for harbouring helpless mortals,
who shall form “ clinical material" for vivisectors to sport with,
Dut for giving shelter to people- without any such evil accompani¬
ment. -•
As to my right to speak of vivisection, I may say that I have
followed very closely for eight years or more the doings of the
experimenters on living animals, and I hold strongly to the opinion
that the experiments are misleading as to what they teach, and in
themselves barbarous. I may say of many of them that they are of
a devilish nature, and if the British public were not deceived by
the Report on Vivisection issued to Parliament from the Home
Office, my opinion would be endorsed by the nation as a whole.
Perhaps you will give this note a conspicuous place in your
journal?
I am, Sir, yours truly,
J. Stbatton.
Wokinghim, July 21st, 189-t.
Dr. Gilbert E. Brooke (Turk's Island). -We thank you for the
photograph which, though artistically interesting, is hardly suit¬
able for the purpose suggested.
A Country Doctor (Cornwall).—We fail to see the point of your
objection. Of course you may be perfectly correct in your view that
the joint affections of gouorrnoea are merely manifestations of the
absorption of the irritntive products of the specific micro-organisms.
On the other hand, however, we have the suggestive fact that the
gonococcus has beep repeatedly found in the effusions into the
joints of gonorrhoeal rheumatism. Curiously enough the organisms
are rarely to be found in the sheaths of tendons inflamed under
similar circumstances. It is hardly too much to say that modern
bacteriology has enabled the physician to approach the question of
rheumatism generally from a new scientific standpoint. Muoh
remains to be learnt about the behaviour of the vagrant gonococci.
Scarlatina rheumatism offers another suggestive field of study. We
congratulate you on your philosophical speculations.
NOCTURNAL INCONTINUENCE OF URINE.
To the Editor of the Medical Press ahd Circular.
Sir,—I n answer to the request of your correspondent in your
issue of June 7th, I would advise that the bladder be filled almost to
distension with a weak solution of chloretone, of the strength of
about one part to 125 (8 grams to one litre), the solution having a
temperature of about 100 deg. F. Chloretone is a new product,
having a definite chemical formula, being a combination of chloro¬
form and acetone. It occurs in the form of a white crystalline solid,
sparingly soluble in water. It acts as a local ana-sthetic, and is
entirely free from toxic or other untoward effect. Moreover, it is a
powerful antiseptic, and its action in my bands has proved highly
satisfactoiy. Internally, I would recommend the use of the sulphate
of strychnine, in gradually ascending doses, and the oils of santal
and saw-palmetto.
I procure the chloretone and globules of saw-palmetto and santal
oils from Parke, Davies and Company, and as they have an estab¬
lishment in Loudon I presume the medicines can be procured there.
I am, Sir, yours truly,
Cuvier R. Marshall, M.D.
1505 Wood word Ave., Detroit, Mich.
THE LIVERPOOL SAMARITAN HOSPITAL FOB WOMEN,
AND THE LATE MB. LAWSON TAIT.
In our last issue we noted with surprise that the committee of the
above hospital had at its annual meeting “ elected Mr. Lawson Tait
to be consulting surgeon ” several weeks after that distinguished
surgeon had passed away. Dr. G. A. Hawkins-Ambler writes us
that the late Mr. Lawson Tait had been consulting surgeon to the
hospital since its establishment some two or three years ago, and
had taken the wannest interest in its progress. The mistake, he
says, occurred in the report of one of the Liverpool newspapers,
and singularly enough in the one which contained a lengthy obituary
article on the deceased surgeon. It probably arose from the reporter
present copying the names of the staff from a former report.
^ppointnuniB.
Bennett, Robert A., M.B.Lond., M.B.C.S., L.B.C.P.Lond., Dis¬
trict Medical Officer Niger Coast Protectorate, West Africa.
Berrt Jambs, B.S., F.B.C.S., Surgeon to the North London
Hospital for Consumption and Diseases of the Chest.
Freeman, W. T., M.D.Durh., F.R.C.S., Surgeon in charge of the
Department for Diseases of the Skin, Beading Dispensary.
Hatfield, Ronald, M.B.Lond., L.R.C.P., M.R.C.S., Senior Resi¬
dent Assistant Medical Officer for the Workhouse. Bradford.
Hutchinson, F. A. S., L.B.C.P.Lond., M.R.C.S., Medical Officer
- for the Dunmow Sanitary District of the Dunrnow Union.
Jessop, W. H. H. M.B.Camb., FJt.C.S.Eng., Honorary Surgeon-
Oculist of the Royal Masonic Institution for Girls, London.
Lee. Mary B., L.B.C.P., L.R.C.S.Ed., L.F.P.S.Glasg., Honorary
Physician to the Samaritan Hospital for Women, Liverpool.
McLaren, J. B., M.B., B.Ch. Irel., Medical Officer for the 8alford
Workhouse.
Meacher, J. H„ L.B.C.P.Lond., M.B.C.S., Medical Officer for the
No. 9 District of the Bodmin Union.
O’CalLaohan, Robert Thomas A., F.B.C.S.Irel., Surgeon and
Gynseoologist to the French Hospital and Dispensary, London.
Rose -Frank, H., L.R.C.P Lond., M.B.C.S , Anesthetist to the
Bristol Royal Hospital for Sick Children and Women.
Simpson, Francis O., L.R.C.P.Lond., M.B.C.8.En^„ Senior Assis¬
tant Medical Officer to the County Asylum, Rain hill.
Skeen, W. St. John, M.B. C.M.Aberd., Medical Superintendent of
the Durham County Asylum.
Stookes, A., M.B., C.M.Edin., L.R.C.S , Assistant Surgeon to the
Samaritan Hospital for Women, Liverpool.
Tench, M., M.D.Brux., L.B.C.P.Lond., M.R.C.8., Medical Officer
for the Workhouse, Dunmow.
Thomson H. Campbell, M.D., M.R.C.P., Officer in charge of the
Electrical Department at the Middlesex Hospital.
lacancite.
Borough Asylum, Portsmouth.—Junior Assistant Medical Officer.
Salary commencing at £120 per annum, with board, lodging, and
washing.
Carrick-on-Suir Union—Analyst to the Board of Guardians. Appli¬
cations to the Clerk of the Union. (See advert.)
Corporation of Manchester.—Medical Assistant. Salary £200 per
annum. Applications to the Chairman, Sanitary Committee,
Public Health Office, Town Hall, Manchester.
County Asylum, Prestwich, Manchester.—Assistant Medical Officer,
unmarried. Salary commencing at £100 per annum, with
apartments, board, attendance, and washing.
Denbighshire Infirmary, Denbigh.—House Surgeon. Salary £86-
per annum, with board, residence, and washing.
East-End Branch of the Children's Hospital, Sheffield.—Out¬
patient Department.—Lad v House Surgeon. 8alary £70 per
annum, board, lodging, and washing.
Great Yarmouth Hospital.—House Surgeon. Salary £90 per annum,
with boird and lolging. No alcohol found.
Lunatic Hospital, The Coppice, Nottingham.—Assistant Medical
Officer, unmarried. Salary £150 a year, with apartments, board,
attendance, and washing.
Oldham Infirmary.—Senior House Burgeon. Salary £85 per
annum with board, washing, and residence. Also Locum
Tenens. Three guineas per week.
Royal Surrey County Hospital, Guildford. Resident House Surgeon.
Salary £80, with board, residence, and laundry.
Roxburgh District Asylum, Melrose.—Assistant Medical Offioer.
Salary £100 per annum, with furnished apartments, board, wash¬
ing, and attendance.
Somerset and Bath Lunatic Asylum^ Wells, Somerset.—Junior
Assistant Medical Officer, unmarried. Salary commencing at
£120, with board, attendance and washing.
Staffordshire County Asylum, Stafford. Junior Assistant Medical
Officer, unmarried. Salary commencing at £120 per annum,
with furnished apartments, board, &c.
Western General Dispensary, Maryleoone, London, N.W.—Second
House Surgeon, unmarried. Salary £00 a year, with board, and
residence and 10s. a month for washing.
Wolverhampton Eye Infirmary.—House Surgeon for six months.
Salary £70 per annum, with rooms, board, and washing.
girths.
Coldstream.— On July 20th, at Belford, Northumberland, the wife
of George Probyn Coldstream, M.B., C.M., of a son.
Fraser.— On July 22nd, at Epworth, Southsea, the wife of A.
Mearns Fraser, M.D., of a daughter.
Seccombk.— On July 21st, at 45 Madeley Rood, Ealing, the wife of
Philip J. A. Seccombe, M.B., of a son.
Smale.— On July 23rd, at Peuwerris, Darlington, the wife of John
Smale, M.R.C.S., L.R.C.P., of a daughter.
JftarriafleB.
Smith—Thorpe.— On July 20th, at Trinity Church, by the Rev. L.
R. Lee, of Mansfield Woodhouse, William Robert Smith, M.D.,
F.R.C.S., of Beeston, Notts, son of Heury Smith Esq., of
Barton Hall, Norfolk, to Ethel, fifth daughter of W. B. Thorpe,
Esq., of Linton House, Nottingham.
Warrington—Weeks.— On July 20th, at St. Martin's-in-the-Fields,
London, William Barnett Warrington, M.D., M.B.C.P.Lond.,
son of John T. War'ington, Esq., J.P., of Liverpool, to Annie
Alexandra, youngest daughter of Fleet-Engineer G. J. Weeks,
E.N. (Retired) of Forest Hill.
gcathB.
LAURIA.-On July 8th, at Logos, West Africa, William Benjamin
Lauria, M.R.C.S., L.R.C.P., late of Prince of Wales Road,
Battersea Park, London.
Leak.—O n July 12th, at Waveney Mansions, Fairhazel Gardens,
Hampstead, N.W., Walter Leaf, M.R C.S., aged 63 years.
Nesham.— On July 16th, at 12 Ellison Place, Newcaatle-on-Tyne,
Thomas Cargill Nesham, M.D..Edin. and Durh., M.R.C.S.Eug.,
L.S.A., aged 57 years.
Stevenson.— On July 12th, at 105 Gordon Road, Ealiug, W., James
Stevenson, M.D., late Medical Officer of Health for Paddington,
aged 74 years.
Digitized by CjOO^Ic
Ike igUrtiral and Cimtlar.
“SALUS POPULI SUPREMA LEX."
Vol. CXIX.
WEDNESDAY, AUGUST 2, 1899
No. 5.
Original (fTommumcatitms.
A PRELIMINARY COMMUNICATION
ON
AFFECTIONS OF THE TEAR-PASSAGES
IN
NEWLY-BORN CHILDREN.
By SYDNEY STEPHENSON,
Ophthalmic Sm^eon to the Evelina and the North-Eastern
Hospitals for Children London, Ac.
It ib remarkable that ordinary text-booke make no
reference to a condition that is by no rneanB rare in
young babies—namely, a discharge of matter from
the eyes resulting from an affection of the lacrymal
sac and duct. Moreover, a careful search has failed
to bring to li^ht a single recorded English case,
although mention of the subject is to be found
scattered through the literature of other countries.
For the purpose of giving readers a rough
idea as to the frequency of this condition, I may
state that among 1,538 out-patients seen in the oph¬
thalmic department of the North-Eastern Hospital
for Children, Hackney Road, no less than 2f, or
1*75 per cent., were affected. Those figures, however,
probably understate the frequency of the ailment,
since there is reason for believing that many cases
get well of their own accord without treatment at
hospital or elsewhere.
The following practical remarks are based upon
tolerably complete observations carried out upon
fifteen of the above patients (nine males and six
females).
A baby, generally aged less than six months, is
brought with a statement that the eyes have been
noticed to discharge either from or shortly after birth.
The amount of secretion is often said to vary from day
to day without known reason. A history may some¬
times be obtained of a discharge from the maternal
genitalia, but complaints of “scalding” are un¬
common. On examination of the infant, a plug of
mucus or muco-pus can be seen lying at the inner
canthus or gluing the lashes together. There
is no swelling of the lids, and the baby is able
to open his eyes freely ; the eyeball is not bloodshot;
the cornea is clear. Although the palpebral conjunc¬
tiva may be rather hyperaemic, yet it never has the
thick, red. folded, and villous appearance so charac¬
teristic of ophthalmia neonatorum. It is the excep¬
tion for an obvious swelling to exist in the region of
the lacrymal sac—that is to say. at the side of the
root of the nose, behind the tendo oculi. Mora com¬
monly, there is a slight, ill-defined dulness of the
region in question. When moderately firm pressure
is made with the finger over the internal palpebral
ligament, muco-pus exudes from one or another
punctum, and often a notable quantity of discharge
may in that way be squeezed into the conjunctival
sinus. Compression over the sac less frequently
gives rise to an escape of muco-pus from the
corresponding nostril. Most of the children appear
to enjoy excellent health ; among my series of fifteen
cases, one only suffered from hereditary syphilis. No
single patient showed evidences ’of disease of the
nasal or neighbouring bones. Once a histoiy was
got of a similar condition having been present m two
other children belonging to the same family. Lastly,
in my fifteen cases, the right and the left eye^ were
each affected six times, and both eyes thrice. Never¬
theless, it is not rare to find that both eyes were
attacked to begin with, and that while one has
recovered, with or without treatment, the other has
not done so.
If the secretion expressed from the lacrymal sac be
examined by means of cover-glass preparations and
cultures, it will be found to contain bacteria. For
exam pie,complete observations of this kind were made
on thirteen of my cases, with positive results in every
instance. A single organism was present in six
cases, and in the others several. The following
microbes were identified: - pneumococci (8); xerosis
bacilli (5); staphylococcus pyogenes albus (4); strep¬
tococci (3); staphylococcus pyogenes aureus (2);
bacillus coli communis (1); pneumobacilli (1); bacillus
foetidus oztense (1). In addition to the foregoing,
there were found a bacillus like the B. buccalis
maximus (1); a bacillus of the subtilis group (IK
and a large strepto-bacterium (1). Accordingly the
organisms most commonly associated with the
lacrymal mischief are pneumococcus, xerosis bacillus,
and staphylococcus albus. Since the two named last
are frequent inhabitants of the normal conjunctival
sac. their presence is not likely to be very important.
What is the explanation of these cases? The
researches of modern embryology have taught us
that the lacrymal sac and duct are formed from a
solid rod, which originates by proliferation of the
epithelium at the bottom of the lacrymal groove.
By liquefaction of its contents, this rod eventually
becomes hollow and converted into an epithelixim-
lined canal. The canaliculi are produced by a bifur¬
cation of the epithelial ridge at the inner canthus.
Now. if from any cause delay occurs in the elabora¬
tion of the passage, a baby may be born with the
lumen of the lacrymal tube blocked with inspissated
material, and should the latter become septic, it
would furnish a highly favourable medium for the
growth of micro-organisms. In this particular
respect, the lacrymal passages may be likened to the
foetal vagina, the lumen of which has been found
by Dr. J. W. Ballantyne to contain tena¬
cious stuff. An apter comparison would be
with the mastitiB of babies, where an abscess of
the breast may arise from penetration of pyogenic
organisms into the epithelial remains that block
the ducts of the gland. The lacrvmal secretion,
as most persons know, is generally absent from the
eyes of newlv-born babies, and from this fact we
might infer that there was little immediate use for
the drainage apparatus as represented by the tear-sac
and duct. It is possible, indeed, that in every newly-
born child the lacrymal duct is still imperfectly
developed, and that it fails to become altogether
pervious until the advent of tears, say. at the end of
the second month. But such a speculation, although
interesting, may be quite erroneous. At the same
time, we are bound to assume, from the comparative
frequency of atresia of the tear passages in babies,
that more or less structural defect of the drainage
system often does exist at birth. Cases that
Digitized by
Google
104 Tee Medical Fbess ORIGINAL COMMUNICATIONS. Ana. 2. 1899 .
recover spontaneously are almost certainly due to a
trivial obstacle, such as inspissated mucus; on the
other hand, those that persist may be owing mainly
to an impermeability of the mucous fold, known as
Hasner’s valve, which lies at the lower end of the
nasal duct. The sources of septic inoculation are
naturally many in number, but may be briefly divided
into maternal and external. When discharge exists
from the lacrymal sac at birth, infection is tolerably
certain to be derived from the maternal passages,
and a history of secretion from the genitalia is often
forthcoming in such cases. When symptoms are not
noticed for several days after birth, the source of in¬
fection is likely to proceed from some external agency
—as, for example, the baby himself or his surround¬
ings.
Confusion may arise between cases of tear-duct
atresia, on the one hand, and of ophthalmia neona¬
torum, on the other. The two affections, however,
agree only in a single point, viz., that discharge is pre¬
sent from the eye. The points of distinction are
simple enough. Atresia is generally unilateral, but
ophthalmia practically always involves both eyes
sooner or later. Atresia is a congenital condition,
the effects of which often show themselves at birth ;
ophthalmia seldom begins until the second or third
day of life. In atresia, the palpebral conjimctiva is
normal, or, at most, rather hypertemic; in
ophthalmia, on the contrary, it iB thick, red, and
rugged. Ophthalmia is associated with swelling of
the eyelids, and with other signs of inflammation,
which are wanting in atresia. Lastly, the secretion
in true ophthalmia contains gonococci, whereas in
atresia, as already pointed out, it includes several
micro-organisms, of which the commonest are
pneumococci.
No good effect is likely to follow the mere
application of lotions to the conjunctiva, since
but little of the fluid employed can reason¬
ably be expected to reach the lacrymal
sac. Better results follow careful digital pressure
exercised twice a day over the lacrymal sac with a
-view (a) to squeeze out secretion through the puncta
lacrymalia, and (b) to break down the obstruction
that is present in the nasal duct. Indeed, most of
the cases make a speedy recovery under that simple
manoeuvre, which succeeds in accordance with the
care exercised in carrying it out. When compression
fails, we must clear away all obstruction by passing
si small probe down the lacrymal duct. Formerly I
was in the habit of slitting the inferior canaliculus
before probing, but now I content myself with
•dilating the punctum and canaliculus with a fine,
•conical instrument set in a handle, which serves not
■only to stretch the parts in question, but also acts
as an efficient probe for the duct. As a rule, a single
operation of this kind is enough to cure the case. As
some little delicacy is called for to introduce the
probe neatly, I always prefer to operate under a
^general anaesthetic The same method of treatment
generally succeeds in those cases where a definite
swelling exists in the region of the lacrymal sac.
■There is a great risk of setting up a fistula if such a
lacrymal collection be lanced from the cutaneous
.aspect.
Conclusions.
1. Atresia of the tear-duct appears to be fairly
common in newly-born children.
2. It is due to delayed absorption of the material
that exists during fcotal life in the lacrymal groove
-or duct.
3. It probably gives rise to symptoms only when
the obstructing substance becomes infected with
bacteria, of which the pneumococcus is the one most
frequently found.
4. It is generally unilateral.
5. It is comparable with the mastitis of babies.
6 . It is readily cured by periodic compression of
the lacrymal sac; or, if that fail, by introducing a
fine probe into the nasal duct.
HERNIA FOLLOWING ABDOMINAL
OPERATIONS :
ITS PREVENTION AND CURE, (a)
By A. LAPTHORN SMITH, B.A., M.D., M.R.C.S.,
Eng-.
Fellow of tlie British and American Gynaecological Societies;
Professor of Clinical Gynaecology in Bishop's University;
Gyntecologist to the Montreal Dispensary ; Surgeon-in-Chief of the
Samaritan Free Hospital for Women; Surgeon to the Western
Hospital, Montreal, Canada.
Although hernia following abdominal operations
is, in the writer’s opinion, quite preventable, there is
no denying the fact that it occurs with sufficient
frequency to render it a bugbear more or leBs to
every physician who advises a patient to submit to
abdominal section. Rarely does a discussion take
place at any of our great society meetings
m which laparotomy as a method of cure
is recommended, without some speaker, generally
on the opposition side, making the objection
that the opening of the abdomen may be followed by
hernia. And hiB objection is a very tenable one, for,
at the great New York Hospital for the Ruptured
and Crippled, the surgeons report an appalling
number of patients applying to them in whom this
accident has happened after cceliotomy. There may
not be so many of these cases in Great Britain and
Ireland, but even there one has only to read the jour¬
nals for a month or two to learn that it is rather a
frequent occurrence. When it does happen it gives
rise to disturbances, discomforts, and dangers which
are sometimes far greater than those of the disease
for which the abdominal incision was made. Many
of those who came under the writer’s care were suf¬
fering from strangulation of the omentum or bowel,
and were only saved by immediate operation; while
others had reflex disturbances of distant organs
such as the heart and brain, which, while
not dangerous to life, yet caused sufficient
misery to require the patients to be constantly under
medical treatment. And although, as will be
presently shown, the hernia can easily be cured, yet
the general welfare of abdominal surgery demands
that every precaution should be taken to prevent the
necessity of doing a second operation. It may have
been the experience of many of you as it has been
the writer's, that patients who need an abdominal
operation frequently demur and object to the opera¬
tion simply on the ground that once a woman has bad
one operation she will have to have a second, and
perhaps a third. This erroneous idea has been traced
more than once to a single instance of some friend
whose primary operation for the removal of one
ovary has been followed by a second one for the
removal of the other ovary, and a third for the cure
of hernia. In fact this has actually happened in the
writer's own early experience.
No argument, however, is necessary to prove either
the frequency of ventral hernia, or the great desir¬
ability of reducing its occurrence to a minimum.
Before taking up the question of its prevention, let us
for a moment glance at the causes of the accident.
Although they are many they may all be included in
one category, viz . anything which prevents primary
union of the cut surfaces of the middle layer of the
abdominal wall, or which allows the newly united
surfaces to be drawn apart before the union has been
sufficiently well organised to hold the edges together.
^a) Bead before the British Gynaecological Society, July 12th,
Dig itized by
Aua. 2, 1899.
ORIGINAL COMMUNICATIONS.
The Medical Pbess. 105
By the middle layer is meant the recti muscles and
the fascia of the linea alba; by the inner layer is
meant the peritoneum; and by the outer layer is
meant the fat and skin. One cause which is not
generally recognised is the drawing of the peritoneum
up between the edges of the middle layer, so that
they are prevented from approximating. This is
caused by taking too much of the peritoneum into
the bite of the stitches, so that when they are
tightened up the peritoneum is squeezed in between
the raw surfaces, thus preventing them from adhering
to each other. By taking in only an eighth or a
quarter of an inch of peritoneum, this cause could be
avoided.
It would probably be better not to include the peri¬
toneum at all, as it unites very quickly simply by
falling together.
Another cause, which, however, is well recognised,
is failing to take in the bight of the stitches sufficient
of the middle layer. This is due to the retraction of
the middle layer back between the outer and inner
layers. In order to avoid this mishap the skin should
be pushed back above and the peritoneum below, so
that the muscles will be the most prominent part,
instead of the most retracted.
The drainage tube is one of the greatest causes of
hernia, because it most effectually prevents primary
union of the raw surfaces. Not only does it prevent
the surfaces from coming in contact at that point,
but it very often infects them, causing suppuration
and closure by granulation. Ten years ago the
writer drained with a glass tube all pus cases,
and those in which there were many adhe¬
sions, even if there was no pus; but he abandoned
this procedure some three years ago, with the
result that no hernia has occurred among his cases
since then. If drainage must be used it would be
much better to drain by gravity through an opening
in Douglas' cul-de sac, through which a T-shaped
rubber tube has been passed, into the aseptic vagina.
But the most common cause of ventral hernia is
the custom of removing the stitches much too early.
Ten years ago, when the writer succeeded the late
Professor Trenholme in the Chair of Gynaecology, it
was the practice to remove the stitches on the sixth
day, and this was the usual custom throughout
America. Whether this was also the pi-actice in
Great Britain and Ireland at that time the writer is
not sure, but judging from the recent book of Dr.
Webster, of Montreal, in which he advises the re¬
moval of the stitches on the ninth day, and as Dr.
Webster was, until recently, Assistant to the Pro¬
fessor of Gynaecology at Edinburgh, it would appear ,
that such was the time at which it was customary to
remove them in Scotland. Six days, or even nine
days, the author of this paper considers far too early
a date on which to remove them.
In a paper read before the American Gynaecolo¬
gical Society in 1893, the author expressed his views
on this point in the following terms —“ When the
edges of the abdominal incision are brought together
clean and not bruised and with corresponding layers
of tissue in exact apposition, we obtain primary
union. Under this- term we may include all cases of
union in which there is no suppuration or granula¬
tion, although it does not necessarily follow that there
is no exudation of plastic lymph. The ideal union
by first intention is of course one in which the cut
openings of vessels and the cut fibres of other tissues
exactly correspond and unite, but this probably never
occurs after an abdominal section, The union is
rather due to the exudation of plastic lymph from the
opposite surfaces, which forms a gelatinous glue and
which eventually becomes organised into white fibrous
tissue. We can obtain a good idea of this pro¬
cess by observing what take place when the
tendo-Achillis is cut by the orthoptedic surgeon for I
the cure of talipes equinus. After the subcutaneous
division of the tendon the foot is kept for three days
in its former faulty position until the ends of the
divided tendon shall have become joined again by the
exudation of plastic lymph. When a sufficient
quantity of this has exuded, and, while it is still in a
soft and stretchable condition, the surgeon gradually
brings the foot to a right angle with the leg, when
there is perhaps a space of two inches between the
cut ends of the tendon, which are united however by
this band of soft plastic lymph. The foot is then left
in position until this material has become thoroughly
organised, when the patient will be found to have the
full use of the part. The same thing, I take it, occurs
after an abdominal section; and it is owing to the too
early removal of the suture while the plastic lymph
is still soft and stretchable, and before it has become
organised into white fibrous tissue, that we owe the
great frequency of ventral hernia. By leaving in the
supporting silk worm gut sutures for one month after the
operation we can avoid not only the risk of ventral
hernia, but we are also saved the anxiety of the
incision being torn open during a fit of coughing or
other effort, and the intestines escaping out of the
abdomen, as has occurred in several recorded cases. If
the silkworm gut sutures are left in for a month, as
I have done in my last fifteen or eighteen cases, they
can do no harm, and this accident is absolutely pre¬
vented from happening. Although I am not in a
position to Btate the exact time at which the plastic
lymph becomes organised into white fibrous tissue,
yet I am in favour of leaving in the sutures at
least until the process has had time to be completed.
In my last few cases I have been introducing a few
buried silkworm gut sutui'es through the cut edges
of the abdominal fascia, which, of course, remain
there during the whole of the patient's life, and which,
therefore, render the occurrence of ventral hernia im¬
possible. These were introduced after the through-and-
through sutures had been placed in position and before
the latter were tied.” The above was written six years
ago, and seems to have had some influence upon the
practice of the abdominal surgeons of America, for
since then the time for the removal of the sutures has
been greatly extended. After six years’ further ex¬
perience the writer may say that he has left in the
through-and-through sutures one month in several
hundred cases, and with the most satis factory results.
During the last year he has crystallised his procedure
into the following formula: When the abdominal
wall is not more than one inch in thickness he em¬
ploys through-and-through silkworm gut stitches
half an inch apart, which he leaves in one month:
but when the abdominal wall measures over one and
under two inches in thickness, he brings the peri¬
toneum and muscles and fascia together with buried
silkworm gut, which remains for ever, and the skin
is closed with a subcutaneous silkworm gut stitch,
which is removed in ten days. When the abdominal
wall is over two inches thick, then, in addition, the
fat is brought together with fine catgut after the
buried sutures have been tied.
An interesting question is. What becomes of the
buried sutures ? Are they absorbed ? Or do they
remain indefinitely as they were first placed ? In what
percentage of cases do they suppurate? The first
question may be surely answered in the negative. The
writer has found these stitches while performing
laparotomy for the removal of the second ovary more
than four years after they were first introduced, and
they were as clean and smooth as on the day they
were buried, and he believes that they remain inde¬
finitely so. The answer to the third question varies
a little, according to the operator and the rigorous¬
ness of his asepsis. Dr. Noble, of Philadelphia,
reported at the meeting of the American Gynaecolo¬
gical Society, held at Boston last M«y, 472 cases
D
oogle
Digitiz
306 Th* Medical Press.
ORIGINAL COMMUNICATIONS.
Auo. 2, 1890.
with 10 suppurations, or less than 2 p°r cent. The
writer has nad 3 per cent, in nearly 300 cases, con¬
sisting of 102 Alexanders, 120 ventrofixations, about
20 ventral and umbilical hernias, and about 60 ordi¬
nary abdominal sections.
Would any other material do as well as silkworm
gut ? There are three alternative materials—namely,
silver wire, silk, and chromicised catgut. Silver wire
has been used a good deal by Kelly, but it has no
advantages over silkworm gut. It is harder, takes
longer to tie, and is no easier to disinfect than silk¬
worm gut, and suppuration follows in about the same
number of cases. It is possibly more permanent;
but then, if silkworm gut lasts tour years, of which
the writer is positive, that is quite as long as is neces¬
sary. If silk could be prepared so as not to suppu¬
rate any oftener than silkworm gut, it would have the
great advantage of being softer, instead of having
hard and sharp ends. In about forty of his own 120
ventrofixations the author attached the uterus to the
abdominal wall with Chinese silk which had been
boiled and dried, and then dipped in a saturated solu¬
tion of iodoform in ether. It was then kept in
sublimate alcohol until required for use. In only
one case out of forty did one of these stitches have to
be removed, and that was in a case complicated with
pus tubes which burst and infected the incision. The
writer thinks that the pores of the silk being filled
with minute particles of iodoform the capillarity of
the silk is destroyed, and bacteria are also inhibited
from growing in it. In passing it might be mentioned
that there is nothing so good as a crochet hook for
removing a buried stitch, which can lie done in a
moment, and with very little trouble. Chromicised
catgut has a great advantage over all these materials ;
in that we are also able to make it last as long or as
short a time as we like. The author prepares it
as follows: The catgut is bought from Keller, of
Nassau Street, New York, soaked for a month in ether,
then for a month in sublimate alcohol one in five
hundred; it is then placed in a watery saturated
solution of bichromate of potash for a longer or
shorter time. One hour's immersion will make it last
a fortnight, two hours a month, one day three
months, and so on. The author, however, has been so
well satisfied with silkworm gut that he has only a
few times U6ed chromicised catgut in the abdominal
incision, although he has used it extensively in
plastic work, and he is therefore unable to state from
actual experience the length of time it requires for
the above-mentioned catgut to be absorbed in the
abdominal incision.
Another factor in preventing ventral hernia is the
keeping of the patients in bed one month after their
operations, and the wearing of an abdominal sup¬
port for one year. Both of these precautions are
unnecessary in cases in which the middle layer is
closed with permanent sutures; the writer frequently
allows these cases to be up in from ten to twenty days
and to go home in from twenty to thirty. There isabso-
lutely nothing thatthe patientcould do tbatcould cause
the incision to open ; and as the sutures are as strong
at the end of a year as they were at the beginning
there is no need to wear a band at all. This is quite
a boon, as many patients complain a good deal of
the annoyance of having to wear an abdominal belt.
When through-and-through sutures are used and
they are left in a month, the period during which it
is necessary to keep the patients in bed is very much
lessened. One of the writer’s patients against his
will left his private hospital twelve days after an
abdominal section for tubal pregnancy, because her
children were stricken with an epidemic disease. This
lady was none the worse for her indiscretion, and she
walked into his office th^-ee weeks later to have the J
stitches removed. Many others for various reasons (
have gone home in two weeks, and come back at the
end of thirty days to have their stitches removed. Al!
these patients who have temporary stitches, although
they have no need to wear a bandage while the
sutures are in, are all carefully enjoined to wear one
from the time that they are removed.
If, after what the writer has said, anyone will still
persist in removing through-and-through stitches in
from five to ten days, then he should be most careful
not only to keep bis patients in bed for one month
and firmly bandaged, but after the stitches are
removed the patients should be carefully dieted, so as
to keep the intra-abdominal pressure down to a mini¬
mum, as hernia can hardly fail to follow the so early
removal of the 6titches while the uniting material is
soft and extensible.
In order to obtain primary union and to avoid
stitch-hole abscesses, two things are desirable : first,
not to bruise the edges of the incision by putting
powerful clamps on every oozing spot until, as the
writer has seen, as many as a dozen of them are
crushing the tissues. Large vessels should be tied
individually with fine catgut, while finer ones should
be immediately twisted. Oozing can be stopped by
the pressure of very hot sponges.
The silkworm gut should not be tied so tightly
as to cut or strangulate the tissues; such force is
quite unnecessary; it only requires that the recti
muscles which naturally fall together, should be
held there by a very moderately tight circle of silk¬
worm gut. The writer has devised two little improve¬
ments in technique in order to insure thatthe margins
of the incision will not be distorted by introducing
the sutures at unequal distances on the two sides.
First, a rubber stamp having a straight line in the
centre and a scale on each side marked off into
centimetres from one to thirty, is sterilised by heat,
and just before the operation and after the abdonem
has been washed up it is stamped from the pubis to
above the umbilicus in the middle line. When we
come to close the incision we have only to introduce
the needle at one number on one side and bring it out at
the corresponding number on the other side in order
to obtain a very accurate approximation. We
are greatly facilitated and expedited by hooking
up the top of the incision and raising the whole
abdominal wall away from the bowels, and, at the same
time, keeping them on the stretch; with a sharp Pean
needle mounted on a handle we can pass the suturee
through almost quicker than an assistant can thread
them. From four to six stitches can thus be passed
in a minute, a great saving of time on some other
methods, and it makes a much neater result. Of
course, the Trendelenburg posture is a great help in
doing this quick work, because it keeps the bowels
out of the way of the needle. How the wound is
dressed has little if anything to do with hernia. The
writer covers the incision with sterilised boracic acid.
We now come to the cure of ventral hernia. If the
hernia’is a small one, the ring not measuring as much
as an inch in diameter, it may be cured by the fol¬
lowing simple method, which the writer employs in
small umbilical hernia, namely, by means
of a single buried purse - string suture of
silkworm gut, passed in the substance of the ring
and about a quarter of an inch back from the edge
The latter will have been freshened up by the re¬
moval of the sac down to the peritoneal surface of the
ring, so that when the single stitch is drawn tight it
puckers up the ring until the opening is completely
obliterated. It is then tied and the ends cut short.
The relaxed skin should not be removed but carefully
brought together; it is surprising how its redundancy
will disappear in a few days. If the hernia is a long
one a different method must be employed. The
following case in the writer's practice well serves to
Auo 2, 1899.
ORIGINAL COMMUNICATIONS. The Medical Pbess. 107
describe the method he employs. The patient was
one of the first cases ef abdominal section performed
in Montreal by one of our oldest operators, but it was
in pioneer times and the stitches were removed in six
days, with the result that there was an enormous pro¬
trusion of the bowels through an opening at
least ten inches in length and six inches wide.
As the skin was exceedingly thin and the
bowels lay almost next to it, an incision one-sixteenth
of an inch deep from without inwards would have
gone into the intestine. To avoid this a director was
introduced through a small nick in the skin above
the hernia, and tne skin was cut all the way down
Irom within outwards on the director. The intestines
were adherent to the whole length of the fascia which
had originally united the edges of the incision, but
which had stretched out into a thin membrane after
the stitches had been removed. As it was impossible
to remove this without injuring the bowels, it was
cut off the abdominal wall and the intestines were
dropped into the abdomen with this part of the
abdominal wall attached to them. The edges of the
recti muscles were then sought for and found with
some difficulty, and the fascia covering them was
split up on each side, and twenty-five buried silk¬
worm gut sutures then brought the muscular surfaces,
ns well as the peritoneum and fascia, in contact,
leaving a thick line of union.
The peritoneum of the sac was removed from the
skin and the latter was brought together without
removing any of its redundancy by a subcutaneous
suture. Primary union was obtained throughout
without one drop of moisture on the dressing,
and the patient has been heard from at intervals
during the three years which have sinoe elapsed, and
has never had the slightest discomfort from the large
number of buried stitches.
To sum up the paper:—
1. Hernia is a frequent complication following
abdominal section.
2. When it occurs it prevents other women from
undergoing a needed laparotomy.
3. It is quite preventible—
(a) By leaving in the stitches for one month if the
woman is thin enough to allow us to use through-
and-through sutures; or,
(b) By using non-absorbable buried ligatures when
the woman is fat enough to require two layers of
sutures. The writer prepares his silkworm gut by
placing it in sealed glass tubes and boiling it. A cut
with a file is made in the middle, and just when it] is
required for use the tube is snapped across.
(c) By discarding the abdominal drainage tube, and
when drainage is necessary, which it rarely is, draining
through the vagina.
(d) By securing accurate coaptation of the cut
edges by marking the plaoes where the stitches are to
go before the incision is made.
(e) By taking care that no peritoneum is curved
up so as to come between the muscle and fascia of
opposite sides.
4. Hernia is easily cured in small cases with a
single buried silkworm gut purse string suture; and
in larger cases by splitting tne edges of the ring imtil
the recti muscles are exposed from top to bottom, and
suturing them with buned silkworm gut.
5. Patients with buried silkworm gut stitches do
not need to stay in bed more than two weeks, and in
some cases less; and they do not need to wear an
abdominal belt.
6. Patients with through-and-through silkworm
gut stitches left in for a month can, in case of
necessity, go home in twelve or fifteen days, and
return at the end of four weeks to have their stitches
removed. They do not need to wear a support
until the stitches are removed, and even then it is
much less necessary than in patients whose stitches-
have been removed early.
DESCRIPTION OF “TRANSFIXOR.” (a)
As Proposed and Used
By CHARLES WARD, F.R.C.S.I.,
Of Pietermaritzburg, South Africa; Fellow of the British Gyn®co-
logical Society; Fellow of the Obstetrical Society of London.
The “ Transfixors ” are for use where the surfaces
to be brought together are widely separated, as in
certain gaping wounds, where the tension on stitches
would be great. Also where it is considered possible
to do without stitches altogether, by using the trans¬
fixor. But it is in abdominal sections where the
patient’s condition renders it advisable to bring
operative procedures to a close as quickly as possible
that they are most useful, as the abdominal wound
can be closed in a minute, and the aneesthetic stopped,,
the rest of the proceedings not requiring the use of
an anaesthetic.
'/* Si
It will be seen that the “transfixors” are simply
Koeberle’s hysterectomy pins, modified by having a
screw arrangement in the middle. They are intended
to be included among the instruments taken to an
abdominal section, and if not used entirely in place
of stitches, kept in reserve in case the condition of
the patient should require their use as explained
above.
They should be applied as follows
Pass the “ Transfixor ” about | of an inch from
the margin of the wound, and go through all the
tissues involved in ordinary gaping wounds: except
in abdominal cases, in which it should be passed
down to Cooper’s fascia or subperitoneal tissue, and
brought out in a reverse manner on the other side.
Unless the peritoneum has been separated from the
abdominal parietes it will be found to be in thorough
apposition; no stitching is required.
Another “ Transfixor ” is then inserted about 1(
inch from the first, and as many as may be required,
usually four, two long (No. 1), two medium (No. 2);
the small size (No. 3), being for parts where a long
one would be inconvenient. The edges of the wound
are then pressed gently together ana a layer of (say)
double cyanide gauze, laid along it with or without a
dusting of iodoform; this must not be too thick. Over
this a figure of eight twist with sterilised silk is then
passed round each transfixor; the protector is put
on, and a light dressing is applied, with pads of
gauze under the projecting parts of the transfixors
on each side. They may De looked at on the fifth
day, and, if necessary, be left on for a fortnight
or more without risk.
It may be necessary, if the patient has been very-
restless, to put in a cutaneous stitch or two at the
first dressing, but if care is taken in the applica¬
tion of the transfixors this is unnecessary.
It is claimed for them that:—1. They are quicker-
in application than stitches; the abdomen can be?
closed in one minute. 2. They are easily rendered!
aseptic. 3. If anything they deepen the scam-
union, rendering it stronger. 4. They leave-
no stitches or other foreign matter in the abdo¬
minal cavity, or peritoneum. 5. They do net
constrict vessels or portions of muscles so much a*
stitches. 6. They allow the anaesthetic to be dia¬
la) Bead before the British Gynecological Society, July 12th.
1899.
Digitized
by Google
108 Thb Medical Press. ORIGINAL COMMUNICATIONS. Aca. 2, 1899.
-continue^ sooner, and shorten the whole proceedings
by ten to fifteen minutes or more. 7. There is no
fear of stitch abscess. 8. They hold the wound
firmer than stitches. 9. They are not affected by
after-vomiting, they cannot cut out. 10. In the
event of secondary haemorrhage the wound can be
re-opened rapidly by simply pulling the transfixors
out. 11. And the principle of the screw comes in on
their withdrawal; by unscrewing the transfixor, and
drawing out each end on its own side, no material
that has been outside the abdomen, or liable to con¬
tamination, passes through the deep tissues, as in
releasing stitches; and they are removed with less
pain and annoyance to the patients; the pointed
end being seized with a needle-holder at the
roughened part near the point.
Illustrative Case, February 16th, 1889.—A woman,
set. 40, had a movable mass of rapid growth in the
region of pylorus and front of stomach, with
malignant cachexia, on abdominal section, the
cancer was found to involve nearly the whole
stomach. Anaesthetist announced critical condition
of patient, proceedings stopped; abdomen closed in
one minute in the manner described; and the anaes¬
thetic discontinued. On the fifth day the wound
was practically healed ; a superficial cutaneous stitch
or two were put in where the dressing had got disar¬
ranged. Transfixors removed on the twelfth day,
wound firm and comfortable on thirty-first day, no
sign of bulging whatever.
I saw this woman yesterday, seventy-third day from
date of opening abdomen. The disease is invading
other organs, but the lump for which the abdomen
was opened is much smaller. The scar is very firm.
To nave delayed closing the wound in .order to
6titch it (either in layers or not) would in this case
have been dangerous, and would have prolonged the
operation quite fifteen minutes ; whereas by trans¬
fixors the operative proceedings were brought to an
end at once.
They are not advisable, or so likely to be effectual, I
should think, in cases where drainage is employed.
Nor is the idea original except where the screw comes
in.
They are made by Messrs. Ferris and Co., Bristol.
A COUNTRY HERBALIST’S CURE FOR
THE “KINGS EVIL.” (a)
By JOHN KNOTT, M.A., M.D., and Dip. Stat. Med
(Univ. Dub.); M K.C.P.I., M.R.I.A.; &c., &c.
(Continued from page S2.)
Dr. James, the contemporary and personal friend of
Dr. Samel Johnson, published his great *• Medical
Dictionary” in 1745, ten years before the appear¬
ance of the work of the great lexicographer. I may
mention, in passing, that “ Rough Johnson,” is known
to have contributed very largely to the more purely
literary items of this professional Encyclopedia, and that
the idea of preparing his own great English Dictionary
is said to have arisen while taking part in the work
of his friend. James’s Dictionary may be taken as
a respectable criterion of the knowledge of the period,
and of such subjects as that now before us, in the hazy
and unsettled style of its science.
“ Scrophula. —The King’s Evil ; from Scropha, a
swine ; because this Animal is said to be much subject
to such a Disorder.
*■ Quincy remarks, that the Gout and the King’s Evil
agree, in being frequent amongst Persons strong both
in Body and Mind, who are hearty Feeders, and on other
Accounts well and healthful; in this respect, however,
considerably differing, that the Evil generally appears at
three, four, or five Years of Age ; and dries away by that
(u) An abstract of this paper was read in the Medical Section of
the Bojal Academy of Medicine in Ireland on Nov. 18th, 181*8.
State of Manhood that the Gout gives its first
Warnings of approach ; though neither of these are
without some Latitude of Exception. And as the Gout
is owing to sharp saline Humours, that are contracted
by a particular Way of living, and favoured in their
Accumulation by a peculiar Make of the Parts where
they settle, upon the Declension of the natural Strength,
so this Disease seems owing to a hot, Sharp Humour,
propagated a Semine from the Parent, in the first
Formation discovering itself at an Age, when certain
GlandB are fitted for its Reception, and disappearing
when the digestive Powers nave arrived to their
greatest Strength.
“ That Persons subject to the Evil do early show an
uncommon Vivacity of Mind, and Forwardness of Under¬
standing, is a Fact that all have experienced who have
been accustomed to such Opportunities of Observation;
as, also, that if the Distemper goes on without much
Interruption from its natural Course, and dries away
about the Age of Manhood, as it commonly does, such
Persons are generally strong, and free from Distempers
afterwards.
“ That such a Humour can he derived from the Parent,
is granted, perhaps, in more Instances than where it is
really so, and is likely to be yielded by many, more on
the Score of a Vulgar Opinion, than for any true
Notions of the Manner how such a Thing is possible: It
may be, therefore, necessary to form some rational Con¬
ceptions hereof, in order to judge what Disorders spring
from such an Origin, and which not, because, without
some Rules to determine by, Cases may be confounded
and mistaken, from some Resemblance in their Appear¬
ance which flow from very different Causes.
“ To this Purpose, then, I cannot see what we have to
do with the Philosophy of the Microscope, so far as it
asserts the Semen to be animated before generation,
because it seems not in any Manner to affect the Matter
under Inquiry ; but so far as we get any Knowledge of
the sensible and manifest Properties of that small
Portion of Matter, from whence we boast the Production
of the finest Machines in the Crea*ion, it appeals to con¬
sist of a very subtle, active Salt, floating in a soft,
balsamic Vehicle; whereas, therefore, we can conceive
what Consequences to the (Economy already formed,
may flow from an Excess or Defect in the more active
Principles of such a Composition; so may we, by a
Parity of Reason, conjecture, what must be the Result
of every Deviation from the natural Standard in the
same Principle before its Animation in the Matrix.
Where, then, this Principle abounds with Heat and
Pungency in the masculine Semen, it will not only irri¬
tate more frequently and more strongly to Venereal
Embraces, but carry with it the same Qualities into the
impregnated Ovum; and, without some uncommon In¬
terruption, or Contemperature from opposite Qualities,
will increase in the growing Foetus, in Proportion to its
Enlargement, and make a Part of that Constitution to
which it gave Being, with the same Afflictions and Pro¬
perties as it stood possessed of in the generating
Semen.
“ Hence, it will be no difficult thing to imagine what
a Condition the Off-spring of such a Parent must be in:
and how, sooner or later, in one or another Part, this
primitive Matter may show itself in a very troublesome,
if not a very mischievous Manner, as the Circumstances
of Life, and Strength of the Constitution encourage
or obstruct its Exertion, and the peculiar Configuration
of the Glands favour or resist its Accumulation and
Lodgment: And though in the Case immediately under
Enquiry, it principally shows itself from a little Time after
Birth to a State of Manhood, is probable from this Reason,
that sooner, it is not in Quantity enough to be discern-
able, or is hindered from Exertion by tie Laxity of the
Parts, and Viscidity <?f Humours, which is always more or
less the Case of very young Children ; but that when the
parts have got some Degree of Firmness, and have
digested away the tough Humours, this hot, sharp
Matter becomes Sensible to the fine Strainers and Mem¬
branes as it passes in the Course of Circulation, and at
last fixes upon them so as to occasion Pain, Inflamma¬
tion, Swelling, and running Sores: But when, again, the
Aug. 2, 1899.
ORIGINAL COMMUNICATIONS.
The Medical Press. 109
Constitution takes another Turn, and arrives to its
utmost Vigour, the digestive Power* become able either
to destroy its Pungency by Attrition and Comminution,
to detach it off by some natural Outlet, most commonly
tjie Glands rf the Skin, or to lessen it, so much at least,
in Quantity, that it Hows with the ordinary
Current without sensible Effect, and never after¬
wards appears, but in giving to the generating Prin¬
ciple the same bad Taint from whence it derived its
Existence: And that even frequent Coition and Propa¬
gation shall vent and draw off a great deal of this
Matter, to the Benefit of the Parent, and Detriment of
Posterity, is not only probable, but almost demonstrable ;
because, during that Time of Life, and in Proportion to
such Indulgence, the Parent is always the most free
from it.and that during the Travail of a Woman with
Child, before subject to such Humours, or any of the
like Kind, she shall be entirely free from it then, though
if the Issue survives the common Fate of Convulsions, a
little more Age seldom fails to discover when such a
Mother had her temporary Relief.
“ That the Distemper then under Consideration may
be thus propagated, is not only out of Question from
common experience, but the Manner of it may in some
measure be conceived from these Hints, and the Nature
of the generating Matter. The same way of Thinking,
also will sug est in what Circumstances a Person may
fall into this Distemper without having to charge it
upon Parents, or the Milk of a tainted Nurse, which,
also, may possibly happen, tho’, it is believed, very
rarely ; and that is from a Way of feeding, or aijy other
Condition of living, that gives to the Mass of Humours
an uncommon Heat and Sharpness, which in Time shall
fix upon the same Parts, inflame and ulcerate them in
the same Manner as that derived from a distemper’d
Semen.
“The Srrophula or Struma is a hard glandulons
Tumour, usually of the same Colour with the Skin,
seated principally on the Sides of the Neck, about the
Musculi Mastoidei, behind the Ears, and under the
Chin: either more or less moveable single of the con¬
globate Kind, or in Clusters of the conglomerate Kind ;
many Patients having been observed to have them con¬
tiguous from the Ear down to the Clavicle.
“ Though the principal Seat of thiB Disease is in the
Sides of the Neck, scarcely any Part of the Body is
exempted from it; and it affects either Glands, Muscles,
Membranes, Tendons, Bones, or the Viscera.
“The Glands are the most remarkable Seat of thiB
Distemper, and whenever the outward Glands appear
swelled, those of the Mesentery may be concluded to
be so too, the Mesentery being usually' the Part first
attacked by this Malady.
“ If the Struma* have been lonjj ulcerated, and are
become sinuous and virulent; and if they lie near one
another, they often find a communication to one another,
though they appear distinct: In this Case the Lips
grow callous, and the Ulcers corrosive, frequently sordid,
and the Cure is not to be hoped so long as any one Cystis
remains, or the Vessels that feed them; but if the Ulce¬
rations be simple, the Cure is acordingly easy. Those
who are seized with Struma? in the Neck, after forty
Years of Age, seldom recover. As they personally labour
under great Obstructions, whence spring scorbutical
Affections, Jaundice, Fainting, Vomiting, Loss of Appe¬
tite. sometimes a Dropsy, and sometimes a Cough, in
which case they die tabid.”.
“ The Method of Cure.
“ In the Cure three Things are required.
“ 1. A Regimen of Diet, and the other Non-naturals.
“ 2. Pharmacy or Internal Prescriptions.
3. The Applications of Externals, either to discuss,
suppurate, or extirpate the Glands.
•' With respect to a Regimen of Diet, Regard ought to
be had to the Constitution of the Patient, whether it be
hot or cold, dry or moist, old or young, robust or deli¬
cate. If the Body be cold or moist, we generally suppose
a Surfeit preceded, and Crudity to abound; in which
Case, Abstinence from Meat and Drink, or at least great
Moderation, is requisite. Their Diet ought to be
moderately heating and drying, as Mutton, Kid, Rabbet,
Pullet, Chicken, Partridge, Pheasant, Poultry, and the
like, and these roasted ; avoiding all Aliments which
yield a gross phlegmatic Nourishment, such as Water-
Fowl, Fish, especially those of Standing Waters, Herbage,
Cheese, all smoak’d, seasoned or dried Meats. Their
Bread ought to be of wheat, well-baked, and their Drink
medicated Ale or Beer; Wine also is allowed, and Water
utterly forbidden.
“In hot and dry Constitutions tending to a Hectic, we
allow a Diet of a more humid Nature, their Meat being
boild with Lettiee, Spinnage, Purslane, Wood-Sorrel,
and the like; to some of these we dare scarce permit the
eating of any Flesh, but rather a Milk-Diet, or Asses
Milk; though Milk will not be always found agreeable;
in which case we prescribe medicated Broths. Pork is,
by some, forbidden strumous People.
“ Air is a great Help to the Cure, which ought to be
mild and gentle, in cold Weather healing and attenua¬
ting, and in the hot cooling. Exercise of Body ought to
be enjoined, it being necessary to waste Superfluities.
Sleeping in the Day is forbidden, unless where the Case
is painful, to which it is an Anodyne. The Passions of
the Mind ought to be moderated.
“The internal Prescriptions must be qualified accord¬
ing to the Habit of the Body. If it be cold and phleg¬
matic, abounding with gross viscous Humors, the Pre¬
scriptions ought to be? heating and attenuating. In
plethoric Comtitutions, the stronger Cathartics ought to
be exhibited, or the milder often repeated. The Purga¬
tives are, the Species Hierto with Agaric. Diaturbeth,
Pulvic Comacliini, Pilu!a* Cochite e duobus, Jtudii, De
Hermodactylis, Alocphangina*, Imperiales, e Succino,
Trochisci, Alhandal, Diagrydium, Resina Jalapii, and
Mercurius Du cis, and all those Medicines prescribed in
the Lues Venerea.
“Alteratives are also usefully taken on those Days in
whioh the Patient does not purge. Among these a Decoc¬
tion of the Woods claims a Pre-eminence ; to which are
added one or other of the Specifics so called such as the
Roots of Fig-wort, Drop-wort, Devil’s-bit, Soap-wort,
Burdock; the Bark of the Walnut-tree; the Herbs,
Rag-wort, Crane’s-bill, Herb-Robert, the greater Celan¬
dine, Hound’s Tongue, white Hore-hound, Fox-glove,
and the like.
“ In these Decoctions, it is very common to put also a
Lump of crude Antimony, of four Ounces or half a Pound
Weight, grossly powdered and tied up in a Rag . . .
“ Besides these Liquors to be taken as a Diet, there
are other Medicines, such as the diaphoretic Antimony,
Bezoar Mineral, .Ethiops Mineral, and Gum Guaiacum.
"The third Intention is pe formed by the Application
of Externals, 1 To the Tumors which we endeavour to
resolve, or suppurate or to extirpate. 2. To the Ulcers
which are the Effect either of Suppuration or of Extirpa¬
tion. In Tumors we shall begin with Emollients and
Discutients, though it is no easy Work to resolve these
Glands, if we consider the Stubborness of the Matter, and
its being contained within a Cystis ; yet in some soft
delicate Bodies the milder sort of Glands, which are not
too much indurated, frequently resolve. The Emplas-
trum de Ranis cum Mercurio is frequently applied for
this End. as also that of the Gums, Ammoniacum, Gal-
banum Bdellium, to which crude Mercury may be added
as it is in the New Dispensatory. . . Zacutus . . .
says he never used the following Ointment without
success : Take of the Root of Great Bryony, plump and
round, half a Pound ; cut it into small Pieces, and fry
it with three Pounds of recent Olive Oil, till they become
dry and wasted ; strain it, and add Turpentine of Fir,
half a Pound; Yellow Wax five Ounces; remove it from
th« Fire, and make it into a viscid Ointment.
“ The Herb Goose-Grass or Clivers, beat up with Lard,
and the Struma? therewith anointed, discusses the same,
while the distilled Water of the whole Plant lends
further Assistance. Tho Root of Smallago is recom¬
mended by Mr Ray for the like Use. Crollius as highly
extols the Lesser Celandine or Pilewort, whose Roots, he
says, are a Kind of Specific in this Disorder.
“ Etmuller and Mr. Ray recommend the Pulvis Cyani, or
Tincture of its Flowers; others, the Radix Cynoglossi,
Digitized by GoOglC
110 Thb Medical Pbe68.
THE NURSING PROBLEM.
Auu. 2, 1899.
or Root of Hound’s Tongue, drinking the Decoction of
it, and applying it outwardly in Cataplasms. But the
Folium Digitalis, or Leaf of Fox-Glove, pounded and
applied to tbe Strum®, or the Ointment of its Juice, is
highly esteemed by the Botanists. Dr. Bates’s Prepara¬
tion of this Ointment stands thus: —
" Take of May Butter, three Pounds ; fresh leaves of
Foxglove, bruised, as much as you can mix with the
Butter; expose them to the Sun thirty Days ; then boil
them till the Leaves become curled,and let a strong
Expression be made.
“ 1 his seems to be the same with that used by Mr.
Wiseman which he calls the Valentia Digitalis, having
undergone a repeated Infusion of fresh Leaves, by which
the same is further impregnated with the Virtues of the
Plant. Belmont praises the the spongy or hairy Eicres-
cence, growing out of the Canker-Rose, the Powder being
taken to half a Dram mixed with Sugar.
“The Radix Rusci, or Root of Butcher’s Broom, in
fine Powder, given to a Dram every morning in White-
wine, especially if an equal Proportion of those of
Flipen’dulaor Scrophularia be added, and administred
in the like Dose, is praised by Etmuller, as is the Rue¬
leaved Whitlow-Grass by Mr. Boyle. Arnoldus Villano-
vanus says, that the fresh Root of Scrophularia, eaten
for ten Mornings fasting, certainly cures the King's-
Evil.
“ When the Glands discuss not, but begin to enflame,
a Suppuration will be the Consequence; to promote
which, let the stronger emollient Suppuratives be applied,
as the Roots of White Lillies, Bryony, Marshmallows,
Sow-bread, wild Cucumbers, to which may be added fat
Figs, and Pigeons Dung; and if the Progress be very
alow, for stirring up tue sluggish Humour, and rousing
its Heat, the Root of Pellitory of Spain, and the seeds of
Staves-Acre and Mustard. To promote the Suppuration,
it is, also, tommon to pinch them hard; and some People
in the Country thrust a Thom into them, which excites
Inflammation, and disposes them to suppurate. Care
must be taken to endeavour a perfect Concoction; for if
they are opened while any Part of the Gland is hard, it
will encrease, and occasion a Necessity of eradicating it,
■or of leaving the Cure imperfect.”
The writer proceeds to discuss the processes of
incision, extirpation, subsequent dressings, Ac., Ac. And
towards the end of a long dissertation on the various
special forms of strumous disease, he returns to the neck
and indicates a confusion of ideas between scrofula
.and goitre, which does not seem to have prevailed
so much in even less enlightened times. “Those
Tumors are called strumous or scrophulous. which
appear externally, on the anterior and lateral Parts
■of the Neck. Of these Tumors there are different
Species ; some are small, some of a moderate size, and
■some surprisingly large; some are soft, others hard ;
some are moveable, others immoveable ; some are favour¬
able, others malignant. Scrophulous Tumours arise in
indurated glands of the Neck ; i ometimes in the small
moveable glands ; sometimes in the superior and inferior
salival Glands, and sometimes in the Thyroide Glands,
which last are by some particularly called 8cropliulte, or
the King’s-Evil; and by the French, Ecrouel/es.”
(To be continued.)
^Ehe pursing problem.
NURSES OF THE LATEST FASHION.
A.D. 1899.
PROFESSIONAL EXPERIENCES IN SHORT
STORIES.
By FREDERICK JAMES GANT, F.R.C.S.,
Consulting Surgeon to the Royal Free Hospitnl.
SATAN IN PETTICOATS (continued).
Suddenly a change came over the spirit of Lucretia’s
devoted service, and in the name of Him—.
Incredible as it may appear that one whose professed
qualifications teemed to be already verified by her nursing
attendahce, she should, under a week, give practical proof
of her own incompetency; moreover, nurse frankly pro-
tetted her own unfitness, terminated the trial, and must
leave that day—that hour, at whatever inconvenience
and wrongful loss to the patient. But, of course, “ I
claim my wages for the month.” In vain, the poor
helpless “ dear old lady ” implored her all-in-all not to
desert her; for, "you know that other woman, kind as
she is, can do little, or nothing, as you can ; she cannot
turn me in bed, not lift me out of it into my chair ; and
oh, the long nights, without you. Remember, I don’t
terminate the month’s trial.” With a deaf ear to piteous
entreaties, Lucretia still protested her own unfitness —
must go at once—and with tbe month’s wages.
Wher the news of love'y Lucretia’s immediate de¬
parture, Ac., was communicated to the old husband, he,
quite hithei to unaccustomed to such domestic matters,
thought he undei stood dear nurse’s case. She was one
of the itinerant, migrating black birds of passage, who
flit from place to place, quitting each within a few days,
and demanding, extorting from their helpless, world-
excluded victims, a month’s salary, for, say, three days’
service, worthless work, the servitor being quite incom¬
petent to undertake any duty, such as answers to the
advertisements, they are ever scanning for an eligible
“ find.” A very easy mode of making an income, without
any capital of ability, industry, or character.
But Lucretia must go ; very sorry to quit such a happy
plaoe ; but go, she must really, and with the month’s
wages. Lady U-had not paid her wages, on
quitting her ladyship’s service; nor had that same
“unjust, irreligious lady” kindly forwarded to her the
purse she had forgotten in her hasty departure. Con¬
sistently with this explanation of Nurse Lucretia’s
position, it would have seemed more reasonable that she
should have remained in her present situation, instead
of throwing herself out of place, and forfeiting her wages
by terminating her engagement; certainly, however, in
her unfortunate financial circumstances, Lucretia’s
absolute penury would explain and excuse her otherwise
pitiful dishonesty in not having yet paid the shilling
cab-fare borrowed of Nurse 2, as the debtor had neither
received wages owing to her, nor had she come into her
property by book post.
Practised as I am in thinking the thoughts of other
people, women’s thoughts especially, I own that the
movements of Lucretia’s mind puzzled me, so that I
could not interpret to the old husband the real motive
for nurse’s sudden decision.
She demanded a month’s wages for under a week’s ser¬
vice, determined by her own professed inability to con¬
tinue the duties of her engagement. “ She could,” she
said, “summon either the (paralysed) patient or her hus¬
band, to the police-court, and thus prove her rights—as
by agreement, and get her lawful wage”; this threat
being accompanied with a fierceness of utterance by the
playful little mouth, a resonant tone of the silvery voice,
and a gleaming fixed glare of the gazelle eyes, utterly
unbecoming the placid, gentle, loving woman, up-to-date.
Unfortunately, the poor old wife's condition rendered
her totally unable to appear as witness in a police court;
and as she alone had made the (verbal) engagement with
Lucretia, her astute threat was as idle as it was heart¬
less.
But “ No,” she went on to say, “ she knew police-courts
very well, and she knew the law ; her father was a
barrister, only she was not on terms with him ; it would
not become her social position for her to appear in court,
as the case would be published in all the morning papers,
and she would be identified in connection with a petty
claim for wages, as nurse-attendant, when it might not
be known to a wide circle of friends that circumstances
had compelltd her to adopt a calling below her birth.”
Accordingly,' Lucretia was quite willing to remain, but
in the service of the old husband, as cook. “ She had—
she told him—gained considerable experience in the
culinary art, especially for invalids.” “ This offer she
made, knowing that the dear patient bad already engaged
another, and far more capable, nurse-attendant, who
would arrive in the evening ; and as she understood that
the cook was having a holiday from that day, she would
Digitized by Vj
A uo. 2, 1899.
THE NURSING PROBLEM.
The Medical Press. Ill
gladly take her place—as a matter of convenience—in
file household arrangements.”
To the regions below Lucretia descended, there to
exercise her culinary art, in preparing &uch delicacies by
her own little hands as might as much please the palate,
and suit the stomach of the invalid, as in her nursing
capacity she had ministered to other bodily wants, and
had fed the soul with good things. The old husband’s
appetite, not so fickle, would be more readily satisfied.
The most astutely vicious people are often the most
blindly stupid, and are wont to give {evidence
against themselves. It was so with Lucretia. She
readily entered into an agreement—in writing to the
effect—that she surrendered her claim for a month’s
wages as nurse-attendant. She agreed to remain in
service—as cook—for her own convenience; and that one
week’s such service, at the same rate of wages, would
satisfy her previous demands for a month’s remunera¬
tion.
At first, Nurse Lucretia’s cooking fully justified her
claims. Excellent beef tea, and other products of invalid
cooking, were served up to the old lady : while the old
gentleman, himself a great sufferer, fed, as it were, by
manna from heaven, began to feel the renewal of life in
the hands of the angel-cook, breathing a prayer in return
that old Mrs. Clipper might be induced to extend her
holiday sine die.
About the third day of this course of nutriment, the
wife, who during more than a year’s bed-room incarcera¬
tion had slowly regained such general health as made
her life tolerable, although still afflicted with infantile
helplessness, began to throw out symptoms of internal
distress. Persistent diarrhoea, a burning throat, and
thirst, bespoke continued irritation of that tract within
the body, through which passed the products of the
culinary art, with alarming rapidity. What the irritant
might be which thus seemed to convert the stomach into a
saucepan for boiling its own oontents, while the bowels
were the sink for cleaning and washing out, ere the re¬
ceptacle was used again, might have been a mystery to
any other old man, beholding.his poor old wife in writhing
agony at times, rallying again when the invisible enemy
was withdrawn, and so on. But, in the evening, when
the first piteous scene in this tragedy was enacted, for¬
tunately the husband, having a bed-room ticket of admis¬
sion, and being a judge of blacking upon the fair skin of
womankind, had studied the cook-specimon, who under
cover of nurse-attendant had got into his wife’s service.
Sitting in the dining - room, after witnessing
his wife’s agony, the old man fell into a trance,
with his eyes open and conscious of what he
saw, otherwise in a state of abstraction, Sud¬
denly the door opened, and a lurid vision entered, with
outstretched arm, the withered bony hand and fore¬
finger of another old man pointed at the seeming sleeper;
spellbound, the visited could not rise from the couch on
which he reclined. The visitor with a tone of voice,
more in sorrow than in anger, said —“ Beware of your
nurse-cook ; beware of the would-be murderess for money
—beware of the bigamist—of the widow, as she is not—
the liar—the religious hypocrite—the prostitute—the
swindle •—the common thief.'.' !
The old husband, awakening as from ihe abyss of
hell, rose, tottering, and rang the bell. The vision
vanished. But cook, thinking it might be some special
invocation of her culinary art for dinner on the morrow,
answered the summons.
“On this occasion”—the old husband said, with
resonant voice—“ It is I—your master—who orders you
to quite this house immediately.” “ You are a woman
with a past,” said he, as their eyes met. “ Thank you,
yes,” replied the satanic nurse, Lucretia, “ I own I have
a most romantic past for a young lone woman if all were
known.”
But I know something more of you. “ Do you.”
"You are a woman without a future—except a prison—
or death.” " Thank you ; do you, know that.” Lucretia
never looked more self-possessed, calm, gentle, modest,
kindly-cruel. But Robinson, the maid, found her in the
hall, hanging over the stair-rail in a fainting condition.
To forthwith get rid of nurse-cook—thus convicted—
was yet no easy matter. She not only had the effron¬
tery to reclaim a month’s wages by the wife’s verbal
agreement with her—as Nurse, which, if valid for three
days service terminated by herself, she had afterwards
cancelled by her willing signature to the terms of the
written agreement for one week as cook; she now
claimed a month's wages in that capacity; two months,
in all for both services. She “ knew the law ”; and
“she would certainly lay her case before the police
magistrate, Mr. P-n, who would protect her
rights.” “No”—on second thought —“ she would not.”
But why—in addition to her vocation as swindler,
should Nurse Lucretia have been cook-poisoner in this
case ? Money moved her influence over the mind of an
old lady who is exceedingly susceptible to kindness, un¬
suspecting in her own simple honesty—who possesses
property in personal estate, at her own disposal by Will.
Now, the mysterious reason for her desire, and deter¬
mination to suddenly relinquish her nursing attendance
on her victim, was evidently explained by the circum¬
stance that cook’s holiday gave Lucretia the opportunity
for carrying out her diabolical design. Her greed for
money had impelled her to practice the old trick of
demanding wages not her due, but she at once
relinquished her fraudulent claim in view of her far
longer expectations under the Will, in the event of a
successful issue to her cooking service.
Lucretia’s second thought took her out of the house
without further reconsideration.
After her departure, the “ dear old lady "-patient sent
a piece of note-paper to her husband in the dining-room;
“ That woman has carried away all she could rob me of,
without detection.”
Nurse Lucretia’s Immediate Antecedents.
Prior to her appearance in Catchemalivo 8quare I
have received authentic information, written and verbal,
respecting Nurse Lucretia’s immediate antecedents.
When residing with Lady U-, as nurse, she stole
everything she possibly could remove, without discovery
at the time, damaging and destroying much valuable
property in articles of vertu ; notably one vase, of rare
and costly porcelain, cherished as a gift to Lady U-
on the occasion of her marriage. The household ser¬
vants became instinctively alarmed by nurse’s conduct,
as ominous whisperings came to their ears; they locked
her bed-room every night, lest she might visit them
during the hours of darkness. At last, she quitted this
situation, being compelled to leave without warning.
In her previous situation, as nurse in sole charge of
an only child—girl, winsome and affectionate, she beat
and otherwise ill-used the nursling, who needed no cor¬
rection of its endearing charms. She always locked the
door of the happy, playful, unprotected little lady, so as
not to be interrupted in her nurse duties, or interfered
with by any servant. The door being unsecured on one
such occasion, the mother, with perhaps her maternal
apprehension aroused, entered the room, just in time to
see nurse in the act of administering a spoonful of some¬
thing from a saucer containing a reddish fluid. The
poor little thing fell asleep, and remained so long in¬
sensible to mother’s voice and awakening cries, that it
was feared «he lay asleep to wake no more.
Whether this well-nigh fatal deed was done by the hand
of a murderess, with some secret motive and purpose,
or whether an overdose of medicine was administered
by the hand of an ignorant, “ untrained,” and “ uncer¬
tificated ” nurse, is known only to Him who seeth in secret.
Certain, however, was the sequel—that Lucretia
forthwith surrendered her charge of the little patient,
and, without the least protest, consented to leave the
house, but demanding (her old claim) a month’s wages.
Threatening the summons from a Police-court, and the
assistance of her legal friend (with whom the reader is
acquainted), at once silenced the mother’s demurrer;
as a nervous lady, she dreaded her name appearing
in the papers, and which would be “ equally distressing
to nurse, a lady born, and well known to the magistrate,”
the case was settled out of Court, “ the mother of the
hapless innocent agreeing to pay nurse’s lodgings until
she could recommence duty in another situation.”
Thus, this head-nurse of the latest fashion disappear
from our view.
Digitized by
LY
112 The Medical Press.
TRANSACTIONS OF SOCIETIES.
Aug. 2, 1899.
Clinical fiecorbs.
CANCER HOSPITAL.
Cases under the care of Mr. F. Boweeman
Jessett, F.R C.S.,
Surgeon to the Cancer Hospital, Brompton.
I .—Case of Large Dermoid Ovarian Cyst removed from
a Woman, set 72—Recovery.
A. M., set. 72, was admitted into the Cancer Hos¬
pital on November 8th, 1898, suffering from a very
large ovarian cyst. Her abdomen has increased in size
rapidly for the last three years. At the birth of her last
child, thirty-five years ago, she remembers the doctor
telling her she had a tumour, and fifteen years ago she
was advised to have an examination but declined. She
has had eleven children.
Pretent Condition. —A healthy-looking woman; has
lost flesh of late. Abdomen enormously distended,
bulging abruptly just below the ribs, of oval shape, with
long axis running obliquely downwards and to the
left. The abdomen is dull over whole area, excepting
just below sternum.
November 15th.—I opened the abdomen with a small
incision in the middle line below the umbilicus. The
cyst presented, and was found to be generally free from
adhesions. Trocar was inserted but no fluid escaped, on
withdrawing the trocar a quantity of small greyish-brown
masses, the size of pearl barley, escaped mixed with
thin brownish fluid. There was a large mass containing
nucleus of matted hair. The cyst when emptied was
drawn out of the wound. There were a few adhesions
to the omentum, which were readily torn through, a long
pedicle was ligatured and dropped back. The patient
made an excellent recovery from the operation. Some
time later she had a slight convulsion accompanied by
right hemiplegia. Her condition now is much the same,
having never recovered from the attack.
II. — Case of Carcinoma of the Cervix Uteri Complicated ,
with Pregnancy—Vaginal Hysterectomy—Recovery
E. P., set. 30, married, three children. Patient’s atten¬
tion was drawn to a dull pain in hypogastrium at Christ¬
mas, 1898, eince which time she has had continuous
discharge accompanied with haemorrhage. The discharge
very offensive. She was admitted into the Cancer Hos¬
pital on February 22nd, 1899.
She is a healthy-looking woman, but complains of pain
in hypogastiium. On examination of abdomen tender¬
ness is elicited. Per vaginam the os and cervix are
found to be deeply ulcerated, the vaginal walls, how¬
ever, are not invaded. The uterus is quite mobile.
Examination causes haemorrhage.
February 28th.—Vaginal hysterectomy was performed.
Uterus and ovarian vessels were clamped by Doyen’s
forceps. Forceps left on for thirty-six hours before re¬
moval. The vagina was packed lightly with iodoform
gauze, which was not removed until the fifth day.
The patient made an excellent recovery.
On opening up the uterus, which was enlarged, it was
found to contain a fcetus of about two months’ gestation.
III. — Cate of Fibro-Myoma of Uterus taking on Malignant
Action — Panhysterectomy — Recovery.
Miss R—, ajt. 56, brought to me by Mrs. Marshall,
M.D., with the following history,—No family history of
cancer. Menopause—in 1895 ; late in the year she con¬
sulted Dr. Macan, of Dublin, on account of loss of blood
per vaginam. On examination some fibroids were dis¬
covered. The bleeding however continued, and she
consulted Dr. Cullingworth, who considered the fibroids
were the cause of the htemorrhage. In 189(5 she saw Sir
John Williams and Dr. Cullingworth in consultation,
they at that time could find no reason to suspect
malignancy. She spent the winter of 1896 at the
Riviera, but the haemorrhage still continued. On her
return to England she again sought 8ir J. Williams’
advice who then suspected there mgliit be some inter-
uterine mischief.
On June 2nd, 1897, she was placed under ether and
the uterine canal dilated, and Sir John Williams removed
Borne growth which proved to be malignant.
It was thought that the disease had invaded the broad
ligament, and that it was not a suitable case for operative
interference. '
She consulted me on October 28th, and with Mrs. Mar¬
shall, M.D., we placed the patient under an ameathetic
and examined her. The uterus was found to contain
several fibroids, and there was a badly smelling discharge
from the os. The vagina was quite free from disease,
and the os and cervix also felt healthy. The right broad
ligament felt somewhat thickened. On examination per
rectum this thickening was evidently due to the presence
of fibroids; the whole uterus appeared to be covered with
bosses.
The uterus was quite movable, but there appeared to
be some adhesion in Douglas’s pouch.
The conditions found, in my opinion, quite warranted
my advising an operation for the removal of the diseased
organs, an opinion in which Mrs. Marshall agreed. Owing
to the size of the uterus, I thought it wiser to remove it
by the abdominal route, and on Nov. 7th, with the assist¬
ance of Mrs. Marshall, Mr. Ryall, and Mr Richardson,
Dr. English giving the anesthetic, I performed panhyste¬
rectomy in the usual manner. There were some firm
adhesions in Douglas’s pouch, otherwise no trouble was
experienced. The patient made an even recovery, and a
month ago when I saw her she was quite well.
IV.— Case of Malignant Disease of the Fundus of the
Uterus—Vaginal Hysterectomy — Re< orery.
Mrs R., ret. 43, three children, youngest ten years,
since which time she has suffered a good deal from
“bearing down” pains, in consequence of which Dr.
Campbell Pope, her medical man, took her to Sir John
Williams in May, 1890. It was not until May, 1897, that
these pains increasing she again saw Sir J. Williams.
In September, 1897, excessive menstruation commenced
lasting for six weeks at a time, stopping only for three
or four days then commencing again. This state of things
continued until April, 1899. On April 12, Sir J. Williams
dilated the uterine canal, and curetted the uterine cavity.
The debris on being examined were pronounced to be
malignant.
On June 20th Dr. Campbell Pope asked me to see the
patient with him, he administered an anaesthetic, and I
made a thorough examination, the uterus was very
large and a sanguineous discharge was escaping from
the os. The broad ligaments were free, and there was
no ulceration of the os or vaginal walls. The uterus was
fairly movable. On introducing a sound it passed readily
i for 3J inches and caused bleeding.
I advised vaginal hysterectomy, which was agreed to,
and I with, the assistance of Dr. Campbell Pope, and Mr.
Ryall, performed the operation on June 27th.
There was some difficulty owing to strong adhesions
in Douglas’s pouch and the sizeof the uterus in delivering
it, this was overcome, however, by splitting the anterior
wall of the uterus up and pulling it down. The broad
ligaments were ligatured. There was, however, some
haemorrhage from a small vessel somewhat high up. As
there was some difficulty in ligaturing this I clamped it
with a pair of pressure forceps. The patient made a
slow recovery and was troubled with some little urinary
leakage, which was due probably to the ureter being
nipped by the forceps, this it is hoped will disappear as
the wound cicatrises.
‘tEransactioits of §orietice.
BRITISH GYNAECOLOGICAL SOCIETY.
Meeting held Thursdat, July 13th, 1899.
Dr. Macnaughton-Jones, President, in the chair.
Mr. Boweeman Jessett showed: 1. A case of car¬
cinoma of the cervix uteri complicated with pregnancy.
2. A case of malignant disease of the fundus of
the uterus. 3. A case of fibro-mycma of the uterus
Google
Digitized by
Aug. 2, 1899.
TRANSACTIONS OF SOCIETIES. The Medical Pbe«8. 113
taking on malignant action. 4. A large dermoid ovarian
cyst removed from a woman, ®t. 72. Notes of which will
be found under “ Clinical Records.” 1
Dr. Hey wood Smith said that it was very interesting
to trace the transition in these cases between fibroid
tumours and malignant disease He asked whether a
fibroid uterus was more likely to take on malignant
action than one that was not fibroid.
Dr. Snow thought that malignant disease of the body
of the uterus could be treated with success much later than
when the disease affected the cervix ; because in the
former case the growth was encysted, whi'st in the latter
the lymphatics were involved far earlier. There were
two ways in which myoma and malignant disease might
be related, (a) The association might be merely acci¬
dental. ( b) Malignancy might follow myoma, owing to
the predisposition brought about by congestion. This
was not a true passing of myoma into malignant
disease, but the course of events was as follows : First,
owing to the hyperplasia of the uterine muscle this
passed into an embryonic condition, and this condition
in turn merged into sarcoma. It was only in this way
that the one growth could pass into the other.
The President said that the course of opinion tended
in the direction that a myoma cculd sometimes become
malignant, i.e., sarcomatous. He had Bhown a case
some time ago at the Society, and had seen another
case since, in which myoma and carcinoma co¬
existed ; but in both cases it was difficult to say whether
the connection was accidental, or whether the carcinoma
was an invasion of the myoma. In cases of large uterus
where they were uncertain whether they had to do with
hyperplasia or with malignancy, they should be prepared
to warn the patient that the uterus might have to be
removed. These were just the cases in which a diagnosis
could sometimes lie made early.
Mr. JE88ETT, in reply, said that his main object was to
lay stress on the importance of early diagnosis. He had no
doubt that for carcinoma of the fundus vaginal hyster¬
ectomy was a most successful operation. He had now
many cases in which this had been done for some time,
and the patients had remained quite well. Cases in
which the disease affected the cervix and spread down to
the external os were the most unfavourable, for then the
glands were involved much earlier. He believed that
the prognosis was much better in old patients, say, after
60, than it was in young women. The same remark
applied to malignant disease of the breast.
Dr. Georoe Keith showed, for Mr. Skene Keith, the
ovaries from a case in which they were removed for a
bleeding fibroid, and a diseased appendix from the same
case. The patient, «t. 27, had had pain in both sides
and in the back since she was eighteen, for which she had
had a great deal of local treatment. Four years ago she
had an acute attack of appendicitis. Examination showed
both ovaries prolapsed, with a retroversion of the uterus
At the operation a fortnight ago the ovaries were found
prolapsed and adherent; and the appendix was very
long and adherent to the abdominal wall. The interest
in the case was the condition of the appendix combined
with the diseased ovaries.
Mr. Targett had made an examination and reported
that the chief features of the specimens were 1. Closed
ostium and moderate dilatation of the tube. 2. The
presence of blood distending the tube. 3. Thickened
prominent rugae of mucous membrane of the tube,
which were seen embedded in the clot. 4. Microscopical
examination showed acute tuberculous infiltration of
this mucous membrane, which was evidently a primary
lesion as there was no tubercle on the serous surface.
The President showed a case of primary tuberculosis
of the Fallopian tubes, associated with hematosalpinx.
Dr. Heywood 8mith had had a similar case some
years ago, both sides being affected. He removed both
appendages, and after the operation the patient gained
considerably in weight.
Dr. Powell asked whether the lungs had been
examined in this case ? He had lately seen a case which
was thought to be one of primary tuberculosis of the
larynx; but later on tuberculosis was found in the
lungs. He believed that most cases were primary in the
lungs.
Dr. Arthur Giles asked whether in the President’s
case the tubal condition was associated with hydro-
peritoneum ? Four years ago he saw a patient, ajt. 16,
with a cystic pelvic swelling, which was diagno.-ed as
localised tuberculous peritonitis. On opening the
abdomen this was found to be the case, but in addition
there was tuberculosis of both Fallopian tubes, which
appeared to have been the primary seat of the mischief.
The lungs had been examined and found healthy. He
removed the tubes and drained the pelvis; and the
patient recovered and improved greatly in general
health.
The President, in reply, said that an interesting
feature of the case was this, that the ovaries had been
carefully examined, and there had been found no
extension of the disease, either to the ovaries or to the
uterus. The latter was small and fiddle-shaped, thus
accounting for her sterility.
A paper by Mr. Charles Ward, Pietermaritzburg, was
read, on “Transfixors. for Securing the Abdominal
Wound.” The Secretary also read, in the author’s un¬
avoidable absence, a paper by Dr. A Lapthorn Smith,
Montreal, on “ The prevention and Cure of Hernia after
Abdominal Section.” The papers will be found in
another column.
In the discussion that followed,
Dr. Purcell remarked that stitches remained buried
and unchanged for a long time. Thus he had done a
perineorrhaphy with buried stitches which had remained
for twelve months, and which he had then removed, as
they were giving pain. They were unaltered.
Mr. Bowreman Jessett thought it would be interest¬
ing to know what 1G7 ventrofixations were done for in
a few years. It seemed a very large number. In England
he thought that two weeks was considered along enough
time to leave stitches in after abdominal section. He
had used silk for ventrofixation, but had always regretted
it. for it so often gave rise to abscess. For the removal of
sutures he had not found anything so handy as a crochet
hook.
Mr. Furneaux Jordan observed that probably no two
surgeons sewed up the abdominal wall in the same way.
The greal preventive of hernia was primary union, and
the secret of primary union was asepsis. The length of
time stitches were left in was not of great importance.
As regards suture material, he would not like to leave
silkworm gut buried, since the hard ends were apt to
hurt; boiled silk answered very well as long as it was
aseptic. In most cases he used through-and-through
sutures of silkworm gut.
Dr. Heywood Smith said that since the method of
suturing in three layers had been adopted there was very
little fear of hernia. Further, the wound healed better
if the incision were made through the recti instead of
through the linea alba. For the middle layer he thought
that interrupted sutures were better than the continuous.
The President did not think that on this side of the
water they had an “ appalling number ” of hernias fol¬
lowing abdominal section. He had had only one case of
hernia, and that was due to the patient herself, who was
insane ; she did what she could to open the wound. He
took exception to the statement that this kind of hernia
was easily cured. He had no doubt that drainage was
responsible for many of the cases of hernia that used to
occur. His own practice was to use three layers of in¬
terrupted sutures. He would not like to bury silkworm
gut nor silver wire as advocated by Howard Kelly. The
principal thing was to get primary union of the fascia
and muscle. He concluded by expressing the indebted¬
ness of the Society to Dr. Lapthorn Smith for this
interesting paper which he had sent them from Montreal.
THE LATE MR. LAWSON TAIT.
The President dselt o:. the great loss the Society
had sustained by the death of Mr. Lawson Tait, one of
their honorary Fellows. Their loss was shared by Great
Britain and Ireland, as well as by gynaecology all over
the world, for Mr. Tait was one of the most prominent
representatives of this branch of surgery of his time, an
original thinker, and a bold and successful surgeon. At
a recent meeting of the Council a vote of condolence
with Mrs. Tait on their common loss had been unani-
114 Th*' Medical Press. SPECIAL ARTICLE.
Auo. 2, 1899.
mously passed, and he felt sure that the Council had
but expressed the sentiment of every Fellow of the
Society.
The remarks of the President were cordially and
respectfully endorsed by the meeting, which then sepa¬
rated.
Jlrticle.
TUBERCULOSIS OF THE BONES, JOINTS, AND
GLANDS, AND ITS TREATMENT BY THE
OPEN-AIR METHOD AT THE SEASIDE
(INSTITUT VERNEUIL. LA BAULE—LOIRE
INFERIEURE).
In discussing the treatment of tuberculosis it is neces¬
sary at the outset to distinguish clearly between pul¬
monary tuberculosis, the only fQrm of the disease with
which the public in general are as yet familiar, and the
various localised manifestations of tuberculous infection
which are so frequently met with in bones, joints, and
lymphatic glands. Although all forms of the di-ease
are, roughly speaking, answerable to the same method of
constitutional treatment it is necessary in practice to
make a distinction, because the risk of infection which
is inseparable from the pulmonary form does not obtain
in the more strictly localised lesions met with in the
bones, in joints, and especially in the lymphatic gland3.
It follows that the treatment of the latter requires to be
carried out in separate establishments, specially organised
to deal with this particular class of cases.
In the course of a recent voyage in France it was our
good fortune to have been afforded an opportunity of
visiting a remarkable institution m Southern Brittany
where the treatment of delicate children of both sexes
haB for many years past been carried out on a large scale
by what was described as the open air marine treatment
with results which appear of sufficient interest to merit
publicity in this country where public opinion is fully
alive to the necessity of measures having for object the
cure of the afflicted and the prevention of infection.
Some thirteen years ago a local philanthropist pur¬
chased a large plot of land surrounded by water and
isolated from the mainland at high tide, situated near
Le Croisie (Loire Inflrieure) for the purpose of instal¬
ling a sanatorium for the reception and treatment of the
young of both sexes suffering from tuberculous disease
other than phthisis. The buildings, all on the ground
floor, are built on the principle of securing an ample
supply of fresh sea air, and are provided with every
modern sanitary appliances. Surrounded on all sides by
extensive tractB of sandy soil and bathed by invigorating
breezes from the ocean, the inmates pass their lives
virtually in the open air. Caressed by the balmy and
uncontaminated air, enveloped by direct sunlight, and
suitably nourished, the miserable and degenerate pro¬
ducts of town life, incapacitated for childhood’s pleasures
by the ravages of tuberculous disease, find in the Pen-
Bren Marine Hospital a milieu admirably calculated to
stimulate their inherent vitality, and to enable them to
react against ihe further spread of the disease.
The credit for the success which has attended the
administration of the Pen-Bron Hospital is mainly due
to Dr. Jan-Karguistel, the medical superintendent, who
has from its foundation displayed a scientific and affec¬
tionate interest in its management. Thanks to his
activity the hospital was formally recognised by the
State as of public utility in 1893, and it receives sub¬
ventions from a large number of communes and muni¬
cipalities, who in turn send their sick to the hospital for
treatment. The conditions of admission are very strict
from a medical point of view, the benefit of the institu¬
tion being restricted to those whose condition is such as
to justify the hope of eventual cure, or at any rate of
material improvement, by the Marine treatment. Al¬
though the object of the founders was exclusively the
treatment of the victims of localised tuberculosis, the
benefit of the treatment is in exceptional circumstances
.accorded to debile and convalescent children on the
express condition that they do not present lesions capable
of proving injurious to their fellows.
The Pen-Bron Hospital at present accommodates
between three or four hundred children of both
sexes. There is no limit of age as regards
the girls, but males are not admitted above the age of
15. In the course of our inspection we were shown
examples of pretty well every variety of local tuberculous
lesions—tuberculosis of various bones and joints, tuber¬
culous ulcers, involving the bones of the skull, the
antrum, the mastoid, the nose, kc„ but the predominant
feature was tuberculosis of the lymphatic glands, espe¬
cially of the neck, suppurating and non-suppurating.
Most of the incoming patients a-rive in an advanced
stage of cachexia, and it is impossible not to be impressed
with the promptness with which these little sufferers
had regained strength, colour, and gaiety under the
influence of these surroundings. The treatment com¬
prises not only an existence under peculiarly favourable
hygienic and dietetic conditions, but care is taken to exer¬
cise the minds as well as the bodies of the inmates. Under
the sympathetic but firm rule of the sisters, who have
devoted themselves to the task, every hour of the day
has its allotted occupation, educational, religious and
recreative.
There could be no more touching spectacle than that
of the children basking in the shade of the trees, their
eyes beaming with the sensation of recovered vitality,
smiling, with faces expressive of affection and gratitude,
to the sisters and to the doctor who knew each one of
his flock by his or her name The pallor and the hectic
flush in all save the most recent ariivals had given place
to the tawny glow of health, and their placid happy
physiognomies testified to the joie de « irre.
The average duration of treatment is from twelve to
eighteen months. There is an operating theatre fitted
up in a way which would do credit to a London hospital,
for the surgical treatment of cases requiring operative
measures. The wards are spacious, with large windows
on both sides, with ample space between the beds,
and scrupulously clean throughout. In the spaoe
at our disposal it is impossible to do justice to
the admirable organisation of the institution. We
cannot do more than sketch the main outline
of a scheme which enables children capable
of deriving benefit Irom Nature’s own treatment, to be
restored to health at a cost not exceeding lfr. 80 (rather
less than Is. 6d.) a day. The benefits of the Pen-Bron
Hospital, as we have explained, are restricted to the
children of the poorer classes, the cost of maintenance
being defrayed by the local authorities by whom they
are sent. The unquestionable and excellent results of
the treatment during the last thirteen years have
attracted public attention, and a movement has been set
on foot to extend these benefits to the children of
persons of a higher social standing who would be willing
to pay for similar privileges on a scale commensurate
with the greater comfort and conveniences. This move¬
ment has recently led to the construction of a building
at La Baule, a few miles distant from the Pen-Bron
Hospital, situated on the shore of a bay and sur¬
rounded by extensive pine woods forming part of the
grounds. This is known as the Institut Vemeuil.
The Institut Vemeuil is to all intents and purposes a
Pen-Bron institution on a more luxurious scale. Built
of granite on a rising plot of ground facing the ocean,
it is at once an architectural monument and an ideal
sanatorium. The main block is reserved for the recep¬
tion of young patients, but isolated villas are scattered
through the extensive pine-clad grounds for the recep¬
tion of adults. To the visitor in search of rest and
recreation, as well as to the invalid requiring a thorough
course of treatment, the Institut Vemeuil, which is under
the patronage of the most eminent French medical
authorities, commends itself as a summer and winter
residence by its complete organisation and unique
natural advantages. A special department is provided
for children of both sexes, with this unique advantage,
that those of delicate health are enabled to pursue their
education ; n company with others of their own age, while
deriving lasting benefit from skilled treatment and a
favourable climate. The establishment, indeed, affords
This Medical Press 115
FRANCE.
Aug . 2, 1899.
•the freedom and comforts of home under circumstances
which, we believe, cannot be rivalled elsewhere
The locality is celebrated for its salubrious and
restorative climate owing to its geological conformation,
its exceptional situation and the influence of the
Oulf stream which baths its shores, it possesses in
all seasons that uniformity of temperature so essential
to the recuperation of the debile and convalescent.
Eucalyptus, pomegranate, and similar treesfgrow freely
in the open air, a fact which sufficiently testifies to the
mildness of the winter.
The Institute, built in 1896, is of four stories, to which
access is obtained by an electric lift and by two wide
staircases. It comprises a main building and four
detached houses, in addition to a farm, laundry, and
electric station. It is within a short distance of the
railway station. The various halls and rooms are well
ventilated and lighted by electricity, and they all overlook
the sea or the surrounding evergreen pine forests. The
sanitary arrangements are on the latest and the mo6t
approved principles, insuring pure air, inside as well as
outside. The sy»tem of drainage is all that can be
desired, and special machinery has been erected for flush¬
ing sewers with electroli*ed sea water (Hermitte's
system), a remarkably efficient disinfectant and anti¬
septic. Drinking water of absolute purity is obtained
from a deep subterranean sheet of water underlying the
sandy soil, and no expense has been spared to make the
arrangements as perfect and as complete as possible.
The treatment of patients varies, of course, a cording
to the nature of the affection from which they are suffer¬
ing. There iB an admirable hydropathic department
conducted by an experienced specialist of the celebrated
8 wiss school, under the control of a carefully selected
staff of medical officers, according to the most approved
Continental methods. It comprises hot and seawater baths,
seaweed baths, electric brine baths, and hot air baths,
together with vapour, douche, rain, shower and medi¬
cated baths. The brine is produced in the neighbour¬
hood, where sea salt is prodixeed on a large scale by
evaporation, the mother liquor (a saturated solution)
being thus available for therapeutical purposes. The
services of experienced masseurs are available, and there
is a medical gymnasium fully equipped with all modern
appliances. The home farm is within reach of the main
building. It insures a constant supply of fresh milk,
butter, eggs, vegetables, and fruit, and houses the
horses and donkeys belonging to the establishment. The
laundry is on a magnificent scale, and it comprises a
large disinfecting apparatus.
The marine open-air treatment is necessarily depen¬
dent for its success to a large extent on the resources at
the disposal of the visitor for amusement and distrac¬
tion. In this respect the Institut Vemeuil is singularly
favoured. There is a beach of fine sand extending
several miles on either hand, sloping gradually into the
eea, thus affording safe bathing at all hours of the day.
At low tide the firm sand affords ample opportunity for
tennis, cycling, Ac. There are plenty of boats, and the
outlying rocky islands provide objects for enjoyable
excursions, fishing, shooting, Ac. The roads in the
neighbourhood are good for cycling, and there are
numerous places of interest within easy reach.
It was impossible not to be impressed with the advant¬
ages which the Institut Verneuil offers for the regenera¬
tion of the debile and the recuperation of the convales¬
cent. Nature has lavished her richest gifts, and art has
supplemented them by providing all the comforts and
appliances which favour recovery from disease. Last,
but not least, La Baule is readily accessible from
London, the journey not taking more than fourteen
hours. The terms are very moderate, taking the luxury
of the installation into consideration, ranging as they
do from £3 to .£4 a week for adults, and £10 to £12
monthly for children, exclusive of fees for medical
attendance, baths, Ac., which can be contracted for at a
email additional cost. The only restriction imposed is
that patients shall not be suffering from affections
likely to incommode or prove injurious to the others.
The managing director is Monsieur A. Pavie, 4, Rue
du General Foy, Paris, from whom all particulars can be
obtained. 1
dfrance.
[fbom our own correspondent.]
Paris, July 30th, 1686.
Hysterectomy.
At the meeting of the Societe de Chirurgie, M. Ricord
spoke on abdominal hysterectomy for uterine cancer
and said that he had performed that operation ten times
with only one death. The gravity of the operation was,
consequently, in his opinion, not so great as was
believed. None of his patients could have been operated
on through the vagina, as the disease had in each case
destroyed the greater portion of that organ. The speaker
acknowledged that abdominal hysterectomy was
a tedious operation, especially where the ligaments
were infiltrated, but it had the advantage over the
vaginal method that it permitted ablation of the
infected glands.
M. Segond said that he performed ninety-five times
ablation of the uterus by the vaginal method with a
total mortality of 14 per cent.; most of the unsuccessful
cases were those in which the vagina and the broad
ligaments were invaded by the disease. As to the
ultimate result of the operations, out of forty cases
of relapse of which he had knowledge himBelf, the disease
returned in thirty cases within the first year, seven in
the [second, one in the third, and one at the end of the
seventh year. Among the cases thai might be con¬
sidered cured, one has already survived ten years,
another nine years, two four years, and two two
years. He only practised six times abdominal
hysterectomy for uterine cancer. Surgeons, consider¬
ing this method is superior to vaginal hysterectomy
in the treatment of uterine cancer, believed
that it was less grave than the latter, according to them,
it was the only rational operation, permitting the removal
of all the ganglions, and they hoped that by-and-bye the
prognosis would be much more favourable than that
given by vaginal hysterectomy. As to the gravity of
the intervention, it was certain that, thanks to the per¬
fecting of the method of operating, abdominal hysterec¬
tomy was as benign as vaginal hysterectomy, but it was
none the less true that in cases where the extension
of the lesions necessitated ligature of the iliac artery
the operation could not be considered less grave than
the vaginal method. Those who advocated the abdominal
method gave for one of their principal reasons the
facility with which the infected tissues could be removed,
but that pretention was impossible to realise, for if some
few glands were removed could the operator affirm
that he left no tissue susceptible to be attacked by the
disease ? However, he admitted that for a cancer of
the body of the uterus or for those forms complicated
with softening of the neck, so that it did not
afford a hold for the instruments, the abdominal
method was the best. When the lesions were not
limited to the uterus he never interfered, preferring
palliative treatment, which eased the patient and pro¬
longed her existence, frequently for a considerable
period.
Blennorrhaoia in a Boy Three Years Old.
Nothing is more frequent than vulvo-vaginitis of
specific origin in little girls in certain classes of society,
as a consequence of the promiscuity in which the parents
and children live and in which the gonorrheal virus
Digitized by
116 The Medical Press THE OPERATING THEATRES.
is communicated by the sheets, towels, or other instru¬
ments. On the other hand, urethral blennorrhagia is
very rare in boys of tender age. Dr. Rouher reports
a curious example of the kind.
He was called to a boy, aged three years, who, accord¬
ing to the mother, had not urinated for the previous
three days. The penis was swelled, and pus flowed from
the urethia. Another child of six years, who suffered each
time that he tried to micturate for the last month, was
also presented to the doctor. Here also by pressing on
the penis a feV drops of muco-pus were brought to the
surface. On seeking the origin of the infection, M.
Rouher learned that the two children slept in the bed
with their eldest sister, who had herself suffered from
acute gonorrhoea.
A case of infanticide was recently tried here, where
the medical man who was called in showed up in rather
a sorry light. The girl, a servant, being ill, he was
asked to examine her. He came to the conclusion that
she was five months’ pregnant, and advised her removal
to hospital. At the Hopital Cochin it was found that
she had recently been confined, and on search being
made the dead body of an infant at term was found in a
box in the bedroom. The doctor, in giving evidence, was
fain to admit that he had only made a cursory examina¬
tion, an admission which drew upon him some very
pungent remarks from the bench.
A few days since a M. Vidal was sentenced to a fine of
1,000 francs and one month’s imprisonment for the
illegal practice of medicine. The curious feature in the
case was that the accused, a commercial traveller, had
succeeded in getting admitted to one of the services at
Lariboiau're hospital as a dresser, which post he had
filled for three years.
Austria.
[from our own correspondent.]
Vienna, July 29th, 18 W.
Diabetic Blood.
Among recent discoveries one was announced for
the detection of diabetes, by examining the blood
with methylene blue, when a distinct red colour was
evolved if sugar were present. If such a novelty could
have been sustained it would have been of some practical
value, but unhappily for the genius who startled the
clinical world with such a simple means of diagnosis,
the sugar is not the agent that strikes the red colour,
but the acid of the blood which miy occu.- in many other
diseases besides diabetes. Schneider finds that a drop of
urine added to normal biood will give the red colour
that Bremer holds to be diagnostic of sugar.
The sugar in Bremer’s new discovery is a mere acci¬
dent, as any increased acidity of the blood will give the
same reaction. This is Schneider’s version of its dia¬
gnostic worth in medicine.
Midler, on the other hand, gives us a large number of
experiments to confirm the accuracy of Bremer’s deduc¬
tions. Muller's earlier experiments were carried out in
the morbid condition as well as the healthy, and found
satisfactory. He goes further, and adds sugar to the
healthy blood and thus obtains as positive a result as
in the morbid condition. With this conflicting evi¬
dence before us we must pause before accepting the
test as diagnostic or reliable.
Aug. 2, 18 99.
Spindle-shaped Dilatation of the (Esophagus.
Schworer relates a remarkable case of dilatation of the
oesophagus, caused by spasm of the cardial end of the
tube. The diagnosis was made daring life, but was not
confirmed till the post-mortem was performed. It was
in consequence of a spasmodic attack when a bougie was
used more violently or forcibly than usual that a rup¬
ture into the peritoneum took place, resulting in death.
Aseptic Operation Wounds.
Dbderlein discovered some time ago that the fluids of
the peritoneum after an operation were not free from
germs which were attributed to the hands of the surgeon
after a protracted operation in the abdominal cavity.
These germs were shown to come from the deeper layers
of the surgeon's hand which lay embedded below the
epidermis, but became exposed after the epidermis was
shed. This discovery led to the use of surgical gloves by
some operators which Doderlein affirms is equally in¬
efficacious, as no wound can be kept absolutely germ free.
He is not so reckless, however, as some who having dis¬
covered the impossible give a licence to operate in any man¬
ner. He charges the surgeon with grave responsibilities,
and admonishes him to be more careful than ever by
covering the hands with some impermeable medicated
substance in order that the risk may be reduced to
a minimum.
Ruptured Ovarian Cyst.
Happen records an ovarian cyst which he had
diagnosed, but before operation was decided upon it sud¬
denly burst. On operating, the peritoneum was found
filled with a colloid material in which were seen large
semi-solid masses of the same material. The whole was
washed out and the wound closed and perfect recovery
followed although the patient was collapsed at the time
of the operation.
He relates another of a similar nature where chronic
bronchitis existed, in which he used ether as an anaes¬
thetic with an equally happy result.
The Source of Pain in Colic from Biliary
Calculi.
It has frequently been asked, is it the calculus in the
gall-bladder that causes the intolerable pain, or is the
inflammation induced by the pressure of the foreign
body r Different answers have been given by able physio¬
logists. Bertelsmann places biliary colic on the same plat¬
form with colic of the bowel, and disagrees with Riedel
that in all biliary colic there must be perialienitis present.
Bertelsmann contends that the local inflammation which
causes the bladder to contract is the cause of the pain>
or at any rate the factor which makes it intolerable. If
this be so the indications are antiphlogistic, but there
are many cases with no inflammation whatever in which
there is intolerable pain !
‘Che Operating theatres.
GT. NORTHERN CENTRAL HOSPITAL.
Operation for Caries and Necrosis of the Lower
End of the Femur implicating the Popliteal
Artery and Vein. —Mr. Peyton Beale operated on a
boy, «‘t. 12, for caries and necrosis of the lower end of
the left femur. The history of the case was of interest *
the boy was originally admitted suffering from pytemic
abscesses over and around the right and left knee-joints,
the right hip-joint, and in the left arm near the elbow-
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Aug. 2, 1899 .
THE OPERATING THEATRES.
Thk Medical Press. 117
joint. As so often happens, these abscesses did not
then open into any of the joints. They were freely
opened and stuffed, and those about the right hip and
knee and left arm did well, one or two subsequent opera¬
tions being needed to remove pieces of dead bone. In
the case of the left knee however, the conditions became
more serious. In spite of free incisions the joint became
infected and had to be freely laid open and drained for
some weeks. It eventually healed up leaving only two
sinuses [which led down to dead bone just above the
intercondyloid notch of the femur. The present opera¬
tion was performed in the hope that this dead bone might
be removed completely. Before commencing the operation
Mr. Beale stated that he had learned, by previous ex¬
perience, to regard cases of this kind as very serious, for
it commonly happened that the popliteal artery and
vein were surrounded by pus, their walls were thus
rendered very rotten, and both were liable to rupture at
any moment. This fact rendered cases of the kind
occurring in private practice much more serious than
those in a well-equipped hospital where prompt and
efficient aid was always speedily forthcoming. It was
well, therefore, in operating on these cases to be
fully prepared to ligature the popliteal artery or vein, or
both, at a moment’s notice. Mr. Beale then proceeded
to enlarge the existing sinuses, first by the knife and
then by Hilton’s method, until the opjer half of the i
popliteal space was laid fairly open, the popliteal vein
and artery being both exposed to view. It was found,
as expected, that the caries was very extensive, reaching
into both femoral condyles ; moreover, several flakes of
dead bone which had peeled off the Bhaft of the femur
were seen and carefully removed. "During the removal of
one of these pieces the popliteal vein suddenly burst. It
appeared as if part of its walls, which were quite rqtten,
had suddenly given way. Both ends were at once
clamped and securely ligatured. The dead bone having
been removed, and the carious bone scraped out as
thoroughly as possible, the wound was freely irrigated
and stuffed with iodoform gauze. The popliteal artery
•was seen to be in a very unhealthy condition, but it was
not ligatured then in the hope that its lumen would be¬
come more and more obliterated, and so collateral circu¬
lation would be established—if it had not already been
fully established. The wound was dressed and the
patient ordered to be removed to bed and watched care¬
fully.
Mr. Beale stated that it was ons of the golden rules
of surgery to amputate at once should the main artery
of the limb be wounded. He said that he had had
under his care previously two cases exactly similar to
the one on which he had just operated, but in those cases
about three inches of the popliteal artery and vein were
excised at the same time. In neither case had any gan¬
grene supervened, and in one of them the carious and
necrosed bone had been completely removed and the
wound had healed up soundly. The other was still under
observation, having still one small sinus in the ham.
The point, he said, in these cases was that the colla¬
teral circulation became established during the time that
the artery was exposed to the discharge from the carious
bone and when the artery did give way, the hemorrhage
was very gradual at first and enabled the surgeon to
tie the vessel above and below the rupture. Should
secondary hemorrhage occur, it was most essential to
find the end of the vessel and apply a ligature about one
inch above it. That having been done, one could then
consider whether it would be wise to ligature the
femoral at once or not under these circumstances. Mr.
Beale said he should ligature in Scarpa’s triangle, taking
the greatest care not to infect the wound from that in
the popliteal space, but he would not amputate the
limb unless other complications supervened. In these
days amputation in such cases should be looked upon
only as the very last resort.
It is interesting to follow the subsequent progress of
the case. The wound was dressed on the second day
and re stuffed. On the fourth day the dressing was seen
to be blood stained, and the house surgeon dressed
the wound. He then saw that there was a small
hole in the popliteal artery, from which blood
was oozing, not spurting. The haemorrhage was
controlled by pressure and Mr. Beale was sent Vor. On
h>.s arrival he at once ligatured the artery above and
below and excised about one inch of it, giving orders
that if, in three or f< ur days time, more haemorrhage
took place, a fresh ligature was to be applied upon the
bleeding end. This expected haemorrhage did occur and
the house surgeon proceeded to look for the bleeding
point; this, however, he was unable to find, so he liga¬
tured the femoral at the apex of Scarpa’s triangle. This
operation controlled the haemorrhage and the leg did
not suffer in any way, thereby proving that the collateral
circulation around the knee-joint had been fully estab¬
lished.
ST. THOMAS’S HOSPITAL.
Hydronephrosis from Conoenital Deficency of
Ureter.— Mr. Battle operated on a girl, aet. 25, who
was suffering from a tumour on the left side of the
abdomen. The tumour had been noticed of varying
size from time to time, and caused her a good deal of
pain chiefly when large. She had not, however, noticed
that there had been any increase in the amount
of urine passed when the tumour had diminished
in size. The swelling occupied the left side of the
abdomen in the kidney region; it was dull on percus¬
sion, but the resonance of the colon could not be made
out over it, fluctuation could be obtained; it was not
tender. There was no rise of temperature ; the urine
was normal and her general condition healthy. The
tumour was removed by the usual lumbar incision,
being shelled out from the bed in which it
was lying, a much elongated kidney being first
met with; afterwards a cystic swelling, which had
been partly emptied by a trocar and cannula
introduced through part of the tumour, which was
found to be chiefly kidney substance. The cyst-like
part was found to consist almost entirely of the dilated
renal pelvis and contained clear urine. The ureter left
the cyst about three inches from its lower margin. It
was much diminished in size, being represented by a
small tube which only admitted a bullet probe : there was
nothing obstructing it. No difficulty was experienced
in ligaturing the vessels and ureter separately,
but it was found difficult to reach them in
the first instance on account of the large deve¬
lopment of the cyst towards the aorta. The wound
was closed in the usual way with deep and superficial
stitches, and a drainage tube inserted. Mr. Battle said
the absence of anything like renal colic made it likely
that the condition was due to defect in the ureter, pos¬
sibly as a result of kinking, but the condition found at
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LEADING ARTICLES.
Ado. 2, 1899.
118 The Medical Press.
the operation made it probable the defect was of
congenital origin.
It is satisfactory to state that the patient made an
uninterrupted recovery.
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“ SALUS POPULI SUPREMA LEX.”
WEDNESDAY, AUGUST 2, 1899.
THE HOSPITAL QUESTION.
Th e hospital question has been exciting a good
deal of interest in London for some time. Our hos¬
pitals. great and small, were in low water. Their
incomes had fallen off or their expenses had increased!
and they were beginning to find themselves in diffi¬
culties. How to get money was the question,
Charity with some does not always go hand in hand
with Faith and Hope; and perhaps for this reason
some take the view that “ the greatest of these is
Charity.” Important changes have taken place
during the past half century, so far as the sick
poor are concerned, in the relations between
dispensers and recipients of Charity. The
Fever Hospitals, Metropolitan Asylums, and
Infirmaries, are not regarded as charitable
institutions, any more than our Army and
Navy. They are all supported by the State for its
own benefit, and no sentiment of charity regulates
the charges made on the people for their cost.
Whether hospitals are needed now so much as they
were, when little or no provision was made for the
sick poor, we need not dLcuss. It certainly looks as
if the sentiment of real charity in regard to hospitals
was not active now, when we see appeals made through
bazaars, balls, concerts, and fancy fairs for funds to
help them. Is this a symptom of coming dis¬
solution, preceded by expiring energy ? It looks
as if hospitals will have to be classed with |
such social combinations as clubs, insurance com¬
panies. building societies, and many of the
same chaiacter. Hospitals may be organised so as-
to provide not for the wants of poverty, but for those
of sickness, that is for some of the accidents of life.
If this is so, well and good. We shall then appeal
to a sentiment altogether different from that of
Christian charity. Our hospitals depended at one
time largely on the influence of our clergy, through
whom the most potent appeals could be made to the
public. Through the great body of practitioners a
great deal was done for our hospitals, more really
than by any class, when legacies were being considered,
or gratitude was having influence on those who
wished to show sympathy for suffering, and could do
so in no way better than through a hospital. We
are rather doubtful now of the feelings of the clergy,
and are not certain of those of the great body of
practitioners towards hospitals. The institution of
the Hospital Simday has rather taken away the
interest which certain of our clergy had always felfc
in certain hospitals, for in most parishes there
existed a close relation between the sick poor and the
ministers of religion. As regards the great body of
practitioners, there is not the least doubt hut that
hospitals have injured them much in many ways,
as those well able to pay their doctors have
found they could do without them. Now the
hospital authorities have resorted to another
power to help them, and have appealed to Royalty for
its patronage. The Prince of Wales has naturally
done his best to assist, and for a time the result may
be satisfactory. But only for a time, and sooner or
later the collapse will come, if hospitals are to find
support from charity. If we are asked what are th©
chief purposes for which hospitals are intended and
on which their right of appeal to the public aa
charities should be based, we think that one of th©
chief is the advance and improvement of the Science
and Art of Medicine, by which the whole people ia
benefited. One of the most important duties of hos¬
pitals is to educate those who are going to devot©
themselves to the practice of the profession.
If the public does not require such servants, then
hospitals as schools are not wanted, and the question
of education does not come under consideration. It
ought to be clearly recognised that the services of
physicians and surgeons to hospitals must in some
way be repaid. In old days, that is, about a century
ago, when the Windmill Street School existed and
the Hunters were the great teachers in London, edu¬
cation was a private matter. Things are changed
since then, and now a special hospital may be worth
a great deal more from a pecuniary point of
view than even the chief of the general hospitals.
Hospitals, particularly the specials, are adver¬
tising mediums, through which practice Jean best be
obtained. There are some who take pleasure in
teaching and who prefer it greatly to private practice,
but if they can not afford to teach for little or nothing
they must retire from hospital life. Whether the
institutions suppoi'ted by the State should be used as
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Ado. 2, 1899.
LEADING ARTICLES.
The Medical Press. 119
schools of medicine, as they ought to be. particularly
as the great class of infectious diseases are now
removed from hospitals to which schools are attached,
is a question which ought to be considered. Seeing
there is not much hope of any great assistance being
given to hospitals by the recent efforts made to obtain
funds, we may leave the matter for the present sub
judice, very much as the Transvaal affairs are being
treated in the world of politics.
COMBINATION.
Lancashire is well known as an active centre of
“ strikes "—as they are called—that is to say, of
organisations trained to stand shoulder to shoulder
and obtain a fair share of the wealth they are engaged
in creating. That northern county, however, is now
the scene of a combination of a novel character, the
issue of which is fraught with importance to the future
welfare of the medical profession. Strange as it may
seem, the sturdy population of that busy district are
slow to recognise in others the right to secure a
fair remuneration for their services. There, as else¬
where all over the United Kingdom, medical
men have been induced to act as the offi¬
cers of lay societies upon terms that have
become by degrees hopelessly attenuated and paltry;
that have been conducted on lines of personal adver¬
tising and canvassing repugnant to professional
traditions ; and that have brough t, substantial profits
to the coffers of these Societies. In other words, the
trade societies have been astute enough to make
money out of the members of a disorganised and
disunited profession. The moral of the whole matter
is clear as daylight. The weak strategical point is
the want of organisation, and the remedy is com¬
mon concerted action and proper generalship. That
was the burden of the cry of the medical re¬
former fifty years ago, and that is the refrain he
is still chaunting in the wilderness. But there are
Bignsof hope that have for years past been steadily
climbing up from the horizon. During the past fif¬
teen or twenty years many associations of medical
men have sprung into existence, with objects many
and varied, but always with the central nucleus of
some common interest to defend or foster. It is to
such combinations that we must look for that self-
help which alone can lead to salvation. Turning to
the facts of the present deadlock, we find from the
details, so far as reported, that the Lancashire Col¬
liery Surgeons' Association, which is stated to have
a membership of over one hundred, has become
dissatisfied with the terms offered by a local friendly
society. The origin of the dispute lay with the
Wigan and District Miners’ Permanent Relief
Society, which has 20,000 members, and which
refused to pay its medical officers what they considered
adequate amounts for attendance in accident and
other cases. The Wigan Society, not being able to
come to terms, has engaged outside surgeons, who
unfortunately are always forthcoming on such occa¬
sions. At that point in most instances the matter
would have ended. The newcomers, having gained
a footing in the district by means that cart
hardly be described as creditable, would have gray
dually acquired practice at the expense of the
gentlemen into whose shoes they have stepped, and
by degrees the whole affair would have died out of
memory, while friendly societies would have been the
stronger by another victory scored over the medical
profession. Fortunately, however, the colliery sur¬
geons of Lancashire have had the prudence to unite
and form a strong association, so that the cause of
Wigan is not only that of a single district but also
that of a large and important county. To replace
the surgeons of a single society is one thing, but tc
find surgeons for a hundred societies is another and
totally different matter. It is the old stoiy of the
colliers themselves, divided we fall, united we stand.
The result of the present dispute should arouse the
attention of the whole medical profession of Great
Britain. Why should not a fund be raised to
support the Lancashire surgeons in their spirited and
resolute action ? If they are to be left to fight their
own battle without moral and material support from
their professional brethem, then the outlook will be
indeed hopeless. The association of the Lancashire'
surgeons is worthy of imitation in every county in
England, and were there some universal system of
such confederated bodies, the urgent need for reform
in the medical profession would be to a great extent
met. But how about the black sheep who have
accepted the vacant poets at Wigan. It would be of
interest to learn their names and antecedents. Would
our friends the Medical Defence Union —“ our hope
for times to come ”—undertake the task ?
TUBERCULOSIS AND ITS PRETENTION BY
DISINFECTION.
One of the results of the crusade against tuber¬
culosis, now in progress, will be to impress the public
with the fact that the disease is markedly contagious,
and thus it is not difficult to foresee that as time
progresses the conviction to this effect will be¬
come firmly established in the public mind. This 1
then, having once taken place, one cannot avoid
reflecting upon the possible results which are likely
to accrue to the unfortunate persons who have been
pronounced to be tuberculous. In all probability
they will come to be l-egarded as tainted beings f
sources of leprous, so to speak, contamination, to be
avoided at all hazards, and unfitted to mingle
with the healthy portion of the community. If this
state of affairs should come to pass it cannot be
denied that those responsible for the present crusade
against the disease will be answerable for it. At the
same time who can doubt that the more tuberculosis
is regarded as an infective malady the better are vhe
results of its prevention likely to be. Carried, there¬
fore, to its extreme, the warfare against tuberculosis
will possibly, in the near future, enter upon a stage
of expediency as opposed to sentiment. Under
such circumstances the afflicted will have to suffer
for the healthy; so much so, that, perhaps, com¬
plete isolation will come to be the rule among
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NOTES ON CURRENT TOPICS.
120 The Medical Press.
those infected with tubercle. It is difficult, of
course, to contemplate such an eventuation of a
modern system of prevention of disease as this
without feeling some pity for the hapless per¬
sons concerned. Nevertheless, further contemplation
will show that the effects of this system will be likely
to prove assertive far and beyond the persons imme¬
diately involved. Even the healthy members of
tuberculous families will, perhaps, in the future be
held to be ineligible for matrimony among families
which are not tuberculous, and so it might come to
pass that tuberculous families would have to limit
their mati-imonial undertakings to families of
the same taint as themselves. This, of course,
would be a most undesirable development of
the tuberculous crusade, if it were to occur, and it
would be calculated to defeat in a large measure the
main object for which the movement has been under¬
taken. However, it is not only in this country that
the trend of opinion, both professional and lay, is in
the direction of making much of the infectivity of
tuberculosis. For example, a paper was recently
i-ead before the American Climatological Associa¬
tion, in which it was pointed out that the larger and
better class hotels at the different health resorts
in the States are refusing to receive tuberculous
patients. The result of this has been that the
latter are now compelled to seek refuge in
private houses, the proprietors of which are, so far,
heedless as to the necessity of disinfection in such
cases. For this heedlessness it is proposed to enforce
disinfection under municipal authority, and thus, in
view of such compulsion, the end may be that,
rather than expose themselves to the trouble of this
interference, the owners of private houses will
deem it best to refuse a harbour of refuge to
the hapless tuberculous person. We believe
that in New York and Philadelphia the muni¬
cipal disinfection system is already in vogue,
and, therefore, it is quite likely that the plan
will be adopted by other large cities. Taking then,
all these facts into consideration, trouble appears
to be in store for those who unfortunately happen to
be infected with tuberculosis; let the public once
firmly grasp that they are being taught to regard
such persons as sources of dangerous contamination,
and then sanatoria for their reception will become a
matter of necessity th roughout the country, and not,
as now, merely a new method of profitable investment
for capital.
Jtotfcs on (Eumnt topics.
Plague in Europe.
Upon the appearance of the plague in Egypt we
ventured to assert that its spread to European ports
was simply a matter of time. From exclusive infor¬
mation which has come to hand it would seem not
altogether improbable that the disease has broken
out at Oporto. The facts of the case are that during
the past few weeks there have been a number of
suspicious deaths in the place mentioned, a promi¬
Auo. 2, 1899._
nent feature of the sickness being swellings of the
groin and axilla. Should this epidemic prove to be
really plague the outlook is gloomy, for the wretched
sanitary state of Oporto is notorious. Preventive
medicine in .that country is in a most elementary
condition, and the ignorance and superstition of the
population render special precautionary measures
well nigh hopeless. If the disease which has invaded
the important fea-port in question be not plague it is
possib'e, in these days of practical bacteriology, for
the authorities to settle the question within a few
hours. We would suggest that not less in their own
interests than in those of the rest of Europe the Portu¬
guese Government should cause this most necessary
investigation to be made forthwith. Under the stress
of a threatened invasion by pestilences of the plague
or cholera type the value of a prudent sanitary
organisation is conspicuous and becomes an enduring
comfort to the community that has set the house in
order.
Boxing of Ears and Ear Disease.
The fact that the boxing of ears is apt to set up
serious middle ear disease has long been accepted as
a canon in medicine. Indeed, no schoolmaster who
is in touch with the times would resort at this time of
day to the barbarous discipline in question. That a
simple box on the ears may be a remote cause of
death is readily capable of proof. The blow either
ruptures the di-um of the ear or sets up inflammation
of some part of the auditory passages, septic pro¬
cesses intervene, and middle ear suppuration is
established. The next step is the formation of a clot
in the veins within the skull, in which they are
anatomically in close connection with the internal
auditory structures. As already hinted, this know¬
ledge has long been a commonplace possession
both of lay and of medical folk in our own
country. It has only lately, hqwever, received a prac
ticail recognition in Austria, where the absurd and
childish practice of boxing the ears, of soldiers has
hitherto been in vogue. Instructions have recently
been issued by the general in command of one of the
army corps prohibiting both commissioned and
non-com missioned officers in future from resorting
to that degrading form of punishment. The reason
given for issuing the order was the alarming increase
of ear diseases in the Army. Of a truth, apart from
sentiment, and viewing things in the cold dry light
of experience, it were better to lash a soldier to the
triangle and give him forty strokes with a cat-o'-nine
tails than to box his ears. The one hurts and leaves
a scar, the other permanently cripples, and perchance,
kills.
Dangerous Advice.
The prevailing cause of chronic inebriety is un¬
questionably the absurd habit of offering and accept¬
ing drinks, not because either party is thirsty, but in
deference to a mistaken notion of good fellowship.
By-and-bye the habit of taking drinks at odd times
is formed, and so the drinking habit is gradually
established. For this reason one cannot but deplore
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Aug. 2, 1899.
NOTES ON CURRENT TOPICS
The Medical Press. 121
advice, given ostensibly in the interests of temper¬
ance, when it takes the form of urging the drinker
4 ‘ to stop as soon as he has had enough.” Yet this is
apparently all the moral suasion which the Bishop of
Ely cares to exert over his flock, judging from the
report of a recent speech of his, which went the round
of the Press. As well might one advise the reckless
cyclist to Btop on the down grade when he is going
too fast. That is precisely what he often c?innot do
if he tries, and in respect of alcohol, moreover, the
desire to stop is usually absent. Alcohol is an
insidious poison, and the appetite grows by what it
feeds on. It is comparatively easy to stop at the
threshold, but every glass of liquor lessens the indi¬
vidual's power of self-control, and after a certain
stage his one desire ie to go a step further. The
principle which ministers of religion and advocates of
temperance should seek to inculcate is the desirability of
strugglingugainst the invading habit of indiscriminate
drinking which is the root of the evil. It matters
little what one takes with meals, the harm follows
on the between-meal nips, and unless this funda¬
mental weakness be resisted it is idle to talk of
stopping at a particular stage on the road to ruin.
The London Hospital Sunday Fund
Award.
The large total (£'50,71*!) reached by the Hospital
Sunday Fund this year is inclusive of a donation of (
£10,000 from Mr. George Herring. But the Fund
has other sources of income than that derived from
the churches. It receives the interest from £45,000
Consols left by the Guesdon Trust, and the reversion
belongs to it of £50,000 on the death of a lady. Alto¬
gether, with the addition of the collection this year,
the Fund has now been the means of awarding a sum
of £1,000,000 to the London hospital charities.
Coming now to the awards, the first noticeable
feature is that the unfortunate Queen's Jubilee
Hospital is credited with " nilnot the first time,
by the way, in which this institution has been so
dealt with. It would seem from this that the Sunday
Fund authorities have not condoned the attack made
upon the hospital by Truth. Either this is the case
or the authorities of the hospital have failed to J
satisfy the requirements of the Fund as to the details I
of their management of the charity. In any case, |
to be publicly branded as unworthy of participation |
in the awards cannot fail to be damaging
to the interests of the latter, and we should imagine
that the Queen’s Jubilee Hospital rather loses than
gains by the efforts of its committee to obtain Borne
recognition of its work from the authorities of the
Sunday Fund. The next matter of interest is the
award to St. Thomas's Hospital. This only amounts
to £104 3s. 4d. Surprise must naturally be felt at
the paltriness of this sum. But at the meeting of
the Fund last week it was explained that the hospital
-waB so largely endowed that its needs w ere small.
We wonder if this expression of opinion has found
favour with and been endorsed by the authorities of
the charity concerned. For the rest it would be
interesting to learn the reasons for awarding
£729 3s. 4d. to the Poplar Hospital, when the
West London and Great Northern Central
Hospitals are credited with £625 only. No one
doubts for a moment the excellent work
performed by the Poplar Hospital, but how
can the large award to it be explained in comparison
with that credited to the West London Hospital, an
institution which is now recognised as being one of
the most important centres of post-graduate tuition
in London, and contains 152 beds.
The Punishment of 14 Peculiar People.”
Among the cases tried at the Central Criminal
Court last week was that of a man and his wife,
members of the 44 Peculiar People,” on a charge of
manslaughter in respect to one of their chil¬
dren. The child, aged five years, fell ill, and
in the course of a few days died, and the parents,
in accordance with the custom of the sect, never
called in medical aid. They were acquitted by
the jury of manslaughter, but on the following day
they were arraigned on a charge of cruelty and
neglect. In the course of the rase the defendants
admitted that if one of their children were to 6U6tain
a fracture of the leg they would apply for treatment
to a medical man. On the other hand, they advanced
the curious argument that there was abundant reason
for their refusal to seek medical aid, inasmuch as a
neighbour had had three sick children attended by a
doctor, and a fatal result had followed in each in¬
stance. It is, of course, impossible to argue with such
persons, and doubtless recognising their inability to
see the error of their ways, previous criminal court
juries have avoided bringing in a verdict of guilty
against 44 Peculiar People.” However, since the law
upon this point was settled by the Court for Crown
Cases Reserved, matters have been different, and
punishment is now being regularly meted out in
these cares. In the present case the husband was
sent to prison for six weeks, and the wife for one
month. Parents are bound to provide medical aid
for their children, and the law rightly takes no
account of any conscientious scruples which they—
as their guardians—may happen to hold against
carrying out this necessary duty. As the judge re¬
marked, it was impossible to believe that there was
anything in Christianity which implied that children
should be allowed to suffer from disease when they
could be relieved by medical aid.
London and its Water Supply.
Already, with the summer scarcely half gone, some
concern is ‘ being expressed in regard to the possi¬
bility of a water famine in London this year. It has
been pointed out that if the present dry weather
continues a very serious state of affaire will ensue.
Official returns show that during the month just
ended the rainfall was quite inadequate to have any
effect upon the sources of water supply, and it is
even now admitted that unless rain in sufficient
quantity to spoil the harvest and the enjoyment of
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Auo. 2, 1899.
NOTES ON CURRENT TOPICS.
122 The Medical Press.
the holiday season were to fall, the situation would
be scarcely changed for the better, owing to the
intense dryness of the soil It would seem that
every year this question of the possible failure of
London’s water supply is becoming more and more
one of urgency. The Thames cannot be relied
on to meet the necessary requirements in this
respect. The river remains the same in size
while the metropolis grows, and the demand
increases. Fortunately, other and purer sources
are available in the “ New River ” and the
“ Kent ” supplies, or London would, indeed, be in a
sorry plight. It is even now a question whether th®
County Council, will not eventually be compelled to
consider seriously the proposed scheme of drawing a
supply from Wales.
The Academic Costume Again.
A correspondent in a contemporary has urged as
a reason for endowing the Members of the Royal
College of Surgeons, England, with an academic
costume that they would be able to make use of it at
the annual meeting of the British Medical Associa¬
tion, and he expresses, at the same time, the hope
that in 1900 every member of the Association will be
requested to wear a gown. But he goes further still.
He thinks that a gown should be worn in the consult¬
ing room, and that medical men would command
more respect and extract larger fees from patients if
they were to prescribe thus academically clad. What
a descent is this from high ideals to the low level of
commercialism! We do not dispute that “fine
feathers make fine birds,” but we have yet to learn
that patients are likely to be attracted by
the costume, however gaudy, which their practitioner
may choose to adopt. The public usually follow the
custom of employing practitioners whom they find to
be capable and trustworthy, and their respect and
regard for their medical men are dependent upon
those two qualities. It is, therefore, not in the least
possible tlmt they would be impressed by seeing their I
doctor in his consulting room robed in a gaudy hood ;
on the contrary, they would be much more likely to
regard the matter from a humorous aspect, and
associate the display with the development of an
element of eccentricity in their medical adviser
suggestive to them of the necessity of being
watchful respecting his future proceedings
However, it is scarcely needful to condemn
these suggestions. It is self-evident that they
must be described a3 foolish. Let the Members
of the Royal College of Surgeons ask the Council to
procure for them a return of the number of Fellows
of the College who have availed themselves of the
privilege to procure a Fellow's gown, and then ask
themselves whether agitation in favour of a Member’s
gown is worth the candle. We should not be sur¬
prised, if such a return were made, to find that not
more than 2 per cent, of the Fellows had provided
themselves with the gown designed for their special
benefit, and quite possibly what would be true of the
Fellows would be the case with the Members. As a
matter of fact, busy practitioners, whether Fellows
or Members, have something more to think about
than to trouble themselves concerning the question
of an academic costume.
A “Haunted” Hospital.
We gather from the Liverpool Poet, that one of the
large hospitals in the town—the name is not given—
has the reputation of being “ haunted.” The appa¬
rition, which has frequently, so it is stated, appeared
to the nurses of the institution, is that of a porter •
who, some years ago committed suicide by cutting hie
throat in in a small room off one of the landings,
and was carried along the landing from the room to
one o» the large wards in which he died. “ Now and
again," continues our contemporary, “ a nurse will
see, either standing in some part of this corridor, as
if awaiting orders, or walking along it a porter in the
official uniform of the hospital. He appears in every
respect an ordinary official, but on addressing him or
in approaching him nearly he suddenly disappears. The
matron evidently treats the matter as one of serious
moment, for any mention of the * ghost ’ is strictly for¬
bidden among the nurses for fear of alarming the proba¬
tioners.” A haunted hospital is certainly a novelty in
hospital life. But we should like to know, admitting the
authenticity of the statements, what it is that has
made the spirit of the porter uneasy ? Possibly he
has a grievance against a nurse who failed to treat
his suicidal wound antiseptically. Or perhaps he
has been making this special effort to reproach one
of the medical staff who did everything that was
possible to save his life. Anyhow, something should be
done to “lay” the ghost, and no doubt this would be an
easy matter as soon as the cause of the grievance was
ascertained. We would suggest in the meanwhile, as
a remedy, a fire hose containing a one in twenty-
solution of carbolic acid; as, however, the porter
does not allow himself to lie approached, it would be
necessary to circumvent his wariness by special
arrangements adapted for the purpose Spraying a
ghost with a one in twenty carbolic acid solution
would be quite in keeping with the principle of
sterilising instruments and other things regarded as
indispensable in hospitals in the present day.
Food and Drug Adulteration.
Sir Charles Cameron, M.P., deserves the
thanks of everyone but the adulterators for his
scathing denunciation of the Government Bill—as
doctored up by the President of the English Local
Government Board—for the protection of the trader.
We have already spoken of this measure as being a
wolf in sheepskin, an attempt, under pretence of pro¬
tecting the public, to prop up trade interests.
The real contest is between the vendors of
margarine under the name of butter and 1 the
butter merchants, and between other traders
in other commodities whose money interests are
opposed, and the public is scarcely thought of in the
dispute. The Government evidently think that the
wholesale adulterators are a more useful voting force
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A uo 2, 1899. _NOTES ON CURRENT TOPICS. Th* M.dical Paxss. 123
than the tame and careless consumer, for its latest
move has been to strike out of the Bill a clause which
would have made the wholesaler legally liable if he
issued an invoioe of his adulterated stuff—falsely
describing it under the designation of a pure article.
The small shopkeeper, who is prosecuted for an
adulteration of which, probably, he is perfectly inno¬
cent, iB thus made a bafFer upon which the sanitary
authority may expend its energy intended for the real
culprit—the wholesaler.
The Summer's Death Toll.
Delightful as summer weather may be it, never¬
theless, always exacts a death toll, especially among
the infant population, and its death-dealing qualities
bear an adverse ratio to the height of the tempera¬
ture of the air. Thus the prevalence of the seetival
wave of heat during the past few weeks has been
associated with a gradual rise in the mortality
throughout the country, mainly among the infant
population. For example, last week, according to the
Registrar-General’s Returns, out of 4,028 deaths of
all ages and from all causes, no fewer than 1,423. or
35 per cent, were infante under a year old. For the
most part the increased death-rate is attributable to
diarrhea and dysentery, the origin of which is
probably zymotic. Not even children who are
nourished by their mothers’ milk escape the diarrhoeal
attacks, although the mortality is much greater
among those that are hand fed. It is certain, how¬
ever, that if the present heat increases the infant
death rate is bound to assume excessive proportions,
inasmuch as the experience of previous years has
taught that despite every care as to prevention and
treatment fatal summer diarrhoea always accom¬
panies a wave of heat.
The Effects of Vaccination in Germany.
The anti-vaccinationists are a never-satisfied body
—they always want to prove too much. They are
claiming now that the Conservative party lost the
Oldham election entirely as the result of the efforts of
the anti-vaccinationists in the town. But it is
scarcely needful to seriously discuss such a statement
as this. We, therefore, deem it more to the purpose
to direct the attention of the Anti-vaccination.
Society to the figures relating to the subject of
vaccination in Germany. The statistics are remark¬
able. The population in Germany in 1871 was
40,000,000, and of these no fewer than 143,000
died from small-pox. After that year vaccination laws
were introduced, making vaccination compulsory, and
the result lias been that the average number of persons
who now die from small-pox in the Fatherland is 110.
What more eloquent testimony than this could be
wished for in order to show the value of vaccination ?
To dispose of such statistics as these is beyond the
power even of the anti-vaccinationists, and their
discontent under the circumstances is not surprising.
But the general use of calf lymph is playing sad
havoc with the anti-vaccinationist propaganda, and
there are now reasons for supposing that the “ tre¬
mendous experiment,” such as the Vaccination Act
of last year was regarded, will in the end prove a
very useful measure.
Arsenic in Thyroidism.
A French observer calls attention to a means of
controlling the untoward symptoms which not un-
frequently follow the administration of thyroid
extract for obesity and goitre, and in certain diseases
of the skin. He found that the exhibition of from
two to twelve drops daily of Fowler’s solution sufficed
in most instances to obviate the palpitation, dyspnoea,
&c., induced by a course of thyroid extract. The
symptoms ceased when the arsenical treatment was
instituted and reappeared when it was desisted from.
As far as he could judge the co-administration of
arsenic and thyroid extract, in no wise interfered with
the therapeutical effects of the latter. We are
familiar with the controlling effects of the arsenical
treatment in affections, such as Graves' disease, which
are supposed to be due to hyperactivity of the thyroid
gland, and it is therefore, not surprising to learn that
a similar controlling effect is produced on artificially
induced thyroidism and the suggestion is one which
deserves attention in view of the very large scale on
which thyroid extract is now employed.
Vicarious Menstruation by the Ear.
Dr. Lermoyez recently related before the Paris
Hospitals Medical Society a curious case of vicarious
menstruation. The subject was a girl who some years
before began to lose blood periodically from the right
ear. Every month, after some headache and general
lassitude, an escape of clear non-coagulable blood took
place from the auditory meatus, although on examina¬
tion no local lesion or solution of surface continuity
could be discovered. It was noted that the tympanum
was intact. Three years after the onset of this
irregular menstruation the function became esta¬
blished per vias naturalee, and since that time the
aural discharge had only recurred at rare intervals.
Dr. Lermoyez regards the abnormality as a neuro-
symptomatic manifestation of latent hysteria, inas¬
much as examination revealed the existence of slight
hypoa?sthesia of the tympanum and of the auditory
canal, as well as a certain degree of auditory anzes-
thesia.
The Kissing Bug.
The inhabitants of several cities in the United
States are suffering from a sort of epidemic due to
the bite of an insect to which the euphonious name
of “kissing bug” has been given, by reason of its
preference for the lips. There is nothing amusing
about this animal apart from its name, for its kiss is
followed very promptly by marked swelling, pain,
and tenderness of the lips and adjacent parts of the
face, sometimes culminating in unequivocal evidence
of active cellulitis. The incriminated animal is
described as about an inch in length, of a dark
brownish-red colour, and is provided with six legs
and long antenna*. Let us hope that our American
Cousins will keep this offensive specimen of the
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124 The Medical Press.
NOTES ON CURRENT TOPICS.
Aug. 2, 1899.
genus bug for home consumption as we have no use
for it over here.
Ventilation and Change of Air.
Some ingenious person lias suggested that if
people were careful to secure more perfect ventila¬
tion of their homes throughout the year they would
be able to dispense with the • costly obligation of
taking a periodical holiday. There is certainly
something to be said in favour of this idea since none
would care to question the superiority of a constant
supply of fresh air over casual indulgence therein.
Our correspondent, however, overlooks the fact that
holidays subserve other purposes than to secure an
unlimited supply of pure air. They provide an
opportunity for change of occupation, which is a
form of rest, for relief from the intolerable mono¬
tony of the existence led by so many human
beings in factories, offices, shops, and counting
houses. Moreover, there is virtue in the mere
change of air as this entails change of en¬
vironment and habits. The hygienic value of
a holiday largely depends upon the way in which it
is spent, and this, of course, must vary according to
the age, health, vigour, and tastes of the holiday¬
maker. The young and vigorous do net need physical
rest, but change of habits; consequently a long
journey by road, rail, or sea is preferred, while the
middle-aged clerk, with no spare muscular energy,
manifests a preference fora vegetative existence, free
from the preoccupations and worries of his normal
existence. The ever-increasing popularity of the
cycle leads many people, physically unsuited for the
strain, to undertake tours de Jorce on wheels which,
when reduced from theory to practice, prove the re¬
verse of exhilarating. Fortunately, many of these
persons are wise enough, at the end of the first day
or two, to recognise the inanity of such excursions,
and to abandon th e trip, which has been the object
of such elaborate preparations, in favour of a less ex¬
hausting method of whiling away the summer days.
Every autumn, however, brings to one's notice a cer¬
tain number of instances of heart strain unquestion¬
ably the result of ill-judged physical exertion during
the holidays, and it behoves the middle-aged man
more especially to bear this risk in mind when
making his plans. Many of these cases, it is true,
recover after more or less distress, but in a tangible
proportion the cardiac function remains permanently
impaired.
Presentation to Dr. R. Phillips Geleton.
A few days since the officers and attendants of the
C lare Lunatic Asylum presented Dr. Gelston, late
resident medical superintendent, on the eve of his
departure from Ennis, with a beautiful illuminated
address and a magnificent album-blotter, designed
and executed in the most elaborate manner. The
address was of the most eulogistic character, as were
also the subsequent speeches of the representatives
of the asylum officers and of the church. The affec¬
tion entertained by the inmates of the asylum
towards Dr. Gelston was testified by a presentation
to him at the same time from a female patient,
consisting of two linen pockethandkerchiefs, on
which her imaginary initials (those of a really titled
English lady) were beautifully worked with the
needle, and which she inscribed “ A slight token in
kind remembrance.”
Fees for Certifying Dangerous Lunatics.
As we note that the new Guardians of the Boyle
and other Unions have assumed the authority to
“ fix ” the fee payable by them for the examination
of dangerous lunatics at a much less sum than the
£2 allowed by the Act of Parliament, we think it
well to remind our readers that the Guardians' sole
function is to pay what the magistrates order (under
£2). They may advise or remonstrate, but they have
no more legal authority in the matter than the blue¬
bottle which buzzes about the window pane. We
would refer our readers to Clause 14 of the Dangerous
Lunatics Act 38 and 39 Viet., Cap. 67, in proof of our
contention.
Edinburgh University Graduation
Ceremonial.
Last Saturday the final wind-up of the University
of Edinburgh’s medical work for the year took place,
a large number of degrees of M.B., Ch.B. being con¬
ferred, and a considerable number of men raised to
the higher M.D. degree. Six of the theses for the
latter received the coveted Gold Medal. One of the
recipients of this honour being a lady practitioner.
William J. Barclay, B.A., M.B., Ch.B., gained the
“Ettler Scholarship,” and a namesake of “Oom
Paul,” and, we believe, a nephew of his, the “ Syme
Surgical Fellowship.”
A New Steriliser.
A new preparation composed of chlorate of
potash and sulphuric acid has been introduced by
Professor Berge, of Brussels University. He claims
for it that when brought into contact with water the
chloric acid of the mixture becomes decomposed into
oxygen and what he calls “Poleozone,” which he
says is the most energetic oxidising agent and
bactericide known. Fishes and plants, he alleges,
live well in water impregnated therewith, but that it
at once destroys all microbic life.
PERSONAL.
Mr. A. F. Stanley. M.A., has been appointed Pro¬
fessor of Physiology in University College, Bristol.
Mr. Norman Hay Forbes, F.R.C.S.Ed., has been
appointed a Justice of the Peace for the borough of
Tunbridge Wells.
Mr. Robert O'Callaghan, F.R.C.S.I., has been
appointed surgeon and gynaecologist to the French
Hospital, London.
Dr. Sutherland, Assistant Professor of Pathology in
Glasgow University, was appointed on Saturday last to
the Chair of Pathology in St. Andrew’s University.
The Empress Frederick of Germany (Princess
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Ado. 2, 1899.
MEDICO-LEGAL INTELLIGENCE. Thi Medical Press. 125
Royal of England) has promised to lay the foundation
stone next spring of the new building of the Nottingham
Children’s Hospital.
A beneficent contributor, whose personality is only
publicly known under the initial “ M,” has sent a further
donation of .£5,000 to the treasurer of Guy’s Hospital
for the re-endowment fund.
Dr A. G. Da vet, Senior Physician to the Royal Isle
of Wight Infirmary, had the honour of being presented
to the Queen on Saturday last on the ocoasion of the
opening of theChildren’s Wing which has been built in
commemoration of Her Majesty’s long reign.
Her Majesty the Queen has bestowed the Decoration
of the Royal Red Cross on Miss Leonora Maxwell-
Muller, late Superintendent in the Indian Army
Nursing Service, in recognition of her special devotion
and competency in the discharge of her duties in
the Army Hospital Corps.
THE BRITISH MEDICAL ASSOCIATION
AT PORTSMOUTH.
Members of the Association may be congratulated on
this year's choice of Portsmouth as a meeting-place. The
interests associated with the town are many and varied,
and there will be abundant opportunities for visitors
to acquire new experiences, not only in intellectual but
also in social and physical directions. As a seaport
town and a centre of a busy shipbuilding industry the
place has long been familiar, but it is best known, per¬
haps, in connection with the Government dockyards. It
is practically continuous with the fashionable district of
Bouthsea. Gosport is contiguous, and Southampton, the
Isle of Wight, and the New Forest within easy reach.
Visitors will have opportunities of visiting Neiley and of
inspecting some of the men-o’war stationed in the
locality. Turning to the scientific aspects of the meeting,
we find even more than the usual allowance of papers,
of which it may be presumed a large number will be
taken as read. Judging from past experience, there is
some room for improvement in that direction, for not
all the papers handed in to the honorary secretaries
of sections have subsequently seen the light of
day. So far as we have heard, however, the
editor of the British Medical Jovmal is in no way
responsible for this local process of editing by excision.
At the same time it would be well if inquiries were
made from the head office as to the ultimate fate 1 of
articles that have been handed to local secretaries. As
a general rule, nothing but praise can be accorded to the
organisation of the enormous amount of detail business
that is involved in the conduct of so vast a concotirse as
that of the Annual Meeting. This year, for the first
time, the railway companies have made a considerable
concession to members of the association. Members who
have ignified their intention of being present at Ports¬
mouth ave received an official permit, on presenting
which they will be enabled to secure a returu ticket at a
fare and a quarter. It is announced that the concession
has been made this year as an experiment, so that it is
to be hoped members will avail themselves of the oppor¬
tunity thus offered to such an extent as to encourage
the railway companies to repeat, if not to extend, these
facilities in future.
Many matters of special interest to general practi¬
tioners are to be brought forward at the general meet¬
ing, which it is to be hoped will be attended by more
than the usual somewhat scanty average of members.
Such important questions as the licensing of midwives
and of opticians by registered practitioners are down
for discussion. Another point of special interest is the
inquiry by the Coventry medical men why the recom¬
mendation of the Council of the Association made last
year with regard to local friendly societies has not been
enforced.
The entertainments are very numerous and varied,
and include garden parties by Inspector-General Mac¬
donald, C.B., and medical officers of R.N., and by
Colonel Commandant Poore and officers of Royal Marine
Artillery. Mr. Benjamin Barrow, of Ryde, the senior
Vice-President of the Association, will also give a recep¬
tion.
The annual dinner of the Association will be held in
the handsome Town Hall on Thursday, and on the
same evening a reception will be given by the Ladies'
Committee; the Mayoress and Mrs. Lloyd will receiv
the guests.
The final general meeting will be held on Friday in
the Albert Hall. The same day garden parties will be
given by Mr. Montague Foster at Shiblington, and by
Director-General Nash and officers of the R.A.M.C. at
Netley. The Mayor gives a garden party on Wednes¬
day at Melton, and a ball on Friday. Saturday will be
devoted to the excursions, and Surgeon-General Cuffe,
C.B., and the officers of the R.A.M.C. entertaining have
invited a party of 200 to make a trip on the steamer
Dandie Dxnmont to Cowes and round the Isle of Wight.
On the evening of the same day the last ceremony of
the meeting will be a grand Military Tattoo by massed 1
bands of the garrison, a torchlight procession, and grand
display of fireworks.
The forty-first annual meeting of the New Sydenham
8ociety is announced for to-day (Wednesday), August
2, at five o’clock p.m., in Committee Room No. 1, Town
Hall, Portsmouth. Business : Annual report, balance-
sheet for 1898, election of officers for 1899-1900. The
attendance of all members of the society is requested.
Altogether the prospects of the present meeting are
brilliant. With a large attendance, perfect summer
weather, and the social and professional advantages
afforded by the neighbourhood, the meeting should be a
red-letter one in the history of the association.
^cbico-l^egal intelligence.
TALLERMAN v. THE DOWSING CO.
Treatment by Radiant Heat.
An application for an injunction was heard on July
19th and 20th by Mr. Justice Stirling in the Chancery
Division of the High Court of Justice. As the case
involves various points of interest to the medical pro¬
fession, a short outline of the main features is appended.
Counsel for Tallerman asked the Court to decide on
the facts that the defendant Dossing Co. had
fraudulently used for their own purposes the
case-notes and the testimonials of the plaintiff,
and had fraudulently made use of the plaintiff’s reputa¬
tion, and that an injunction be granted to restrain such
appropriation. A number of affidavits were put in on
both sides, and the hearing of the case, which involved
the arguing of a number of legal principles and other
technicalities, occupied two days. The plaintiff’s case
e
126 The Medical Press
LABORATORY NOTES.
Auo. 2. 1899:
was briefly, that in 1893 he patented an apparatus for
the application of dry air, a system of treatment
that had been very successful. He had never
advertised his methods to the public, but in¬
troduced them to hospitals, and trusted to cases,
speeches, articles, and so od, published by medical men
in the medical journals. Mr. Tallerman’s Secretary, Mr.
Pritchard, left him, and became secretary to the de¬
fendant company in March, 1899.
Two medical men, Dr. Sibley and Dr. Hedley, were
also concerned in the case. With egard to Dr. Hedley,
the plaintiff’s position was thus defined in his evidence.
Dowsing was instructed and aided in the manufacture
of his apparatus and its application by Dr. W. S.
Hedley, who had in the year 1894 been instructed
by Mr. Tallerman in his treatment by hot air, and he
became the plaintiff company’s agent and representative in
Brighton on the terms that the plaintiff company divided
with him the fees received from patients for advice and
treatment on his system. While occupying that position
the said W. 8. Hedley in the year 1895 constructed
an apparatus which the plaintiffs alleged infringed the
aforesaid patent, and he was called upon to surrender
the apparatus. This he did, and further agreed not to
be connected with the working of a similar one in future.
As regards Dr. Sibley, in August, 1896, that gentleman
published in the Lancet an article on the Tallerman
treatment, giving his experience at the North-West
London Hospital, with which he was connected. The
Lanctt article had been edited and published in a pam¬
phlet by the Dowsing Company as if it applied to the
Dowsing treatment. Dr. Sibley’s article was read in
that way by the editor of the Daily Mail, who stated
in a paragraph in his newspaper that the Dowsing
bath had been favourably commented upon by Dr.
Sibley in an article in the Lmcet, and by Dr
Hedley, physician in charge of electro-therapeutics
at the London Hospital. The Daily Mail article
appeared in one of the pamphlets issued by the
Dowsing Company. On May 6th, 1899, the Lancet said
in an editorial note:—“ We have seen the pamphlet and
we cannot recommend its dissemination upon their
business methods. It contains a mutilated article, the
original of which was written by Dr. W. Knowsley
Sibley in support of the Tallerman treatment. The
title of the article is suppressed in the pamphlet. Dr.
Sibley’B words now wear the appearance of a commenda¬
tion in the Land of some other treatment. Such
tactics will not win the approval of the medical profes¬
sion or the publio.”
Dr. Sibley also made a speech at the Balneological and
Climatological Society during a discussion about March
1st, 1899, on the treatment of disease by heat. The
report of Dr. Sibley’s speech was not inserted in the next
number of the Journal of Balneology and Climatology,
but nevertheless appeared in the Dowsing pamphlet,
but has since been printed in the journal. The published
report contained the speech edited, but omitted all
reference to the Tallerman method, just as in the Lan et
article.
The position taken by counsel with, regard to defen¬
dant was mainly that of legal objection to the form of
the action in attributing fraudulent intention. It was
several times suggested that if the dispute had been
approached in a friendly spirit an arrangement might
have been made. It was also stated that they were
willing to say Mr. Pritchard should not be employed
after September next. No affidavits were produced
either from the last-named or from Dr. Sibley and Dr.
Hedley. The defendant Dowsing, however, made
the following statements in his affidavit:—“ 18. The
article by Dr. Sibley in the Lancet of Aueust 29th.
1896, contained a number of well-stated propositions
applicable to any of the existing systems for the applica¬
tion of dry heat for therapeutic purposes. Believing
that the copyright of the article belonged to Dr. Sibley,
I asked if he saw any objection to my extracting from it
these propositions for insertion in my company’s pamph¬
let of extracts from the medical press. He assented to
my doing bo. My only object in thus acting was
to utilise Dr. Sibley’s general riews ot' the
principles common to the treatments of the
kind. Dr. Sibley was at that time acquainted with
my apparatus. It is true that the remarks of
Dr. Sibley to the Balneological Society referred to iu
plaintiff's affidavit do not appear in the April number of
that Society’s journal, though I understand they are
intended to appear in the current number. I obtained
from Dr. Sibley an advanoe copy of the number for in¬
sertion in my company’s pamphlet and believe them to
be a true report of what he said at the adjourned meet¬
ing of the said society on March 23rd, 1899. I inserted
them exactly as received, and Dr. Sibley correctel my
proof-print before publication. If there was any
omission of a reference to the plaintiff’s or
any particular system in the original report it
was made by Dr. Sibley himself. The proceedings
at the adjourned meeting were too late for insertion
in the April issue of the journal, which had gone
to press. I am not aware that I have furnished
these extracts in such a form as to prejudice or damage
the plaintiffs.”
With regard to the editing of articles, it was
explained that Dr. Sibley objected to names. Plaintiff’s
counsel interposed by pointing out a difference between
the balneological speech as quoted in the journal and in
the Dowsing pamphlet.
The learned judge remarked that the altera¬
tion was in Dr. Sibley’s handwriting, a fact at
which he expressed surprise, and later: — “ I cannot
imagine that a professional physician like Dr. Sibley
would deliberately falsify, for that is what it comes to,
his own speech in order to give one an advantage over
the other.” After a prolonged hearing the learned
judge reserved judgment, and added:—“I should be
very unwilling to come to a conclusion that enough
was proved in this case to justify the action in the form
in which it is brought, but I have no hesitation
in saying that, whatever the legal result may
be, I think the defendant has made a mistake,
and that the statements of fact which have been put
into this pamphlet, and the article have been so modified
as to produce a wrong impression on the mind of the
reader; and, having regard to the statements in the
affidavit of Mr. Dowsing himself that he desires to
make his money by his own merit, I can hardly suppose
that he will not take steps, whatever the law may be, to
at once correct that erroneous impression.”
Judgment accordingly reserved.
Xaboratorg Jtotes.
MARTELL’S “THREE STAR BRANDY.”
We have carefully examined a sample of this well-
known spirit by the usual tests, and the results obtained
by analysis fully warrant our recommending it for
medical and dietetic purposes. The analysis gave the
following figures:—
Alcohol (as proof spirit)
1 Extractives
Ash.
Acidity .
Ethers (as alcohol)
86 5 per cent.
68 ,. ,.
Nil.
03e „ „
028 „ „
As appears from the above, it contains a relatively
high percentage of alcohol, being well over the
minimum alcoholic strength required by the New Food
and Drugs Amendment Act (75 per cent, of proof
spirit). The amount of ethers present is such as is
usually found in genuine old brandies distilled from
wine, and its flavour and aroma compare very favourably
with those of similar high-class brandies. It is free
from any undue amount of acidity, as well as from the
various products met with in ill-matured spirits.
We analysed this product some ten or more years
ago, and finding that it still maintains its exceptionally
high character, we are consequently in a position to
speak highly of it as a genuine old brandy made from
wine, well matured, and free from all compounds which
might detract from its value as a medicinal agent.
Digitized by GoOglC
Jolt 26, 1899.
MEDICAL NEWS.
Th* Medical Press. 127
CflorreBponficncc
We do not bold ourselves responsible for tbe opinions of our
correspondent*.
A DESERVING CASE.
To the Editor of The Medical Press and Circular.
Sir,— Being in the position to know the facte and
circumstanoes concerning the regretted and unexpected
death of Dr. W. B. Lauria on July 8th, I write to you
on behalf of his wife and family in the hope that this
appeal may not only reach the friends of Dr. Lauria,
but also the charitable members of the profession. Dr.
Lauria, through the effects of a severe accident, had
been for nearly two years prevented from practising his
profession. Directly his health permitted, he secured
an appointment at Lagos, but shortly after taking up
his work there he succumbed to the deadly nature of
the climate. Dr. Lauria leaves a widow and three chil¬
dren quite unprovided for. All subscriptions to the Dr.
Lauria Fund should be sent to Dr. Beers, 6, Wandsworth
Bridge Road, London, 8.W., or to Dr. Haitnell, 1, Rye-
croft Street, Fulham, S.W.
I am. Sir, yours truly,
Victor Horslet.
26, Cavendish Square, London, W.
July 27th, 1899.
©bituarn.
PROFESSOR JOSEF MAYER. OF CRACOW.
With the death of Professor Mayer, whose name is so
well and favourably known in this country, Cracow has
lost one of its most prominent members. He was born
in Cracow 1808, where he studied and took his degree in
1831. In 1833 he was appointed Professor of Medicine
in the Jagiellon University of Cracow. In 1848 he was
appointed Rector, and inaugurated many reforms. In
1877 he retired from professorial work and devoted him¬
self wholly to literature and scientific investigation, on
which he was a varied and prolific writer. He was the
founder of the first medical paper in Poland—viz.,
Przeglad Lekartki, still the leading journal in that
country. During his lifetime Franz Josef had conferred
on him many honours and titles of dignity. He had
entered on the ninety-second year of his age at the time
of death.
^ttebical
Careless Death Certification.
An inquest was held a few days since at Hammersmith
on the body of a child who had been attended by an un¬
qualified person of the name of Achille Monpalao. who
claimed to possess an Italian diploma. The child had
previously been seen by Mr. Swindale, a local practi¬
tioner, who ultimately certified the death when Monpalao
declined to give one. We would advise Mr. Swindale
to be more careful in future in certifying the deaths of
persons attended by unqualified persons, especially as in
this instance he was rebuked by the coroner for his
laxity in the matter. Just to show how necessary is a
reform of the laws in this respect we may add that on
inquiry it turned out that the death had not been regis¬
tered at all, and the child was buried without the pro¬
duction of a registrar’s certificate. It is to be hoped this
incident will receive attention at the hands of the proper
authorities.
The Royal University of Ireland.
At the meeting of the Senate on Friday last. Sir
Thomas Moffett in the chair. Mr. Dease, Dr. Allman, Dr.
McKeown, Dr. Macalister, Most Rev. Dr. Healy. Bishop
of Clonfert, Rev. Dr. Delany, Sir William Thomson, His
Honour Judge Shaw, 8ir Christopher Nixon, Dr. Sin¬
clair. Right Rev. Monsignor Molloy, Rev. Dr. Hamilton,
Dr. Leebody, Rev. Dr. Brown, Dr. Cox, and Right Hon.
Mr. Justice O’Brien. Sir James C. Meredith
and Dr. M’Grath, secretaries. A letter was read
from Miss Redington thanking the Senate for
their resolution of sympathy passed at last meeting.
Her Majesty’s Royal Warrant was received appointing
Lieutenant-Colonel John G. F. Ross, of Bladensburg,
C.B., to the vacant seat on the Senate. The Right Hon.
Lord Morris, LL.D., was unanimously elected vice-chan¬
cellor. The reports upon the results of the summer
examinations were considered, and passes, honours, ex¬
hibitions, Ac., were awarded in connection therewith.
It was resolved that history be inserted in the list of
subjects of examination at Second University. The
following resolution was adopted :—“ That the Senate
accepts with great regret Dr. John Campbell’s resigna¬
tion of his fellowship, and desires at the same time to
express its high appreciation of his devoted services to
the University during the long period of seventeen years
for which he has held that office.”
Measles at Liverpool.
During the last six weeks no less than two thousand
cases of measles have occurred at Liverpool, and the
epidemic has been followed by a disquieting increase in
the mortality returns. The Medical Officer of Health
reported that a drop had taken place on the closure of
the board schools. Forty-one elementary schools have
had to be closed on account of the epidemic.
Respecting Leicester Guardians.
The judges of the Queen’s Bench Division have granted
a mandamus to the Leicester guardians to appoint a vac¬
cination officer in accordance with the Statute, but seven
days’ grace has been accorded in view of an appeal. On
their return home a large and enthusiastic crowd, duly
garnished with biass and other wind instruments, met
them and serenaded them to the Floral Hall, where a
meeting was held, at which much perfervid oratory
was disposed of. This is a victory for the Local Govern¬
ment Board, and we shall await the next stage of the
proceedings with interest.
The Clerical Botanist.
The trial of the LL.D. and ex-clergyman, on a charge
of manslaughter, came off on Saturday last at the
Central Criminal Court. The prisoner, who practises as
a medical herbalist, had attended a child suffering from
diphtheria which he had not recognised, with the result
that the child died and another child contracted the
disease. The medical evidence tended to show that the
treatment was altogether unsuitable, and even injurious,
and after a patient trial the jury returned a verdict of
guilty, coupled with a recommendation to mercy, based
apparently on the implicit confidence which the prisoner
evinced in his ignorant practices. In the upshot he was
let off with two months' imprisonment.
PASS LISTS.
Society of Apothecaries of London.
During the examinations in July, 1899, the following
candidates passed in :—
Sunrery.—R. P. N. B. Bluett, H. R. Cross, A. B. Dunne (Sections
I. and II.). A. D. Evans, F. R. Featherstone (Sections I. and II.),
C. Fisher (Sections I. and II.), J. E. Griffith, E. S. Johnson, F. S.
Leech (Section I.», G. S. Moore. O. H. Roberson (Section I.), A. F.
Weston (Section I.), C. C. Worts, T. H. B Yornth.
Medicine.—F. G. Aldrich (Section I.), B. P. N. B. Bluett. T. S.
Elliot (Section I.). H. Fawcett, E. L. Gowlland (Sections I. nnd II.),
H. M. Hardy. O. E. Lemin (Section I.), R. A. Lyster, V. S. Pnrt-
rid(re (Section II.), J. W. Robertson. F. C. Torbitt, L. E. Whitaker
(Section I.), W. H. Willcox, E. D. Wortley (Section I.), T. Youngr
(Section I.)
Forensic Medicine.—R. P. N. B. Bluett, T. S. Elliot. E. L. Gowl¬
land, H. M. Hardy, 0. E. Lemin, K. A. Lyster, W. P. R. Newth, E.
S. Pushonfr, L. K. Tickner, F. C. Torbitt, W. H. Willcox.
Midwifery.—M. A. Alabone. R. P. N. B. Bluett, A. M. Davis, C. A.
W. Eean, H. C. Holden, H. R. Miller. A. C. Oliver. E. S. Pushonfr,
G. M. Smith, L. K. Tickner, S. J. Welch, L. E. Whitaker, W. H.
Willcox.
The diploma of L.S.A. was granted to the following
candidates, entitling them to practise medicine, surgery,
and midwifery:—
R. P. N. B. Bluett, H. R. Cross, A. D. Evans, E. L. Gowllanl. J.
E. Griffith, E. S. Johnson. G. S. Moore. V. S. Partridge. - T . W.
Robertson, L. K. Tickner, W. H. Willcox, and T. H. B. Yorath.
Digitized by Google
128 The Medical Press NOTICES TO CORRESPONDENTS. Ado. 2,189ft.
^otitce Jo
(Eorrcfipcmbents, Short ^tetters, &r.
4h6~ 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 “ Reader,"
“Subscriber,” "Old Subscriber," &o Much confusion will be
spared by attention to this rule.
Local Eepobts a>d News.— Correspondents desirous of drawing
attention to theee are requested kindly to mark the newspapers
when sending them to the Editor.
Reading Cases. —Cloth board cases, gilt lettered, containing
twenty -six strings for holding the numbers of The Medical Press
ahd 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 intnct, clean, and flat after it has passed through
the post.
Reprists.—A uthors of papers requiring reprints in pamphlet
fora, afterthey have appeared in these columns can have them, at
half the usual cost, on application to the printers before the type is
broken up.
Original Articles or Letters intended for publication should
be 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.
“ LENNOX ” IN THE " ECHO."
As an example of the freedom with which certain evening “ rags ”
publish mendacious statements, a correspondent calls our attention
to the utterances of the notorious “ Lennox’ - in a recent issue of
the nclio. He asserts that the large amounts subscribed to hospital
funds by the public avail the public but little, because, forsooth.
“ the honorary staff draws the money and the patients are treated
like cattle.” How the "honorary” staff can draw the money this
disreputable correspondent of a not leas disreputable journal doee not
stoop to explain. He vouchsafes the information that he has been
served with a writ in an action for slander, and if bis utterances in
regard to private individuals are characterised by the wanton
mendacity of his remarks on professional men in general, the issue
of the action ought to be tolerably certain,
Inex. —You will find all the information you require in our Educa¬
tional Number, which will appear very shortly.
A WARNING TO SPRAYERS.
The latest adulteration vagary is the colouring of ordinary-
copperas with Prussian blue and selling it for wheat and potato
spraying (for which it is totally ineffectual) as sulphate of copper.
This'fraud has been recently brought to notice by Dr. Vaelclter,
Public Analyst for the Bath district, who believes that it has been,
already, very prevalent.
" Secret art " asks :—" Where are advertisements for secretaries
of hospitals, Ac., most likely to be seen They do not appear in the
medical journals, and very rarely in ordinary dailies.” The position
is usually non-medical, and, therefore when advertised at nil the
announcement is generally to be found in the daily press. But, very
often, the appointments are made without advertisement.
TAITIANA.
A corresjTondent writesCan you inform me where I can
find Mr. Lawson Tait's ‘ General Summary of Conclusions
from4,000 Consecutive Cases of Abdominal Section” 1894? It is
entered in the “Medical Directory” under Mr. Tnit's name, but
with no reference to auy journal. A former colleague of the deceased
informs me that he has no idea where it appeared, but he fancies
that it was published in parts in the Medical Press and Circular.
•,* The majority of Sir. Lawson Tait s communications of late
years have appeared in this journal, but we cannot trace the
Summary alluded to in 1894. A brief summary of “ The Life of
Lawson Tait ” lias recently been issued (price 6d.), by Messrs.
Bailliere Tindall, and Cox, wliich contains a good many interesting
notes. Ed.
Mr. Wtnter will receive a private note as soon ns the necessary
inquiries are complete.
SOAPSTONE FLOUR.
The Secretary of the State Board of Agriculture (Maine, V.S.),
hns issued, by circular, a warning to the public that flour is being
now adulterated, to n considerable extent, with " mineraline,”
which is nothing more nor less than ground sonpstone. We have
often heard of bone dust ns a constituent of bread, but this seems
to l>e n distinct improvement in adulteration, at least in point of
sentiment !
Vacancies.
Birkenhead Union. -Assistant Medical Officer for the Infirmary
Workhouse and Schools. Salary £80 per annum, with board,
washing, and apartments. Applications to the Clerk of the
Guardians, 45, Hamilton Square, Birkenhead.
Cheltenham Gene*nl Hospital.— Assistant House Surgeon for two
years, unmarried. Salary £luu per annum, with board and
lodging.
County Asylum, Gloucester.—Junior Assistant Medical Officer,
unmarried. Salary commencing at £120 per annum, with board
(no stimulantsl and washing.
.untv Down Infirmary. - Registrar, Assistant-Surgeon, and
Apothecary. Salary £63, with board, lodging, washing, Ac.
Applications to Dr. Tste. (Seeudvrt.).
Denbighshire Infirmary, Denbigh.--House Surgeon. Salary £80
per annum, with board, residence, and washing.
Dnndee Royal Lunatic Asylum.—Medical Assistant. Salary £100
per annum, with rooms, board, and washing.
Ennis District Lunatic Asylum.—Resident Medical Superintendent.
Salary £350 with extras valued at £110 per annum. Applications
to the Chairman. (See advrt.).
Enniskillen Union.—Medical Officer pro temp. Remuneration
£3 3s. per week. Applications to the Guardians. (See advrt.).
Halifax Royal lufirmary.—House Surgeon, unmarried. Salary £80
S r annum, advancing £10 a year, with an extra allowance of
2s. 6d per annum. Residence, board, and washing provided.
Hospital for Consumption and Diseases of the Cheat, Brompton.—
Assistant Resident Medical Officer. Salary £100 per annum,
with board and residence.
London County Asylum, Cane Hill, Purley, R.S.O.—Junior Assis¬
tant Medical Officer. Salary £150 per annum, with board, fur¬
nished apartments, and washing. Applications to the Clerk to
the Asylums Committee, 6, Waterloo Place, S.W.
Lunatic Hospital, Nottingham.—Assistant Medical Officer, un¬
married. Salary £150 a year, with furnished apartments, board,
attendance, and washing.
Oldham Infirmary.—Senior House Surgeon. Salary £85 per
annum with board, washing, and residence. Also Locum
Tenens. Three guinea*.
Rochdale Infirmary and Dispensary.—House Surgeon, unmarried.
Salary £90 per annum, with board and reeidenoe.
Royal Hants County Hospital, Winchester.—House Surgeon.
Salary £65 per annum, rising to £75, with boird and residence.
Roxburgh District Asylum, Melrose.—Assistant Medical Officer.
Salary £100 per annum, with furnished quarters, board, washing,
and attendance.
8eamen's Hospital Society (Dreadnouaht), Greenwich.—Senior
House Surgeon for the Branch Hospital in the Royal Victoria
and Albert Docks, E. Salary £75, per annum, with board and
residence and an additional £25 per ainumif certain clinical
work is performs i satisfactorily.
West Bromish District Hospital.—Resident Assistant House Snr*
geon. Salary £50 per annum, with board, lodging, washing, and
attendance.
Western General Dispensary, Marylebone Road, London, N.W.—
8econd House Surgeon, unmarried. Salary £80 a year, with
board, and residence and 10s. a month for washing.
Armstrong, Hubert, M.B., Ch.B. Viet., Honorary Assistant Physi¬
cian to Infli mary for Children, Liverpool.
Baker, Oswald, L.R.C.8., L.B.C.P.Edin., Physician to Out-
Patients of the Seamen’s Hospital Society, Greenwich.
Botd, F. D., M.D.. F.B.C.P.Edin., Assistant Physician to Edinburgh
Royal Infirmary
Duncan, Andrew, M.D., F.R.C.S., Physician to In-patients of the
Seamen’s Hospital Society, Greenwich.
Hall, C. Beauchamp, F.B.C.S.Eng., District Surgeon to the City of
London Lying-in-Hospital, City Road.
Ltlr, H. S., M.B.C.S., Senior Medical Officer to the Liverpool
Cancer and Skin Diseases Hospital.
McCria, Philip Wm., A.B., M.5., B.Ch., B.A.O.Dubl., Deputy-
Public Vaccinator for the Ashley District Union.
McGavin, Lawrie Hugh, M.B.C.S., L.R.C.P., Surgical Registrar
and Tutor to Guy's Hospital, London.
Mahont, M. J., M.B., B.Ch.Irel., Senior Medical Officer to the
Liverpool Cancer and Skin Diseases Hospital.
Phidmore, John Walter, M.B.C.S., L.B.C.P.Lond., Assistant
Medical Officer to the St. Saviour’s Infirmary, Dulwich, London.
Rentzsch, S. H , L.B.C.P.Lond., M.B.C.S., Divisional Surgeon to
the Cornwall Constabulary.
Rick. David, M.R.C.S.Eng., L.R.C.P.Lond., Assistant Medical
Officer to the County Asylum, Cheddleton, Staffordshire.
Shennan, T., M.D., F.B.C.S.Edin., Pathologist to the Royal Hospi¬
tal for Sick Children, Edinburgh, and to the Leith Hospital.
Still, G. F , M.A..M.D., M.B.C.S., Assistant Physician for Diseases
of Children at King’s College Hospital, London.
Wat, Montague H., M.B.C.S., L.B.C.P.Lond., Assistant Houae
Surgeon to the Royal Portsmouth Hospital.
Sirtlts.
Garman.— On July 24th, atOakeswe’l Hnll, Wednesbury, the wifeof
Walter Garman, Esq., M.D., of a daughter.
Monro. —On July 27th, at 17, Queen's Gardens, Muswell Hill, N.,
the wife of J. D. B. Monro, M.B., of a daughter.
rtftoriages.
Baillie -Gould.—J uly 27th, at Park Church, Grosvernor Road,
Highbury, James Baxter, son of the late Alexander Baillie,
Kinnaird, Forfarshire, to Annie, eldest daughter of Wi lliam
Gould, M.D., of Highbury.
Baresdt—Crowe.— July 27th, at St. Augustine's Church, Liver¬
pool, by the Rev. W. J. Adams, Vicar, assisted by the Rev. J.
Henderson, Rector of St. Paucras, Chichester, Frank Hugh
Barendt, M.D.Lond., F.B.C.S.Eng., of 66, Rodney Street,
Liverpool, third son of the late D. E. Barendt, of Liverpool, to
Mary Bure hull (May), eldest daughter of Mrs. Crowe, 47, Bed¬
ford Street, North Liverpool.
Jwths.
Mott.—O n July 37tli. at St. Leonards-onSen, Marcus Wm. Mott,
M.D., aged 69, sou of the late Clms. Mott, of Church Stretton.
Dig itized by
“SALUS POPULI SUPREMA LEX."
Vol. CXIX. WEDNESDAY, AUGUST 9, 1899. No. 6.
ODrigittal GTomnumicaiions,
RECENT ADVANCES IN PRACTICAL
MEDICINE, (a)
By Sib RICHARD DOUGLAS POWELL,
Bt., M.D., F.R.C.S.,
Physician in Ordinary to Her Majesty the Queen.
The author dwelled upon the comparatively short
time that had elapsed since the introduction of many
appliances now in general use, such as the stetho¬
scope, the clinical thermometer, Ac. He then
reviewed the present position of bacteriology, and
its bearings on susoeptibility or immunity, passing
on to discuss the prevention and treatment of tuber¬
culosis. Among the questions that have in the
present year ripened considerably, and have been
urged forward strenuously towards a final settlement,
that of the prevention and treatment of tuberculosis
has, he observed, taken a very prominent place, and
it is impossible not to allude to it here, although
it will be the subject of a special discussiou in the
Medical Section. Truly a disease which still claims
one-ninth of our mortality may well command our
deepest interest. That much has been done to
diminish our national liability to consumption by
improved sanitation on general grounds by Parkes,
Simon, Bowditch. Buchanan, Milroy, MacCormac,
Smith, Greenhow. is evident by the gradual reduc¬
tion of the mortality in the last hall century from
38 to 14 per 10,OK) living, or in proportion to the
population for England or Wales by one half since
1851 (Tatham). Even in comparing the quinquen¬
nium 1875-79 with that of twenty years before, Long-
staff found that the mortality from phthisis at the
ages between 5 and 35 had decreased by 15 to 28 per
cent., and he could say in 1884 that “ the decline of
the deaths in recent years is chiefly to be attributed
to a diminished number of deaths assigned to fever
and phthisis.” All this had been effected without
direct reference to the special bacillus element in the
disease, chiefly by amending those conditions to
■which he had alluded as being intermediate between
the bacillus attack, of which most of these pioneers
in tubercle sanitation knew nothing, and the illness
of the patient.
That it is aufond a right grouping to place all the
previously ascertained causes of consumption
among the predispositions, and to regard the
disease itself as produced by definite infection or
contagion through the inhalation of sputum dust, or
by the ingestion of tuberculous foods, had been
accepted at least for the last ten years; but, he
urged, we must not discontinue to attach a due
importance to the other etiological factors because
one of them may seem prinui facie to be sufficient.
To set heredity at nought, to regard climatic con¬
siderations as of no importance, and to state that the
disease is always acquired by direct contagion or
infection is, in his opinion, to ignore much that is
true, and to magnify that which should be carefully
guarded from exaggeration.
(a) Abstract of address delivered at the annual meeting of the
British Medical Association, August 1899.
Thirty years ago Sir W. Jenner, in an address
to the Epidemiological Society, declared the trans¬
mission of tuberculosis from parent to child to be
one of the best-established facts in medicine. Jenner
did not mean by this the actual transmission of
tubercle, nor has anyone that I know of, in modern
times at least, made any such contention; but that
the susceptibility to become tuberculous rmis in
families, and this I must confess remains with me
an unshaken belief. Take, for example, on the one
hand, the striking account by Dr. Reginald
Thompson of 80 families of consumptive parentage
yielding 385 children, of whom 194 became phthisi¬
cal and 37 died in infancy, leaving only 154 exempt.
Consider this in account with the unproven direct
communicability of the disease to which I shall
presently allude, as shown by the distribution
of mortality among married people compared with
their numerical liability as members of the general
public, and the case for heredity as a predisposing
cause of consumption is a strong one if not still " one
of the best-established facts in medicine." We can¬
not, of course, prevent consumptive people from
marrying; there are exceptional conditions under
which they may rightly do so, but the advice of the
family physician should be steadfast in discouraging
such alliances, which are unfortunately often prolific.
Life assurance offices, whose calculations are based
upon experience, will probably wait for much further
evidence against the heredity of phthisis before they
will feel justified in accepting without surcharge
the lives of those who present a consumptive family
history.
We are all familiar with circumstances connected
with the incidence of certain cases of tuberculosis
which render it probable that they have been acquired
by indirect contagion through the contaminated dust
of dirty rooms, and know that under certain condi¬
tions of stagnant, dark surroundings a patient with
advanced phthisis of unclean habits would cause local
danger of tuberculous infection to his attendants and
friends, and to future occupants of the room. But
except under such and similar almost experimental
conditions the evidence of the contagiousness of
phthisis is extremely slender.
It, for instance, has not been proved that tubercu¬
losis is more prevalent among married than single
people, and Dr. Longstaff has shown that normal co¬
incidence would account for more than the deaths
reported. Pulmonary consumption is comparatively
rare before puberty, infantile mortality being
almost exclusively from bowel consumption through
milk infection. Tuberculosis is nearly twice as fre¬
quent among male as among female infants. The
mortality from tuberculosis has diminished more
greatly, by from one-third to one-fourth, among
females than males above the age of 20 in the last 30
years (Hugh Beevor), when one would think that
industrial, nursing, and indoor conditions generally
would have told against the female in this respect.
The records of the officials and servants of one of our
largest consumption hospitals taken out for 50 years,
including a period precedent to the use of any special
preventive measures beyond those of ordinary sanita¬
tion, show a death-rate not in excess of that of the
ordinary population.
Digitized by CjOO^Ic
130 The Medical Press. ORIGINAL COMMUNICATIONS. Auo. 9. 1899.
Whilst, therefore, on the one hand advising every
ordinary measure of cleanliness, avoidance of dust,
and proper disposal and disinfection of sputum, we
may, and indeed must, avoid all exaggerated state¬
ments calculated to alarm the public -as to the con¬
tagion of phthisis. In respect of sanitary precaution
he instanced the simple and efficient directions of the
Medical Officer of Health for Brighton as being in
most reassuring and refreshing contrast to the theo¬
retical and alarming precautions printed for some
other health resorts and published on no official
authority. These directions are privately sent
through the medical practitioner to the person
affected.
It is again difficult to recognise the striking testi¬
mony of such trustworthy observers as Middleton, Bow
ditch, and Buchanan as to the influence of a wet sub¬
soil on the prevalence of consumption with the present
view of the acquirement of the disease only by human
and bovine infection. We must recall, too, to mind
the enormous prevalence of bovine tuberculosis, not
be it observed only among stall-fed, crowded, and
insanitary cattle communities, but among animals
under good open-air conditions. Do we not find in
this prevalence of tubercle among pasture-fed cattle,
and in the fact of the prevalence of the disease in
localities with wet subsoils and deficient sunlight,
some probability that the tuberculous organism, like
those of actinomycosis, tetanus and anthrax may have
an independent and preparasitic existence, and that
like malaria tuberculosis will probably be found to
have a double origin from purely microphytic as well
as from parasitic infection.
It is remarkable that two at least of the most
deadly of disease microbes, tetanus and anthrax,
should be normal inhabitants of the soil, and yet how
comparatively scarce these diseases are, and, as
regards one at least, how communicable. It would
seem that, as is the case also probably with malaria,
whilst the ultimate source of the disease is vegetation
in the soil, yet a greater virulence and activity is
attained, and for a short time maintained by cultiva¬
tion in the human body, or in that of certain other
warm-blooded animals. With regard to tubercu¬
losis he pointed out that whilst we may hope on
the one hand by further careful sanitation, by
destroying and diminishing the careless distribution
of bacillary dust, and by withdrawing from human
consumption tuberculous foods, still to effect a con¬
siderable inroad upon the remaining 14 per 10,000
mortality from consumption; we cannot afford, on
the other hand, to withdraw or i-elax precautions
dictated by observations, sound in themselves,
although in some regards capable of amended ex¬
planation, or we may have to make some deductions
from the two-thirds diminution in mortality already
achieved. There is probably a mephytic laboratory
beyond our special control, yielding organisms ever
ready to attach the unwary and those whose vitality
is depressed. General sanitation and cleanliness is
our first line of defence against them all. Wherever
the conditions of insanitation, dampness, deficient
sunlight, and the prevalence of favouring diseases are
present there aggressive activity may be again looked
for.
A SKETCH OF THE CENTURY’S
PROGRESS IN
MEDICINE AND SURGERY, (a)
By J. WARD COUSINS, M.D., F.R.C.S.,
Senior Surgeon to the Royal Portsmouth Hospital.
After reviewing the state of medical science at
the beginning of the century, the orator referred to
(a) Abstract of Inaugural Address delivered at the meeting of the
British Medical Association at Portsmouth on August 2nd.
the history of vaccination, and deprecated the ill-
advised action of the Legislature in deliberately
minimising the protection which Jenner’s discovery
was the means of affording.
Passing on to the subject of pathology, he observed
that the early part of the century will ever be recog¬
nised as the birthtime of modern pathology—the
period when the huge chasm between dead morbid
anatomy and living pathology began to be bridged
over. The teachings of John Hunter had long ex¬
ploded the old humoral theories of disease. The lead¬
ing minds in those days no longer considered that
disease depended upon an excess of bile, or blood, or
phlegm, and the other fluids of the body, and that it
could be cured by getting rid of these faulty elements.
The principles formulated by Hunter were main¬
tained by succeeding writera in the same field for
many years. His pathology was a long way in
advance of his predecessors, and he was the first to
recognise that all the processes of the organism be¬
longed to biological science.
To-day, he observed, we are able to appreciate the
fact that the evolution of our new pathology has pro¬
gressed side by side with the evolution of biology,
and that, in its broadest sense, pathology is an out¬
growth of biology. The work of the last fifty years
may be rightly defined as the great unravelling of the
deep relations between the healthy phenomena of life
and the variations which are outside the normal
cycle of these vital phenomena. Through many
years biology and pathology have been mutual helps
in their onward and remarkable evolution, and we
may rest assured that in the coming century their
healthy reaction on each other will still go on.
Pathology will still advance, and the new discoveries
of biology will serve as starting points of new patho¬
logical truths ; at the same time, the ordeal of biologi¬
cal criticism will be accepted as the test of every new
pathological development.
The orator then discussed the relations between
the disorders of mankind and those of the lower
animals. Recent investigations in bacteriology, he
said, have proved a great stimulus to the study of
the relations between the diseases of mankind and
those of the lower animals, and this relationship will
form an important part of future researches. It is
only a few years ago that the real nature of that
dreadful scourge of the human race, tuberculosis,
was discovered, and its intimate association with the
same disorder in domestic animals clearly brought
to light. Laennec was the first observer who
described tuberculous nodules, and traced their
development from miliary tubercles. In 1865 the
inoculation of animals with caseous material was
found to produce tiny masses in their bodies which
were in all respects similar to the disease in man.
Some physicians were bold enough to assert that the
henomena suggested the probability of contagion,
ut the notion only excited the ridicule of the pro¬
fession at that period. Tuberculous disease was
generally regarded as an hereditary disorder trans¬
missible in various degrees of intensity. At the same
time external influences were looked upon as powerful
factors which could kindle the smouldering flame
into activity. From the very dawn of modern patho¬
logy tuberculous disease received profound investiga¬
tion, and the researches only corroborated the time-
honoured theory. The microscope failed to detect in
the diseased parts any specific elements, and in vain
cells and granules, and cells of giant form were
searched for some characteristic quality. Tubercle
was examined by the best observers in the civilised
world ; thousands of clever eyes had gazed at it with
intense devotion, and with a remarkable unanimity
they pronounced the opinion it was so indefinite in
structure that it could lie recognised as much by
negative as positive qualities.
Die
boogie
Aug. 9, 1899.
ORIGINAL COMMUNICATIONS.
Thk Medical Pbbsb. 131
In 1882 the whole pathology underwent a great
revolution by the demonstration of the life-history
of the tubercle bacillus. The disease, occurring in
any tissue or organ, is now universally regarded as a
specific disorder, the bacillus the absolute proof of
its invasion, and the cause of the morbid changes.
The long accepted causes are now dislodged from
their position, and are rightly grouped as morbid
tendencies. The inheritance of chronic inflammations,
and the susceptibility to external influences, are now
regarded as conditions which help the microbe to
establish itself within the body. Still these factors
are not less potent because the specific characters of
tuberculosis nave been revealed.
This pathological transformation has around it
still many unsettled problems. It is, however, a fact
of history that Koch, by his own researches, brought
to light from the microscopic elements of tubercle a
living atom which no human eye had seen before.
1 believe one may anticipate that this great discovery
will be of priceless benefit to mankind.
Bacteriological investigation has already unfolded
many of the problems connected with diphtheria.
The researches began in Germany in 1882. the chief
experimenters were Drs.Behring and Kitasato, and
they were soon followed by Dr. Roux, of the Pasteur
Institute in Paris. We now know that many animals
are liable to its attacks. It is communicable to the
horse, rabbit, guinea-pig. and fowl, and some species
seem to suffer from a chronic form of the disease. 1
Horses when attacked develop similar symptoms to
those which follow inoculation of diphtherial toxin.
The orator insistedonthegreatimpulsebacteriology
has given to the study of the intimate connection
between the diseases of mankind and the diseases of
animals.
What, he asked, may we expect from this young
science in the future ? We are only touching the
fringe of its possible revelations. Much that has
been done -will have to Ire done over again, and much
that has been written will have to be rewritten. How
many questions have yet to be solved ? Will the
further evolution of bacteriology solve the great
problem concerning immunity ? The striking differ¬
ences in the susceptibility to disease in individuals
are still unfathomed. Some seem to possess a natural
insusceptibilityto infectious disorders while others are
susceptible on the smallest exposure. He did not
believe that any individual can inherit or acquire a
resisting power for all forms of disease ; some races
appear to acquire immunity, and native population in
some parts of the world exhibit very little suscepti¬
bility to yellow fever and malaria. Race immunity
is generally explained by natural selection and pro¬
tection by inheritance, but we learn from experience
the resisting power to infectious diseases is very
variable and that there is no 6uch thing in the world
as absolute immunity.
Thera can be no doubt, he observed, that the
pathogenic organisms are a huge factor throughout
our world in the causation of disease and that we
must never cease to combat the conditions in which
specific organisms can grow. Still we must not for¬
get there is always another factor which we may call
feeble resisting power or impaired vitality. The
susceptibility to disease bears a direct relation to the
vigour of the body, and the health of every indi¬
vidual is the real measure of the power t o resist
infection. Personal immunity indeed can almost be
acquired by the daily practice of temperance, cleanli¬
ness, and periodic repose.
The next subject to engage the attention of the
orator was the discovery of anresthesia and its influ¬
ence on surgical practice, concluding with the remark
that surgical anaesthesia can never be wholly stripped
of risk, and that to-day the risk is greatly reduced
by our modern safeguards and improved methods of
administration. It is certain, he added, that we
have not reached finality in the matter of surgical
anesthesia, but he believed that by experience and
the skilful adjustment of the dose we are entitled to
regard the inhalation of our present agents as prac¬
tically safe.
In regard to the future he asserted that the medical
profession was never so earnest in its efforts to pre¬
vent disease as it is to-day, and it is really a fortunate
thing for the world that its ranks are not getting
thinner. On the other hand, the people of this
country, especially the educated classes, are more
anxious than ever to obtain professional assistance
in the early stages of their disorders, because they
are beginning to appreciate the fact that this is the
best time for cure. In the near future he believed
far less medicine would be taken than formerly, not,
perhaps, on account of any reduction in the quantity
prescribed by the faculty, but rather that people
generally are growing wiser, and will trast less to
mysterious and puffed-up remedies. He hoped the
day would come when every vaunted specific pro¬
tected by a Government stamp will carry a label
revealing the exact nature of its composition-
The President next entered upon the consideration
of recent advances in medicine and surgery, and con¬
cluded his address by a forecast of the role of preven¬
tive medicine in the future.
During the last fifty years, he observed, there has
been a steady increase in the value of human life,
and we can confidently hope that the health of the
people of Great Britain will continue to improve. In
the coming century a stronger and broader warfare
will l>e carried on against preventible disease; sani¬
tary authorities will grow in wisdom and will more
graciously accept their responsibilities; the public
health service will be better organised; the medical
officers of health will be better paid, and wholly
devoted to their duties; hospital accommodation for
contagious disorders will be considerably increased ;
and the houses of the working classes transformed
and reconstructed on modern lines. He believed
there was reason to anticipate that the death-rate of
the country may still be greatly reduced, and that 10
to 12 per 1,000 may be the figures of the coming
century.
The great hindrance to the progress of preven¬
tive medicine which we have to overcome is the over¬
crowded and insanitary condition of the dwellings of
the working classes. This is the field, he said, on
which the great battle with infectious disorders will
have to be fought out. Our warfare will not be
directly with microbic life, but rather with the condi¬
tions in which specific organisms are grown. We
want to sec more progress in getting rid of the
crowded and dirty courts in every city. We want to
behold fewer of these revolting pictures of impurity
and wretchedness herding together in the narrow
avenues where the light of heaven strives in vain to
pierce the patched and broken windows, and where
the meridian beams struggle in vain to penetrate
through the gloom and corruption of these denlike
homes. These denlike homes are the arch-enemies
of sanitary progress in all our great centres. Philan¬
thropy has long pleaded for the removal of these great
Bocial evils; the \ oice of the medical profession has
long sounded the alarm ; but we are still waiting for
the educated and wealthy classes of tliecommunity to
catch the same inspiration, and to join in demanding
more sweeping measures by which these nurseries of
disease may be exterminated.
But the battle against disease and death will only
end in disappointment unless we have something
more than the force of legislation and the unceasing
watchfulness of a complete sanitary system. The
great mass of the people must become willing and
active helpers: the fathers and mothers of our land
oogle
132 Thb Medical Pbbss. ORIGINAL COMMUNICATIONS.
Aua 9, 1899.
must learn how to maintain the healtbfulness of
their homes, and the blinding forces of selfishness
and ignorance must be replaced by the best and
purest aspirations.
If we had the power of transforming the dwelling
houses throughout the land, and of establishing
everywhere a perfect system of drainage, and oi
securing for all an abundant supply of pure water,
we should accomplish but little without the help of
the people themselves. The basis of national health
is the personal cultivation of health. We want the
fathers of England to be the enlightened sanitary
officers of their own households. We desire to see a
wider knowledge of the laws of health, and he hoped
the day was not far distant when they will be
zealously taught in every school in the kingdom.
A COUNTRY HERBALIST’S CURE FOR
THE ‘‘KING’S EVIL.” (a)
By JOHN KNOTT, MA, M.D., and Dip. Stat. Med.
(Univ. Dub.) ; M E.C.P.I., M.R.I.A.; Ac., Ac.
(Continued from page 110.)
The views of the commentators and editors of the
famous “ Regimen ” drawn up by the medical faculty of
the University of Salerno for the profitable physical
instruction of Robert of Normandy, throws a good many
side-lights on the pathological views held during the
Dark Ages on scrofulous and allied disorders. I proceed
to quote as a specimen the two lines which specially
allude to strumous disease, from an edition which bears
the following title“ Schola Salernitana, sive De con-
servandd VaJetudine Prsecepta Metrica. Autore Joanne
de Mediolano hactenns ignoto. Cum luculentA and
succincti Amoldi Villanovani in Singula Capita Exegesi.
Ex RecenBione Zacharise Sylvii Medici Roterdamensis.
Cum ejusdem Prsefatione. The first line, indeed, com¬
pletes the notice of scrofulous disease ; the second carries
on the pharmacology.
“ Scrofa, tumor, glandes, ficus cataplasmate oedunt,
lunge papaver ei, confracta foris tenet ossa.”
These lines have been thus Anglicized—
A plaister made of Figges by some men’s telling,
Ib good against all Kimels, boyles, and swelling,
With Poppy joyn’d, it drawes out bones are broken,
—in the anonymous English Version published in London
(1607), with the title: “The Englishman’s Doctor, or
The Sohoole of Saleme. Or, Physicall Observations for
the perfect Pr< serving of the Body of Man in continuall
Health.”
The fact that over 160 editions of this remarkable
production appeared in the centuries preceding the
modern literary deluge is proof positive of the immense
influence which its verses must have exercised. They
were addressed to Robert, Duke of Normandy, eldest son
of William the Conqueror, and prepared in the Medical
Faculty of the University of Salerno, the “Mater et
Caput ” of all the Universities and Medical Schools of
Christendom.
The universal celebrity of the “ Regimen ” of the famous
School of Salerno caused its translation into English, in
the still embryonic state of that language. The results
ing rare and curious black-letter gem bears the follow¬
ing title:—‘ Regimen Sanitatis Salerni. This booke
teachyng all people to gouerne them in health is trans¬
lated out of the Latine tongue into Englishe, by Thomas
Paynell, which booke is amended, augmented, and
diligently imprinted, 1575. Imprynted at London, by
Wyllyam How, for Abraham Weale.” And the ortho¬
graphy, etymology, and syntax of pre-Shakespearian
English are all thoroughly illustrated in the commentary
on the first line of the above quotation, which I here
reproduce:—“Here the auctour saith, that plaisters
made of figges are holsome againste thre diseases, yt is
(»> An abstract of this paper was read in tlie Medical Section of
the Royal Academy of Medicine in Ireland on Nov. 18th, 1898.
to saie swines yueli, kirnels, and Bwellingee. By swynes
euil is understand inflasion under the cbynne about
ye throte. And it is called scrofula a scrofa, that is to
say, a sowe or a swyne, either because this disease
chaunceth manie tym*>s too swyne through their gnlo-
sitie; or els because y® shappe of this diseases islykened
to a swyne, as Avicen sayth. By kymels are understand
impostumes, whiche commonly chaunee under y® arme
pittes, and in the groynes. And by swellyng may be
understands inflasions in any parte of the body. Where¬
fore to hele these impostumes, & specially to rype
them, fygges should be sodde in water, and w* the water
shuld be mixed a little curtsy of vineger. y« whiche
helpeth ye vertue of figges to entre. And whan it is
sodde, the fygges must be beaten in a morter: and than
myngled with a courtsy of water that they were sod in,
A so make a plays'er. A playster is proprely
medicine made of some herbe or flower, and the
juyce therof: . . .
Another, more rare, more copious, and in many ways
quite as interesting a black-letter volume devoted to
“ matters medical ” had appeared even before (1568) that
from which the last quotation has been made. It con¬
sists of four parts, of which the first has the following
title:—“ The Secrets of maister Alexis of Piemont, by
him collected out of diuers excellent authors, and
newly translated out of French into English. With a
general! Table of all the matters oonteyned in the sayde
Booke. By William Warde.” A good many of the
"secrets” are found to oonsist of various modes of
“cure” for the King’s Evil, showing very forcibly how
much the treatment of this peculiarly untractable form
of disease had puzzled the wits and overtaxed the scien¬
tific attainments of both amateur and professional
healers, down through all the centuries.
The first “ secret ’’ which I have selected happens to be
one which I have not found in print elsewhere; and
its existence in the collection of “ maister Alexis ” is a
curious illustration of the widespread diffusion of simi¬
lar popular ideas among the uninitiated of all the
countries and all the ages. The item in question ib a
method of making an absolutely accurate differential
diagnosis—a most important contribution to the know¬
ledge of the period, when the diagnosis was generally
as hazy as the treatment was doubtful.
“ Howe to Knowe the Kings euill.
“ Take a grounde worme alyue, and laye hym upon
be swelling or sore, and couer him with a leafe : if it
the the kings euill, the Worme wyll chaunge and toume
into earth, if it be not, he wyll remayne whole and
Bounde.”
In my boyish days in the West of Ireland, I heard
this method of diagnosis enunciated by an agricultural
labourer, who was a relative and near neighbour of a
person who practised a “ cure.” The only difference is
that the Hibernian worm merely died at once: there was
nothing said of hasty decomposition.
I now proceed to give a series of remedies culled from
the pages of this very rare and very interesting volume
of “ Secrets ”:—
“ A verie good easie remedie against the disease called
the Kinges euill.
“Take the herbe called Farfara, Foale foote in Eng-
lishe, well stamped with his rootes, and then beeyng
mingled with the flowre of the seede of Line or Flaxe,
and the grease of a Barow, make thereof a plaster,
and laie it upon the sore changyng it twice a daie,
and all the sores of the disease shall be resolued into
sweate. After thei be healed, washe often the place
with white Wine, by the space of ten or fiftene daies.
“ An other remedie against the same disease.
“ Take the stones of an Horse, and put them in a Fire¬
pan emongr the embers and coles, leauying them there,
untill thei maie be beaten into pouder, then giue the
Pacient drink of the saied pouder in white Wine, the
quantitie of twoo penie weight, continuyng this the
space of xxi daies, by this meanes you shall make hym
caste out at his mouthe, all the ordure, and filth of
the euill, and shall heale hym throughly.
“ A verie good remedie against the Kynges euill.
—“ Take Ceruse or white Leade well stamped, fower
,oogle
li!o. 9, 1899. ORIGINAL COMMUNICATIONS. The Medical Press. 133
unces, oile Oliue eight unces, let this boill together five or
sixe howers, styrring it continually, and when it is waxen,
or become verie blacke, it is sodden enough: then spreade
it uppon a linnen clothe, and laie it unto the place of the
sore : if the sores bee broken, thei will bee healed incon-
tinente: if not, they will resolue and loose, and shortly
heale throughly.
“ To heale the same disease, by a substance taken at the
mouthe.
“ Dresse a Henne as it were to eate, so that she bee
boiled in a great Potte, or Caudron, with a greate deale
of water without Salte. lettyng it boile untill all the bones
bee separated from the fleshe, then take the eaied bones,
and drie them in an Ouen, or at the fire, so that thei bee
not burned, or waxe blacke; after this, beate them well
to pouder, and take of the seede of Seiamum, beaten well
likewise into ponder, and mingle it with the pouder of
theBennes bones, as muche of the one as of the other.
And so take a sponefull of the twoo pouders,
and mingle it with Honie, causyng the Pa-
ciente to eate of it at Night, when he goetli to
bedde, and in the Mornyng when he riaeth. This ought
to bee dooen from the beginnyng of the quarter
decreasyDg of the Moone, unto the ende : It is a verie
excellent Secrete. It also happpened to me of some
menne, in whom the saied disease was so olde, and farre
gone, that the saied remeadie could not help them,
whom I caused to take with the eaied pouder specified,
as followe, whiche oughte to bee made after this maDer.
Take a certaine little Serpente called a Slowe worme, j
boile hym in oile Oliue, untill he be broken and con¬
sumed, then rubbe the euill with the saied oile, and laie
pieces of To we upon it, leauying it so three or fower
daies.- and after that, make a newe annointyng, and laie
Towe to it againe, as before. By this saied remeadie I
healed them perfectly, thankes be unto God.
“ To heale the Kings euil, a disease called in
Latine Seruma.
“ Take a great Tode aliue. and when the Moone
draweth towarde the conium tion of the sunne, cut of the
legges from him, and put him about the necke of the
patient, and it will doe him muche good. Take also the
hoofe of an Asse and burne it, and lay it upon the sore,
for it is very good and profitable for such sicknesse.
“ To heale the disease called the Kings euill.
"Take Barley floure, Liquide Pitch, Waxe, and oyle of
equall quantitie, mixe all together, and seeth it well, and
put into it a little piste of a yong childe, and stirring it
well about.layo it upon the sire in maner and forme of
a playster, and it wyll heale it.
“ To remedie the Kinges euill.
" Wash the sore and wartes with the deooction of the
rinds of Caphers: then take a Serpent, and hauing cut
away his head and tayle, put the other part into an
Earthen pot that hath holes in the bottome, and beyng
well luted both aboue and beneath, put unto it another
pot as a receiver, whiche you shall cause to stande upon
a pot filled with water, which shall boyle so long untill
the Serpent bee dissolued into oyle, unto the whiche
adding the pouder of the rootee of Capers, annoynt the
griefe eight daies therewith and it shall be healed.
“ Against the Kings euill in children.
" Take of the iuice of Sothern wood, and of marsh
Mallowes, and of the Mucillage of the kernels of unripe
grapes, of ech like like quantitie: lay them beyng all mixed
together upon the sore. But if it be hard, dissolue in
the said iuices, of Gum Armoniack or of Bdellium, and
use it as a plaister uppon the euill, and you shall see a
happie succesee.
“ Against the Kings iuill.
“ Take of liquide Pitche, of waxe, of urine of children,
and of meale of Barly, of eche as muche as you please .-
mixe them togither, and putting thereunto a little oyle
Oliue, laye thereof many tymes upon the griefe.
“ To remedie the Kinges euill.
" Take Vitriol and put it upo the coles, and let it boyle
and cast spume so long, that it become red : then braie
it, and put it to disBolue in Aqua vitte, and beyng taken
out, let it drie, and thus doe three tymes: in thendeput
it into a fine peece of linnen cloth and let it bang in a
moist place, with a potinger or some other recipient
under it, for it will cast oile like unto oile of Tartar.
Take as muche of the saied oile, as of Aqua vita?, and
bathyng therin a sponge, bind it upon the sore, and in
short space it will breake it.
“To heale the Kinges euill and other harde im-
postumeB.
“ Take of Mustarde seede, of Nettle seede, of Sulphur,
of the spume or fome of the sea, of Aristologia, of
Bdellium, of Ammoniack, and of olde oyle, of eche like
quantitie, braye all thinges that are to he brayed, and
dissolue the Gummes in vinegar and make n plaister.
“To dissolue the Kings euill, and every hard im-
postumation.
•* Take of Salt Peter one pounde, of Litarge of Siluer,
as muche more, of the filthe of oyle vesselles foure
pounde. of Galbanum foure pound and a halfe, braye
the Salt, and the Litarge, and putting thereto the filthe,
bray it againe, and set it to boyle in an earthen vessell,
laboring it often with a spatter, and when it doth not
cleaue to the fingers, take it from the fyre, and bray the
Galbanum with a Pestell of wood, and meddle and dis¬
solue them together, and beiDg wrought upon Marble,
keepe it to use when neede shall require, it will be verie
marueilous.”
So much for “ maister Alexis of Piemont.”
It is well known to all those who are acquainted with
the conditions of life in the Middle Ages, that a large
proportion of the practice of the healing art was then
exercised by the ecclesiastical orders. In the years of
monastic retirement which long preceded hia elevation
to the see of St. Peter, Petrus Hispanus benevolently
occupied hia leisure hours in the compilation of his
“ Thesaurus Pauperum,’’ a " Poor Man’s Treasury ” of
the most celebrated known remedies, an English version
of which appeared (without date) about 1560.
A comparison of the remedies collected by "maister
Alexis of Piemont,” and by Petrus Hyspanus, with those
mentioned by Bonet, and the writer of the article in
James’s Dictionary, cannot fail to impress the careful
observer with the hopeless thraldom to which the human
intellect was subjected in presence of the incubus of
“ Authority ” down to comparatively recent times. The
authorities of Hippocrates and Galen, of Aristotle and
Pliny, possessed nearly the same power to charm in the
middle of the last century, that they had possessed 1,600
yearB before.
The same helpless and hopeless groping in the dark
for relief still unattainable is illustrated in the writings
of all those who have dealt with this scourge of humanity,
down almost to our own times. We have seen how large
a part of existing medical practice the Church appro¬
priated in the Middle Ages; and we know that as know¬
ledge became more widespread its more enlightened
votaries did not neglect to educate themselves in the
healing art. Francis Bacon tells us that he had been
"puddering in physick” all his life. His successor on
the throne of English philosophy, Robert Boyle, com¬
piled a “ Collection of Choice and Safe Remedies.” many
of which were intended for the King’s Evil.
In common with so many of the learned men of what
may, I think, be fairly called the pre-scientific centuries,
the courtly and accomplished warrior and adventurer.
Sir Walter Raleigh, devoted many of his leisure houra
to cultivation of the theory and practice of the healing
art. His “ Cordial ” long possessed a very high reputa¬
tion in the healing of scrofulous and other inveterate
diseases which bad resisted the orthodox meanB employed
by the licensed members of the faoulty. In the very
interesting little volume, “ The Court and Character of
King James, written and taken by Sir A. W., being an
eye, and eare witnesse,” we are told that: " Queen
Anne, that brave Princesse, was in a desperate, and
beleaved, incurable Disease, whereof the Phisitians were
I at the furthest end of their studies to find the cause, at a
Non plus for the Cure, Sir Walter Rawleigh being by his:
long studies an admirable Chymist, undertooke, and per¬
formed the Cure, for which he would receive no other
Digitized by GoOglC
134 The Medical Pbess.
THE NURSING PROBLEM.
Au«j. 9, 1899.
reward, but that her Majesty would procure thatcertaine
Lords might bee sent to examine Cobnam, whether he had
accused 8ir Walter Rawleigh of Treason at any time
under his hand; the King at the Queen’s request
(and in Justice could doe no lesse) sends six Lords
. . . to demand of Cobham, whether he had not under
his hand accused Sir Walter Kawleigh at Winchester, upon
that Treason hee was Arraigned for ; Cobham did protest
never, nor could he; but said he, that Villaine Wade did
often sollicite me, and not prevailing, got me by a trick to
write my name upon a piece of white Paper; which I
thinking nothing did, so that if any Charge came unde*
my hand, it was forged by that Villaine Wade, by writing
something above my hand without my consent or know¬
ledge. These six returning to the King, made Salisbury
their Spokes-man who ?aid: Sir, my Lord Cobham hath
made good all that ever he wrote or said, and this was an
equivocating trick, for it was true, he made good what¬
ever he writ, but never wrote anything to accuse Rawleigh;
by which you see the basenesse of these Lords, the cre¬
dulity of the King, and the mine of Sir Walter Rawleigh.
I appeal now to tne judgement of all the world, whether
these Bix Lords were not the immediate Murtherers of 8ir
W. Rawleigh and no question, shal be called to a sad
account for it.” If it be true, as Court gossip stated,
that the malignant revenge of Salisbury was dictated
by a “kind of wild justice” for the too serious
practical joke which Rawleigh had played upon him
in former years, and which in the end cost each his
life, we have in this case one of the most striking
examples that history affords of the inextricable con¬
nection between private passions and public life, between
individual morality and historical pathology. Of the
nature of the disease of which Salisbury was the victim,
his numerous enemies, at least, professed to have no
doubt, as some of the epitaphs with which they pursued
their vengeance after his death clearly show. The fol¬
lowing has been preserved by Osborne:—
“ Here lies thrown, for the worms to eat,
Little Bossive Robin, that was so great.
Not Robin Qoodfellovi, nor Robin-Hood,
But Robin the Encloeer of Hatfield Wood:
Who seem'd as sent from ugly Fate,
To spoil the Prince and rob the State.
Owning a Mind of dismal ends.
As Traps for Foes, and Tricks for Friends.
But now in Hatfield lies the Fox
Who stank while he liv’d, and died of the —.
Others among his detractors announced that he died
of the “ Herodian disease,” while his apologists aver that
he perished as a victim “ of a complication of disorders
operating on a scorbutic habit of body.”
The constituents of Rawleighs cordial have been pre¬
served for us in a remarkable eulogistic commentary!
written by a French scientist of the period. For the
benefit of the curious it is here reproduced
" Recipe Rasurte Corni Cervi libram unamj Carnis
viperarum cum Cordibus & Hepatibus unci as sex;
Florum Boraginis, Buglossre, Boris Marini, Calendula?,
VetonicfB Coronari® rubr®, Boris Solis, Rosarum rubra-
rum, & Sambuci, singulorum libram semissem; Herba-
rum 8cordii. Cardui benedicti, Meliss®, Dictamni Cretici,
Menth®, Majoran®, Betonic®, singularum manipulos
duodecim -, Granorum Kermes recenter in rob redac-
torum, Cubebarum, Cardamomi majoris. Baccaram Juni-
peri, Maceris, Nucis myristic®, Caryophyllorum, Croci,
singulorum uncias duas; Cinnamomi acutissimi, corticis
ligni Sassafras, flavedinis malorum Citriorum & Auran-
tioram, singulorum uncias tree; Lignorum Aloes A Sas¬
safras uniuscujusque uncias sex; Radicum Angelic®,
Valerian®, Carlin®, Fraxinell® sen Dictamni albi. Ser¬
pen tari® Virginian®, Zedoari®, Tormentill®, Bistort®
Aristolochi® long®, rotund® A cav®, Gentian® A Impera-
toriffi, singularum unciam unam A semissem. Omnia
incisa A grosso modo contusa in vasi idoneo posita cum
Spiritu Vini rectificato extrabantur secundhm Artem.
Tmctur® filtrate in extractum mediantee, in Mari®
balneo, distillatione evaporentur. Magma expressum
comburatur; Cineres reverberati per aquam elixivientur,
unde Sal purum lege Artis paretur, quod Extracto
misceatur. His itA peractis, huic Extracto adde, ut
Artis est, Pulverem sequentem ceteruque ingredientia.
Recipe Lapidum Bezoardicorum orientalium and occiden¬
tal ium verorum uniuscujusque unciam simiBsem,
Magisterii solubilis Pelarum orientalium uncias duas,
Magisterii solubilis Corallorum rubrorum uncias tres ;
Boli orientalis, Terr® Sigillat® ve«®, Unicomu mineralis.
Cornu Cervi Philosophic^ preparati, A Cornu Cervi
calcinati, singulorum unciam unam; Ambr® grisee
electiBsim® in Essentiam redact® unciam unam;
Moschi orientalis optimi essentificati drachmam unam
A semissem; Croci Solis cum tinctura Antimonii Baailii
Valentini parati drachmas duas: Sacchari candisati albi
subtiliasime pulverisati libras duaf Ex his omnibus mixtis
A ex Arte unitiR fiat confectio vere Regia, qu® ad usum
reservetur in pyxidibus apprime clausis.”
Whatever opinion we may form in the present day
of the therapeutic value of this e aborate formula, it can
hardly be denied that there is something to admire in
the studious attention which the gay and gallant Sir
Walter must have bestowed upon its preparation.
The famous “ Brevarie of Health” of Andrew Boorde —
the “ Merry Andrew of Physicians,” Andreat Perforatut
of his own periods of comic dignity—contains but one
short chapter on the subject, and his method of dealing
with the condition reminds me forcibly of the time¬
serving policy of John of Gaddesden, to be afterwards
referred to.
“ The 236 Chapter doth show of the Kings euill.—
“Morbus regius be y® Latin words. In English it is
named the kings euill, which is an euill sicknesse or im¬
pediment.
“ The Cause of this Impediment.
“ This impediment doth come of the corruption of
humours, reflecting more to a perticuler place than to
universall places, A it is much like to a fistle, for and if
it bee made whole in one place it will break out in an other
place.
“ A Remedy.
“ For this matter let euery man make friends to the
king’s maiestie, for it doth pertein to a king to help this
infirmitie, by the grace ye which is giuen to a king
anoynted. But for as much as some men doth iudge
diuers tymes a fistle or a French pocke to bee the kings
euill, in such matters it beehoueth not a king to meddle
withall, except it be thorow A of his bountifull good-
nesse to give his pitifull and gracious councell. For
kings ana kings sonnes and other noble men hath
beene eximious Phisicions, as it appeereth more largely
in the Introduction of Knowledge, a book of my making.”
As our author enjoyed what some of us would prob¬
ably consider the uneasy dignity of physician to his
Majesty King Henry VIII., we can appreciate the
discretion which dictated the remedial diplomacy recom¬
mended in this chapter. It may not be uninteresting to
mention in this connection that the “ Brevarie ” from
which the above quotation has been taken is said to be
the first manual composed in English by one of the
Faculty.
(To be concluded in our next.)
^he JUirsiitij problem.
NURSES UF THE LATEST FASHION.
A.D. 1899.
PROFESSIONAL EXPERIENCES IN SHORT
STORIES.
By FREDERICK JAMES GANT, F.R.C.S.,
Consulting Surgeon to the Royal Free Hospital.
II.-THE HUSBAND-HUNTRESS AND
TRAPPER-NURSE.
In contrasted alliance with the inhuman species of
woman, Satan in Petticoats, who is the exponent of the
latest possibilities of nurse or nurse-attendant - I now
ntroduce the reader to one who is morally very unfit
or a heaven-born calling, and socially a very dangerous
Digitiz
oogle
Aug. 9, 1899.
THE NURSING PROBLEM.
Th* MlDICAL Pk*86. 135
type of feminine nature, gaining admission into families
—as a nurse, for the exercise of her art. That such is
the way of the world with either sex, does not ennoble
and beautify the character of one who plays her part
under cover of a dress and vocation which specially offer
opDortunities for her purpose.
See yonder sick and suffering wife; her husband in
daily intercourse with Nurse Lovibond; she readily and
rightly wins the heartfelt grat'tude of him who sees in
her ever-watchful attention and devoted care, on behalf
of the sufferer, all the qualities of that womanhood
which has blessed his own life, she who might replace a
mother to his young children. Or, the only son of his
mother—a widow, is attracted by the fidelity and
womanly grace of one who nursed her in her lingering
last illness—a vision of the woman who would
share his fleeting joys of sunshine, support him
^n tempest-tossed hours of adversity, dispel the
clouds of sorrow — in the loss perhaps of love’s
pledges, in sickness, God’s Nurse - messenger; and
forsaking all other, keep only unto him, until she
receded from his longing eyes and holden hand to re¬
appear in his first consciousness beyond the veil. In
either of these cases, say you, what a divine union with
father, or son. Surely some such women, by their
natural endowments and life-training, are the truest of
Eve’s daughters, and have proved themselves the best
wives. I am certain that no such woman, in the
vocation of a nurse, would be a disguised husband-
huntress and trapper.
In a villa on the wild and weird coast of Tenby, in
North Wales, a palsy-stricken lady rested during the
last few years of her troubled wav, with nothing true
about her but the first beams of heavenly light in her
soul, and a daughter of comfort and consolation.
Husband, not a deserter, but absent by private “ deed
of separation ; ” an only son, a drunken sot, &e.,
occasionally visited his invalid mother.
To be accurate with regard to their relationships, I
may mention that the son was his father’s, Mr. Goat-
man’s stepson, by his wife’s former marriage. Mrs.
Goatman, who was divoroed from her (previous) husband
in exceptionally painful circumstances, readily con¬
sented to her son’s exchange of surname, which would
thus to all the world conceal a wretched, a hideous past.
Her (present) husband, Mr. Goatman,as a stock-jobber,
usurious money-lender, and bubble-company promoter,
had amassed a large fortune, increased by building
investments, &c. He well knew how to keep that which
he had thus gathered, without indulging his generosity
for the benefit of others, apart from self-gratification as
his motive.
If the love of money be the root of all evil, in the
soul, this passion would seem to be BOul-deetroying by
first enthroning self, as the idol of worship, with all the
mind, with all the heart, and with all the strength of
the moral nature ; extinguishing the love of self- sacri¬
fice for others, as the true source and sustenance of the
higher life, whereby, whomsoever will lose his life shall
find it; and he who would keep his life, shall lose it.
Thus had the greed for money killed the soul of its
victim in the person of Mr. Goatman, the embodiment
of selfishness.
In an illness prolonged and tedious, passing into a
pathetic imbecility, nurse-attendants on his poor wife
came and went in succession. But the last such
attendant. Nurse Lovibond, eclipsed all the previous,
BiBters in her ministrations; for as they paid attention
only to the wants of the restless invalid, our Nurse Non¬
pareil found time to extend her favours to one other, the
witless boy-stepson, who despite his personal demerits,
possessed an overpowering attraction to her, money.
A young lady, tall, tender-eyed, and otherwise per¬
sonally well-favoured, and equipped with more than the
average of woman's sail, and bottom-ballast of steadi¬
ness, would surely capture the ever-floundering craft of
a young man who could never pull an oar, or steer his
course in life, when pursued by a clever and experienced
adventuress on the same ocean.
In the person of our present adventuress, it must be
admitted that her methods were refined and delicate;
all the more engaging to a young man who could the
better appreciate a tone of character he did not himself
possess. It is thus that the lowest and most depraved
moral nature often experiences the refining influences of
companionship and conversation, which the reading of
healthy books would fail to impart. Character begets
and moulds character by association. The drama
teaches, not only by studying the pages which portray
human life in its highest forms of virtue, or would correct
vice in its unloveliness and repulsiveness; all the
dramatis personm must act and speak for themselves, as
in life, to really and fully convey the lessons which the
dramatist would teaoh. Even Shakespeare’s most living
creations of character are dead-liveless forms, as seen
only in the plays he wrote; until vivified by the true
actor’s art, they speak and move on the stage. Thus it is,
that Hamlet, Othello, Macbeth, Lear, with the accom¬
panying types of feminine character, fulfil the teaching
purposes of the Drama, when rightly interpreted and
impersonated. To return from this digression.
Mr. Alfred Goatman (fils) and Nurse Lovibond are
sitting closely coupled together on a rock, under the
cliff, at Tenby, and as the lady draws thoughtless figures
on the sand with the point of a sunshade, she pours her
domestic history of pitiful privations and troubles into
the ear of a sympathetic listener. A few sea-gulls
perched on recesses in the adjoining cliff, or flapping
their wings around the happy pair are the only other
depositories of her moving tale; and of his response
whose heart was open to distresses, which in idle affluent
circumstances he bad never known.
Mr. Alfred, however, iB a man with a past. His mar¬
riage with a barmaid, undiscovered for a while by
Btepfather and the mother of her darling boy, was never¬
theless, in due time blessed by the birth of a girl-baby,
then a boy was bom ; both of whose characters, as they
grew, have thus far done much to redeem an unhappy
legal union.
We have now reached the stage at which fair Nurse
Lovibond has hooked and landed Mr. Alfred: but it was
not long before accident apprised her of his much married
past.
The announcement that Mr, Alfred was a married
man having been made by letter by the lady-nurse who
had caught him of the music-hall species, he was inter¬
viewed by the fair trapper. He coolly admitted the
impeachment—simply remarking—“don’t I look like a
married man "; a rather mortifying challenge of the
trapper’s skill; who at once let him escape to enjoy his
married liberty and felicity.
Nurse Lovibond resumed her duties of attendance on
the old invalid lady with more singleness of purpose, now
that she was no longer pre-occupied with the all-absorb¬
ing designs of. captivating ana capturing Mr. Alfred.
She performed her duty more efficiently and faithfully
when freed from the distraction of her former pursuit to
find a man suitable at least for her purpose in marriage;
who, whatever his personal qualification and social
position might be, would be provided with a certain
“ settlement ” on her in this uncertain life.
As the end of the case drew near for the poor wife’s
release from long suffering, and the blighted faith of
years, let us hope and believe that some restoration of
conjugal affection and respect for manhood were felt by
the departing spirit; that some words of reconciliation
passed between her and her husband, and that some lost
appreciation of a truly good woman, wife and mother,
awakened Mr, Goatman’s dead soul, and somewhat re¬
deemed his grievous errors in the past.
Our lady-nurse in the loss of her patient, loses also her
situation. But she bears—it seems—a good character
for faithful attendance and kind attention, and of having
such knowledge as an “ untrained ” nurse may have
casually acquired. Cast upon the world to find her own
way, and in her own way, she was not long in making, as
she thought, a good venture. She would rent of Mr.
Goatman the pretty and well-furnished residence in
which his wife had died, and convert it into a small
sanatorium for invalid ladies and gentlemen. The air
of Tenby is, perhaps, more generally salubrious than
the climate of the Riviera. Mr. Goatman, with his
large fortune, gladly let, at a nominal rental, a villa
which recalled to him no. happy memories.
Digitized
, y Google
136 The Medical Press.
BRITISH MEDICAL ASSOCIATION.
Ado. 9, 1899.
In her new enterprise, the lady-nurse tenant, associ¬
ated with her own disqualifications, the “ trained ” quali¬
fications of a younger sister - a “ certificated ” nurse.
Not unlike in personal attractions, the two young
ladies were bound to each, other by a strong sisterly
affection; but. differing in the inner woman. Nurse E.
Lovibond shared not her sister’s craft and design ; under
cover of her nursing vocation, she would have scorned
to captivate and capture any man in marriage. The
elder sister—of whom we have yet to know more—had
started her sanatorium with a double prescience; the
possibility of its failure as a business speculation, and
an ulterior view in that event.
At the end of a year the landlord, not seemingly a
hard-hearted man, as he had shown himself at his wife’s
grave, was unwilling to allow the fourth quarter to pass
over without any payment—for business with him meant
business, and he then gently reminded his fair tenant of
her forgetfulness. She frankly confessed the failure of
her enterprise, invalids coming and going, or leaving the
place empty, as in other such resorts ; but Nurse Lovi-
bond would willingly work out her rent in some other
way. Old Mr. Goatman had occasionally visited the sana¬
torium during the year, and had seen and admired the
younger sister no less in view of her personal outfit,
than that he saw in her also a woman to his taste as a
business man—steady, and with singleness of purpose;
as compared with the flippant, coquettish, love-making
elder sister.
Mr. Goatman felt a sincere sympathy for the younger
sister in the distressful failure of her efforts to make the
sanatorium a success; and to cut short any description
of his prosaic proposal to relieve her anxiety as to what
her future might be—he plainly proposed to offer her a
home as his wife! The landlord-widower would thus
cancel her sister* debt due to him as rent. In these cir¬
cumstances the younger sister reluctantly accepted the
offer of a new way to pay a heavy debt, which assuredly
the rich landlord would not otherwise have cancelled,
than by having his “pound of (her) fair flesh.”
Meanwhile, the elder sister had not forgotten her
resource in the event of the sanatorium proving to be a
financial failure. In an interview with the landlord,
she proposed to him her method of paying the rent, with¬
out incurring any further liability. She had heard that
Mr. Goatman was in quest of a housekeeper ; and she at
once offered her service in that capacity. Her failure
had not been owing to any ignorance of housekeeping;
the sanatorium had not answered as a health resort.
She had full confidence in her ability to conduct the in¬
ternal arrangements of Mr. Goatman’s large establish¬
ment at rT 'enbv. What might be Nurse Lovibond’s
ulterior view in making this proposal, the reader of this
story will shrewdly and surely guess.
In the final interview of Nurse Lovibond with Mr.
Goatman, he would have accepted her proposal to work ]
out her rent—when she again pressed upon him her
service—as his housekeeper. But, said he, “there is
just this difficulty; I am about to marry your sister, and
it would hardly do for me to have you in my service,
with your sister as my wife.” Alas, the poor husband-
trapper was foiled a second time, after her first adven¬
ture with Mr. Alfred G., the stepson; caught again in
her own trap.
Of course, she never again tried to establish a
sanatorium. She returned to private practice. I have
heard that she married a young doctor which would take
her out of practice; I cannot credit the report; for
although I believe some doctors have found wives in
nurses and good wives; it would be incredible that aDy
man having any knowledge of nurses, would himself select
one of Nurse Lovibond’s speciee, or have been caught by
her in marriage.
What may have been a'l the aptitudes which Nurse
Lovibond possessed cannot be fully and fairly estimated,
in addition to her personal gifts, which doubtless sur¬
passed her qualifications, as an “ uncertificated ”
nurse. She moved among the wealthier classes of
society— or as she expressed it—in good families. But,
unfortunately, the public of that world more especially,
cannot distinguish between the true and the false species
of nurse: while the personnl gifts which "ociety might
value most—in charms of appearance, manner, and con¬
versation, are often such as would least qualify a woman
to honourably, not to say religiously, fulfil her duties.
Of strictly technical qualifications, the public can hardly
be expected to know anything —nor of the Nurse Lovibond
species.
Clinical Jiecorfie.
WESTMINSTER HOSPITAL.
Two Cases of Fatal General Phageda‘*a.
Under the care of Mr. Walter G. Spencer, M.B.Lond.,
F.R.C.S.,
Surgeon to tlie Hospital.
Case I. was that of an unmarried man, set. 61, who
had not drunk excessively, and in whom evidence of
Byphilis was limited to a superficial ulceration of
one eyelid. The disease had been inoculated a week
before and gangrene had extended to the external
genitals, periueum and lower part of the abdomen, as
well as perforating the anterior wall of the rectum.
The eangrenous parts were removed and strong antiseptics
used with the result that healthy granulations covered
the whole surface, and recovery seemed almost possible,
when slight signs of broncho-pneumonia appeared, and
the patient died on the tenth day, 2J weeks from the date
of infection. No other disease was noted.
Case II. was that of a woman, a*t. 35, who had
had years before pelvic inflammation of venereal
origin, but for the previous year had felt quite well.
A fortnight before admission Bigns of severe pelvic inflam¬
mation reappeared, with a foul blood-stained vaginal
discharge During a month in hospital the vaginal dis¬
charge became less, and she was then operated for
double pyosalpinx bylaparotomy. Owing to dense
pelvic induration and adhesions, the whole of the distended
tubes could not be removed. Extremely foul pus escaped.
The pelvis was plugged with gauze. For the first week
the patient did well, only a little foul discharge escaping.
Then menstruation, which had been absent beforehand,
came on, the pelvic inflammation lighted up, and the
abdominal wound, which had previously been healing
was infected from within, and each gaping surface was
found to be covered with phagedasoa. By vigorous treat¬
ment this was arrested on the surface, but progressed in
the pelvis until the small intestines were perforated,
and fteces were freely discharged for the last two days.
The patient died on the fifteenth day after the operation.
The phagedaenic process had extended to the uterus, but
not to the vagina. The coils of intestine in contact
with the pelvis and abdominal wound had been invaded.
The rest of the peritoneal cavity was free, and no other
disease was found post-mortem.
Mr. Spencer finally referred to the progress which had
been made in connecting phagediena with tho presence
of a peculiar bacillus.
Jlnnttal getting of British <ittcbual
JUsociation,
HELD AT
PORTSMOUTH, AUGUST, 1899.
TBE ANNUAL EXHIBITION.
The annual exhibition was held in the Drill Hall at
Portsmouth. It was well up to the average so far as
exhibitors and exhibits were concerned, but the attend¬
ance of members was decidedly small. This falling-off
was probably due to the heat of the weather and the
host of attractions that claimed attention elsewhere.
But whatever the reason, the contrast between the num¬
bers that were to be seen at Portsmouth and at the cor¬
responding show in Edinburgh last year was, to say the
least of it, conspicuous. Appended will be found brief
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Auo.:9, 1899. uRITFSH MEDICAL
notices'of the more important exhibits, all of which have
already become familiar to readers of the Medical
Press and Circular through the medium of our adver¬
tisement columns.
THE ENTERTAINMENT.
Whatever view may be taken as to the general organi¬
sation, and the sectional work, at the Portsmouth meet¬
ing, thure can be no doubt whatever as to the success of the
recreational side of the affair. The excursions were
numerous, most interesting, and, on the whole, exceedingly
well organised. The most brilliant reception was the bail
given by the Mayor (Alderman Scott Foster) and
Mayoress, on Friday night, at the Town Hall. That
magnificent buildiftg was brilliantly decorated and illu¬
minated, both inside and out. The effect of the broad
facade of steps in front of the building and the high
relief lent by the electric lighting to its lofty pillars was
one of the most striking and artistic that could have
been conceived. Dancing was kept up to a late hour,
and the guests, including a number of townsfolk, were
entertained at supper in a large marquee erected behind
the hall. The hospitality of the Mayor of Portsmouth
certainly eclipsed that shown at the a 'erage of
association meetings, not only in the scale of
generosity but in attention to the minutest de¬
tails of organisation. Those of the members who
stayed over Saturday had the opportunity of witnessing
a “ Tattoo ” by the massed bands of the garrison, The
effect of the torchlight marchings, and of the bicycle
evolutions, relieved by a brilliant display of fireworks in
the illuminated grounds, formed what may be described,
without exaggeration. a3 a gorgeous military spectacle.
Space does not permit any detailed description of the
rest of the entertainments.
THE PATBOLOGICAL MUSEUM.
The two chief features of the scientific museum may
be summed up in the phrases, gunshot wounds and
Rontgen photographs. A large and varied collection of
bones injured by bullets was sent from the Royal Naval
Hospital at Haslar and the Army Hospital at Netley.
In it were shown almost every conceivable injury of bone,
immediate and remote, dependent on missiles, to say
nothing of injuries to soft tissues. These two
hospitals contributed between them no less than
169 specimens of first excellence. The London Hospital
Medical College was represented by a neat collection of
up to-date anatomical and pathological specimens. The
Leeds Medical School sent an interesting case of
specimens, especially of some renal tumours. Mr. L V.
Cargill exhibited some excellent specimens of patho¬
logical eyes, mounted in glycerine jelly. Mr. Jonathan
Hutchinson, jun., had a number of interesting surgical
specimens, and of radiograms, amongst which may be
specially noted the photograph of separation of lower
epiphyses of femur, and a sub-coracoid dislocation of
the shoulder before and after reduction. Mr. Mackenzie
Davidson showed stereoscopic views of much beauty and
interest. One of the upper thoracic skeletons reproduced
the cancellous tissue of the numerous and other
bones in striking perspective relief. He showed eight
cases of calculus. Professor Stevenson, of Netley, had i
a good stereoscopic view of a buckle buried in the tissues
by the impact of a bullet. Mr. Hugh Walsham had a
series of good photographs of pathological conditions of
the lungs and heart, and an excellent one of a renal
stone, both in situ, and after removal. Mr. H. A.
Boone showed some interesting X ray records, including
various badly united fractures, and a subturation of the
knee by the kick of a horse. Dr. David Walsh
showed a chest with sharply defined miliary tubercles,
scattered through the lungs—a record of a tumour
apparently connected with the kidney in a tall stout
woman, possibly of an hydatid origin; absent clavicles,
fractured ribs, and a htemophylic knee. There was a
most valuable and interesting collection of ancient
medical books from Netley, which also sent numerous
radiograms of gunshot injuries. Dr. Claremont showed
some good pathological specimens, and Dr. J. Eyres
ASSOCIATION. The Medical Press. 137
exhibited some water-colour sketches of tuberculosis of
the conjunctiva.
THE MUSEUM.
The Sanitas stall was filled with its usual display,
including the Ringzett sulphur fumigating candles.
Local Government Board corrosive sublimate pellets and
an imposing array of 8anitas preparations. Sanitas wool
of excellent quality was exhibited, and from personal
experience we are able to testify to the excellences of this
particular preparation. Sanitas soap is another article that
will repay a trial. A special preparation is the peroxide
of hydrogen. Ringzett’s patent, a stable article which
it is claimed, does not deteriorate after opening the
bottle, and is not decomposed by light. The bronchitis
kettle for the use of Sanitas vapour is so familiar an
article now in the sick-room that there is no need to
enter into a detailed description of its excellences. A
similar remark applies to other well-known productions
of this enterprising firm.
The Formalin Company has this year introduced a
powder containing the active antiseptic in a potent and
convenient form. The alformant lamps in the different
A and H shapes were shown, and the later form, which
is on the principle of a water bath. Grutol is a gela¬
tinous preparation of formalin intended for the treat¬
ment of wounds. At body heat the antiseptic is slowly
liberated and acts on the tissues. A fine spray is also
provided, the working part being a metal atomiser of
showy but simple construction. A scented preparation
of most agreeable nature is provided for geneial pur¬
poses about rooms. Formalin is also put up in bottles
for household use.
Messrs. Parke, Davis & Co. showed all their usual
preparations, such as liquor sedans, eutliymol, syrup of
hft*inatichypopho8phites, and vakadiastase. Among the
newer things was a fine line of chocolate-coated tablets,
including nearly two hundred varieties of drugs and
combinations of drugs. These practically replace in a
pleasant and palatable form the old-fashioned pills and
powders, and are quite in accordance with the modern
tendency to elegant pharmacy.
Our attention was particularly arrested by senna cor¬
dial, an elegant elixir of that standard aperient. Its
chief characteristic was a pleasant taste of figs. The
throat mentholated tablet is a good voice and throat
lozenge, specially suitable for singers and speakers. It
contains menthol, cocaine, benzoic acid and other drugs,
and has the advantage of being perfectly safe. We
should mention the excellent work done by this firm in
the direction of the physiological standardisation of
those drags not capable of chemical assay, such as ergot,
strophanthus, digitalis, and cannabis indica. These
preparations deserve the confidence of the medical pro¬
fession. Another point is their serum preparations,
which are supplied in the familiar hermetically-sealed
bulbs that have been from the first adopted by this firm.
They include the antistreptococcic, antitetanic, anti-
dipbtheritic serums, with Coley’s fluid, malloin and
tuberculin, and are carefully tested and standardised.
Messrs. Bayer and Co. had an exceedingly artistio
stall. The covering, a delicate shade of olive green
embroidered with various devices, and fringed with a
most tasteful edging of raised and stamped scroll-work
of faint maroon colour, twined with green velvet
leaves. On the stall itself were conspicuously placed
several oval shie'ds, the borders of which were fashioned
into raised pattern, with an effective bay-leaf and berry
ornament made of several kinds of differently coloured
metals. The upper part of the stall was draped in a
delicate plush of an artistic tint, which it would be diffi¬
cult to name, but which with its iridescent shades
formed a perfect contrast from the pale olive green of
the main motive. The principal exhibits are too well known
to need detailed mention, for such drugs as phenacetin,
Bulphonal, trional, and lycetol are household words in
the therapeutic world. Among the newer productions are
asperin, a substitute for salicylic acid, which claims to
avoid the disadvantage of the latter, and heroin, the
newest and most effectual derivative of morphine, with
its soluble salt, hydrochloride of heroin, the latter
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138 The Medical Press.
FRANCE.
Auo. 9, 1899.
intended especially for hypodermic use. Heroin does not
constipate, and is less tozic generally than morphine.
Protargol, as everyone knows, is a combination of silver
with a proteid substance. It contains about 81 per cent,
of silver, and unlike other silver compounds, it is
unirritating, and, at the same time, very penetrating.
Tannigen and Tannophen for use in enteritis; two
intestinal antiseptics that have lately attracted a good
deal of attention. Tannigen is a triacetyl of tannin and
tannophen, a combination of tannin with urotropin.
Trional and lycetol are both prepared as oxycarbonate
waters by Messrs. Cooper, of Gloucester Road, London.
This is an excellent method of administration under
the pleasant guise of an aerated water.
The British Somatose Company, Ltd., of 166, Queen
Victoria Street, who now possess the sole selling rights of
somatose, make an exhibit of their three well-known
preparations, somatose, iron somatose, and milk somatose.
The Hunyadi Janos water had a handsome stall in a
commanding position just opposite the entrance. The
pyramids of differently sized bottles decorated with the
familiar red labels, had a remarkably good effect. The
sales of this excellent water, we are glad to learn, have
advanced of recent years to high-water mark, and testify
to the high appreciation of the medical profession and
of the public. There is no need to descant upon the
virtues of this, perhaps the most popular of all natural
aperient waters. Its merits are established on a suffi¬
ciently firm basis to secure their lasting fame.
Newbery and Sons had a varied assortment of drugs.
Their exhibit, as usual, was especially strong in sugar-
coated pills of many different formulae. A special feature
was the preparations of sumbul, a heart tonic used in
hysteria and other conditions. This was put up in pill
form, and also as a liquid in tono sumbul. Bromo-soda,
an effervescing nerve tonic and calmative, was con¬
spicuous, and also a number of other elegant pharma¬
ceutical products of Messrs. Warner and Co., Phila¬
delphia, for which firm Newbery and Sons are the agent*.
A special note should be made of the effervescing lithii
tablets for use in gouty conditions. A portable
and sterilisable hypodermic syringe with metal
plunger appeared to be excellent in type and construc¬
tion, besides being of moderate cost.
Mellin’8 food and other preparations were strongly
in evidence on a most artistic-looking stall. The food
for invalids and infants is so well known that it need
not be more than mentioned. It may be added, however,
for the benefit of those who admire the older product that
Mellin’8 food biscuits are prepared largely from that
material. They are specially recommended for use in
childhood. The cod-liver emulsion claims special atten¬
tion from the fact that it is the only 50 per cent, emul¬
sion on the market, and is rendered agreeable to the
palate by a cinnamon flavour, and is to be recommended
in all cases of phthisis and other disease of malnutri¬
tion. Blended with Mellin’s food it is said to make a
good malted emulsion. A number of attractive little
souvenirs were distributed to visitors.
The Apollinaris Co., Ltd., had a show of the various
waters which form their specialties. Apenta, as every¬
one knows, is a natural aperient water that has come
into vogue within recent years. Its chemical composition
is such that it stimulates the gastro-intestinal tract
without causing irritation. Another important point
is that it contains lithium. Tho Johannis lithia and
Johann is potash, are two new waters, the nature of
which is sufficiently indicated by the names. They are
both composed of additions of lithia and of potash to the
Johannis natural sparkling water. With a little inge¬
nuity in the direction of flavouring agents, it is possible,
with the aid of these admirable waters, to administer
remedies in a pleasant and indeed an almost impercep¬
tible manner. Apollinaris needs only to be mentioned
as the Queen of Table Waters.
Brand & Co., Mayfair, showed their well-known pro¬
ducts on a neatly arranged stall. Prominence was
naturally given to their meat juice, which is ready for
immediate use and cheaper than most preparations of
the kind. The analysis is satisfactory, and it is
guaranteed to be made from the finest English beef. A
new preparation of tbiB firm is the “ Nutriment Powder,"
made from raw meat deprived of its natural moisture.
It can be taken in a sandwich or in water or wine, in
both of which it is partly soluble. The chief advantage
of this new product is that the nutrient qualities of the
meat are retained in an almost tasteless and odourless
form. There is also a special “fever” food for use
specially in the tropics. It contains essence of beef,
cream, and egg. Altogether, the exhibit was quite
worthy of the representation of the firm.
Messrs. Nestle had a handsome show of their special
products. The well-known children’s food, and the
Viking brand of unsweetened milk ; as everyone knows
the latter contains milk and cream without sugar. It
keeps well, and is palatable. Sample of milk and soda
water were freely dispensed at this stall, and the firm also
endeavoured further to assuage the tropical heat that
prevailed in the exhibition hall by distributing Japanese
fans to visitors, who availed themselves widely of these
timely gifts.
Mr. B. Kuhn exhibited an imposing array of special
preparations, of which the popular and efficient antiseptic,
Chinosol, was the moBt conspicuous. This drug, as all
surgeons know, is non-poisonous, non-corrosive, and a
powerful deodorant and germicide. It is put up in
tablecs, dressings, dusting powder, and other forms con¬
venient for surgical purposes; and is, fuithermore,
adapted for veterinary practice, for hygienic and toilet
purposes, and for general sanitation. Other prep&rtions
of this firm include argentol, vannalbin-knoll, diuretin-
knoll, colchi Bal capsules, betul ol, and papain tinkler,
the special properties of which need not be entered into
here. A large number of the articles on show cannot be
mentioned here, but in conclusion note may be made of
the ethyl-chloride glasB bulbs.
cfrancc.
[from our own correspondent.]
Pabis, August 5th, 1899.
Myocarditis.
At the Medical Congress held at Lille last week, M.
Huchend read a paper on the different formB of myocar¬
ditis. He said that one should be on guard against the
present tendency of diagnosing myocarditis where it did
not in reality exist. Simple troubles in the innerva¬
tion of the heart, disturbance of the cardiac
rhythm of reflex order, modifications in the arterial ten¬
sion, auriculo-ventricular thrombosis could lead the
inexperienced to suppose the existence of myocarditis in
the course of such infectious maladies as typhoid fever
or influenza. But if abuse was frequently made of the
term of acute myocarditis the study of the chronic form
was generally overlooked and gave rise to errors of con¬
siderable importance.
Taken in the true sense of the word, myocarditis means
inflammation or myositis of the cardiac muscle. When a
microbe or a toxin penetrate into the substance of a
tissue, their action, if sufficiently energetic, operated
the destruction of the anatomical elements by cellular
necrobosis. The dead cell became a thorn in the
side of the parenchyme: it was then that inflammation
intervened to remove from the organism the foreign
body. In acute myocarditis the inflammation
constituted, consequently, but a secondary or
transiting phenomenon the same might be said of
chronic myocarditis. Thus all the lesions which served
to classify chronic myocarditis (interstial modifications,
sclerous condition, fatty degeneration, segmentation of
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Auo. 9, 1899.
GERMANY.
The Medical Pbksb 139
the cardiac fibre) had frequently but the name of
inflammation. Forgetting the extreme rarity of muscular
inflammation, abuse was made of the word myocarditis to
include every degeneresence of the fibre of the cardiac
muscle. All case; of chronic myocarditis comprised in
different proportions, lesions of the insteretitial tissue,
parenchymatous alterations, and vascular lesions, but
different pathological conditions of the myocardia, pre*
sented particular characteristics which required a special
description.
Sclerosis in patches or arteriosclerosis of the heart was
characterised by degenerative lesions occupying the
territory of a stenosed artery, and ending in dystrophic
sclerosis, the ultimate term of a trouble of nutrition due
to ischemia. Those patches might be very small
and disseminated, consequently stricture of the
coronary arteries should be sought for. If those pate! es
interested a large extent of the walls of the heart, a
large vessel had been obliterated. In such case, the
heart, voluminous, assumes a globular form. General
dilatation of the ventricule, or partial dilatation
(aneurism of the heart) might result. At the seat of
the sclerosis there was always to be found atrophy of the
wall, frequently resulting in lupture of the heart.
In diffuse sclerosis, chronic instertitial myocarditis,
rings of sclerosis surround directly the artery, and
progresses in destroying the cardiac fibres ; the arteries
were not the seat of obliterating endoarthritis, but
rather that of irritation of the peri artery, terminating
in thickness of the vessel. The microscopic appearance
of the heart was also different, the organ frequently
enormous, and kept its conical form without dilatation
of the cavities or atrophy of the wall
Senile sclerosis was the terminal point of cardiac
lesions exclusively provoked by the progressive disinte"
gration of the elements of the organ by reason of the
advanced age of the individual. The cardiac fibre under¬
went senile atrophy, whilst the fibrilla of the conjunctive
tissue took its place to fill the empty spaces.
Three principal clinical forms of cardiosclerosis might
be admitted—painful or cardiac stenosis, arythmic and
tachycardia, myovalvulaire. The arhythmic form was
characterised either by intermittent attack s of arhythmia
or by a sort of cardiac folly which could persist six, ten,
or even fifteen years as the only symptom. It was
generally unaffected by digitalis. In the myovalvular,
type a scuffle of insufficiency of the orifice could be heard
due to sclero atheroma of the valve.
A phenomenon appearing generally at the debut of
arterial cardiopathy was the toxi-alimentary dyspnoea
That dyspnoea proved the existence of renal insufficiency
even in the absence of albumine, and yielded to milk
and vegetable diet. Death in arteiio-sclerosis of the
heart could be sudden, by syncope or by angina pectoris.
It could be rapid either from ' upture of the aneurysm of
one of the coronary arteries in the pericardium or from
rupture of the heart itself, or it might result from acute
oedema of the lungs, uremic trouble, hemorrhage, or
cerebral softening. On the contrary, the fatal termina¬
tion might arrive slowly by asystolia, cardiac throm¬
bosis, or from arterial cachexia, characterised by general
emaciation and pallor of the face.
As to the treatment of cardiac sclerosis, the fun da.
mental principle was to ease the organ by attenuating
ihe peripheric resistances. Diuretic drinks, notably
milk and oertain mineral waters, should be prescribed,
while tea, coffee, liquors, pure wine, should be sup¬
pressed. Aliments containing a great deal of ptomaines,
meat, preserves, fish, cheese, Ac., should be forbidden.
Abuse should not be made of drugs; theobiomine *?as
an excellent diuretic, while saline purgatives might be
given with advantage. As a vaso-dilator nitro-glycerine
rendered good services given in solution (1 per cent.)
during twenty days a month in increasing doses of from
4 to 20 drops daily. During the remaining ten days of
the month iodide of sodium might be prescribed.
(Sertnattp.
[FROM OCR OWN CORRESPONDENT.]
BKRLIK, August ^th, lfj&e.
At the Medical Congress Er. Kronig, Beilin, reported
on
Lumbar Puncture.
which in some cases had led to very interesting
diagnostic conclusions. With a very delicate apparatus
he had investigated as to pressure in fonrteen healthy
men, and had ascertained that in the horizontal lateral
posture the pressure was 125 mm., in the upright 410
and that the physiological range in the horizontal side
position was between 100 and 150 mm., that in the
sitting posture between 300 and 460, that in the hori¬
zontal side position the fluid exuded drop by drop; but
that in the sitting posture it flowed in a stream. He was
able to confirm Quincke's statement, that in the healthy
individual the microscopical elements consisted of a few
lymph corpuscles, with individual red blood corpuscles
The question as to whether there was aserous meningitis
or whether such supposed caseB were really simple hyper¬
emia with oedema was still debatable. Among other
cases he had examined two of typhoid with cerebral
symptoms from which a simultaneous serous meningitis
might have been suspected. He found high pressure,
but extraordinarily few cell elements, and those of a normal
character. An autopsy was made in one case, and nothing
but pronounced hyperemia and oedema were found, and
microscopical examination showed no trace of inflamma¬
tory serous infiltration. In two cases of chlorosis the
speaker found pronounced capillary oedema, a few lym¬
phocytes, and here and there an endothel. In a case of
diabetic coma nothing was found beyond hypertemia and
oedema. In acute serous meningitis the same was found
as in acute serous pleuritis, viz., only lymphocytes.
Polynuclear elements were scarcely ever found ; occa¬
sionally there were apparently polynuclear elements pro¬
duced by fragmentation of lymphatic nuclei. He had
come across the chronic form of serous meningitis in
various ways. His histological investigations were only
positive when there were distinct oscillations in the tube
of the manometer, as the oscillation showed that the
communications between the brain and the cord were per¬
fect, and the condition of the fluid withdrawn was an
illustration of the condition of both cavities. If
nothing was found in the spinal fluid, then nothing
would be found in the cerebro-spinal fluid. If
there were no oscillations it showed that con¬
nective tissue was present, preventing the pulsation
of the basal arteries being passed on downwards, and in
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140 The Medical Press. AUSTRIA.
such a case the fluid in the brain might be different from
that in the spinal cavity.
In 4 cases there was proof of softened cerebral sub¬
stance in the spinal fluid.
The oscillations in the tube in the case of healthy
individuals were 2 to 5 mm. "With a weak radial pulse
only weak oscillation were to be expected. If excessive
oscillations were met with with a weak radial pulse
this would be due to strong pulsation of the basal
arteries. In such a case his diagnosis would be either
pulsating tumour or aneurysm. The pulsation oscillation
with great significance in the case of cerebral tumour.
At the Society fer Innere Medizin, Hr. Litten showed
preparations of
Cystic Kidney and Cystic Liveb.
They were taken from a woman a?t. 55, who 10 years
ago had had an accident, the nature of which was not
clear, and who at intervals since then had suffered from
hsematuria. For this she was admitted into hospital
four days previously. There was extreme weal ness. In
the right hypochrondrium was a soft fluctuating tumour
apparently connected with the kidney. In general the
abdominal organs were normal, the urine was 1,200 ccm.
in the twenty-four hours, clear, contained a little albu¬
men, and had a specific gravity of 1 005 to 1006. thus
the symptoms resembled those of contracted kidney.
There was moderate hypertrophy of the left ventricle.
The following day there was headache, dulness of
intellect, and then coma-ureemia. The probable diagnosis
was hydro-nephrosis with contracted kidney, the cause
of the uraemia closure of the ureter by kinking. Death
took place in forty-eight hours. The autopsy revealed a
peculiar condition: the liver was strewn with cysts of
various size s, and also the kidney, which was very much
enlarged. There were also cysts in the ovaries, and
hypertrophy of the left ventricle. The diagnosis of
cystic kidney could not be certain. It was difficult
because acquired cystic kidney was always double.
Generally hydro-nephrosis was assumed. Puncture did
not assist differential diagnosis, as the fluid was
the same in both forms of disease; it contained
a large percentage of urea. There were connective tissue
bands between the cysts, as in contracted kidney. It was
very peculiar that increase of urine should generally
be found in such degenerated kidneys. No reason for
this could be given. Recently Nauwerk had given a
plausible explanation; there were actual tumours with
a typical glandular growth in normal or already mis-
formed kidneys. Children born with cystic kidneys died
soon after birth. Acquired cystic kidney generally made
its appearance in the fifth decennium. The patients
died of chronic and subacute uraemia in consequence of
renal insufficiency.
At the Free Society of Surgeons Hr. Bahn showed
Two Cases of Ruptured Liver.
The first, a young man, tet. 17, fell when cycling, lost
consciousness, and on recovery he felt acute pain in the
abdomen. There was great paleness and dulness over
the depending part of the abdomen.
Laparotomy was performed at once; in the abdomen
2 litres of blood were found. On the convexity of the
liver a rent 8 ctm. in length was felt, but at first not
seen. Only on separating the suspension ligament could
the liver be turned out bo far that the rent could be
Auo. 9, 1899.
closed with fine catgut sutures. The abdomen was then
closed, and recovery was uninterrupted.
The second case was one of gunshot wound. The point
of entrance was between the middle line and the right
margin of the ribs. The ball lay just behind and above
the crest of the ilium, it could be easi'y felt and was
removed without difficulty. Laparotomy was then per¬
formed. Entrance and .exit openings were found in the
liver, mesentery, pancreas, and parietal peritoneum.
Pledgets of iodoform gauze were packed into each of the
openings the ends being left outside. Recovery
uninterrupted. In all cases of rupture of the liver the
speaker advised operation as quickly as possible, in order
to master the great danger — the hemorrhage —
and this was best accomplished by suture through the
whole substance of the liver.
Hr. Israel remembered a case caused by a table-knife.
The knife entered in the tenth intercostal space. The
tenth and eleventh ribs were resected, the pleural cavity
full of blood, the diaphragm being perforated. The
abdomen waB then opened, and the wound in the liver
sutured and recovery took place.
Austria.
[from our own correspondent.]
Vienna, August 4th, 1899.
The Operating Glove.
We are still reminded by Schloffer that the operating
glove is an absolute necessity notwithstanding Doderlein’s
experiments and conclusions on the subject, and who ia
of opinion that a glove for operations in the abdominal
cavity is useless as an aseptic agent if the surgeon use
due diligence in disinfecting the hands, as no wound,
whatever care may be used, can be kept quite free from
germs. Schloffer haB been experimenting with the
leather gloves introduced for the u-e of surgeons by
Wolfler, and now records some wonderful results.
The glove, according to Schloffer’s experiments,
was first smeared over with a virulent culture,
and then washed with a one per cent. Lysol solution,
which again frees it from all danger of germ life ; the
glove is then put on the operator, the abdomen of a
guinea pig is next opened and the hand maintained
there for half an hour in a similar manner to the surgeon
when removing morbid growths from the abdomen, with
the result that out of sixteen animals acted on not one
succumbed, while all the control animals conducted in
the usual way died from sepsis.
The same results were obtained if a half per cent,
solution of Lysol was used, or when the infected part
was smeared over with vaseline.
From the foregoing, Schloffer concludes that the
“ Lederhandschuh ” is a perfect protection against the
transmission of germs into the peritoneum. He also
adduces a large amount of clinical evidence to prove the
benefits that have been derived from this provision in
the operation of abdominal cases and deprecates
Doderlein’s efforts to diminish the importance of such a
useful precaution. Lysol, according to his experience, is
not injurious to the healing process and need not be
dreaded. The leather glove is superior to the woven one.
Grangrkne Foudroyant.
Hitschmann, in his lecture at the Deutscben Gesell.
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SOUTH AFRICA.
The Medical Press. 14L
Aro. 9, 1899.
achaft, related the history of six cases of gangrene
foudroyant, all in yonng people occurring after acci¬
dents. He thinks these cases must he quite separated
from malignant tedema with which they have much in
common. The severity of the injury, however, plays no
part in modifying the course, or recovery, of the patient.
The characteristic symptoms of the disease are local
objective coldness of the affected parts with subjective
insensibility, while pressure produces a crackling noise
under the skin. In addition to these the general con¬
stitutional indications of infection are present in the
form of icterus and mental stupidity. The usual ter¬
mination is death.
The local anatomical conditions observed during life
can be demonstrated in the pathological room to depend
on the constitutional influence. The internal organs
have cloudy swelling and parenchymatous degeneration.
There is no enlargement of the spleen, thus showing that
the poison confines its ravages to the lymphatic paths in
its progress, as bacteria are found to develop rapidly i n
the lymphatic vessels after death. The greatest number
of these germs are to be found in the gas vesicles that
crackle under the skin The muscular tissue is broken down,
and the colour quite lost, evidently from the effects of
fermentation that takes place between the glycogen
and albumen of the muscles.
abduction alone. By Lorenz the leg is abducted, rotated
outwards, bent and extended, as if moving the hand of
a pump, by which means the capsule is stretched, the
head ultimately springing into the cavity with an audible
rush.
Lorenz further recommends a plaster of Paris support
with the leg abducted and rotated inwards.
The treatment is useless when the child is over ten
years of age. Out of 42 unilateral cases so treated only
four were unsuccessful. The eldest was six.
Schede’s method is extension pressure over the tro¬
chanter major. Thirteen were treated by this principle
with good results.
Transposition in a large number of the cases is un¬
avoidable from the thickened ligamentum teres filling up
the acetabulum which allows the head to slip forward or
upward, leaving on the whole a fairly good joint. On
this account Lorenz’s method of putting the joint in a
plaster of Paris is good.
South Jlfrica.
Tfrom our own correspondent.!
Cape Town. July 'Jnd, 1809.
In the six cases examined four were found to give in
pure cultures a short stiff rod, which has the power of
causing albuminous bodies to ferment with the
evolution of butyric acid. In one of the cases this germ
was found associated with another, to be frequently
found in the soil and bowel, which is pathogenic in
guinea pigs. Fraenkel has found an identical bacillus in
a phlegmonous gasy inflammation.
In the sixth case the bacteria coli with a streptococcus
were found. The bacterium coli produces fermentation
in the carbohydrates alone, but do not in albumen,
and is more likely to be present in the gasy phleg¬
monous formations met with in diabetes. But the
Proteins produce another gaseous condition some¬
times met with in pathological changes which
were not found in any of the six cases. Whether the
bacillus in the four preceding cases Is an isolated and
distinct species or a modification of Fraenkel’s “gas*
phlegmone ” bacteria is yet difficult to affirm, but it is
certainly one that decomposes muscular structure with
the evolution of gas.
In Buch cases amputation of the morbid part is the
only hope of saving life.
Congenital Dislocation of Hip Joint.
Hoffa, in reviewing his success in this subject, said the
mechanical treatment of congenital dislocations first
practised at the hip joint was followed by a more heroic
one, now known in history as the “ bloody" operation
for its correction; but recent surgery had supplanted
both these operations by a more humane and satisfactory
method, known as the bloodless operation, which had been
recently popularised by Lorenz, while Paci, Schede, and
Mikulicz had modified the operation. All the published
facts were in favour of Lorenz’s method of reposition in
transposing the head of the bone forwards. Hoffa has
operated on 84 unilateral dislocations and 73 bilateral.
Lorenz’s method was practised 64—42 unilateral and 22
bilateral. Kiimmel i» of opinion that extension is
unnecessary, as reposition can be accomplished by
The Medical Board of Rhodesia.
The profession in Rhodesia is very much up in arms
against the Medical Bill of that colony. The principal
objections appear to be that the Medical Board is to be
entirely nominative, that it is to include a chemist and a
dentist, and that the total strength may possibly not be
more than three, thus putting the “auxiliaries” in a
majority on purely medical questions. The Act. how
ever, allows the board to have as many as nine members,
and it is not likely that the Administrator will keep
much below that number. Another objection is that
Cape registration is to carry with it Rhodesian registra¬
tion, but this is surely a very flimsy objection, as,
except for the cases of a very few unqualified men
registered retrospectively, at the passing of our Act,
our requirements are stringent enough. It does not seem
that our Rhodesian confreres have very good grounds
for their agitation.
Registration for Immigrant Doctors.
The Cape Medical Council has adopted a new regula*
tion requiring a sworn declaration from applicants for
registration to the effect that they have never been
punished by any licensing body for any misdemeanour.
This is to obviate the possibility of a man who had been
struck off the Register in England getting registered here-
Hypnotism Among the Natives.
The S. A. Medical Journal publishes an interesting
paper by Mr. E. C. Long, of Maseru, Basutoland, on
observations in hypnotising natives at the hospital at
that place, of which he is medical officer. He reports
having attempted hypnotism for the purpose of inducing
anaesthesia, in seventy cases, succeeding completely in
forty-five, and partially in six. When he failed, he had
never made a second attempt. Sometimes the anaesthesia
was complete, sometimes only partial, and in a good num¬
ber even with complete anaesthesia, consciousness was re.
tained. Generally the result was attained in from five
to ten minutes, and in no case were ill-effects observed.
I The surgical cases included tooth extraction, opening
Digitized by LjOOQle
142 The Medical Pbem. THE OPERATING THEATRES.
of abscesses, removal of carious bone, and exploration
of hip-joint. Medically he used hypnotism in neuralgia,
chorea, and hysteria. Considering that he was handi¬
capped in the way of suggestion by having to use an
interpreter, his results seemed fairly good, and he thinks
that, to the single-handed South African practitioner!
hypnotism is a very useful means of bringing about
anaesthesia.
The Prevention of Tuberculosis.
The Cape Town Branch of the British Medical Asso.
ciation discussed at its last meeting a committee’s report
on the prevention of tuberculosis. The matter was
gone into somewhat exhaustively under a few headings,
but nothing of special importance was elicited. At the
next meeting the discussion will be continued, and it
is probable that it will result in the establishment of
an association on the plan of that in England, or possibly
a branch thereof.
Infantile Mortality and the Creche.
Another Cape Town medical charity has been estab¬
lished, a creche, very much wanted in this city. It has
commenced under good auspices, and is likely to be of
great benefit to the working classes. It is to be hoped
that it may do something towards reducing the heavy
infant mortality. During last month eighty-seven
deaths were registered, and out of those fifty-six were
under five years of age. Out of the total death-rate
seventeen were credited to tuberculosis, a somewhat
high ratio for a climate like this. Zymotic diseases
account for twenty-five deaths. There is evidently
room for preventive medicine in this good city.
^hc Operating theatres.
THE SEAMEN’S HOSPITAL (DREADNOUGHT),
GREENWICH.
Periurethral Abscess Probably Traumatic in
Origin.—Mr. William Turner operated on a man, tet.
about 35, who had been admitted complaining of pain and
swelling in the scrotum. The patient stated that the penis
when in a state of erection had been forcibly bent, with
the result that the organ was still inclined to the left
side; this accident had caused him great pain, and
shortly alter he noticed some swelling at the base of
the penis. The accident occurred four days before the
date of admission, and forty-eight hours after the
accident he had a severe rigor, and felt very ill.
He had not noticed any real difficulty in passing
urine, though the stream was not so large as be¬
fore, and there was a certain amount of pain during
the act. He had never had any symptoms of stricture
during his life, but some years before he had suffered
from an attack of gonorrhoea. On admission he had a
temperature of 102 degs., the tongue was dry and very
furred. On examining the parts affected, the penis was
found to be enlarged, swollen, and cedematous, and was
inclined towards the left side ; the scrotum was cedema¬
tous and between the two testicles, passing backwards,
there was a tender, indurating swelling, undoubtedly
corresponding to the peri-urethral tissue ; this swelling
extended forwards to within an inch of the glans
penis, and backwards within about 2J inches of the
margin of the anus. Fluctuation could not be detected
on account of the induration of all the parts.
aug. 9, 1899.
house surgeon had ] assed a full-sized instrument with¬
out difficulty into the bladder on account of the possi¬
bility of there being extravasation of urine. The
diagnosis of peri-urethral abscess was made, and imme¬
diate operation was deemed necessary. An anesthetic
having been administered, and the patient placed in the
lithotomy position, the parts having been shaved and
purified in the usual way, an incision was made exactly
in the media raphe of the scrotum, the testicles being
held carefully apart on either side. The scrotum being
thus divided, the inflammatory mass was exposed. On
cutting into it about 3 ozs. of foul-emelling, putrid pus
were evacuated and a large abscess cavity extending
round the urethra and running up nearly to the glans
penis was found ; a pair of scissors were then introduced
and the whole of the abscess cavity laid open forwards
and backwards. The floor of this cavity round the
urethra was found in a very sloughy condition, and on
this account it was thought advisable to incise the
bulbous portion of the urethra- and pass a drainage tube
into the bladder, in order to give the anterior part of
the urethra a rest, it being very doubtful whether this
could recover without the formation of a penile or
scrotal urinary fistula. The parts were well washed
with perchloride lotion and then packed with
iodoform gauze, provision being made in the
dressing for the soft catheter draining the bladder
to be connected with an india-rubber tube passing into
a vessel under the bed. Mr. Turner said that the cause
of the patient’s condition was doubtful, it was certainly
not an ordinary lacunar abscess becoming peri-urethral
occurring in acute gonorrhoea, as the patient certainly
was not suffering from gonorrhoea. There was no com¬
munication with the urethra, and there was no urine in
the abscees, thus excluding any idea of extravasation of
urine. The most likely pathology of the condition was
that a hsematoma had formed from the injury, and
that this had become infected in some way with
micro-organiBms, and probably the bacillus coli
communis was the cause of the foul odour, it
being a well-known fact that this organism
is constantly found in abscesses in the region of the
urethra and the rectum. There was no evidence as far
as could be detected of any rupture of the corpus caver-
nosum on either side. Mr. Turner stated that in the
treatment of cases of this kind he always advocated very-
free drainage and no direct treatment, such as scraping
or the application of pure carbolic acid or chloride of
zinc, as such treatment is liable to increase the slough¬
ing of the surrounding parts. Had such procedure been
adopted the floor of the urethra for a space of about
2J inchf s would have been nearly certain to slough as the
wall of the canal was already very thin and seemed almost
a part of the sloughy base of the abscees.
A week after the operation the patient was going on very
satisfactorily, the temperature came down to normal 24
hours after the operation and remained so. The bladder
was 8-till being drained by the perineum, the urine
being normal; there were no sloughs in the wound at
all, and the two sides of the cleft Bcrotum and of the
wall of the abscess were covered with early granula¬
tions, all the sloughy condition had disappeared,
and the wall of the urethra had not given way-
The treatment that had been adopted was regular
dressing with thorough irrigation of 1 in 2,000
The | perchloride lotion. On Mr. Turner’s suggestion
Digitized by V^OOQLe
LEADING ARTICLES.
The Medical Pexss. 143
Aug. 9, 1899.
the sides of the scrotum were brought together by the
houBe surgeon, and a few stitches put in superficially
to keep the opposing surface in apposition, whilst
drainage was allowed for in an antero-posterior direction
along the urethra. The next step in the treatment will
be the discarding of the perineal drainage, together with
regular catheterisation, so as to allow the perineal
wound into the urethra to heal up and the drainage put
along in the peri-urethral tissues gradually shortened,
so as to permit of the complete filling up of the abscess
cavity.
Begisterkd roB Tbakbmissiok Abboad.
€h* Jtes attb (Eircular.
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“ SALUS POPULI 8CPREMA LEX.”
WEDNESDAY, AUGUST 9, 1899.
THE ADDRESS IN MEDICINE AT
PORTSMOUTH.
The Presidential opening of the Section of Medi*
cine at last week’s Association meeting, delivered
by Sir Douglas Powell, was a cautious, solid, and
hopeful summary of recent advances in practice. His
utterances were those of a cultured man who, ripe
with past experiences, had not failed to gather to
himself the facts and principles of modern progress.
In this respect his utterances may be instructively
compared with those of the chosen head of the
contiguous Section of State Medicine. Both men
touched upon serum therapeutics and upon bacteri¬
ology in relation to tuberculosis. But while the one
appraised these researches at their proper value, and
pointed out their possibilities and their limitations, the
other indulged in a fierce onslaught upon the scope,
the methods, the results, and even the ethics of bac¬
teriologists in what he termed, with question-begging
narrowness, “ the insane hunt after the tubercle
bacillus.” Whatever grain of truth this reactionary
attitude may contain yet it must be abundantly
clear to all reasonable men that the chair of an
important section of a great assemblage of repre¬
sentative medicine in Great Britain was not a fit
place from which to issue rhetorical thunder of that
kind. Comment upon a Presidential Address
is forbidden, or, we venture to say that, at
the meeting a strong protest and entire logical refu¬
tation would have been at once brought forward. If
insanity be inseparable from the quest after the
acknowledged source of the dread pestilence of
tubercle, then in Heaven's name let a fair pro¬
portion of our best and brightest intellects sacri¬
fice themselves for the love of mankind and go
mad forthwith. It is a relief to turn to the
broader views of Sir Douglas Powell, who opened
his remarks upon bacteriology by saying that the
science “ in its application to diagnosis and treat*
ment in practical medicine is yet in its infancy ; but
it is a very robust infancy, full of promise, the com¬
plete fulfilment of which none of us will live to see.’
He pointed out that bacteriological work must neces¬
sarily be a matter of expert investigation, aB it would
be impossible for the busy practitioner to find the
time and the necessary appliances for the purpose. At
the same time, it may be remarked that an elemen¬
tary examination, with the aid of cover-glasses
and a few easy cultures, is becoming of in¬
creasing importance. At the same time, there can
be no doubt aB to the truth of the main proposition
that practitioners of medicine will in future have for
the most part to deal with the results of bacteri¬
ology, both in abstract scientific research and in prac¬
tical bedside work. As to serum therapeutics, the
speaker recognised the immense value of the know¬
ledge that every infection required a separately pre¬
pared serum for its treatment. Some of our failures
might be explained by the fact that a manifold patho¬
genic pathology lay at the root of many diseased con¬
ditions. Such associated poisons might be recognised
in the third, and often in the first stage of enteric
fever, in the suppurative stages of scarlatina, and
perhaps in gonorrhoeal rheumatism. But while the
neutralising the specific poison of various diseases by
appropriate remedial serums would relieve the prac¬
titioner of vast anxiety, yet, on the other hand, his
responsibility would be greatly increased by the abso¬
lute necessity of early diagnosis, and by the scrupu¬
lous care needed to prevent the introduction into the
body of his patient of furthor dangers of micro¬
bial origin. As regards phthisis, while advo¬
cating the use of every ordinary measure of
precaution in the way of cleanliness, avoid¬
ance of dust, and disinfection of sputa, Sir
Douglas Powell, on the other hand, counselled the
careful eschewing of exaggerated statements likely
to alarm the public as to the contagiousness of the
disease. One striking point to which he drew atten¬
tion was the enormous prevalence of bovine tuber¬
culosis not only among stall-fed cattle, but also in
those kept under good open-air conditions. He
argued that, like malaria, tuberculosis will probably
be found to have a double origin from purely micro-
phytic as well as from parasitic infection. He
Digitized by L^OOQle
144 The Medical Press.
LEADING ARTICLES.
Ai o. 9. 1899.
remarked that we may hope by rigid sanitary control
to reduce considerably the present death rate
of 14 per 1,000 living due to consumption, a figure
which already marked a reduction of 20 per 1,000
living from the same cause. In his belief there
exists a mephytic laboratory beyond our special
control, yielding organisms ever ready to attack the
unwary and those whose vitality is depressed. General
sanitation and cleanliness are our first line of
defence. Wherever the conditions of insanitation,
dampness, deficient sunlight, and the prevalence of
favouring diseases are present there aggressive
activity may be again looked for.
DISCUSSION AT GENERAL MEETING OF
THE ASSOCIATION.
This meeting had been looked forward to with
special interest by members, from the fact that a
number of notices of motion had been lodged. At
least half of these propositions had been ruled out of
order by the late President of Council, Dr. Saundby.
Under these circumstances it is much to be regretted
that the somewhat arbitrary position taken up by
Dr. Saundby, on behalf of the Council, had
to be sustained in his absence. Dr. Ward
Cousins read a letter of apology for absence
from Dr. Saundby, who said that he “ had to
return to Birmingham to give evidence at the
Assizes, or he would not have run away from ” that
discussion. Now, the general meeting took place on
Wednesday, August 2nd, from 2 to 5 o'clock, in the
afternoon, and Dr. Saundby was present at functions
of the Association, both in the afternoon and evening
of that day, and was also seen in Portsmouth next
morning. With these facts in view it seems abundantly
clear that members of the British Medical Associa¬
tion are entitled to demand a further explanation
from one who continues to occupy a high position on
the Council. Dr. Lorrimer Hart struck the keynote
of the position of members in the debate by rising
on a point of order to ask under what powers the
President of Council (Dr. Saundby) had ruled out of
order certain notices of motion duly sent in for dis¬
cussion at general meeting. The originally excluded
motion alluded to by Dr. Hart was raised nominally,
and to put himself in order, on a reduction of the
editor’s salary by £10, in order to call attention to
the exclusion from the journal of several
matters of prime importance to the profession.
That was ruled out of order, and so did
not come before the meeting. In the courso of the
discussion, however, the whole question of the powers
of members in general meeting over the expenditure
of the Association upon its journal was raised, and
practically a vote of censure was passed upon the
Council. The specific resolution concerned was pro¬
posed by Mr. Victor Horsley, seconded by Mr. Tomlin,
and carried. It ran as follows:—“ That inasmuch as
the President of the Council, and subsequently the
Council itself, have ruled that the members of the Asso¬
ciation have no right to discuss in general meeting the
question of the expenditure of the Association upon its
journal, this meeting strongly disapproves of the action
of the Council." In the upshot Dr. Hart moved a
modification of his original excluded motion, which
was accepted by the president (Dr. Ward Cousins).
It ran:—“ That the attention of the Council he invited
to the exclusion of the editor of the British Medical
Journal of matters of interest to the Association and to
the profession ; especially in reference to the. memorials
of the General Medical Council against the certification
of unqualified persons by registered practitioners;
and to his silence on such matters obstructing reform.."
This resolution wus seconded by Dr. Frederick
Spicer and passed. Curiously enough, the issue of
the British Medical Journal that has since appeared
(August 5th), emphasizes the position by omitting
from what would have been otherwise a fair report
all mention of two most vital subjects that took a
conspicuous place in the discussion. Those two omis¬
sions were:—I. The mention of petition of fellows
and members of the English College of Surgeons
claiming the privilege of electing their representa¬
tive on the General Medical Council. II. Mention
of the memorial addressed to the General Medical
Council against the certification of unqualified per¬
sons by registered practitioners, and signed by over a
thousand medical men. It should be added that the
meeting absolved the editor from personal respon¬
sibility.
A SERIOUS INDICTMENT AGAINST THE
NAVY AND ARMY MEDICAL SERVICES.
It was, perhaps, quite in accord with the natural
fitness of thingsthat Professor Ogston, of Aberdeen
should have discussed in his address in surgery at
theannual meeting of the British Medical Association
the affairs of the Navy and Army Medical Services.
In the midst of such a naval and military community
he would be certain to attract not only an attentive
but an appreciative audience. Our confreres in the
Services, however, were probably not quite prepared for
the outspokenness in which Professor Ogston indulged.
The picture which he presented of the unpreparednees
and inefficiency of the two medical departments must
have been a revelation to many to whom the facts in
this regard were unknown. But such an address
was nevertheless well-timed and apposite. It has
for long been known, for example, that the officers
of what is now the Royal Army Medical Corps have
felt extreme dissatisfaction with the want of sym¬
pathy displayed by the War Office towards their
efforts made to increase the efficiency of the military
medical service. No one knows better than the army
medical officer how deficient hie department is
in the matter of modern medical equipments-
Instead of doing everything in their power to
foster the zeal for efficiency among their medical
officers the War Office seem to make a point of
deliberately following the opposite policy. The
following quotation from Professor Ogston’s address
will reveal something of the state of affaire in this
regard. “ Under the existing system no junior officer
Digitized by v^ooQle
Aro 9, 1899.
NOTES ON CURRENT TOPICS.
The Medical Press. 145
of the Royal Army Medical Corps has any opportunity
of practising modern surgery; even if an occasion
offers he is tied down by modern restrictions and
impediments enforced by his seniors, and his natural
desire to prepare himself for the highest work is dis¬
regarded and repressed, so that few, if any, are cap¬
able of the class of surgical work which will l>e
expected of them by the country, and for the non¬
performance of which they will be unjustly blamed
when the test of war is imposed upon their perform¬
ances. So long as the medical services afford their sur¬
geons no proper facilities for acquiring and maintain¬
ing a competent knowledge of their highly important
and necessary matters; so long as the junior medical
officers, as the junior medical officers, have neither the
chance nor the encouragement to perfect themselves
in their science, and especially in what would lie
before them in the event of a war, it can hardly be
wondered at that a service entailing on those who
enter it what is from a professional point of view
almost an intellectual sterility, should be a mode of
life our best graduates recoil from and which few of
them can be persuaded to adopt." The natural
corollary from this is, that the services must either
adapt themselves to the altered spirit of th e times,
or remain undermanned, and lacking in everything
which an up-to-date department should possess
It seems a curious anachronism that the poorest
subjects of Her Majesty should have an opportunity
in our hospitals of profiting by the benefits of modern
medicine and surgery, when these are practically
denied by the War Office and the Admiralty to the
soldier and sailor as long as he remains in the service.
That is really the position of affaire, and there is no
disputing the fact. Under the present system under
which the medical departments are being conducted,
it would be impossible to predict the consequences
in the event of this country becoming involved in a
great war. We do not for a moment deny that in
our expeditions in the Soudan and to the North-West
Frontier the medical department was found efficient,
and worthily earned the praise bestowed upon it.
But the authorities have beeD repeatedly reminded
that the past little wars in which we have been
engaged cannot be regarded as affording any test of
the requirements of the department. On the other
hand, were we to be engaged on equal terms with a
large European power, the belief among those best
qualified to judge is that the horrors which occurred
during the Crimean War would be repeated. But
however melancholy it may be to discuss these
matters in respect to the Army Medical Service, it is
more so still to contemplate the picture drawn by
Professor Ogston of the horrors in store for the wounded
on board our battleships during a naval engagement-
Its central feature is that everything on board ship
that can destroy life is in the highest perfection,
while everything that can save it is of the rudest de¬
scription and behind the age. Professor Ogston
states that on board none of Her Majesty's vessels is
there any possibility of performing a laparotomy for
a gunshot wound of the abdomen. There is neither
accommodation, nor instruments, nor accessories for
the purpose. We have not space to discuss
the many excellent points put forward with
the object of remedying the defects to which atten-
t on is diawn in the address. Suffice it. however, to
say that Professor Ogston makes many valuable sug¬
gestions which the authorities would do well to take
into their serious consideration. We believe that the
address is bound to bear gor*d fruit, inasmuch as
even if the authorities remain obdurate, the grave
indictment to which it amounts cannot fail to
excite earnest attention among the medical and lay
public.
tea on Current ‘Copies.
A Retrograde Sanitarian.
Food for unpleasant reflection is afforded in the
remarks with which Dr. Wilson opened the Section
of State Medicine at the annual meeting of the
Brit'sh Medical Association. We are sorry to
have to admit that *he sum and substance of
this address was the belittling of the work
of bacteriologists especially apparently because of its
association with experiments upon animals. With
considerable temerity, and quite inconsequentially,
Dr. Wilson avows that he is prepared to contend that
the indiscriminate maiming and slaughter of animal
life with which bacteriological methods of research
and experimentation are, in his opinion, inseparably
associated, cannot be proved to have saved one single
human life, or lessened in any appreciable degree the
load of human suffering. Dr. Wilson, of course, is
entitled to hold any opinion that he likes
upon the subject, but it is a pity that in
his official position as president of the section
of State medicine he should have reiterated
statements entirely opposed to the teaching of
modern scientific research. To hold such retrograde
views upon the subject of bacteriology, for example
a science still in its infancy, and, we may reasonably
believe, full of promise in the near future, and to ex¬
press such views officially, is not only calcu¬
lated to do harm to the profession, but also
to disturb the confidence of the public in
the validity of medical progress. What sensible
person can admit, because bacteriologists have
so far failed in their attempts to isolate and cultivate
a specific organism of scarlatina, whooping-cough or
measles, as urged by Dr. Wilson, that no such specific
organisms exist. To accept a statement of this nature
is to imply that finality has been reached in the
methods of bacteriological technique, but who can
imagine for a moment that this is the case ? Bacterio¬
logists are gradually feeling their wav, in an entirely
new field of science, and time and opportunity must be
permitted them to work out the problems with which
they are confronted. In the legitimate prosecution of
their investigations experimentation upon animal life
is indispensable, and is at the same time permitted
by law, and it was, therefore, scarcely the duty
of a medical man, placed by his confreres in a
Digitized by CjOO^Ic
146 Th* Medical Pbxss. NOTES ON CURRENT TOPICS. Apq. 9, 1899.
position of trust and responsibility, as Dr: Wilson
was, to avail himself of the opportunity to throw
discredit upon the work of some of the ablest medical
scientists of the day, whose claims to honesty and
singleness of purpose moreover are fully equal to those
advanced by the orator on his own behalf.
The Section of Tropical Diseases.
Thanks to the enthusiasm which has been
thrown into the problem of promoting the study
of tropical diseases this subject has forthwith
attained to the dignity of a separate section.
In the introductory remarks with which Dr. Thin
inaugurated the section at Portsmouth we get a
glimpse of the immense amount of patient study and
observation which have been devoted to the study
of malarial fever. Day is apparently just beginning
to dawn in this dark region of medicine, but at the
price of many deceptions and disappointments, due in
part, no doubt, to the desire to discover some one
fact which should explain and co-ordinate the protean
manifestations of the diseases classified en bloc as
malarial. Hitherto all classifications have been
made on a purely clinical basis for the simple
reason that no trustworthy pathological data have
been available for a more scientific arrangement. To
the general reader papers dealing with the re¬
sults of recent investigations on this subject
are more or lees unintelligible, owing to the large
number of new terms which grace the termin¬
ology of this particular department of research.
We are fain to await the services of an interpreter
who shall give us a plain statement of facta divested
of the technical obscurities which at present close
the avenues of knowledge to all save experts.
The evidence in favour of the mosquito being the
means of transmitting, at any rate, certain forms of
malaria seems tolerably conclusive, though as malaria
occui s in parts of the world where mosquitoes are un¬
known this insect cannot well be the only, possibly not
even the principal, means of its transmission. We are
glad to see that due credit is given to Italian
observers for the many years of patient unrecom¬
pensed labour which they have devoted to the subject.
If they did not earlier achieve results of a kind to
command general assent, this fact must be attributed
to the inherent difficulties of the subject It is
hardly possible to exaggerate the importance of this
branch of investigation, bearing as it does upon a
group of diseases which virtually close large sections
of the globe to the white man.
Matron and Doctor.
The Chelsea Board of Guardians have been much
occupied of late concerning a dispute which has
arisen between one of the surgeons to the Infirmary
and the matron. We gather that a man had been
operated upon for hernia and was left with instruc¬
tions that he was not to be moved without permission
in view of the danger of reopening the wound. In
the face of those instructions the matron, in order to
guard against bedsores, ordered a pillow to be placed
under the loins, with the result that the wound re¬
opened and dangerous liaamorrhage supervened. As
the matron declined to acknowledge having com¬
mitted an error of judgment, for that is all it amounts
to, the matter was brought before the Guardians with
a request that the facts should be laid before the
Local Government Board. This, however, they were
indisposed to do, and after a brief discussion, the
motion to that effect was negatived. The members,
or some of them, who voted in the minority asked
permission to see the documents, but as the clerk
suspected that this was for the purpose of
obtaining information to be sent direct to the
Local Government Board, he took upon him¬
self to refuse access thereto in spite of a favour¬
able opinion by the chairman. He held, like
the President of the General Medical Council, that
the Board as a whole could alone order him to pro¬
duce the documents in question. The matter in dis¬
pute may appear a small one but it must not be for¬
gotten that a very important principle is at stake—
viz., the subordination of the nursing, to the medical,
staff. Obviously if nurses and matrons take upon
themselves to disobey the orders of the Medical
Officer, with the approval of the Guardians, the
Medical Officer must disclaim any responsibility for
the results to the patient. Of course one would like
to see surgeons and nurses working together har¬
moniously in the interest of their patients, but this
cannot be unless discipline is maintained. The
matron after all was guilty merely of injudicious
interfe rence, but her fault is aggravated by her sub¬
sequent attitude, and if she persists in that attitude
the Local Government Board, in default of the
Guardians, will, sooner or later, have to adjudicate.
Cockles and Typhoid.
A serious epidemic of typhoid has prevailed in
Chichester for some months past. Fifty-five cases
have occurred, and close enquiry revealed the fact
that in at least 20 of these the patient had partaken
of local cockles. These come—as all larger fat
cockles do—from the black mud in the neighbour¬
ing harbours which was abundantly watered with
Bewage from the neighbouring villages. In one
instance the father of the family, the only one of
eight who abstained from the cockles, was the only
one who escaped the typhoid.
Recent Vaccination Returns.
In spite of the fuss that have been made about the
large number of conscientious objectors, we have it
on the authority of the President of the Local
Government Board that the total number of certifi¬
cates of successful primary vaccination received by
the vaccination officers during the first six months
of the present year amounted to 353,992 as against
277,821 in the first six months of 1898, that is to say
there has been an increase of upwards of 76,000
primaiy vaccinations, equal to more than 27 per cent,
in the first six months of the present year as com¬
pared with the corresponding period of 1898. Mr.
Digitized by v^ooQle
Auo. 9, 1899.
NOTES ON CURRENT TOPICS The Medical Pa^ss 147
Chaplin added that these results had been obtained
in the first six months of the Act notwithstanding
the difficulty of giving effect to an entire change of
method throughout the country from stational to
domiciliary vaccination, and also in spite of the fact
that in numerous cases there was very considerable
delay in the fixing of fees and the appointment of
officers, and that in some cases, such as Leicester for
instance, the necessary appointments are not made
even yet
The Food Preservative Danger.
For some time past the dangers of the use of anti¬
septics in the preservation of food has been increas¬
ingly apparent. Boric acid, salicylic acid and many
other chemicals of a more or less potent nature,
have been discovered in food stuffs of various Kinds,
and have in several instances formed the subject of
prosecutions. It can hardly be said, however, that
the judicial attitude with regard to this form of
adulteration, for so it must technically be termed,
has been yet clearly and authoritatively defined.
The scientific knowledge of the agency of bacteria in
putrefaction is of recent growth, and the sub¬
sequent practical application of the newly born
science have, in many instances, introduced into
the ethical life of the community problems that
still await a satisfactory solution. So far as the
addition of chemical preservatives is concerned the
greatest offenders have hitherto been the milk and
the butter man. As a general rule the drug chosen
for their purpose is comparatively harmless, but a
repoit comes from New York of the use of a deadly
poison, to wit, nothing more nor less than arsenic-
The fact was brought to light by the poisoning, in
Brooklyn, of nine persons, two of whom are not
expected to live. The occurrence was traced to milk
an analysis of which revealed the presence of arsenic.
As the outcome of further investigation the dairyman
confessed that he used the poison systematically in
order to keep the milk sweet. Medical men gener¬
ally will do well to bear in mind the fact that some
cases of obscure illness may be due to food preserva.
tives. If the milkman is going to embark in a whole¬
sale round of chemical experimentation, the com¬
munity will find a fresh terror added to their daily
life.
Gunshot Wounds in Civil Life.
The increasing use of the revolver among a certain
class of the community has more than once been
pointed out by police magistrates, and confirmatory
evidence of the fact was given last week by Mr.
Butlin in his opening address in the Surgical Section
at the British Medical Association. In his experience
of late years the use of firearms, for the most part the
revolver or pistol, in civil life has increased alarm¬
ingly. “ If ” he said, “ a young man has a grudge
against his fellow workman he buys a pistol and
shoots him; if a youth quarrels with a maiden he
shoots her, sometimes fatally, then turns the weapon
against himself, but rarely with such success that he
blows out the little brains that he has." The records
of St. Bartholomew’s Hospital show that while in
the seventies and early eighties the average number of
gunshot wounds used to lie about three a year, the aver¬
age lately has beenat least twelve for the same period. Of
course the moral of this state of things is that an
Act should be introduced either restricting the sale
of such weapons as pistols and revolvers or of pro¬
viding that they shall not fall into the hands of those
likely to improperly uset hem. However, any effective
legislation, in this direction might be a difficult
matter to accomplish, but it goes without saying
that unless something is done to put a stop to the
facilities for causing gunshot injuries in civil life the
time will come when every peaceful citizen will be
compelled to carry a “ six shooter ” in self defence.
A Medical Slander Case.
We congratulate Mr. Hugh Cameron Kidd, the
Medical Officer of Health for Bromsgrove, in charge
of the local isolation hospital, on the issue of his
action for damages against a slanderer. The defen¬
dant was a baker who, possibly with the best inten¬
tions, made, published, and reiterated a series of grave
charges against Mr. Kidd in connection with the
management of the institution. The hospital in ques¬
tion is apparently a temporary structure, mainly con¬
sisting of tents, hence many of the amenities of
properly-constructed buildings were lacking. The
fault, if any. for these shortcomings obviously could
not be placed at the door of the medical officer, who
is only concerned with the medical care of the inmates.
The hypercritical baker, however, charged him with
neglect and gross mismanagement, and at the
trial he waived the question of privilege and
attempted justification, thereby exaggerating the
recklessness which originally led him to formulate
the allegations. Mr. Kidd challenged the allegator,
and the jury, after a two days' trial, gave a verdict in
favour of the plaintiff for £150 with costs, coupled
with an intimation that, but for the social position
of the defendant, they would have awarded a much
larger sum. We would not for a moment seek to
curtail the right of free criticism; indeed, the possi¬
bility of this is one of the best safeguards we can
have for the good management of public institutions.
It is, however, one thing to criticise an institution
and another to attack the reputation of a particular
officer, and the latter course can only be condoned
when the hostile critic fully authenticates his asser¬
tions in a court of law. British juries can generally
be trusted to do justice in such matters, and the
result in this instance confirms the opinion we had
formed.
The Malaise of “Paddling.”
Paddling in moderation is not attended with
harm, but carried to an extreme it is likely to cause
symptoms of malaise indisputably harmful to chil¬
dren. The physiological effect of the pastime is to
cause distention of the cerebral blood vessels,
the action of the cold water upon the leg,
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148 The Medic al Pb ess. NOTE S ON CU RRENT TOPICS. _ Auo. 9, 1899.
being to drive tlie blood away from the lower a conspicuous item of the curriculum. By tbe time a
extremities. Probably most of the organs in con- chemist.reachedthis stage of graduation, however, he
sequence of this also become unduly vascular for the would probably relinquish counter-prescribing and
time being, but it is chiefly in the brain that the tlie sale of tooth brushes and soaps in favour of the
symptoms are manifested. Headache is the most more purely scientific departments of his calling, and
common symptom of prolonged paddling, and irrita- it is probable that his fees would be on a scale which
bility and lassitude are also noticed in the children, would indispose the average practitioner from having
the cause of which is often overlooked. Parents and recourse to his assistance. Abroad it is usually the
others hav ing charge of children at the seaside should pharmacien who is entrusted with the analysis of
therefore be careful to bear these facts in mind, and urine, for the simple reason that for their proper exe-
imit the “ paddling” zeal of their charges to a short cution the process takes more time and requires more
period during the day. technical appliances than are at the disposal of the
- average practitioner. For the present the retail
A Curious Poisoning Case. chemist in this country i6 neither willing nor able to
Mr. Wilkes, practising at Sparkhill, near Bii- undertake such work, and it is doing him a sorry
mingham, was called in last week to a girl who j service to publish for his benefit little books which
exhibited symptoms of what he took to be hysteria, 1 cannot reasonably be expected to do more than give
but which subsequently proved to lie due to the him a smattering of the knowledge required for this
effects of “vermin poison” (strychnine), to which she | department of research. At some time in the future
ultimately succumbed. Naturally enough public ! it may well be that the medical practitioner, who by
opinion is very hard on the practitioner who failed j that time will have given up dispensing his own
to make the diagnosis in time to save the girl s life, medicines, will get his analyses and bacteriological
but we, on the contrary, are disposed to sympathise j examinations done by his chemist, but this time is not
with him. The public cannot possibly appreciate the ; yet.
immense and even insuperable difficulty which
must attend a correct diagnosis in the absence of any Spectacle Fellow,
suggestion of attempted suicide. The mild spasms The only person, as far as we recollect, who
which usher in the more formidable toxic mani- addressed a lady as a “ fellow ” was Dick Swiveller,
festations of strychnine, for example, point to wh o applied that term of endearment to Miss Sally
nothing in particular, and one is compelled to await Brass, but the Spectacle Vendors Society has ex-
more precise information, either clinical or verbal, tended the title to a MisB Frances Troulan, who is the
before deciding as to the nature of the affection, premier female member of that very venerable
When a case is labelled “attempted suicide,” treat- society. At an outing which it had m the 28th,
ment is vastly simplified, but in some instances the lady was present, and held the place accorded by
this nature can only be a matter of inference, and chivalry at a subsequent dinner, at which she was
inference means time for observation and reflection" presented with a bouquet, had her health proposed.
This may seem unsatisfactory to the public, but it and made a speech. We offer our congratulations
must be so. to Fellow Troulan.
Urine Analysis by Chemists. The London Universities Future Habitat.
The organs of tbe pharmaceutical press have been A Treasury minute was issued last week which
discussing the propriety of chemists taking up the declares the terms upon which the University is to
analysis of urine for medical men, and, with certain occupy part of the buildings of the Imperial Institute,
reservations, the idea has much to commend it. If The “ consideration ” is the payment off of a mortgage
chemists care to undertake this particular branch of of £40,000, and a number of debts to the amount of
research, however, they must qualify for the work, and, £15,000, and for these sums the University is to
so far, their training is hardly such as to fit them forthe acquire the eastern and central parts of the building
task. Medical men are not likely to have recourse to and certain other accommodation within its walls.
their services in this direction merely in order to • -
ascertain qualitatively the presence of albumen or The Progress of Cremation,
sugar in the mine. This much is well within the Although cremation has not yet attained to the
time at the disposal of the busiest man. What would dignity of a craze it is making steady progress,
be required is the exact quantitative analysis not only witness the fact that from three cremations in 1885
in respect of albumen and sugar, but in regard to the annual number had risen in 1898 to 240. This
urea, uric acid and the various abnormal consti- method of disposing of one’s remains only appeals
tuents of morbid urine. To be able to furnish trust- to the “ intellectuals,” or, at any rate, to persons of
worthy reports on these lines would require very such social rank as ensures a cultivated mind. On©
special training and experience of a kind not at reason inter alia for its lack of popularity among
present within the reach of most retail chemists, persons of a lower social and intellectual status is
When our universities awaken to the opportuneness of that the matter must be thought over and decided
instituting a degree in pharmacy, urine testing and upon beforehand, and the average person respectfully
tbe analysis of alimentary substances might well form insists on limiting his field of vision to the near
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Aro. 9, 1899.
CORRESPONDENCE.
The Medical Press. 149
future, and nothing is less to his taste than discus¬
sions bearing on the disposal of his mortal remains.
The Annual Museum.
The ever-increasing sums charged for space at the
annual museum, which is one of the features of the
meetings of the British Medical Association, and the
scant consideration shown for the .comfort and
accommodation of exhibitors, who have gone to the
expense of putting up and furnishing stalls, appear
to have had the inevitable effect of alienating a
large number of those who, in years gone by, gladly
availed themselves of this opportunity of bringing
their wares before the profession. The building at
Portsmouth where the museum was located was a
modern reproduction of the famous Black Hole of
Calcutta. Unprotected from the solar rays, which were
tropical in their incidence, the temperature oscillated
about 80 degs. F., and, as there was a complete
absence of ventilation, the exhibitors and their rare
victims gave unequivocal signs of cerebral irritation-
We trust that at future meetings more consideration
will be meted out to a very deseiving class of men.
The fact that commercial instincts underlie their
propaganda does not detract from the intrinsic use.
fulness of these annual exhibits. The country prac¬
titioner is thereby enabled to examine the year’s
innovations and novelties, his practical knowledge in
matters pharmaceutical and instrumental is brought
up to date, and unquestionably his visit to the
an nu al museum is by no means the least useful item
on his programme of engagements.
The Value of a Hand.
A case of some interest from an insurance point
of view was heard last week at the City of London
Court. A labourer lost his right hand in consequence
of a heavy barrel falling upon it, and he sued his
employers for damages. Under the Employers'
Liability Act the case was given against him, but
under the Workman’s Compensation Act the deci¬
sion was given in his favour, and his employers have
been called upon to provide him with nine shillings
a week for life. The case undeniably shows how well
provided for the workman is now in the event of
accidents occurring to him <‘uring his employ. A
few years ago the law could not have helped such a
man to obtain any compensation in a case of this
kind.
Meaeles in Dublin.
The epidemic of measles from which Dublin has
been suffering, and which appeared to be decreasing,
has now again increased—75 deaths from the
disease took place in the week ending July ‘29th, being
more than double the number (35) in the previous
week.
PERSONAL.
Dr. J. R. Thormston, of Bournemouth, has been
appointed President of Council of the British Medical
Association vice Dr. Saunby.
The Baly medal has been awarded by the Royal
College of Physicians of London to Professor Sherring¬
ton for his researches on the physiology of the nervous
system.
Dr. E. Starlihg, F.R.S., has been elected to the Jodrell
Professorship of Physiology by the council of University
College, London, in succession to Professor E. A.
Schafer.
The Queen has conferred the decoration ef the Royal
Red Cross upon Miss Annie Gill Mark, superintendent
Army Nursing Service, and Miss Gertrude Mary Payne>
Army Nursing Service, in recognition of their services in
tending the sick and wounded.
The Bieset Hawkins Gold Medal has been awarded to
Dr. James Burn Russell, M.D., LL.D.Glasg., Medical
Adviser of the Local Government Board for Sootland, by
the Royal College of Physicians of London. This is the
first award which has been made of the medal, which
was founded in 1896 in memory of the late Dr. Francis
Bisset Hawkins, to be given triennially for work done in
advancing sanitary science as in the opinion of the col¬
lege deserves special recognition.
CtarespmtAena,
We do not bold naraelvet responsible for the opinions of oar
correspondent*.
OUR RULERS.
To the Editor of The Medical Pbess awd Circular.
8ir. —Why does “R. B. W.” not write over his name ?
Why is our profession such a cowardly gang ? We are
ground to powder by Our rulers, and yet we have not a
kick in us. They fleece us in their schools and hospitals
and colleges and universities, and then cut the ground
from under our feet by turning hospitals that were
intended for the poor into so many hotels for the
rich. Alone among all professions, the medical man of
to-day cannot offer the meanest privilege to his son in
g >ing to the father's profession. The General Medical
ouncil established (blesB the mark) an apprenticeship
system, driven by the reports of their own visitors as to
the insufficiency of the present system, and by
conscientious men among themselves, but they so
contrived it as to make the whole scheme un¬
workable, and so it has| completely fallen through
—a brilliant example of how not to do it. L<v>k
at what our Dublin rulers have done. The Dublin
licensing bodies established some time ago a precious
regulation under which a knowledge of pharmacy is to
be acquired—where do your readers think ? Well, in
the lecture-room, of all places in the world. Some time
since 1 presented a memorial to the General Medical
Council on the subject of a notorious and admitted
fraud on the curriculum of the General Medical Council
in the existence of side doors through which parties
may slip who would not face the public examina¬
tions, on the oollapee of the apprenticeship regulations,
and on the interference with the statutory rights
of members. What do you think they did ? They
strangled it. Afraid to publish and unwilling to deal
with it, they allowed it to die out in the hands of the
executive committee. I now- publicly call on the
elected representativ* s of the professional masses to
show a little more loyalty and a little more onergy than
they have done, and bring the whole matter forward at
the next meeting of the Council. Why should these
gentlemen show any loyalty or any energy ? Are they
not all, or nearly all, members of the governing classes
themselves ? I am ashamed of the profession I belong
to, for when, in Ireland, at all events, we might have re-
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150 The Medical Press.
MR. VICTOR HORSLEY.
Auo. 9, 1899.
turned men who would confound our blunderers, we, like
the Roman pleba of old, went basely and meanly into the
enemies’ camp for our tribunes, and we certainly have
no right to complain of the result. I shall appeal to
the Privy Council, and shall in that way ensure publicity
for my memorial, and compel our worthy representatives
to show their hands.
I am. Sir, yours truly,
Thomas Laffan.
Cashel, Ireland, August 1st, 1899.
THE INSTITUT VERNEUIL.
To the Editor of The Medical Press and Circular.
Sir,—M y attention has been drawn to a very able
article upon La Baule Hydropathic Establishmen
appearing in your issue of the 2nd inst.
I notice two errors, which ho we r er in no way detract
from the value of the article, from a medical point of
view.
I represent the proprietors of the establishment in
England, and all inquiries by intending English visitors
suould be made of me, and not as stated in the article.
The management thought this the better plan, as, being
near at hand, I am enabled to spare intending English
visitors trouble and to avoid delay.
The terms for children I may add are .£10 to .£12 a
month inclusive of medical attendance, baths, &c.
I shall be obliged if you will kindly insert this letter
in the next issue of your valuable paper.
I am, Sir, yours truly,
Ralph S. Leach.
10 Serjeant’s Inn, E.C.
August 3rd, 1899.
MR. VICTOR HORSLEY ON THE WORK OF THE
GENERAL MEDICAL COUNCIL.
We have received from Mr. Victor Horsley a copy of
his sixth annual report to the registered practitioners of
England and Wales, the salient portions whereof are as
follows :—
Mr. Horsley recapitulates the incidents of the struggle
between himself and the president of the General Medi¬
cal Council respecting the right of members to have
access to documents—a struggle which terminated virtu¬
ally in favour of Mr. Horsley.
The result is that the unconstitutional action which he
protested against has been entirely abrogated and the
rights of the members of the Council are now, after
twelve months of futile and expensive delay, fully
restored to them. He concludas with the hope that we
shall not have any more absurd attempts to introduce a
despotic regime which “ is entirely out of date in the
affairs of this or any other public institution.”
In reference to the Hunter case, Mr. Horsley remarks
that in the session just concluded he at last, against an
unscrupulous resistance, headed by Mr.Carter, gained an
opportunity to draw attention to the scandalous proce¬
dure of the cfficials of the Council in relation to the
Hunter case. Mr. Horsley comments, in what appears
to us to be unnecessarily violent terms, upon the action
of the law officers and of the Penal Cases Committee in
the matter. He points out that the original charge of
the illegal use of an American M.l). was, without the
authority of the Council, converted into one of the illegal
use of the titles physician and surgeon, and he chal¬
lenges the right of the Penal Cases Committee to resist
the appeal without the sanction of the Council.
Passing on to the conduct of the legal business of the
council, Mr. Horsley points out that no formal appoint¬
ments have ever been made constituting any person or
persons ‘ legal assessor to the council,” so that it is
obvious the council is at liberty to employ any legal
assistance it may prefer.
In respect of personation and fraudulent misrepresenta¬
tion of the register, Mr. Horsley recalls that the special
committee of which he was appointed chairman duly
reported, but when the report was presented the council
recognised that the subject was an extremely complex and 1
important one, and it was therefore agreed that the deter¬
mination of the alterations which the committee suggested
ought to be made in the procedure of registration and
in the work of the offico, should be postponed till the
November Session of the present year.
In discussing the present state of the reciprocity
question, Mr. Horsley observes that the reciprocity
question has come up in a totally different and more
pertinent form, viz., on a species of international
bargain which was proposed by the Italian Ambassador,
and concerning which the executive committee had
already illegally taken it on themselves to make a state¬
ment to the President of the Privy Council. In that state¬
ment the executive committee had expressed a desire to
see the privileges and rights of medical practitioners in
this country extended to all foreigners who could offer
in exchange the privileges of practioe in their own
country. The adoption of the executive committee's
principle would, of course, render entirely nugatory the
whole system of medical education and registration in
the United Kingdom. The matter was ultimately
postponed te the next session.
On the examination for higher qualifications, Mr
Horsley relates his several attempts to induoe the Coun¬
cil to take cognisance of the defective nature of the
examinations for the fellowship of the Faculty of Physi¬
cians and Surgeons of Glasgow. His first attempt was
thwarted by the President, to whom the memorial had
by error been addressed (instead of to the Council), and
his second attempt, on an impersonal and purely legal
basis, failed by reason of a number of members of the
Council abstaining from voting. In this particular the
division list on page 72 of the minutes of the Council
(Vol. XXXVI.) is interesting because it shows that
abstention from voting was resorted to in order that the
view expressed by the officials of the Council should be
protected regardless of the facts of the case.
Mr. Horsley then deals with illegal certificates of pro¬
ficiency in medicine, surgery, or midwifery. This
important matter, he remarks, prejudiced as it was by
the language and terms of the memorials presented to
the Council from the Corporate and Medioal Reform
Association, was treated very unsatisfactorily by the
Councl. The executive committee had had the matter
referred to them, and had, of course, reported to the
effect that nothing ought to be done. Thereupon Mr
Brown and he moved that a special committee be
appointed to report on the subject at t he next session,
but the amendment was lost.
Medical Aid Associations.
With regard to the serious matter of Medical Aid
Associations the committee appointed, under the chair¬
manship of Dr. Glover, to report to the Council on that
subject at last presented their long looked for report.
Practically, that report dealt with only two points. Frst,
it proposed the appointment of a Conciliation Board ;
and, secondly, the adoption of a resolution of general
disapproval of medical practitioners taking office under
Medical Aid Societies. As he was unable to obtain any
satisfactory explanation from the members of the com¬
mittee respecting the formation of the Conciliation
Board, or the conditions under which the profession was
asked to join such aboard, he spoke against the proposal
as being an inchoate one, and also because the
report of a conference held between Dr. Glover’s com¬
mittee and certain representatives of the Friendly
Societies showed beyond all manner >f doubt that the
BO-called Conciliation Board would not be allowed to take
into consideration the important point of wage limit. In
fact, the attitude of the Friendly Societies on the sub¬
ject of wage limit Is actively hostile to the opinion of the
medical profession. Under these circumstances, unless
the conditions under which such a Board is to meet are
clearly laid down, he could not see how its deliberations
could be of any service, nor how the profession is to
elect its delegates, nor how the Board is to enforce its
decisions, nor how the expenses of the business are to be
met. During the discussion in the Council very serious
statements were made by Mr. Bryant and Dr. Glover,
which evidently influenced many members of the Council
in favour of the Conciliation Board, but for which no
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Aug. 9, 1899.
MEDICAL NEWS.
The Medical Press. 151
specific authority was forthcoming. He therefore ad¬
vises the profession to reserve judgment until it has dis¬
tinctly before it in print all the necessary conditions for
the establishment of such a Board.
Mr. Horsley congratulates tbe profession on the warn¬
ing addressed to persons accepting office under Medical
Aid Societies, and upon the progress made at the recent
Session in regard to the legislation further inhibiting
unqualified practice by persons forming the 'nselves into
companies.
Regarding the Midwives Bill, Mr. Horsley points out
that the Bill will doubtless come up next Session when
care must be taken to prevent its passage in it« present
pernicious form, since it neither secures safety to the
public nor adequate observance of the interests of the
profession.
Mr. Horsley congratulates himself on the fact that he
was enabled to secure the registration of the F.R.C.S.I.
on the Colonial List as an additional qualification, in
spite of the uninformed opposition of the law officers of
the Council.
In respect of the scientific education of students, Mr.
Horsley comments in strong terms on the unfortunate
fact that the English Conjoint Board, i.e., the College of
Surgeons and the College of Physicians, had adopted an
attitude of hostility to the provisions of the Council for
securing a thorough scientific training to the student,
an attitude which was aggravated by the representative
of the College of Physicians, who defied the Council.
The Council, however, were not intimidated by this dis¬
loyal action on the part of the English Conjoint Board,
and supported the views of the Education Committee.
11. The number of members of the Penal Cases Com¬
mittee has been increased by the addition of Sir Chris¬
topher Nixon, Dr. Bruce, and himself.
Mr. Horsley concluded with some remarks on Council
finance, which, he alleges, is in a serious state. If the
accounts of the pharmacopoeia were separated as they
ought to be (and as at the last session of the Council it
was finally determined that they should be), and a
true estimate obtained of the finances of the Council,
it would become clear that the income is diminishing,
while the expenditure is increasing, that the reserves
of the various branches are also decreasing, and that
the Irish branch is already bankrupt. The proposal was
made by the junior treasurer that money should be lent
from the funds of the English branch to the bankrupt
Irish branch, but this provisional and unsound proposi-
, tion fortunately met with no support from the Council.
The whole trouble of the Irish branch arises from the
fact that the financial system of the Council and its
branches is faulty. The necessary expenditure of the
branches imposed upon them by the Medical Act of 1868
is by the same Act only to be met by such registration
fees as happen to be paid into the account of that par¬
ticular branch Council, the result being that if, as is the
case, the students educated in Ireland to a considerable
extent register themselves in England and Scotland, the
Irish Branch of the Council is deprived of its proper
income. The whole constitution of the Council and its
Branch Councils and their financial arrangements there¬
fore need immediate revision, and this fact alone, in Mr.
Horsley’s opinion, constitutes a powerful argument for
obtaining as quickly as may be an amendment of the
Medical Acts. A committee, however, which was pro¬
posed by Dr. Glover to consider amendment of the
Medical Acts was refused by what Mr. Horsley describes
as “ the customary clique of obstructionists,” headed as
usual by Mr. Carter, and in the discussion upon Mr.
Glover’s motion, the same obstructionists suggested that
all propositions for a Medical Amendment Bill should
come from the outside.
Summarising the work of the last session of the
General Medical Council, the profession, Mr. Horsley
observes, can be fairly congratulated on the fact that at
thi* last session the majority of the questions raised for
discussion not only have been accredited sufficient time
for their consideration, but also that the interests of the
profession have obtained on the whole nearly as much
consideration as the interests of the general public. '
^ttebical
Edinburgh University Scholarships and Prizes.
At the Graduation Ceremonial last week, the follow¬
ing Scholarships and Prises in the Faculty of Medicine
were awarded:—The Ettles Scholarship—William John
Barclay, B.A., M.B.,Ch.B. The Beaney Prize in Anatomy
and Surgery—Arthur Preston, M.B., Ch.B. The Syme
Surgical Fellowship—Carol Hendrik Kruger, M D., C.M.
The Goodsir Memorial Fellowship—Percy Theodore
Herring. M.D., C.M. The Mouat Scholarship in Practice
of Physic—John Jeffrey, M B., Ch.B. The Murchison
Memorial Scholarship in Clinical Medicine — Alfred
Charles Sandstein, M.B., Ch.B. The Gunning Victoria
Jubilee Prize in Zoology—James Peter Hill, B.8c. The
Gunning Victoria Jubilee Prize in Pathology—William
Thomas Ritchie,M.D., C.M. The Pattison Prize in Clini¬
cal Surgery—Ernest Francis Bashford, M.B., Ch.B., and
Hubert Dunbar Shepherd—equal. The Buchanan Scho¬
larship in Gynaecology—William John Barclay, B.A.,
M.B.,Cb.B. The James 8cott Scholarship in Midwifery
—Frederick Adolphus Fleming Bamardo, M.A., M.B.,
Ch.B. The Cameron Prize in Therapeutics—Major
David Bruce (R. A.M.C.), M.B., C.M. Edin., for his dis¬
coveries of the cause of Malta Fever and of the Tsetse
Disease, and the great value of these discoveries]in their
prevention and treatment.
Voyage d'Instruction.
The circular trip, organised to leave Neris on Septem¬
ber 2nd to visit the best known French watering-places, to
which we have previously called attention, will be under
the superintendence of Professor Landouzy. Starting
on September 2nd the party, which is open to medical
men and students of all nationalities, will visit La Bour-
boule, Mont Dore, St. Neotaire, Royat, Durtol, Chatel
Gayon, Vichy, Bourbon, l’Archambault, and 8t. Honor6
winding up on September 13th by a visit to Pougnes.
Arrangements have been made to secure half fares for
intending members to and from the rendezvous (N4ris),
The cost is fixed at 200 francs (.£3) per head exclusive
of travelling and hotel expenses, luggage, tips, carriages,
Ac. Subscriptions are received up to the 15th inst. by
Dr. Carron de la Carriere, 2, rue Lincoln. Paris.
Apothecaries’ Hall of Ireland, Examinations.
The following gentlemen have passed:—In Biology:
E. A. Reilly. Physiology: A. J. Barnes, H. W. Mason.
Medical Jurisprudence: Stafford Adye-Cnrran, S. W.
Battle, M. A. O’Carroll, James Barnes. Hygiene: S. W.
Battle, James Barnes - Pathology : S. W. Battle, James
Barnes, A. Thompson. The following completed the
Third Professional Examination: A. J. Barnes, S. W.
Battle, A. Thompson. M. A. O’Carroll. Passed in
Ophthalmology: William Harding, Frederick Bass,
S. W. Battle, Patrick O’Neill. Passed in Midwifery .-
William Harding, M. O'Carroll, S. Battle, Patrick
O’Neill. Passed in Surgery: M. O’Carroll, S. Battle,
Patrick O’Neill, H. Bass. Passed in Medicine: 'M.
O’Carroll, S. Battle, Patrick O’Neill. The diploma was,
therefore, granted to the following candidates, entitling
them to practise medicine, surgery, and midwifery:
M. O'Carioll, S. Battle, Patrick O’Neill.
Apothecaries' Hall of Ireland.
At the annual meeting of the governor and council of
the Apothecaries’ Hall of Ireland, held on August 1st,
the following were duly elected for the ensuing year:—
Governor: James Raverty, L.R.C.S.Ed.: Deputy Gover¬
nor : Hugh A. Auchinleck, F.R C S.I. Directors: F. G.
Adye-Curran, F.R.C.S.I., M.D., Dublin University; John
Evans, L.R.C.S.I.; W. V. Furlong, L.R.C.S.I.; F. D.
Finucane, M.D.; J. A. Johns, M.B. ; Robert Mont¬
gomery, M.R.C.S.Kng.; Robert J. Montgomery, MB.,
F. R.C.S.I.; R. G. O’Flaherty, M.B.; Christopher
O’Brien, M B.Dur.; James Shaw. L.R.C S.I.; J. tS.
Stritch, L.F.P.I.; S. M. Thompson, L.R C.S.I. ; C. R.'C.
Tichbome, LL.D, L.R.C.S.I. Representative on the
General Medical Council: C. R. C. Tichborne. Secre¬
tary : Robert Montgomery, M.R.C.S.
152 Thb Medical Pbess
NOTICES TO CORRESPONDENTS
Adg. 9, 1899.
Notices to
GIomBpmtbenis, $hort Cotters, &c.
Original Articles or Letters intended for publication should
he written on one aide 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.
A MOULDED BED-PAN.
A correspondent asks for the address of the manufacturer of a
special form of porcelain bed-pan, the upper part whereof is moulded
to the form of the parts with which it comes into contact. We are
unable to trace the notice which originally led him to purchase it,
but possibly some of our readers can assist him.
M. B.—We will endeavour to fall in with your suggestion at an
earlv date, but there is too much pressure on our space at present
to allow of our dome so forthwith. Tou shall be communicated
with in due course.
Critic.— It would be unjust to blame the persons whose linea¬
ments have been reproduced without authority. There is no law to
prevent a newspaper publishing what purports to be a portrait,
even in the event of the latter being a gross libel, from an esthetic
point of view. It is one of the penalties of greatness, end also of
notoriety, to be liable to be caricatured.
THE LIMITS OF COMPETITION.
According to the Da*ly Mail, a dispensary has just been opened
in Stepney, and the prioes set forth on the usual card in the window
range as follows:—
Medicine for the Working Classes.
Advice and medicine. 4d.
Advice and medicine for the week . Is.
This is certainly cutting it fine 1 We presume the patients furnish
the bottles and corks.
A. T. S.—A chemist is required to dispense the exact product
mentioned in the prescription, that is to say, the product of the
particular brand or mark designated, and not a presumed chemi¬
cally identical product. To do otherwise would be to incur a charge
of fraudulent substitution.
laomcieB.
An coats Hospital, Manchester.—Resident Junior House Surgeon-
Salary £50 per annum, board, Ac.
Birkenhead Union.-Asslirtant Medical Officer for the Infirmary
Workhouse and Schools. Salary £80 per annum, with board,
washing, and apartments, but no extra fees. The Clerk to
the Guardians, Birkenhead.
Cheltenham General Hospital.— Assistant House Surgeon for two
years, unmarried. Salary £100 per annum, board and
lodging.
County Asylum, Gloucester.—Junior Assistant Medical Officer,
unmarried. Salary commences at £120 per annum, rising £10
yearly to £150, board (no stimulants) and washing.
Dundee Royal Lunatic Asylum.—Medical Assistant. Salary £100
per annum, with rooms, board, and washing.
General Hospital, Nottingham.—Assistant House Physician for
twelve months. Salary £50, board, lodging, and washing in
the hospital.
Guy’s Hospital Medical School, London, S.E.—Lecturer on
Biology ; also Demonstrator of Chemistry and Physics. Apply
the De»n.
Hospital for Consumption and Diseases of the Chest, Brompton.—
Assistant Resident Medical Officer. Salary £100 per annum,
board and residence. Also Resident House Physician for six
months. Honorarium of £25 each.
Lunatic Hospital, The Coppice, Nottingham.—Assistant Medical
Officer, unmarried. Salary £150 a year, apartments, board,
attendance, and washing.
Macclesfield Infirmary. Junior House Surgeon. Salary £70 per
annum, with board and residence
Metropolitan Asylums Board.—Assistant Medical Officer, pro tem.,
at tbe Leavesden Asylum, near Watford, Herts. Salary £3 3s.
a week with the usual residential allowance. Apply Medical
Superintendent.
Miller Hospital and Royal Kent Dispensary, Greenwich Road, S.E.
—Junior Resident Medical Officer for six months. Salary at
the rate of £40 per annum, board, attendance, and washi ig.
Boyal Hants County Hospital, Winchester.-House Surgeon, un-
married. Salary £65 per annum, rising to £75, with board,
residence, Ac.
Seamen’s Hospital Society (Dreadnought), Greenwich.—Senior
House 8urgeon for the Branch Hospital in the Royal Victoria
and Albert Docks, E. Salary £75 per annum, with board and
residence and an additional £25 per annum if certain clinical
work is performed satisfactorily.
St. Luke's Hospital, London, E.C.—Clinical Assistant for six
months. Board and residence provided.
St. Pan eras and Northern Dispensary, 126, Euston Road, London.—
Resident Medical Officer, unmarried. Salary £105, residence
and attendance. Hon. Sec., 23, Gordon Street, W.C.
University of Durham College of Medicine, Newcastle-upon-Tyne.
—Lecturer in Midwifery and Dis< ases of Women and Children.
Victoria Hospital for Children, Queen’s Road, Chelsea, S.W., and
the Victoria Convalescent Home, Broad stairs.—House Surgeon
for six months. Honorarium at the rate of £50 per annum,
board and lodging in the hospital.
West Kent General Hospital, Maidstone. Assistant House Sur¬
geon for six months. Honorarium at the rate of £50 per
annum, with board and residence.
Westminster Hospital.—Pathologist. Salary £250 per annum, and
£80 per annum will be allowed for expenses, including the
services of an Assistant.
^ppoirttnuntB.
Aitken, W. L., M.B., Ch.B.Melb., Acting Officer of Health for the
Citv of South Melbourne, Victors, Australia.
Bkgg, We , M.B., Ch.M.Edin., Officer of Health for Walhalla Shire,
Victoria, Australia, vice W. A Forsyth, resigned.
Black, L. P., M.B., B.C.Camb., L.B.C.P.Lond., M.B.C.S., Medical
Officer to the Rural District Council, Braintree.
Butler, James, M.B., C.M.Glasg., Senior Assistant Medical
Officer, Go van District Asylum, Hawkhead, vice Francis O.
Simpson, resigned.
Crowther, E. E.. L.B.C.P., L.R.C.8.Edin., L.F.P.S.Glaag., Medical
Officer for the Luddenden Sanitary District of the Halifax
Union, vice Thomas Crowther. resigned.
Cuppaidoe, John Loftus; M.D., B.Ch.DubL, Medical Officer to the
Totnes Cottage Hospital.
Gibbon, Georoe John, M.D., H.Ch.Irel., Medical Officer to the
Totnes Cottage Hospital.
Gunther, H. A., M.B- House Surgeon to the Great Northern
Central Hospital, Holloway Rood, N.
Hains, L. J. Cart, L.R.C.P., L.R.C.B.Edin., J.P., Medical Officer
to the Totnes Cottage Hospital.
Hordes, Thomas J., M.B., B.Sc.Lond., Physician to Out-Patienta
at the Great Northern Central Hospital, Holloway Boad.N.
Johnson, 8., M.D., M.Ch.Irel., Medical Officer to the Town Council,
8toke-on Trent.
Milks, W. Ernest, F.B.C.S.Eng., Assistant Surgeon to the Cancer
Hospital (Free', Brompton, and also 8urgeon to Out-Patienta
to the Gordon Hospital for Diseases of the Rectum, London.
Muspratt, E. L. C., L S.A., F.C.S., Resident Medical Officer of
the Wolverhampton Medical Association in succession to W. 8.
Mercer.
Parsons, Walter Brock. M.B.C.S., L.B.C.P.Lond., Junior House
Surgeon to the Nortn-West London Hospital, Kentish Town
Road. N.W.
Puevis.W. Pbior, B.Sc., M.D., M.S.Lond., F.B.C.S.Eng., Surgeon-
in-Charge of the Ear and Throat Department of the Royal
South Hants Infirmary, Southampton.
Rkntzbch, S. Henry, L.B.C.P.Lond., M.B.C.S., Medical Officer
for the South District of the Stratton (Cornwall) Union, vice
A. H. Minton, resigned.
Smith K. Rawlings, M.D., B.S.Lond., M.B.C.S., L.S.A., Medical
Officer to the Totnes Cottage Hospital.
Smith, F. W., L.B.C.P.Lond.. M.B.C.8., Medical Attendant to the
men in the employ of the 8t, George’s Vestry, St. Saviour’s
Union, London
Southwell, C. E., L.B.C.P., L.R.C.S.Edin., L.F.P.S.Glaag.,
Assistant Medical Officer to the Town Council, Stoke-on-Trent.
Stevens, William Mitchell, M.D., L.B.C.P.Lond., M.R.C.S.,
Pathologist to the Cardiff Infirmary.
Sutherland, L. B., M.B.Glasg., C.M., the Chair of Pathology in St.
Andrew’s University .vice Professor Muir.
Whitklaw, F., L.R.C.P.Lond., M.B.C.S., Medical Officer and
Public Vaccinator for the Block Torrington Sanitary District of
the Holsworthy Union.
Williamson, R. T., M.D.Lond., M.B.C.P., Honorary Physician to
the Ancoats Hospital, Manchester.
girths.
Cazalet.— On July 28th, at Grey Friars Green, Coventry, the wife
of Grenville W. Cazalet, L.R.C.P.Lond., M.B.C.S., of a son.
Cownie.— On July 26th, at 89, Severn Road, Cardiff, the wife of
James F. Cownie of a daughter.
Edelsten.— On July 29th, at Brixton Road, 8.W., the wife of
Ernest A. Edelsten, M.A., M.B.Oxon., of a daughter.
Fraser. -On July 22nd, at Epworth, St. Edward’s Road, Southsea,
the wife of A. Mearus Fraser, M.B., of a daughter.
Goodchild.— On July 30th, at Highgate Road. N.W., the wife of
N. John Goodchild, M.R.U.S.Eng., L,B C.P.Lond., of a son.
^ftaxriageB.
Guthrie—Power.— On July 26th, at Frant Church, Thomoa
Clement Guthrie, M.B., to Norali, second daughter of Sir
William Tyrone Power, K.C.B., of Kilmore, Tunbridge Wells.
Moffat—Vavasseur. At Knockholt Parish Church, on the 3rd iust.,
by the Rev. Havard Jones, M.A., rector, Robert Unwin Moffat,
C.M.G., M.B., C.M., to Hilda, youngest daughter of J. Vavas-
seur, Esq., of Knockholt, Kent.
Simpson—Barbour.— On July 26th, at St. Alban’s Church, Tatten-
hall. Cheshire, G. F. B. 8impson, M.B., Ch.B., second son of
Professor Simpson, M.D., Edinburgh, to Caroline Elizabeth,
eldest daughter of George Barbour, of Bolesworth Castle,
Cheshire.
Williams—Harvet.— On August 3rd, at the Parish Church, Hamp¬
stead, by the Bev. Burchell Herne, Alfred Henry Williams,
M.D., of Harrow, third son of the Right Rev. the Bishop of
Waiapu, N.Z., to Lucy Caroline Simpson, second daughter of
Captain Frederick Harvey, B.N., of Hampstead.
gcaths.
Evezard.— On August 1st, Edward D’Arcy Evezard, of Regent
Cottage, Broadstairs, retired Surgeon Major of Her Majesty's
Madras Army, in his 70tli year.
Keene.— On July 31st, at Merton House, Grantchester, Cambridge,
Frederick Joseph Keene, L.R.C.P.Lond., M.R.C.S.Eng., L.S.A.,
aged 68 years.
i Pilleau.— On July 28th, at Brighton, Henry Pilleau, B.I., Deputy
| Inspector-General of Hospitals, of Keusington Court Mansions,
W., aged 86 years.
Digitized by G00gk
®1j« 'SHdical |?«ss and Circular.
“SALUS POPULI SUPREMA LEX."
Vol. CXIX. WEDNESDAY,
Saris Clinical lectures.
PYREXIA DURING CONVALES¬
CENCE FROM TYPHOID FEVER
By Professor POTAIN,
Of Paris
[From Our French Correspondent.]
I recently called your attention in the Piorry
Ward, to a young woman who was admitted to the
hospital suffering from typhoid fever. We hesi¬
tated for a time as to the diagnosis, especially as
this patient, a Dutch woman, understood no French,
and oy reason of the malady was plunged into a state
of extreme prostration. At the end of a few days all
doubt was removed by the appearance of lenticular
rose spots on the abdomen. The fever followed the
usual course, and about the fifteenth day the normal
temperature was attained and everything led to believe
that the patient had entered on convalescence.
One evening, however, the temperature rose and
oscillated for several days between 102 degs. and
104 degs. F. What could have been the cause ofthis
increase of the temperature in the course of con vales-
cense from typhoid fever ? That is the question I
wish to examine with you to-day.
You know that in typhoid fever the temperature
follows, at first, a regular ascensional movement; it
then remains a few days stationary, and finally it
gradually falls, returning to normal, in uncompli¬
cated cases, towards the twenty-first day ; the tem¬
perature not unfrequently falls for a few days below
the normal. Now, there are a certain number of
causes which may interfere with the classical curve
of the temperature absent during convalescence. First
there are cases where the thermometer is seen to go
up suddenly two or three degrees above the normal
level. This rise, which may persist four or five days,
coincides with the change from liquid to solid food.
It is what is called the febris conus, and has but little
significance.
In other cases, the temperature creeps up gradually
until it attains the height observed at the outset of
the malady, and a second crop of lenticular rose
spots are not unfrequently observed in such cases. I
proposed to apply the term reiteration to this phe¬
nomenon in order to distinguish it from relapses,
with which it is so frequently confounded. Relapses
which really deserve that name are the result of a
fresh infection, while reiterations, on the contrary,
simply continue theworkof the primary infection. Two
or three successive reiterations can be observed. I
myself have witnessed four consecutively of gradu¬
ally decreasing severity. The distinction between
reiterations and relapses is very important, because
the former are generally very benign, while the latter
are frequently fatal. In some convalescents the fever
reappears under a paroxystic form, called by the
Germans nach-fieber, or secondary fever. It sets in
without any apparent cause, and the temperature
may rise from one to three degrees for some days,
sometimes insulating the march of intermittent fever,
the paroxysms being separated by an interval of two
or three days of normal temperature.
AUGUST 16, 1899. No. 7.
Among the latent accidents capable of causing a
rise of temperature in convalescents from typhoid
fever, constipation takes the first place; it would
seem at first that the intestine ought to empty itself
easily after a malady, of which diarrhcea was one of
the principal symptoms. Yet in convalesence from
typhoid constipation of an obstinate character is
observed, producing tympanitis and fever. In such
cases attention is immediately drawn to the consti¬
pation, and the diagnosis is rendered easy, as indeed
is the treatment. On the other hand, the fever may
be the result of chronic enteritis usually localised in
the small intestines, and generally provoked by ill-
advised diet. The cause of the return of the fever may
also be due to disturbances of the liver or kidney.
There is no organ in fact that may not be affected
more or less during convalescence from typhoid
fever. Thus the lungs may become the seat of
various lesions, acute bronchitis, broncho-pneumonia,
tuberculosis. Ac. It has been assei-ted that patients
who entered the hospital for typhoid fever have there
contracted tuberculosis, but such a statement is an
exaggeration, to put it mildly. No doubt pulmonary
phthisis does sometimes appear during convalescence
from typhoid, and it is obviously difficult to affirm
positively that hospital infection was not the cause,
but for my part I have never witnessed chronic
tuberculosis developing under these conditions, except
in patients who had displayed indubitable signs of
the malady on admission to hospital. Hospital
infection is less improbable when the complication
takes the form of acute tuberculosis; I have
observed several cases of this kind. In one of them I
found, at the autopsy, two varieties of ulceration, one
appertaining to the usual lesions of typhoid fever
while the other was distinctly tuberculous as proved
by the presence of Koch’s bacilli.
You all know how frequently suppuration follows
typhoid fever, sometimes it develops insidiously, but
more frequently it determines a rise of temperature
in the convalescent patient. These suppurations
may present themselves in regions very fur apart,
muscles, larynx, thyroid body, osseous system, &o.
This concludes what I have to say on this occasion
concerning the accidents susceptible of provoking a
return of the fever. These complications are some¬
times due to the presence of the bacilli of Eberth, alone
or in association with other microbes ; frequently they
are the result of secondary infection. Thelre are also
cases in which the fever might be called idiopathic
since the cause cannot be discovered, and this is the
case in respect of the patient who is the subject of
this lecture.
AN OPERATION FOR HAMMER-TOE.
By J. JACKSON CLARKE, M.B., F.R.C.S.,
Surgeon to Out-patients at the North-West London and City
Orthopaedic Hospitals.
Operative treatment in cases of hammer-toe is only
required when the deformity is fixed to a greater or
less extent. When the affected toes can be readily
straightened by the surgeon’s fingers, instrumental
treatment will suffice to correct the condition. If
the degree of fixation is but slight, Adams's subcu¬
taneous operation, as practised in the right second
Digitized by GoOglC
Aug. 16, 1899.
154 Thb Medical Pbkss. ORIGINAL COMMUNICATIONS.
toe of the patient whose case is given below, is all
that is necessary. If, again, the degree of fixation is
great, it points not only to shortening of the lateral
and plantar ligaments of the joint or joints concerned,
but also to shrinking of the skin on the under
side of the toe. For such a toe, either excision
of the head of the proximal phalanx of the
affected joint through a lateral incision (Ander¬
son’s operation); or cutting through all the soft
parts: skin, tendons, and ligaments, on the flexor side of
the affected joint and leaving the open wound that
remains when the toe is straightened to granulate up
(Petersen’s operation) must be practised if a satisfac¬
tory result is to be obtained. Both these operations,
in different ways, allow for shortening of the skin on
tbe plantar aspect of the toe, but neither of them
makes provision for the wrinkling-up of the skin that
occurs on the dorsal aspect of the affected joint
when the toe is brought straight. This skin, as is
shown in the accompanying illustration, is the seat
Schematic drawing of a Hammer-Toe, showing the Incisions
recommended by the Author.
of a painful corn and usually covers an adven¬
titious bursa. When the previously deformed toe
has been straightened out after operation and placed
upon a small splint the tension in the altered
skin on tbe dorsal aspect of the joint gives rise in
my experience to a degree of pain out of proportion
to the extent of the operation. In order to obviate
this I have designed the following modification of
Anderson’s opera ion Two slightly curved incisions
meeting over the lateral aspects of the affected
joint, see figure, are made to include the area
occupied by the corn. This portion of skin and the
subjacent bursa are removed. The joint is now
opened by cutting through the expansion of the ex¬
tensor tendon and the synovial membrane, and an
elliptical portion of these corresponding to. but
smaller than, the piece of skin already removed is cut
off. The head of this proximal phalanx is freed by
division of the attachments of the lateral ligaments,
and is removed by bone forceps after being grooved
transversely by a fine saw. The toe is then straight¬
ened and the dorsal tendon and synovial membrane
are reunited by a catgut stitch. The wound in the
skin is finally closed by two fine silkworm-gut stitches.
As an example of the operation I may give the
following case:—
D. G., set. 20. Second toe on the left foot is
Bharply and rigidly bent at the first interphalangeal
joint. There is a corn over the prominent head of
the first phalanx. The right second toe is bent to a
right angle at the terminal joint. The deformity
on the right side can just be corrected by force.
Both great toes show a moderate amount of hallux-
valgus. The patient has had “rheumatism,’’ and has
been operated on for nasal obstruction, due to
thickening of the inferior turbinate bodies. Several
members of the family have had rheumatic gout. The
condition of the toes has been noticed for five years,
and for the last two years the second left toe has been
the seat of much pain, intei fering greatly with the
patient’s pursuits. The right second toe has not caused
any discomfort.
I performed the operation described above on the-
left side. There was no pain after it, and the-
patient slept well on the evening of the operation.
The toe was readily straightened without any ten¬
sion. A few days later I operated on the second toe
of the right side by Adams’s method. I made a simple-
puncture with a sharp tenotome at the middle of the
flexion-crease of the terminal joint and then intro¬
duced Muirhead-Little’s small hammer-toe knife and
divided the lateral ligaments, the anterior ligament, and
the flexor tendons avoiding the digital vessels and
nerves. The toe came readily straight after this, and the
patient said he felt no pain either during the opera¬
tion (which was done under cocaine anaesthesia) or
subsequently. On the 9th day the toes were dressed,
and on the 14th the patient was able to put on the
boots I had had made for him. A week later he was
able to leave for the seaside, being able to walk about
comfortably.
Comments .—It is hardly necessary to point out
that before any operation is done upon the toes the
corns should, for at least a week, be treated with the
salicylic acid (.“j), ext. cannabis ind. (gr. xv.), and
collodion (sj) application. For at least two days
before operation the feet should be frequently
scrubbed, and at intervals enveloped in compresses of'
1-50 carbolic lotion. A stronger (1—40) compress
being applied for one hour before operation.
THE CAUSES OF COUGH IN
CHILDREN,
WITH
RELATION TO DIAGNOSIS ANI>
TREATMENT, {a)
By J. P. PARKINSON, M.D., M.R.C.P.Lond.,
F.R.C.S.Eng.
I wish to deal with the causes of cough entirely
from the clinical aspect, and with a view to diagnosis,
and consequently effective treatment, and I wish to
lay stress upon the frequency of cough due to other
causes than those affecting the respiratory organs.
For this purpose I have collected 700 consecutive
cases occurring in children, aged from 6 months to
12 years, in which cough was the chief or a very
prominent symptom complained of. In all these the
chest was carefully examined, and any case in which
the symptoms could be interpreted as due to disease
these are included. The results are as follows: —
Cases. I
Cases.
Acute or chronic en¬
Rickets .
23
largement of the
Whooping-cough ...
23
tonsils
170
Acute pneumonia
18
Bronchitis varying
Broncho .
11
in amount
143
Simple dry pleurisy
8
Constipation
09
Laryngismus Stri¬
Gastric-enteritis ...
58
dulus
3
Adenoids (well
Laryngitis.
2
marked) ...
58
Mixed causes as
Pharyngitis
51
pleural effusion,
Worms (chiefly
pleural adhesion.
threadworms)
30
ly m pha denoma,
Tuberculosis of
dental caries, &c.
12
lungs
29
Analysing these cases further, it will be seen that
215 cases were due to various respiratory troubles,
1»>0 cases were due to digestive or intestinal disturb¬
ances. 279 were due to throat conditions, or in per¬
centages :—Due to chest diseases, 31; gastro-intee-
(a) Read before the British Medical Association (Medical Section}
August 3rd, ltW.
Digitized by VJ
A.UQ. 16, 1899.
ORIGINAL COMMUNICATIONS. The Medical Press. 155
tinal causes, 23; throat conditions, 40 ; and other
causes, 6.
Now as regards diagnosis, taking first the most
frequent cases, viz., those due to throat conditions.
In these the cough is often venr severe, generally
worse at night, and sometimes only occurring at that
time, or it may occur in paroxysms after talking,
&c. The cough is not uncommonly followed by
vomiting, and sometimes, especially if adenoids are
present, by epistaxiB.
By far the commonest cause of throat cough is
enlargement of the tonsils, accompanied by more or
less inflammation, and often some surrounding
pharyngitis; in many of these cases adenoids are
also present. On examining the chest one generally
finds some rough breath mg and an occasional
rhonchus. which no doubt leads often to a diagnosis
of slight bronchitis, but treatment applied to this
condition will not effect a cure if the condition of
the tonsils be disregarded. The tonsils may be
acutely inflamed or enlarged, and congested, or
simply enlarged, as a result of frequent previous in*
flammations, and in the latter case removal is the
only treatment likely to be of permanent benefit.
This cause of cough is specially frequent in
children between the ages of six and twelve, and
accounts for nearly a quarter of the cases. Well
marked adenoids were present in 58 cases or about
1 per cent., and no doubt in many other cases they
were present, but did not give such clear symptoms,
in these cases the cough is often followed by vomiting
of mucus and sometimes blood, and deafness and
otitis media are of freqiuent occurrence. The
development of the chest is interfered with, and there
is often seen an inspiratory recession of the lower
.yielding part of the thorax, showing the inter¬
ference with respiration and the necessity cf active
treatment.
A preliminary course of tonics such as iron and cod
liver oil may be tried, and sometimes I have found
much benefit from the nasal injection of an alkaline
astringent lotion such as the following:—
Acid carbolic, gr. 1;
Acidi tannici, grs. 20;
Sod. biborate, grs. 40;
Glycerine, 5 ij ;
Aquas ad, J iv ;
to be injected into the anterior nares occasionally
during the day, but I cannot say the result of this
treatment is very striking in the worst cases, the
symptoms usually continue, and then the removal of
tne adenoid vegetations is indicated. Of course, I
refer only to cases where symptoms are produced by
the vegetations, for there is no doubt they are fre
quently present, and cause no ill effects.
In 51 casss general pharyngitis was present and
appeared to be the cause ot the cough as this
symptom was removed by its cure.
In a few other cases laryngitis with or without
laryngismus stridulus was the cause. Retro-pharyn¬
geal abscess sometimes occurs in infants a few
months old, and the symptoms resemble those of j
enlarged tonsils : there is more commonly a kind
of snuffles than an actual cough. It is easily seen
when the fauces are examined.
The next set of cases producing cough are lung
diseases of which bronchitis is by far the most fre¬
quent. accounting for 143 cases, or about 20 per cent,
of the total number of children. Twenty-nine cases
were due to lung tuberculosis, and the same number
to pneumonia, of which more than half were of the
lobar type. This frequency of lobar pneumonia in
young children seems only to have been recognised
of late years, though the type of the disease is
usually well marked, and the prognosis much better
than in broncho-pneumo ia.
A few cases were due to pleurisy, dry or moist,
bronchiectasis,enlargement of the mediastinal glands,
&c„ &c.
The kind of cough in these last two cases may
exactly resemble whooping-cough, consisting of a
series of expiratory efforts, separated now ana then
by a whooping inspiration and often accompanied by
vomiting or epistaxis and other hsemorrhages; such
cases may be easily mistaken for pertussis. The
chief points to which attention should be directed are-
the following:—
First, there may be a previous history of whoop¬
ing-cough ; this is a disease which rarely occura more
than once, though for a few months the whoop may
return, if the child have a cough.
Secondly, examination of the patient may show
signs suggesting bronchiectasis, as cyanosis, clubbing
of the fingers with deformity, or dulness in the chest
and rftles oere and there. The sputum is generally
described as offensive, but, as pointed out by Eustace
Smith may or may not be so, it may be in large
quantity often brought up at considerable intervals.
If enlargement of the bronchial glands be present
there may be dulness between the scapula about the
level of the fourth or fifth dorsal vertebra, or some¬
times in front over the manubrium stemi. Also
occasionally there may be stridor or harsh or deficient
breath sounds on one or other side of the chest,
usually on the left side.
I have recently had two cases of this condition
under my care at the North-Eastern Hospital for
Children. In both cases the symptoms were much
the same.
Both children had had whooping-cough some years-
previously, and had not been well since, suffering,
from chronic cough.
Case 1.—A child, at. 6. had a chronic cough
followed by occasional vomiting, and often blood in
the sputum. He was pale and thin, fingers mark¬
edly clubbed. The left side of the chest was smaller
than the right and moved less well; there was mode¬
rate dulness front and back, and the breathing was
obscured by numerous moist sounds. On the right
side there was some impairment to percussion at the
base with harsh breathing and numerous rales. The
other organs appeared normal. There was no excess
of dulness behind the sternum or between the
scapulae. The child died a week after admission, and
at the necropsy the left lung was found markedly
restricted, the lung tissue condensed, and the bronchi
uniformly dilated and filled with a muco-purulent
fluid. The left bronchus was slightly compressed
by a mass of caseous glands behind and above
the root of the left lung, which glands by their
proximity to and irritation of the vagus had probably
produced the peculiar cough. The other organs were
fairly normal. The second case was but a repetition
of the first, except that the bronchiectasis was absent
and merely the enlarged bronchial glands present.
The third class of cases in which cough is a fre¬
quent and prominent symptom are the gastro¬
intestinal cases. They include about 23 per cent, of
the whole. ' I have, of course, excluded from this
group all cases in which there was any obvious
disease of the throat or lungs It is worth while to
lay stress on the presence of cough as a marked
symptom in many cases of gastro-intestinal troubles
as a considerable number of these children had been
already treated before they came to the hospital as
cases of cough due to lung disease, and the diarrhoea
was looked upon as secondary, a state of things
which is, of course, very frequent in bronchitis or
broncho-pneumonia, or tuberculosis, owing to the
irritation of swallowed sputum.
The cough is frequent but not very severe, and in
some cases only occura ut night.
The remaining 6 per cent of cases were due tn
various c.iuses, in many rickets was present, a con-
ORIGINAL OMMUNICATIONS.
Adg. 16. 1899.
156 The Medical Press.
dition which is well known to predispose to reflex
nervous disturbances, and in a few cases the cough
was not relieved till numerous carious teeth were
filled or extracted.
I have not alluded to ear troubles as a cause of
cough, for I was not able to satisfy myself that the
cough was not due to the throat disease, which in
children seems to be an almost invariable occompani-
ment of ear disease in children.
THE EVOLUTION OF THE SCIENCE
OF OTOLOGY, {a)
By Professor URBAN PRITCHARD,
President of the International Congress of Otology, Ac.
I cannot do better, for the purpose of inaugurat¬
ing this congress than select for my subject the
story of the birth and growth of otological science.
Although Toynbee was generally acknowledged to be
the father of modern otology, for the date of its
birth we must go back some 3,44)0 years to the then
flourishing country of Egypt. For Professor Roosa,
in his excellent treatise, referred to a certain ancient
papyrus (called, after its discoverer, the Papyrus
Ebers) on which was written a monograph on :
“ medicines for ears hard of hearing ” and “ for ears
from which there is a putrid discharge.'' And there,
in their museum, might be seen a confirmation of
the fact that ear troubles not only existed in those
days, but that they could be cured; for they had
the good fortune to possess a curious old Egyptian
relic, consisting of a wooden tablet on which were
portrayed, in bas relief, two effigies of the sacred bull
and two auricles; this was undoubtedly a votive
offering to the god Hathor from some “grateful
patient.’’ In spite of its early birth, however,
otology, except perhaps with regard to its anatomy
and physiology, did not make itself of great import¬
ance until the second half of the present century.
The Royal Ear Hospital in Dean Street, Soho which
is acknowledged to have been the first successful
aural clinique in Europe—and we believe in the world
— was established in 1816. But, speaking generally,
we may safely assert that aural surgery continued to
be more or less in the stage of infancy until between
1840 and 1860, when the study was vigorously taken
up by Sir William Wilde and Toynbee, who thus gave
a fresh impetus to the study of the pathology and
treatment of diseases of the ear. Even then its im¬
portance was by no means generally recognised;
indeed, only thirty years ago it was a favourite say¬
ing of more than one celebrated surgeon that “ ear
diseases may be divided into two classes—those which
can be cured by any general practitioner and those
which, being incurable, may be relegated to the ten¬
der mercies of the ear specialist.’’ In my student
days I well remember the sarcastic manner of Pro¬
fessor Partridge when he said, “ Ah, gentlemen, a
little wax is a godsend to an aurist,” meaning,
of course, that its removal was an easy method
of earning a reputation. And, no doubt, there was
a certain truth in those words, though not exactly
in the sense implied by the good old professor; for
which of us had not found that, by removing a plug
of cerumen which had either not been diagnosed
or which had resisted all the efforts of the general
practitioner to dislodge it, he has gained kudos and
an appreciation which many of his more delicate
operations had failed to secure ? Things had indeed
changed since then, for instead of a few aural sur¬
geons scattered here and there in Great Britain, we
had now at least a couple of hundred, while the
number of cliniques in London alone had been in¬
to) Abstract of Inaugural Address at the International Congress
of Otology, August, 1899.
creased from two or three to near upon twenty. And
in many other countries this branch of medical
science was even more strongly represented. As a
natural result of the increased interest in the work,
I would call attention to the unique museum con¬
nected with that congress, wherein was to be found
the largest and most valuable collection of otological
specimens, a collection which could only have been
brought together by the union of international
forces. The museum is so complete that if you had
come to visit it alone your trouble would have been
repaid. But in one respect there is still room for im¬
provement. I refer to the need for the better recogni¬
tion of otology by our universities and colleges. One
step has lately been made in this direction, for the
University of Edinburgh has now made it one of the
qualifying subjects for her medical degrees. So far
as the anatomy and physiology of the auditory
apparatus were concerned comparatively little has
been added in the last thirty years to the store of
knowledge already gained, although a more intimate
study of its parts has made that knowledge more
complete and precise. In pathology there has been
considerable advance. In disease of the meatus,
although aspergillus was discovered- before this
period by Meyer, Schwartze, and Wreden, yet it was
not elaborated with any fulness until later. Also,
the nature and classification of exostoses had been
worked out within this period. Our knowledge of
the changes in chronic middle-ear catarrh, and in
sclerosis, has considerably advanced, although much
here yet remains to be done. The effect of
pathological conditions of the nose and naso¬
pharynx upon the auditory apparatus, adenoid
vegetations more especially, has practically been
discovered. In chronic suppurative catarrh, disease
of the ossicles, the implication of the attic,
the antrum, and the mastoid cells lias been
worked out; also the intercranial compliestioas
which sometimes follow. The nature of the granula¬
tions and polypi are now better understood, and,
although Toynbee bad already called attention to
cholesteatoma, its pathological importance in connec¬
tion with mastoid disease was not fully realised until
quite lately. In the pathology of labyrinthine dis¬
ease there has not. perhaps, been so much advance;
but Meniere’s disease is now better understood, and
Politzer has made known a disease of the bony cap-
sule. Finally, the pathology of congenital syphilis
affecting the internal ear has been partially worked
out. The means of diagnosis have been considerably
improved, while in treatment there have been
immense strides due to the adoption of antiseptic
surgery. The 19th century, which has brought to
the world so manv wonderful blessings in other
directions has not been unmindful of their branch
of medical science. For, whereas at its commence¬
ment the ear was regarded almost as a terra incognita,
scarcely worth consideration except as the seat of
one affection only—that which was generally known
as “ a deafness ”—now. at its close, this organ was
fully-explored ground, and has been proved well
worth the exploration. Otology has been raised
from the rank of pseudo-quackery to an honourable
position in scientific surgery, and its importance
and bearing upon the body as a whole is now fully
recognised.
Dr. T. J. Monaghan, for twelve years Medical
Officer of Health for the Borough of Accrington,
has been presented by the mayor, councillors, and
borough officials, with a tea and coffee service. “ as a
mark of personal respect and appreciation of services
1 rendered ” on his leaving for another sphere.
Dii
joogle
Auo. 16, 1899. ORIGINAL COMMUNICATIONS. The Medical Fre68. L**V
A COUNTRY HERBALIST’S CURE FOR
THE “KING’S EVIL.” (a)
By JOHN KNOTT, M.A., M.D., and Dip. Stat. Med
(Univ. Dub.) ; M R.C.P.I., M.R.I.A.; Ac., Ac.
(Concluded from page 134.)
This chapter of the witty Andrew Boorde furnishes
a convenient turning-point from which I proceed to
make a new digression, for the purpose of taking notice
of the curious and interesting practice of curing the
King’s Evil by Royal Touch.
Some sympathetic poet, whose name I have not pre¬
served, penned the following lines, and also appears to
have added the subjoined comment which I find in my
common-place book:—
“The Touching fob the Evil.
You have spoken light word of the touching of old,
But you never have heard of the good An gel-gold.
For it was not alone the Monarch’s kind eye.
Nor the links that are gone, ’tween the low and the high
No, not for these only, though these they were much,
Came the stricken and lowly, to kneel to the touch.
The soft hand was put out, and the soft solace Baid,—
Few mourners could doubt their evil had fled.
For, evil it ceases, and sickness it goes
With broad golden pieces, and Nobles of rose.
Then when in their rest, in the stillness of night,
With their troubles redrest, and their burdens made
light.
Oh, blame not their blindness, ’twas the blindness of
love.
Made them think that this kindness, it came from
above.
And when ’twas thus given to those who had need,
That same thing of Heaven was Majesty’s meed.
Then list to my warning, and cavil no more,
With light words and scorning, at the good forms of
yore.
“ In the reign of the * merry monarch,’ the angel-gold,
which was distributed by his Majesty’s Almoners to
those who came to be touched, amounted to i!5,00()
per annum. When the entire public revenue was
under a million and a half pounds sterling, it
must be allowed that this was a large sum to be
distributed in one form of charity ; and the
historic fact may be held to prove that the
second Charles Stuart possessed some better qualities
than his Puritanical detractors would have us to believe.
We may note that the sum so graciously expended
amounted to .£1,000 a year more than the combined
salaries of the Secretaries of State, and was also jB 1,000
a year more than the allowance to Prince Rupert. But
it is not so much its amount which almost makes a
regret for this graceful superstition, as the direct com¬
munication it brought about, between the highest and
the lowest, between the King and the Poor. If Royalty
did but condescend to lower itself to a familiarity with
the people it is curious that they will raise, exalt, adore
it, sometimes even invest it with divine and mysterious
attributes; if, on the contrary, it shuts itself up in an
august and solemn seclusion it will be mocked and
caricatured. This was one of the secrets of Napoleon’s
strength, and one of the secrets of Louis XVIIIth’s
weakness. If the great only knew what stress the poor
lay by the few forms which remain to join them, they
would make many sacrifices for their strength and pre¬
servation. Dr. Johnson—a m^n of the people, if there
ever was one—was yet prouder of having been touched by
Queen Anne, when he was a child, and of speaking about
‘ the great lady in black,' of whom he had an indistinct
recollection, than he was of all his heroism under mis¬
fortune, or of all the erudition of his works.”
The famous and loyal antiquarian scholar, Thomas
Hearne, appears, from the evidence affoided by an
(a) An abstract of this paper was read in the Medical Section of j
the Royal Academy of Medicine in Ireland on Nov. 18th, 1W8.
entrance in his Diary, to have been as orthodox in his
faith regarding the efficacy of the Royal touch for the
King’s Evil aB he was in the other articles connected
with “privilege” and “legitimacy.” “Yesterday, Mr.
Gilman of St. Peter’s parish in the east, Oxford (a lusty,
heartick, thick, short man), told me that he is in the
85th year of his age, and that at the restoration of
K. Charles II. being much afflicted with the King’s
Evil, he rode up to London behind his father, was
touched on a Wednesday morning by that King, was in
very good condition by that night, and by the Sunday
night immediately following was perfectly recovered,
and hath so continued ever since. He hath constantly
worn the piece of gold about his neck that he received
of the King, and he had it on yesterday when I met
him.”
It is interesting to note here that the custom of
treating the King’s Evil by the royal touch is mentioned
by the Earliest English writer on medicine whose works
have descended to us. GUbertus Anglicus is made by
Bale a contemporary of King John, while Freind argues
from the internal evidence supplied by his own writings,
that he was more probably coeval with King Edward
the First. I quote from the English version of Freind’s
“Historia Median®”:—
“In treating of a strumous swelling in the glands he
tells us that this disorder is otherwise called the King’s
Evil because Kings cure it. This account, however con¬
cise, from a Physician who seems not to have been led
by any biass of interest, is sufficient to convince ub, that
the custom of touching, was very early introduced by
our Kings; and from this author’s manner of expressing
himself, it is very plain, that he look’d upon it as a very
ancient Practice. The French historians can trace up
this usage of Touching in their own nation, by undoubted
authorities, as high as the eleventh century, in the reign
of Philip the First, but can give no account (which can
be rely’d upon) how much more ancient it was: tho’
some pretend to trace it as high, as Clovis. There is
the like reason to think, even by this passage as well as
by what is here and there hinted in our English his¬
tory, that the same usage had, for some Centuries at
least, prevail’d here ; and they who carry it up as far as
the time of Edward the Confessor, contemporary with
Philip the First of France, seem to have good grounds
for their opinion; at least I do not see any proofs,
which can be brought against it. If the Monkish
writers are suppotea to be at all partial, and inclin’d
to flatter the Crown, there are others, whose veracity
cannot be oalled in question. Sir John Fortescue, a
very learned and wise man, in his defence of the title of
Lancaster, just after Henry the Fourth’s accession to
the Crown, represents the gift of healing as a privilege
which had for time immemorial belong’d to the Kings
of England: and he is so particular as to attribute this
to the Unction of their hands, which is us’d at the Coro¬
nation : and therefore Bays, that Queens can have no such
gift, because in this case that part of the ceremony is
left out. However, we know Queen Elizabeth thought
herself so much a King, that among oilier regal Functions
she frequently exercised this. Archbishop Bradwardine
who dy’d in 1348, and who appeals to the world for the
cures performed by the royal Touch, uses, you will see,
very strong expressions concerning the antiquity of it,
which surely he would never have done, had it been so
modern a practice, as some think it.”
The following is the passage in Sir John Fortescue’s
“ Defence of the House of Lancaster,” to which Freind
refers, and which he had found preserved in the Cotton
Library. It will, I feel sure, interest all students of the
history of our profession.
“ Item Regibus Anglia? Regali ipso officio plura insum-
bant, quaa naturae muliebri adversantur.—Reges Anglia?
in ipsa unctione sua talern calitus gratiam infusam
recij ient, quod per tactum manuum ana rum unctarum
infectos morbo quodam, qui vulgo Regius morbus
appellatnr, mundant A curant, qui alias dicuntur
incurabiles. Item aurum A argentum sacris unctis
manibus Regum Anglise in die Paschte Divinorum tem¬
pore (quemadmodum Reges Anglia? annuatim facere
solent) tactum devote A oblatum, r.pasmaticos A caducos
curant; quemadmodum per annulos ex dicto auro seu
D
Digitized
.oogle
158 The Medical Press.
ORIGINAL COMMUNICATIONS.
Aug. 16. 1899.
argento factos, & digitis hujusmodi morbidorum impo-
sitos, multis in mnndi partibns crebro usn expertum est.
Bute graiia Reginis non confertur, cum ipsse in manibos
non ungantur.”
The following extract from Archbishop Bradwardine’s
“ Liber de causa Dei,” contains the passage alluded to
by our medical historian :—“ Quicunque negas miracula
Christiane, vini & vide ad oculum, adhuc istis tempori-
bus in locis sanctorum per vicis miracula glorioea. Yini
in Angliam ad Begem Anglicum prasentem, due tecum
Christianum quemcimque habentem morbum Begium,
quantumeunque inveteratum, profundatum et turpem,
& oratione fusa, manu imposita, ac benedictione, sub
Bigno crucis data, ipsum curabit in nomine Jesu Christi.
Hoc enim facit continue, & fecit sa*pissime viris & muli-
eribus immundissimis, & catervatim ad eum ruentibus,
in Anglia, in Alemania, & in Francia circumquaque;
sicut facta quotidians, sicut qui curati sunt, Bicut qui
interfuerunt & viderunt, sicut populi Nationum, & fama
quam Celebris certissime contestantur. Quod et omnes i
Reges Christiani Anglorum solent divinitus facere, &
Francorum, sicut libri antiquitatum & fama regnorum
concors testantur: unde & morbus Regius nomen
sumpsit.
The first medical author who appears to have formally
recommended sufferers from the King’s Evil to have
recourse to the Boyal Touch when all the resources of
his own profession had failed, was the diplomatic John
of Gaddesden, whose famous “ Rosa Anglica ” still, for¬
tunately, survives for the edification of professional pos¬
terity. This interesting treatise is coloured by the
mysticism, and quaint—very often, indeed, loathsome—
therapeutics, of the dark age in which it was produced.
(The volume appeared somewhere between the years 1305
and 1315.) It is also distinctly redolent of professional
avarice and unprincipled charlatanism. The wily John
had “ boo’d ” himself into the position of Physician-in-
Ordinary to the King, and his successful treatment of
the heir-apparent to the Crown, while suffering from
small-pox—by swathing him in scarlet, and draping his
room so completely with the same material that only
rays of that tint could penetrate to the patient—has
contributed a well-known item to professional history.
In the language of Freind: “ John was no sooner at Court
but he understood how to make a good Courtier, and pay
his compliments in the best manner; and whenever a
scrophulous case does not submit to the sovereign reme¬
dies, such as the blood of a weezel or Doves-dung, he
exhorts the person immediately to apply to the King
for the royal Touch.” In the original of the “Rosa
Anglica,” “ Si ista non sufficiant, vadat ad Regem, ut ab
estangatur A: benedicatur —Valet tactus nobilissimi &
serenissimi regis Anglicorum.”
One of the phenomenal healers of the Annals of Un¬
licensed Medicine was our fellow countryman, Valentine
Greatrakes, who, in Charles the Second’s reign, performed
“ Severall marvaillous cures by the stroaking of his
hands.” This practitioner’s treatment would appear to
have combined the properties and powers of the “Mes¬
merism ” and the “ Massage ” of the present century. “He
was born on the 14th of February, 1628, on his father’s
estate of Affane, in the County of Waterford, and was, on
both sides, of more than merely respectable extradition,
his father being a gentleman of good repute and pro¬
perty, and his mother being a daughter of Sir Edward
Harris, Knt, a Justice of the King’s Bench in Ireland.
The first years of his school life were spent in the once
famous Academy of Lismore ; but when he had arrived
at thirteen years of age his mother (who had become a
widow), on the outbreak of the rebellion fled with
him and his little brothers and sisters to England,
where the fugitive family were hospitably enter¬
tained by Mr. Edmund Harris, a gentleman of
considerable property, and one of the justice’s sons.
After concluding his education in the family of one
John Dnniel Getseus, a High-German minister of
Stock Gabriel, in the County of Devon, Valentine
returned to Ireland, then distracted with tumult and
armed rebellion ; and by prudently joining the victorious
side, re-entered upon the i>ossession of his father’s
estate of Affane. Ho served for six years in Cromwell’s
forces (1650-1656) as a lieutenant of the Munster Cavalry,
under the command of the Earl of Orrery. ... Z ~
“ When the Munster Horse was disbanded in 1656,
Valentine retired to Affane, and for a period occupied
himself as an active and influential country gentleman.
He was made Clerk of the Peace for the County of Cork,
a Register of Transplantation, and a Justice of the
Peace. In the performance of the onerous duties which,
in the then disturbed state of Ireland, these offices
brought upon him, he gained deserved popularity and
universal esteem. He was a frank and commanding
peraonage, of pleasant manners, gallant bearing, fine
figure, and singularly handsome face. With a hearty
and musical voice, and a national stock of high animal
spirits, he was the delight of all festive assemblies,
taking his pleasure freely, but never to excess. . . .
“ On the Restoration, Valentine Greatrakes lost his
offices, and was reduced to the position of a mere private
gentleman. His estate at Affane was a small one. but
he laboured in it with good results.Perhaps
he missed the excitement of public business, and his
energies, deprived of the vent they had for many
years enjoyed, preyed on his sensitive nature. Anyhow,
he became the victim of his imagination, which, acting
on a mind that had been educated in a school of spiritual
earnestness and superstitious introspection, led him into
a series of remarkable hallucinations. He first had fits
of pensiveness and dejection, similar to those which
tormented Cromwell ere his genius found for itself a
more fit field for display than the management of a
brewery and a few acres of marsh land. Ere long he
had an impulse, or a strange persuasion in his own mind
(of which he was not able to give any rational account
to another), which did very frequently suggest
to him that there was bestowed on him the gift of
curing the King’s Evil, which, for the extraordiness of
it, he thought fit to conceal for some time, but at length
communicated to his wife and told her * That he did
verily believe that God had given him the blessing of
curing the King’s Evil, for whether he were in private
or in publick, sleeping or waking, still he had the same
impulse; but her reply was to him, that she conceived
this was a strange imagination.’ Such is his statement.
“Patients either afflicted with King’s Evil, or pre¬
sumed to be so, were .n due course brought before him ;
and, on his touching them, they recovered. It may be
here remarked that in the days when the Royal Touch
was believed in as a cure for scrofula, the distinctions
between strumous and other swellings were by no means
ascertained even by physicians of repute ; and numbers
of those who underwent the manipulation of Anointed
Rulers were suffering only from aggravated boils and
common festering sores, from which, as a matter of
course, nature would in the Bpace of a few weeks have
relieved them. Doubtless many of Valentine’s patients
were suffering, not under scrofulous affections, but com¬
paratively innocent tumours, for his cures were rapid,
complete, and numerous.
“ Greatrakes himself also speaks of his more violent
curative exertions making him very hot. But it was
only occasionally that he had to labour so vehemently.
His eye, the glance of which had a fascinating effect on
people of a nervous organisation, and his fantastic
ticklings, usually produced all the results required by
his mode of treatment.
“The fame of the healer spread far and wide. Not
only from the most secluded parts of Ireland, but from
civilised England, the lame and blind, the deaf, dumb,
and diseased, made pilgrimage to the Squire of Affane.
His stable, barn, and malt-house were crowded with
wretches imploring his aid. The demands upon his
time were so very many and great, that he set apart
three days in the week for the reception of his patients -.
and on these days from six in the morning till pix in the
evening, he ministered to his wretched clients. He
took no fee but gratitude on the part of those he
benefited, and a cheering sense that he was fulfilling the
commands of the founder of his religion. The Dean
of Lismore cited him to appear before the ecclesiastical
court, and render an account of his proceedings.
He went, and on being asked if he had worked any cures
Digitized
THE NURSING PROBLEM.
The Medical Pbess. 1 59
Ado. 16,1899.
replied to the Court that they might come to hie house
and see. The judge asked if he had a licence to prac¬
tise from the Ordinary of the Diocese; and he replied
that he knew of no law which prohibited any man from
doing what good he could to others. He was, however,
commanded by the Court not to lay his hands again on
the sick, until he had obtained the Ordinary’s licence
to do so. He obeyed for two dayB only, and went on
again more earnestly than ever.”
Under the encouragement of high patronage Great-
rakes migrated to England, where he rapidly became a
star of the first magnitude. “ Lord Arlington commanded
him to appear at Whitehall, and perform in his peculiar
fashion for the amusement of His Majesty Charles II.
. . . But the majority of his admirers were ladies, the
Countess of Devonshire entertained him in her palace;
and Lady Ranelagh frequently amused the guests at her
routs with Mr. Valentine Greatrakes, who in the charac¬
ter of the lion of the season, performed with wondrous
results on the prettiest or most hysterical of the
ladies present. It was held as certain by his
intimate friends that the curative property which
came from him was a subtle aura, effulgent, and of an
exquisitely sweet smell, that could only be termed the
divine breath.” Dr. Henry Stubbe, a famous physician
who practiced in Stratford-upon-Avon, informs his
readers that ‘‘God had bestowed on Mr Greaterick a
peculiar temperament, or composed his body of some
particular ferments, the effluvia whereof, being intro¬
duced sometimes by a light, sometimes by a violent
friction, should restore the temperament of the debili¬
tated parts, re-invigorate the blood, and dissipate all
heterogenous ferments out of the bodies of the
diseased by the eyes, nose, mouth, hands, and feet. I
place the gift of healing in the temperament or compo¬
sure of his body, because I see it is necessary that he
touch them. Besides, the Right Honourable the Lord
Conway observed one morning, as he came into his
Lordship’s chamber, a smell strangely pleasant, as if it
had been of sundry flowers ; and demanding of his mau
what sweet water he had brought into the room, he
answered, None ; whereupon hiB Lordship smelled upon
the hand of Mr. Greaterick, and found the fragrancy to
issue thence; and examining his bosom, he found the
like scent there also.” Dean Rust gave corresponding
testimony, and “ Sir Amos Meredith, who had been Mr.
Greaterick’s bed fellow,” also testified to the same effect.
The Anglican career of our fellow-countryman was,
however, not a prolonged one. His outshining brilliancy
naturally made him hosts of enemies: slander became
too active; he was accused of profligacy and blas¬
phemy, and what other vices his enemies thought would
prove most damaging to his position in the public esti¬
mation. The tide of slander proved in this case irresis- 1
tible, and Greatrakes retired before it to seek repose in
his native country. It is not a little remarkable, how¬
ever, that he succeeded in securing the confidence and
patronage of the illustrious scientist Boyle, and of the
famous theologians Wilkins, Patrick, and Cudworth. In
his “ Memoirs of Remarkable Persons,” Caulfield gives a
portrait of V. Greatrakes, Esq., stroking a patient, and
tells us that “ Mr. Glanville imputed his cures to a
sanative quality inherent in his constitution, some to
friction, and others to the force of imagination in his
patients." He further observes that “ His manner of
stroaking some women was said to be very different
from his usual method of operation.”
In a foot-note, on the same page, we are informed
that “ In the reign of Charles I. an accusation
was brought before the Court of Star Chamber, and
afterwards before the College of Physicians, against
one John Leverett, a gardener, who undertook to
cure all diseases, but especially the King’s evil, “ by
way of touching or stroaking with the hand.” He used
to speak with great contempt of the royal touch, and
grossly imposed upon numb-rs of credulous people. He
asserted that he was the seventh son of a seventh son ;
and profanely said, that “ he found virtue go out of
him,” so that he was more weakened by touching thirty
or forty in a day, than if he had dug eight roods of
ground. He a'so affirmed, that if he touched a woman,
he was much more weakened than if he had touched a
man. He was by the oensor of the College adjudged an
impostor.”
Both these methods of treating the King’s Evil were
recognised and practised among the peasantry of the
West of Ireland. The direct application of the Royal
Touch was, of course, out of the question. But a “ know¬
ledgeable ” elderly woman possessed some of the “ Royal
blood and remains”—something mysteriously wrapped
up in a linen rag, with which the “Evil ” was touched
three times, “ w ith certain prayers.” The ceremony was
performed on Mondays and Thursdays only; and no in¬
tervening Monday and Thursday could be allowed to
elapse till the number of applications had been com¬
pleted.
The Seventh son’s touch was applied on corresponding
days, and with similar ceremony. It was usually effi¬
cacious ; absolutely so, if the operator happened to be
the seventh son of a seventh son ; as in the case of
Leverett, just cited. As the touch of the mere seventh
son was not always infallible, it was considered desirable
to test it immediately after birth, by filling the hand of
the new-born infant with healthy earth-worms. If a
born healer, as such a boy usually was, the earth-worms
at once ceased to live.
The only herbal cure I ever heard of being used m the
West was that described at the opening of this paper.
I have now brought to a close my prolonged history
of the blind strugg e of the unenlightened past centuries
with the non-exorcisable demon of the King’s Evil. I
feel that an apology—perhaps I should have said a great
many—is due to my readers for inflicting upon
their attention so very lengthy a catalogue of now for¬
gotten or unrecognisable “ remedies.” Still I must
take the liberty of suggesting that a cur¬
sory glance at the same can never prove uninteresting
to the true lover of our profession, who may not lose
sight of its past any more than of its present; nor un-
instructive to the philosophic student of human nature,
who tries in all directions for the chinks and loopholes
through which light has at length penetrated into its
arcana; nor ungratifying to the philanthropist, who
examines with pleasure the sure, though often very slow,
stages by which means of relief have been discovered for
the otherwise hopeless physical ills to which we all are
born heirs. And if the smart, up-to-date, self-satisfied
scientist feel disposed to turn away with contempt from
the contemplation of the rubbish-heap of old-time
“cures ” and historical items of superstitious faith-heal¬
ing which I have scraped together for his holiday edifi¬
cation,—I would gently whisper in his ear that even in
this last year of our progressive nineteenth century, the
treatment of scrofulous disease still lies a long way on
the human side of perfection, and that his supercilious
self-congratulation in looking over the extracts from
my scrap-book will probably be fully paralleled in the
outlines of thought of the advanced “ professor ” of the
closing months of the year 1999. while glancing back¬
wards at the history of the creed of the bacteriological
pathologist of to-day. with its characteristic outgrowths
of tuberculin and antitoxin.
uhc pursing Problem.
NURSES OF THE LATEST FASHION.
A.D. 1899.
PROFESSIONAL EXPERIENCES IN SHORT
STORIES.
By FREDERICK JAMES GANT. F.R.C.S.,
Consulting: Surgeon to the Royal Free Hospital.
III.—THE DOCTOR-NURSE.
Since the days of Mi’s. Gamp—say, half a century agx>
—the progressive development of the modern nurse has
culminated in the nurse up-to-date ; eclipsing the person¬
ality of the great, great-grandmother, or rather burying
her as an extinct species in ground which can never be
opened again to view her remains, unless by express per-
Digitized by Google
160 The Medical Press. THE NURSING PROBLEM.
mission of the Home Secretary under an Act of Parlia¬
ment for the purpose. There she lies, whatever there is
of the short, fat, fiorid-faoed woman, of kindly disposi¬
tion, but stupid, ignorant, negligent, muddled even more
by perpetual drops of gin or brandy from the bottle she
concealed in her pocket, and stealthily carried to the lips
of its owner. Herdressislooseandslovenly,nottoo cleanly,
certainly not “ antiseptic.” She sat thus asleep, awake, at
fitful intervals, to administer the doctor’s stuff, in con¬
stant attendance, never taking her clothes off for days
and nights together, and never washing herself, if she
damp-towelled and brushed up her sick charge-man,
woman, or child. As death approached the sufferer, the
old-fashioned nurse could not see her patient through
her bleared eyes—still watching ; and when the departed
spirit had flitted from its tenement as a bird escapes
from a broken cage, nurse, or the “ spirits ” within her
fat little body, could hardly tell when the man with the
scythe htd called, and the flesh as grass was mown down.
She believed that sometime in the early morn he usually
did his work, and as the death-dew had moistened the
grass at 4 17 a.m , she was positively certain that at that
hour and minute precisely, a corpse lay before her.
Besides, to make doubly sure, old nurse asked her
unerring witness—the breath steam or its absence, on a
piece of glass held near the mouth of the body, living or
dead, and whether the jaw has dropped. But “ I always
feels their legs,” which soon stiffen.
Then she proceeds to close the eye-lids, to cover the
dull, fixed eyes, lest they should see her maudling grief;
and she ties up the jaw lest the tongue should thank her
for her night-vigils, while the spirit of the departed yet
lingered on the threshold of the unseen, coming back
and receding, with fitful renewals, and retrogressions of
life. Now that death has doubtless gotten the victory
in this world, nurse “ lays out ” and “ washes ” the
corpse, and renders other service) of decency, than
dressing and decorating the body ere it lies in its last
bed. She declares that Boon the wonted smile has
returned, with a freshness of colour in exchange for the
ashy hue, the face “ looks beautiful.” And then—then,
old nurse revives herself from her bottle, looking only
less beautiful. Exit.
My portfolio includes Blanche, the modern and model
nurse. Look on her pioture, and that of her great, great
grandmother. But the two contrast more than in per¬
sonal appearance, dress, and character. The education
of to-day has reached the modern representatives of
nursing-women. The “ schoolmaster is abroad ”—a
saying of Lord Brougham, who did so much to popu¬
larise higher education—has knocked at the door, and
been admitted into hospital training schools; and in the
person of some specially appointed member of the
Medical and 8urgical Staff regular courses of lectures,
and practical instruction, are given to nurses. They
are not left to discover for themselves what should be
their course of training in the wards, and are taught
very much more, in the knowledge of elementary ana¬
tomy, physiology, and practical work with relation to
the treatment of diseases and injuries.
Whether or not the nurse up-to-date is thus overtaught
does not enter into the purpose of this essay to discuss.
A corresponding order of examinations concludes the
nurse’s curriculum ere she can obtain her “ certificate ”
of qualification. The outcome of all this advanced edu¬
cation has produced its fruit; ripe and good nurses,
unripe and bad—as with regard to their technical edu¬
cation and knowledge. But, while possessing far greater
fitness for the duties of a trained nurse, other personal
qualifications being equal, our nurse of the newest
pattern is apt to assume the impersonation of the doctor,
under whose directions she is mostly in service.
I was perhaps the first member of my profession to
pronounce the name “ profession ”—in the former now
defunct “ Association of British Nurses.” The title,
professional nurse, has now grown familiar. But the
two professions, that of physician, surgeon, medical
practitioner, and that of nurse or sister, cannot possibly
be identical; although both doctor and nurse necess¬
arily meet on common ground in their attendance on
the sick for the mutual benefit of the patient, and with
the happiest relation between themselves, so long as
A oo, 16, 1899.
they both fulfil their respective functions never to be
confounded.
The public generally fall readily into error, grievous
to the patient’s welfare. Both doctor and nurse often
act together in the same cases; and their distinctive pro¬
fessions, certainly their relative duties and special
merits, may seem to be a distinction without any essen¬
tial difference. Nay, the public may, perchance, have no
affection for the doctor’s compared with the nurse’s
merits; and then the husband, wife, son, or daughter,
would reverse the famous definition, more witty than
wise:—“The doctor is a man (or nowadays, a woman)
who pours medicine, of which he (or she) knows little,
into a body of which he knows less ; ” but that “ the
Nurse pours medicine, of which she knows much, into a
body or which she knows more! ”
Given, therefore, a fully trained nurse, " such a clever
Nurse,” in attendance with the doctor; the one also
presenting a more winning personality than the other
member of the same profession, as they seem to be in the
eyes of a patient, the relatives and friends; which of
these two will gain most, the confidence and the grati¬
tude of the public ?
Assuming even more on behalf of the nurse; she, with
her qualifications and personal qualities—is self-asser¬
tive, and talks largely of her experience, and of how
little she thinks of some doctors—young perhaps in their
profession and of small practice ; the doctor-nurse quite
eclipses the doctor.
To fill in the picture with more touches of detail.
Nurse arrives in attendance on a case. She enters the
sick room; an old feeble-minded husband is lying in
bed; an anxious, nervously excitable wife is watching
by his side. “ So thankful, Nurse, you have come ;
doctor said he would send you: although (aside) he
assures me there is no danger.” Nurse approaches the
bed with an engaging smile; she places her two fingers
on the pulse ana withdraws from her waistband a small
watch. The old husband looks up at her with a puzzled
expression, the wife eyes her attentively. Suddenly,
nurse’s visage drops to zero as she interprets the
language of the pulse with almost momentary decision.
“ Here we have a bad case.” The old man closes his
eyes in hopeless despair as of one doomed to death in
the prisoner’s box; his wife’s face bespeaks the utter-
able, as she hears nurse’s verdict.
But, no. Nurse yet hopes (d.v.) to “pull the patient
through,” despite the bad case; and she has shrewdly
not pronounced a hopeless prognosis. The patient doe*
recover, and certainly, while in nurse’s hands, the doctor
paying his visits, prescribing, and giving directions,
which may or may not be fully carried out. Has not
nurse fully justified her superior professional claims ?
and does not her self-assertiveness entitle her to the
appellation, “ Doctor-Nurse ” ?
In surgical cases, more especially, a self-assertive nurse
may more readily pass for a surgeon; and in these days,
when properly authorised women-doctors may practise
surgery.
The training of a nurse rightly includes some know¬
ledge of surgical apparatus employed in the treatment
of numerous surgical cases; and she possesses, therefore,
a nurse-knowledge of mechanical appliances in cases in¬
volving their use. But her training does not comprise
the prior detection, the diagnosis of the kind of injury o*-
local disease; pathological knowledge which is needed
for the efficient use of the mechanical appliances. So
again, in the performance of surgical operations, her
knowledge of the instruments used—enabling her to
assist in some cases - does not enable her to follow the
operator, whose hands are methodically at work, deeper,
and yet deeper in the anatomical structure of the body,
while death may hover around the point of hi* knife.
In either respect, the knowledge of a thoroughly
qualified nurse is simply mechanical; and any further
knowledge—as of the structure, functions, and altered
conditions of the parts—from injury or disease, does not
concern her, might, indeed, be positively mischievous in
most cases, but pertains to the surgeon, who is alone
responsible. Nurse cannot lawfully practise surgery -,
she has not undergone any examination—for that pur¬
pose ; and she does not hold any diploma, or degree, in
Digitized by G00gle
Aug. 16, 1899.
FRANCE.
surgery, of any College of Surgeons, or of any Univer¬
sity.
In their rightly understood relationship, the surgeon
fully appreciates nurse’s co-operation with him, and
thankfully acknowledges her services. The patient,
relatives and friends, cannot rightly estimate the one,
and will overestimate the other. The popular conception
is hazy and confused ; and in the eyes of many people,
the nurse handing the instruments and the surgeon using
them, are too intimately associated together, to be prac¬
tically distinguished. The surgeon might be more
readily transferred into the nurse, than the nurse seem
to be discredited as a surgeon. Their identification
would have been once a paradox; but now the time gives it
proof ! Of course, I speak not of hospital practice, but
of private cases, and of some nurses only, as representa¬
tives of “ the newest pattern.”
In the medical, as distinguished from the surgical,
treatment of disease, there are “ doctor nurses,” not a
few. They figure, sometimes, in the daily papers, as
medical authorities ; granting certificates as testimonials,
recommending the beneficial effects of various medicines
and articles of diet for the sick. These nurses are quite
of the latest fashion. Here is one such doctor-nurse, of
many others, whose testimonial of Byrrh, as a tonic
wine, I read in the Sutu/au Time*, March 19th, 1899 :—
Nurse Marina Steene, R.B.N.A.,
Home Villa, 22, North Bank, N.W.
“ As an invigorating and restorative tonic, I must say
Byrrh is far superior to any wine I have tried both for
* patients ’ and for myself." The obvious inference from
this testimonial would be that “ Nurse Steene ” has
patients of her own, under her treatment, as well as
doctoring herself, a case in which probably by a mis¬
taken professional opinion, she could do no harm to any¬
body.
There is yet another nurse of the same species, be they
many or few, whose self-assertiveness assumes another
form. She affects to bo a great authority on all sanitary
arrangements, turning the house round, and ordering
all its inmates in subjection to her special knowledge of
hygiene. Beginning with the sick room : “ I must have
all this altered or I cannot stay here.” She is a radical
sanitary reformer. The same spirit of absolute authority
extends to the household service under her sway. The
husband, who may be very “ much married," now finds
in nurse a new mistress of himself, and of his servants
in their respective offices, whether male or female
domestics. Everybody nurse would order and control,
as subservient to the proper management of the sick
room, and of the patient “ who is under my care.” But
why follow any further the footsteps all over the house
of this irrepressible untameable shrew.
The doctor-nurse figures mostly—for an obvious
reason—when she is in attendance alone, as in cases of
chronic invalid patients. Her self assertiveness to be
what she is not may simply express an unbecoming
character only. But she appears in quite another light
when the same character is that rather of an impostor
upon the credulity of a public ever credulous in nurse-
land.
^raneactionB of gorittuo.
BRITISH LARYNGOLOGICAL, RHINOLOGICAL,
AND OTOLOGICAL SOCIETY.
Meeting held Friday, July 28th, 1899.
J. Dundas Grant, M.D., in the chair.
The following gentlemen were elected officers for the
ensuing year, 1899-1900:—President, Dr. Barclay Baron
(Bristol) ; Vice-presidents, Dr. Percy Jakins, Mr. John
Bark (Liverpool), Mr. Wyatt Wingrave; Council, Dr.
Jiliddlemass Hunt {ex officio) (Metropolitan), Dr. Fumiss
Potter, Mr Dennis Vinrace, Dr. Greville Macdonald.
Dr. Abercrombie (Extra Metropolitan), Dr. Tresilian
(Enfield), Dr. J. D. Hillis (Dublin); Treasurer. Dr.
pandas Grant; Hon. Secretaries, Mr. St. George Reid,
pr. Chichele Nourse.
The Medical Press. 16l
The following cases and microscopical sections were
shown:—
Otology.
Dr. Dundas Grant : Case of pyaemia from thrombo¬
phlebitis of the lateral sinus, subsequent to chronic
suppurative inflammation of the middle ear, treated by
evacuation of the sinus and ligature of the internal
jugular vein with recovery.
Dr. Furni88 Potter : Case of extreme thinning of
tympanic membrane in which there had been no sym¬
ptoms indicating ear mischief until about six weeks
previously.
Microscopical Sections.
Dr. Furnir8 Potter : Columnar epithelioma of
maxillary antrum.
Mr. Wyatt Wingrave: Squamous papilloma of
larynx.
laryngology.
Mr. Wyatt Wingrave: (1) Case of laryngeal papil¬
loma in a little girl tet 7 years. The warts were situated
at the anterior commissure, and were removed by
Krause’s endolaryngeal snare, but had twice recurred
at intervals of one month. There were no “ adenoids.”
(2) Case of keratosis of the faucial and lingual tonsils,
which having resisted treatment by chromic acid, gal¬
vanic cautery, &c., for twelve months, had yielded to the
weekly applications of a saturated solution of salicylic
acid in rectified spfrit.
Dr. Dundas Grant described a case of primary syphi¬
lis of the lip.
Dr. Furniss Potter ; (1) Case of recurring singer’s
nodule; (2) case of recovery of motor power in a case of
complete recurrent paralysis of left vocal cord, together
with marked paresis of left side of soft palate, and
same side of tongue. (Shown at the Laryngological
Society of London, last February.) The patient was a
man, a>t. 48, who stated he had a “ sore ” twenty years
ago, but no rash, sore throat, or other sign of constitu¬
tional infection. When first seen in January of this
year the left cord was observed to be incapable of any
abductor movement, and a month later the paralysis
became complete; the cord assuming the cadaveric
position. The left side of the soft palate was markedly
paretic with some diminution of sensation, chiefly aleng
the lower border, and the tongue, when protruded,
deviated to the left side. No affection of trapezius,
sterno-mastoid or orbicularis oris Examination of
chest gave a negative result. He had taken iodide for
nearly six months, and now had entirely recovered motor
power. The left cord moved freely, the action of the
soft palate was not impaired, and the tongue could be
protruded without any lateral deviation.
[from our own correspondent.]
Paris. August 13th, 1899.
Early Diagnosis of Phthisis.
Professor Grasset, of Montpellier, read a paper at
the Medical Congress on the early diagnosis of pul'
monary consumption by the employment of small doses of
tuberculine. He made the experiment on 28 cases, 14 of
which did not present any reaction, while in the
remainder the reaction was positive. In three cases of
advanced phthisis, where the lesions were well marked,
reaction failed completely. The Professor concluded
by saying that the injection of tuberculin afforded
an excellent means of detecting tuberculosis in man
on the condition that infinitesimal doses were employed,
that no fever were pre-ent and that the lesions were not
too advanced. The reaction could only be considered
positive where the temperature exceeded one degree at
least. That rise in the temperature was only apparent
twelve hours after the injection and lasted forty-eight
hours.
Digitized by Google
162 The MeLiCAL PRESS.
GERMANY.
Aug. 16, 1899.
M. Combe male said that in about thirty cases he had
tried to establish the early diagnosis of tuberculosis by
injections of artificial serum or with serum and tuber¬
culin alternately. The febrile reaction provoked by
the saline injections did not constitute an absolute proof
of the existence of tuberculosis in certain subjects, for
the reaction was found in persons that were not
tuberculous, consequently injections of artificial serum
were far from constituting a practical means of making
an early diagnosis of pulmonary consumption.
M. Clinquet, of Cannes, made 6ome interesting experi¬
ments on the temperature of suspected consumptives.
He recommended the patient to take a walk between
three and four o'clock each day, and took his tempera¬
ture immediately afterwards, and again when he had
rested an hour. This experiment was repeated daily for
ten days. Where the difference in the temperature was
half a degree, and if the temperature of four o’clock was
higher the days the patient took the exercise it might
be affirmed that the individual was tuberculous.
In woman another presumptive sign consisted in the
rise of the temperature of from four to ten-tenths of a
degree one or two days before the menstrual period.
M. Rondot read a paper in which he tried to show that
the first signs of pulmonary tuberculosis showed them¬
selves in the hilus of the lung before any sign could be
detected in the apex. That tuberculosis of the region of
the hilus revealed itself by large rales which subsisted
for a long time, and became exaggerated after injections
of tuberculin, or the administration of iodide of
potassium.
Exophthalmic Goitre.
The treatment of exophthalmic goitre has rarely
given satisfaction. Injections of tincture of iodine into
the body of the gland, which gave excellent results in
simple goitre, produced frequently abscesses in the
thyroid body. Prof. Pitres, of Bordeaux, has tried
injections of a solution of iodoform and ether (one
per cent.), repeated every eight days, with encouraging
effects. The injection was generally painful, but varied
with the degree of sensitiveness of the subject. A short
time after the final injections the nervousness ceased,
the sleep returned, the gland diminished in volume, and
the exophthalmos disappeared. The improvement was
well marked after the third injection ; however, it was
necessary to continue them for several months in order
to render impossible a return of the malady. M. Pitr4s
treated thus a dozen patients, but some of them he was
not able to follow up, as they ceased the treatment
as soon as they had improved enough to return to
work. However, he says he can count six definite
cures. In some cases over 100 injections into the i
gland were made without witnessing any accident, !
but he wishes to notice a phenomenon, which is some- J
times produced in the course of the injections, and which j
might, at first sight, give rise to some uneasiness; it
consisted in a kind of bubbling like that observed in the
case of introduction of air into the veins.
H.R.H. Princess Henry of Battenberg
opened on Thursday last, on behalf of her Majesty, a
new block of the Royal National Hospital for Con¬
sumption and Diseases of the Chest, the foundation-
stone of which was laid by the Princess two years
ago.
(Scrmattg.
[from our own correspondent.]
Bkrlik, August 11th, 1899.
At the Free Society of Surgeons Hr. Neuman reported
on the cases of
Impaling
that had been treated at the Friedrichshain Hospital from
1880. Out of 20,000 accident cases during that period
only 16 cases were of impaling, and out of these the injuries
were to the head in 4 and to the trunk in 16. Injury
to the face with its numerous projections that prevent
glancing off is more likely than over the smoother part of
the skull, and as a matter of fact all the cases were those
of injury to the face. A splinter of wood entered th®
right orbit, injured the ball, penetrated through the
antrum of Highmore into the mouth. After enucleation
of the ball a portion of the foreign body was iemoved
through the orbit, the remainder being extracted from
below. The wound was drained, and recovery took place.
In the second case the spout of an oil can was driven
into the orbit and from there into the orbital fissure.
Orbital phlegmon followed, accompanied by symptoms
of meningitis, but recovery took place after free opening
up.
In a third case the handle of a paint brush penetrated
through the upper lip through the antrum of Highmore
into the orbit. Recovery.
The fourth case was one of so-called trumpet injury.
Whilst the patient was blowing a whistle, this waB driven
in by a blow on the mouth, and it passed through the
palate into the nasal cavity and up to the base of the
brain. Recovery took place.
Of impalings of the trunk, those in front were dealt
with first, the severity of the injury being dependent on
the force with which the instrument was driven in, the
character of the foreign body, whether this had a pointed
or blunt end. and the part of the trunk injured. Im¬
palings of the perineeum did not generally lead to open¬
ing of the peritoneum, they were generaly extra-
peritoneal. The worst case reported was one in which
a stick penetrated from the perineeum to the axilla, the
whole track of the wound was extra-peritoneal. The
four cases of this class all recovered. In another case
the injury was caused by a fall from a window upon iron
spikes one of which penetrated the hip-joint. Here
death took place from pyaemia.
In one case the foreign body passed through the lesser
ischiadic foramen, and through the rectum in three
cases.
In those cases in which the peritoneum was opened,
some one of the solid abdominal organs was generally
injured at the same time. The stomach and intestines
might be torn or perforated, or the bruising they under¬
went might lead to necrosis.
The Weiss Method of Treatment of the Uric Acid
Diathesis.
Dr. J. Weis9, of Bille, gives an account of his so-called
new method of treating the uric acid diathesis in the
Berl. Klin. I Voch., 14 99. The author found that a
diminution of the excretion of uric acid was brought
about by the use of fruits. He tested the activity of the
individual parts, but obtained only a negative result.
On the other hand, on giving chinic acid he found a dis¬
tinct diminution of the uric acid. Whatever the action
Digitized by t^,ooQle
Aco. 16, 1899.
AUSTRIA.
might be, it deserved to be used, as it was the only
remedy against the uric acid diathesis that had no ill
effects. Quinine^diminished the formation of uric acid, but
it was not a remedy that could be given in large doses,
and for long periods a combination of chinic acid with
lithium was the most appropriate. Although lithia had no
influence on the formation of uric acid, on account of its
diuretic action its value should not be under estimated.
As on account of the taste and want of solubility it was
best not to give the acid by itself, but as a salt he pre¬
ferred the lithia to the soda base.
At the Hufeland Society Hr. Jacob read a note on
The Treatment of Tetanus.
He said that at the Congress, of Medicine last year, at
Wiesbaden, he had spoken on a method that had the
object of increasing the therapeutical value of Quincke’s
lumbar puncture. This method that he had called
“ dural infusion,” had been tried in a number of suit¬
able cases in Leyden’s klinik, and to some extent
surprisingly favourable results had been obtained. The
procedure had been further tested experimentally,
especially from the point of view of endeavouring to
- obtain better results in tetanus than by the simple
injection of the serum. In association with Blumenthal,
he had experimented on goats, injecting a certain
quantity of tetanus toxin, and then endeavouring to save
the animal by simple or sub-dural injection of the cura¬
tive serum. He did notsucoeed, however, by either method.
After a few day* the animal invariably died from the
tetanus, the antitoxin not having the power of staving
off for even a few hours. He was able to ascertain that
the tetanus antitoxin was very active, but it was not
able to remove the poison that was already located and
fixed in the central nervous system. Then experiments
were made on immunity, and it was found that animals
first injected with tetanus toxin and afterwards with
tetanic antitoxin in the same way generally remained
well, and it was the same with animals who had first
dural infusion of tetanus antitoxin and later on tetanus
toxin. But, on the other hand, those animals died of
tetanus who were first given tetanus antitoxin sub¬
cutaneously, and some hours later tetanus toxin under
the arachnoid. Inter-cerebral injections were then tried
in animals in which the disease had already developed
but they were without any result.
Reckoning up all that was known on the subject, the
author concluded that at present there was no method
known of expelling the tetanous toxin out of the cerebral
system when it was once chemically combined and
anchored there. The injection or dural infusion could
therefore only have the effect of neutralising the tetanus
toxin circulating outside the central nervous system,
and thereby preventing any further chemical combina¬
tion taking place in the brain.
Infiltration An.ehthesia.
This method of inducing anesthesia seems much more
cultivated in Germany than in other countries, and a
recent article by H. Braun in Volkmann’s Art-hiv. brings
it still further to the front.
The best medium for producing the anaesthesia is the
eucaine B solution (eucaine B 01, sod. chlorid 0 8, aq.
dist. 100 0). This solution admits of sterilisation, whilst
cocaine does not. Before the operation Braun always
gives a morphia injection, but not in the region to be
The Medical Press 163
1 operated on. The method of injection is that adopted
by Schleich himself. He has performed both minor and
major operations under this form of infiltration anaes¬
thesia—tracheotomies, empyo-thoracentesis, abdominal
sections (20 cases). The solution is said to be very suit¬
able for hydrocele operations. After removal of the
fluid, the sac is filled tensely full with the fluid, and in
a quarter of an hour the tissue to be removed is infil¬
trated with the solution. The regionary anaesthesia
recommended by Oberst is most suitable for phlegmons
and diffuse inflammations.
JUistria.
[from our own correspondent.]
Vienna, August 12th, 189t».
Local Anesthesia in Major Operations of the
Extremities.
Bebndt recommends an operation which he practises
with cocain and common salt for local anaesthesia in
operations of the extremities. After applying an
Esmarch bandage, a solution of 4 to 5 centigrammes of
cocain in 40 to 60 cubic centimetres of a “ physiological
9alt solution ” is injected into the neighbourhood of a
large nerve trunk. After injecting, the operator
requires to wait twenty to thirty minutes before anaes¬
thesia is complete.
Angina and Acute Articular Rheumatism.
Some time ago Sanger expressed the opinion that arti¬
cular rheumatism was nothing but a low form of
pyaemia, and gave a few cases in proof of this contention-
Kronenberg adds another of these to our literature, with
a post-mortem that certainly gives some colour to the
original hypothesis. Having occasion to operate on the
concha of one ear of the patient, the throat of the same
side became affected, which, with a little treatment, sub¬
sided in a few days. Later the nostril of the opposite
side of the head was operated on with a similar result
on the same side of the throat as the operation, but this
time did not clear off as quickly as the opposite side of
the throat after the ear operation, but, on the con¬
trary, was rapidly followed by an attack of acute arti¬
cular rheumatism,with its various complications, endocar¬
ditis, pericarditis, pleuritis, pneumonia, and death. The
articular rheumatism in this case had every appear¬
ance of apysemic origin.
Icterus Neonatorum.
We have had a large number of hypotheses on this
subject, but none so original in these days of hygiene
and preservation as that propounded by Schonewald, who
persistently maintains in opposition to Gessner’s philo¬
sophy, that icterus in early life is due to the imper¬
fect oleansing of the infants’ skin before dressing, which
is frequently done without due care! He allowed
67’5 per cent, of his cases to be washed in the usual way,
and all of them had icterus more or less, while the other
32 5 were free from icterus, being cleansed according to
his own preservative method.
H.emophilia.
Gocht at the meeting of Physical Medicine drew atten¬
tion co the bleeding into the joints, and demonstrated his
remarks with three cases under treatment. Haemophilia
Digitized by Google
164 The Medical Press. THE OPERATING THEATRES. Aug. 16, 189ft.
he said, was a congenital condition that usually mani¬
fested itself most prominently in the child about the
period of walking. It may be stated without exception
that the slightest injury will produce haemorrhages into
the joint, particularly the knee-joint. This disposition
to inter-articular bleediog depends on several causes :
for example, period of life. Repeated haemorrhages
cause a change in the anatomical condition of the
joint, and by this means future haemorrhages are
usually prevented.
The diagnosis of these cases is always a difficult task,
wh ich must be conducted by Konig’s test, and which is
entirely symptomatic, while the post-mortem reveals
the pathological changes.
He then showed two brothers with similar histories
whose families had the same trouble. One of the boys
brought forward was remarkable from the number of
times the haemorrhage had recurred, being 45 times in the
right knee, 11 times in the right foot, seven of which
were very severe, and had to be bandaged. The facts of
these cases confirmed Grandidier’s assertions that the
disease is notoriously hereditary.
The treatment might be characterised as prophylactic.
In a recent effusion absolute rest must be rigidly adhered
to, while warm compresses, or ice may be applied with
advantage, but in all treatment the central vital force
must be well sustained. Subsequent muscular exercise
with electricity and massage may be found to be of great
service.
Repeated effusion and sluggish absorption may ulti¬
mately produce contractions and deformity requiring
orthopie die interference. Puncture of the joint should
be carefully avoided, as well as “ Revirement. ’ If the
limb requires an appliance to be worn, the apparatus
should be light and fit neatly.
Tropon.
Neumann gave the meeting a history of the experi¬
ments conducted on himself with this food (tropon).
Three conditions were necessary in all nutrient food
stuffs: (a) it should be easily absorbed ; (4) when given
in large quantities it should not upset the stomach ; (<•)
it should be palatable to the taste; and, lastly, it should
not be too dear. All artificial preparations containing
albumen transgressed the last canon.
The latest on the market were somatose, nutrose, and
eucasin, which were more or less defective in peptones,
and dear, and were, he considered, inferior to tropon.
This nutrient is a dry brown powder, insoluble in water,
and without any characteristic smell, while the taste
reminds one of bean meal. It contains one-third of
animal and two-thirds of vegetable albumen.
^hc (Operating theatres.
MIDDLESEX HOSPITAL.
Laparotomy for Removal of a Solid Ovarian
Tumour. —Mr. John Murray operated on a woman, a;t.
60, who three years before had been operated on for
removal of an ovarian tumour on the left side. She had
continued well till six months previous to admission,
when Bhe noticed a swelling in the lower part of the
abdomen, which gradually increased until a month
before admission, since when the swelling had very
rapidly increased in size. On examination the
abdomen was found to be greatly enlarged, this was
evidently caused by a large accumulation of fluid in the
peritoneal cavity. At the lower part the abdo¬
men felt more resistant, which suggested the
probability of the existence of a tumour. On vaginal
examination the uterus was movable, and an in¬
distinct swelling could be felt in the posterior
fornix. The abdomen was opened in the middle line
below the umbilicus and a large quantity of ascitic
fluid escaped. A tumour was found filling up the entire
pelvis, firmly adherent all over except anteriorly. The
incision had to be enlarged above the umbilicus. The
adhesions were then carefully separated and numerous
ligatures applied. Two coils of intestine were adherent
to the tumour; in separating one of these the wall of the
1 ntestine was partially torn; the tear was at once closed
by Lembert’s sutures. The other coil was so firmly
attached that a portion of the tumour had to be left
adherent to the intestine. All other adhesions having
been separated, tbe tumour was removed. It was found
to be for the most part solid, and probably malig¬
nant in nature; it measured about nine inches by six.
A number of bleeding points had to be tied at the site
of the peritoneal adhesions, and the oozing, which was
still persistent, was arrested by the application
of hot sponges. The wound was closed, and
a glass drain tube inserted into tbe pel via
The patient was very collapsed after the operation,
and an enema containiD g of brandy was administered.
Mr. Murray said that the operation was undertaken for
the purpose of exploration. Arguing from the history
it was probable that there was a simple ovarian
tumour which might easily be removed; on the
other hand the presence of ascites suggested the
possibility that the growth was not only malignant
but diffused. He thought there could be little
doubt as to the malignant nature of the growth.
In the first place, the manner in which it involved part
of the intestine, pointed strongly to malignancy, and in
addition there were noticeable at the operation several
small whitish subperitoneal spots on the intestine,
which he considered strengthened this opinion. Never¬
theless, he thought the removal of the tumour was
desirable, partly because its nature could not be defi¬
nitely known until the microscopical examination, and
also because, owing to the rapid increase in size and the
manner in which it was impacted in the pelvis, its
presence would very t-hortly have given rise to
severe pressure signs. With regard to the intro¬
duction of the drain tube, on account of the amount
of oozing that was taking place, he considered it
advisable to drain the pelvis. If all went well the
tube would be removed in twenty-four hours.
It is satisfactory to state that at the end of a week there
has been no rise of temperature ; the tube was removed
the day after the operation, and the progress of the
case so far is satisfactory.
WEST LONDON HOSPITAL.
Rupture of Extra-Uterine Gestation. —Mr. Bid-
well operated on a woman, set. 26 , whose youngest
child was (5 years of age. Since then her periods had
been regular till two months previous to admission,
when signB of pregnancy had developed. Four days
before admission she had complained of severe pain in
the right iliac region, and had passed a small amount of
Digitized by
Google
Auo. 16, 1899.
LEADING ARTICLES.
The Medical Press. 165
blood per vaginam. The abdomen became distended and
Bigns of peritonitis developed. The general swelling
subsided and a mass formed in the right iliac fossa. On
vaginal examination the uterus was found to be
slightly enlarged and pushed to the left side, and
a mass could be felt in the posterior wall of
the vagina, which was continuous with the mass in the
right iliac fossa. The abdomen was opened in the right
lines semilunaris and a quantity of blood was found
free in the peritoneal cavity. This was washed away,
and after removal of a quantity of blood clots in
Douglas’s pouch, the right Fallopian tube was found to
be ruptured, and had evidently been the site of a preg¬
nancy. The tube was removed together with the right
ovary; the abdomen was flushed out with normal saline
solution to remove blood clots, and closed in the ordinary
way. Mr. Bidwell said the case was interesting, as the
physical signs would rather have pointed to an attack
of appendicitis than to tube-pregnancy, but the history
made the latter the more probable. He thought it always
indicated to open the abdomen when there is any suspicion
of a ruptured tubal pregnancy,, since if it is left and
the placenta formed, this last will become adherent to the
intestines, and make a late operation very difficult and
dangerous. He referred to a case he had operated on at
the tenth month, the child had died and the placental
membranes were in a very sodden state, the result being
that in peeling them off part of the swelling of the intes¬
tine was ruptured. The patient, however, made an excel¬
lent recovery, after excision of several inches of the in¬
volved intestine. He admitted it was not impossible in
some cases of ruptured tubal pregnancy for the blood
and ovum to become absorbed, but even in these
cases the convalescence would be more tedious than
after operation. The reason, he pointed out, for
making the incision in the linea semilunaris instead of
in the middle line was an account of the possibility of
the vermiform appendix being involved. He asserted
that it was no more difficult to remove the uterine
appendages through an incision in the linea semilunaris
than through one in the middle line.
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“ SALUS POPULI SOPREMA LEX.”
WEDNESDAY, AUGUST 16, 1899.
THE ALLEGED INCREASE OF LUNACY IN
IRELAND.—I.
Our contention is—and we shall develop the
supporting argument as we proceed—that if insanity
is to be considered as a distinctive and curable disease
of the human mind, calling for treatment in special
hospitals, a continuous series of scientific efforts
should be made to ascertain its genuine varieties to
the exclusion of all doubtful and spurious caaes. As
we write we have before us the Fifty-Third Report of
the English Lunacy Commissioners just published.
Its bulk is as usual proportionate to the area it
covera, and about one-third the size of what its Irish
fellow probably will be following the good old con¬
ventional and unprogressive lines common to both,
for years. We presume the latter will soon be in
our hands, as the date of its usual appearance (“ old
style ”) is approaching. We can only say now that
the English report opens with the statement, that
the lunacy population of England and Wales, during
the year was ascertained to be 105,086, including
6,000 “ out-door paupers.” The report, occupying
sixty-two pages, is signed by Lord Waldegrave the
new chairman—the remaining 400 pages—being the
usual statistics and inspections, which few will
care to venture on now that there is no Charles
Reade to present them in sensational aspects. We
have also at present before us a printed report that
there are now on the books of the Richmond Asylum
2,127 patients—that Portrane at present accommo¬
dates 400 male patients, and the Grangegorman
annexe 372 females. These figures concerning the
great metropolitan district include all classes of the
“ mentally affected ”—waifs and strays—recurring
“ habitual inebriates,’’ &c., showing the heterogeneous
character of the inmates, the kind of data generally
presented ; to enable us to work out the solution of
the question, or form some idea of the prospect of its
being reached in the near future so as to settle it.
In the cause, and for the sake of a great variety of
interests, it is now obviously desirable that the much
debated question of insanity should, if not cleared
up—which it can never quite be so long as the exist¬
ing conditions of human nature exist—be at least
put on a more satisfactory and sensible basis, than
high-flown ideas can ever accomplish, if only to dispel
alarmist apprehension, and check the entirely un¬
called for rnsh of money expenditure. This
expenditure has been of recent years in strik¬
ing contrast with the parsimony and cheeseparing
which prevailed a few decades ago, simply because
tlite powers had no confidence in the autho¬
rities which then existed—and in consequet ce
imposed various clerkly restraints, implying distrust,
a fatal clog to departmental government, inasmuch
as it starves it down to the vanishing point of all
efficiency. But now, as sure as the swing of the
pendulum, a new epoch operates when newlv-
fledged authorities coming to their work with
sanguine ideas of reform, and inflated notions of
their paramount all-sufficiency for the express pur¬
pose, concurrently with lavish responses from the
Treasury, previously peremptorily and most unreason-
ingly denied, assuming that everything must
be bad, and rotten, proceed with the attempt to
cleanse the Augean stables on an expensive
Digitized by LjOOQle
166 The Medical Press.
LEADING ARTICLES.
Aug. 16. 1899.
scale of simple scavenging. Unfortunately, the
general public take no interest in the subject of lunacy
because it is not associated with any political fer¬
mentation. The only chance of arousing their
dormant sense of its importance is to bring it home
to their pockets. Energetic attempts have been
made by writers conversant with the question
through the medium of magazines and the news¬
paper Press, from time to time, to create the
nucleus of some public opinion on it, but with very in¬
different success. Now, Ireland at the present moment
is most exceptionally circumstanced as regards the
matter, because different from, we believe, most other
civilised nations, its people or their representatives
have its shaping and destinies at last entirely in their
own hands. If some one strong local body would start
with a good and intelligent initiative, commending
itself to the emulation of the others, there would be
every hope of the establishment of the sound popular
system contemplated by the Act on a suitable and
economical basis—this—hand in hand with a masterly
inspection from a central point would most effectually
clear up any mystery there may be as to the alleged
increase and propagation of insanity. We think
whoever originally drafted this Local Government
Act showed an amount of farseeing wisdom, sagacity,
and independence in the framing of the lunacy
clauses, for which due credit has not been given
because the results cannot yet be felt. Feeble
attempts have heretofore been made—through the
rough and ready agency of Commissions—the
resource usually of responsible authorities who are
ignorant of the subject themselves; or, foreseeing
the facilities afforded for the perpetration of some
injustice or favourite job with impunity in arranging
lunacy conditions in this country, resort to them
all the more readily, though by this time they ought
to be pretty well discounted. Thus ten or twelve
years ago, when it was easy to see the ciose of the
nonagerian rule of the Lunacy Department was,
in the natural course of things near at hand,
another inquiry was started, though for all practical
purposes, as the sequel showed by a species of
drum-head court martial, the department had been
summarily tried, condemned, and executed. Later on
as the report of the inquiry urged the formation
of a Board of Lunacy—under cover of which the
condemned system was practically perpetuated—
that is, for so long as there remains any ostensible
reason for such an obsolete system, terminable only
with Home Rule. Probably whatever remained
of the wreck of a department, under the new
Act, did not too large vested interests make it
incompatible, would have been economically utilised ■
in forming a suitable and efficient inspectorial
and clerical staff under the Local Government Board.
There are now in Ireland about 20,<XK) registered
lunatics, more than two-thirds of whom are main¬
tained by the Treasury and local rates, and find their
lodgment in the district asylums, now to be entirely
managed by the local committees. What may be the
extent and utility of the operations of the Inspectors
remains to be seen. We presume we shall be afforded
glimpses of them in the Blue-books, and we hope they
will be commensurate. There are somewhat under 200
criminal lunatics in Dundrum supported entirely by
the Treasury, but if Sir Dominick Corrigan’s policy
had been adopted, which was at onoe summary
and drastic, the irreducible minimum would
have been reached, and there would be no occa¬
sion to raise the boundary-wall, neither would the
term “criminal lunatic” perplex. It is officially
reported that according to the Census there are about
5,000 lunatics at large ” - that they are being gradu¬
ally absorbed into the “ registered ”—and the pre¬
sumption is they will ultimately disappear from
human ken. Further information might be vouch¬
safed as to the grounds upon which, the unregistered
lunatics are regarded to be insane. At page 4 of the
47th Report in Lunacy (Ireland) may be found an
interesting table showing the proportion per 100,000
of the population of lunatics. In the year 1880 in a
population of over five millions the proportion was
250, and in 1897, with a population of something
over four millions and a half it was 430! This
would lie conclusive, were it not that the factors are
based on very uncertain, indefinite, and fluctuating
data, and our primary object is to induce the authori¬
ties to lay the groundwork of unerring and demon¬
strable data as the only means, in conjunction with
another process, of arriving at a correct inference as
to the increase of insanity in the Irish community.
Mr. Corbet, M.P . who has written much on the sub¬
ject, appeare to rely mainly on the official statistics.
We know the greatest statistician this country ever
produced (Dr. Neilson-Hancock) could prove any¬
thing from them; but the great bulk of blue-book
statistics, especially upon such abstract subjects
as insanity, must necessarily be fanciful. We
only believe implicitly in, and make reliable
deductions from, such statistics as the Chan¬
cellor of the Exchequer's Imperial balance-sheet
Mr. Corbet, M.P., pins his faith to the published
statistics of insanity, because they are the outcome
of that official oracle he helped to deify, and is a firm
believer in its increase. He has published many
elaborate papers to show this, but his last, if it
prove anything proves that every child and descen¬
dant of Adam since the foundation of the world
is more or less insane—cranky or a crank—and
in that view there is no doubt that insanity is in¬
creasing and as he reasons, likely to go on increasing.
MODERN IMPROVEMENTS IN
DIAGNOSTIC APPARATUS.
In the interesting address which Sir R. Douglas
Powell delivered at the annual meeting of the
British Medical Association, the orator dwelt affec¬
tionately upon the comparatively recent date at
which so many of the diagnostic appliances now
generally employed were introduced. Among the
senior men there must be many who can recall the
first appearance of the stethoscope, and the impor-
Digitized by {jOOQle
Aug. 16, 1890.
LEADING ARTICLES.
The Medical Press. 167
t&nce of this innovation is enhanced by the fact that
it was the means of directing the attention of prac¬
titioners to the value of physical signs perceptible on
auscultation and percussion in the diagnosis of
disease, for the recognition whereof the practitioner
had previously only clinical observation to guide
him. It is really difficult at the present time
to form a trustworthy idea of the means
which prse-stethoscopic practitioners adopted to
arrive at a diagnosis. Doubtless they cultivated
other special senses and laid greater stress on direct
observation of the patient, a process now discarded
in favour of instruments of precision sometimes
possibly to the detriment of medical science.
Curiously enough the orator went out of his way to
decry the use of the perfected instruments which
have to a great extent superseded the old wooden
tube, and no doubt to some extent liis strictures are
justified. Each variety of stethoscope presents
advantages of its own, and in doubtful and obscure
cases the careful man listens with each in turn, thus
extending hi6 sphere of observation and confirming
his results. The sphygmograph, though a revelation in
its way, has rendered more service to physiology than
to clinical medicine, but one can hardly contemplate
with equanimity the practice of medicine without the
aid of the clinical thermometer,yet its introductiou.we
are told, dates from the days of the late Sir William
Jenner. The sudden importance which the temperature
assumed in medicine when its use became general
has had its drawback in that it paved the way to
antipyretic medication, a method of treatment which
is in many cases the reverse of scientific, and has in
any event been carried to great excess. When we
bear in mind that pathogenic microbes develop most
freely at temperatures approximating the normal, we
may well ask ourselves whether in violently reducing
fever we are not thwarting Nature's reactive struggle
against the invading organism, in fact it would
appear that a given temperature is as normal to a
particular disease as a lower temperature is
to health. Fortunately the antipyretic wave has
passed its apogee, and practitioners are beginning to
employ these powerful and even dangerous drugs
with caution. Another craze that lias well nigh seen
its day is the fond delusion that it is possible to
attack the germs of disease in their stronghold, the
human body, by means of bactericidal and antiseptic
products. For this to be possible the agent would
require to be possessed of an elective action on the
invading organisms, whereas they are all protoplasmic
poisons, as inimical to the human protoplasm as to
that of the bacilli. It was not until the advance of bac¬
teriology paved the way to the introduction of seropathy
that any such selective action became possible, and
■even now we are but on the fringe of the subject. The
value of bacteriology in the diagnosis and study of the
natural history of disease cannot be overestimated,
but its application to the preventive and curative treat¬
ment thereof, with one or two exceptions, is reserved
for the, let us hope near, future. The measures now
in progress for the prevention of tuberculosis demon
strate unquestionably the value of bacteriological
data, even when that knowledge has not resulted in
the discovery of an immunising serum. Knowing
how the disease is spread we are in a position to do
something to circumscribe its ravages, and when the
public have been educated up to a comprehension of
the essentially preventible nature of the disease
much good will doubtless attend organised efforts in
this direction. Our knowledge of the infectiousness
of tuberculosis only dates about a quarter of a cen¬
tury back, and up to within the last ten years the
new views met with a very cold reception. Now,
one'8 only surprise is how the fact could possibly
have been overlooked. We are at present
confronted with the danger that the recog.
nised infectivity of the disease may blind us to
the other determining circumstances and conditions
which render infection possible and favour the sub¬
sequent development of the morbid process. Our
efforts to stamp out the disease must needs prove
disappointing unless something be done to rectify
the conditions which favour its dissemination. We
cannot hope to exterminate the bacillus tuberculosis,
though we may minimise its opportunities for mis¬
chief, and if any great measure of success is to be
achieved, it will be by measures having for object
to reinforce the resistance of the tissues by improving
the hygienic conditions of civilised life. The ten¬
dency to the formation of urban aggregations, and
the further tendency to exaggerate the density of
population by the erection of huge superimposed
mansions, are factors which will have to be reckoned
with on the other side.
THE ETIOLOGY OF HORSEPLAY.
Wheresoever a few men, young in years, or, if
not strictly so, young in mind, are gathered together
some expression of their physical energy, exemplified
by horseplay or “ ragging,” appears to be inevitable.
Nor is this a reprehensible practice so long as it
remains free from any taint of bullying. It forms
properly a mode through which the cerebral cells of
youth are enabled to rid themselves of their natural
inclination towards fun and frolic of an active kind,
removed from all mental malice or tyranny ; a safety
valve for the brain cells of those who suffer from the
repression imposed by civilisation, at a period of life
when desire for physical pleasure is most marked. In
every human brain the love of power and for mastery
is present, lying more or less dormant, or as occasion
affords, more or less active. Naturally it is among
the younger members of civilised races that this ten¬
dency is most often displayed ; the stronger exults in
his power of harassing the weaker, and enjoys, like
the savage, the anguish and painshown by his victim.
Such tendencies, at least when they are displayed by
scions of civilised peoples, necessitate for the future
good of the tyrant and his slaves, regarding them as
future members of a community in which tyranny and
slavery are non-existent, firm repressive measures.
But in dealing with the ordinary types of horseplay
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168 Th* Medical Press.
NOTES ON CURRENT TOPICS.
Ado. 16. 1899.
which are devoid of malicious intent, and from which
the perpetrators fully expect a quid pro quo from
the victims of their deeds at the first opportunity
offered, it should be borne in mind that the natural
high spirits of youthful brains are frequently so
trammelled by the corset of civilisation as to
actually require, and benefit from, such a
liberation of natural energy. The subject is
of interest to members of our profession because
of the outcry every now and then raised over some
report more or less coloured as to-the disgraceful
ongoings of a hospital resident staff. An example
happened lately when the residents of the Edinburgh
Royal Infirmary were reported to be fond of horse¬
play out of hours, and through a complaint to their
board of managers received a severe “wigging”
regarding their unprofessional conduct. It is a ques¬
tion of some psychological importance whether the
occurrence of an occasional “ rag ” does not yield a
greater meed of good to the participators, than harm
either to the “ ragged ” or to the general efficiency of
the first-named. Where the proceedings are free
from suspicion of tyranny, the man who is unable to
take chaff of this physical kind has but little in him.
The work of a hospital will not suffer because the
resident staff have sought in this way an outlet for
their cerebral store of energetic nerve force
during hours of independence; it will rather
benefit, seeing that it entails so long a term
of professional application upon the resident
officials in each twenty-four hours. Is the business
of the Stock Exchange any the worse conducted
because its members, as common report has it, are
not at a’l averse to displays of animal spirits, which
usually spell “ragging ? ” Are they reprimanded by
the daily press for them ? No ; but let the writers of
the lay press hear of any such occurrence in a hos¬
pital, and what unctuous reproof, what calling upon
their Penates to witness that no such depravity had
ever been seen; patients, many of them nigh unto
death, harassed by the rowdy antics of those respon¬
sible for their treatment; physicians in onerous posts
behaying like lunatics, &c.; totally forgetting that it
is after hours of duty,and within private apartments
that the dreadful acta have been committed ; that no
patient has been disturbed; and that the actors have
been employed for most of the day, and of
the many days before it, in devoting their
time to laborious and careful attention to
the sick, thus depriving themselves of all mean 8
fora liberation of their youthful physical impulses.
Jack is made a dull boy when deprived of play. The
brain of youth or while still youthful, however old
its owner may be, cannot be rationally expected to
pursue the line of a “ moudiewort ” as the Scotch
would say, without detriment to itself, unless allowed
some latitude in its manner of expression of revolt.
It is more than probable that the cerebral cells
endowed with different functions are in health so
charged with energy that they can instantly respond
to the stimuli specially fitted for them, while if not
called upon by stimuli which they expect, for many
must be apathetic by reason of entire disregard, and
have been accustomed to, they may be inclined to hint
to the governing mechanism that a little outlet would
be salutary. Is such a message a crime against civilisa¬
tion P Is it not rather an indication that the higheet
civilisation will accompany opportunities freely
afforded for the liberation of that natural nervous
force which inclines towards physical expression R
The Anglo-Saxon love for muscular enjoyments
and physical rivalry have much to do with the
success of the race. Why then reprobate the
harmless exhibitions of similar origin on the
part of junior physicians, “cribbed, cabined, and
confined,” at a time when nature is perhaps most
assertive ? The pity of it is that the hospitals suffer
much from the animadversions of writers in the
press, who have forgotten the days when they
themselves were young, in the gratification given
them, a pleasure closely allied to that of the bully,
in their power to ape authority; the power of jealous
age over the capaoity of youth for an enjoyment it
has itself lost.
oit Current ‘Copies.
Typhoid Fever and Tuberculosis.
There is a noteworthy relationship between the
incidence of pulmonary tuberculosis and typhoid
fever, a relationship which is borne out by the
Registrar-General’s annual returns. The steady re¬
duction in the mortality from typhoid fever which
has characterised the returns of the last quarter of a
century is associated with a corresponding diminution
in the mortality from pulmonary tuberculosis. Nor
can this cause surprise seeing that the conditions
which favour the dissemination of typhoid also in
large part favour the evolution of tuberculosis. Ill-
ventilated and ill-lighted dwellings, foul and insuffi¬
cient water supplies, the accumulation of filth and
the want of proper drainage both in towns and
in houses, not only assist in propagating typhoid,
but also favour the dissemination of tuberculosis.
As Dr. Seaton points out, by lowering the subsoil
water of towns and thus rendering the foundations
of houses drier and cleaner, the conditions which
promote the vitality and virulence of the typhoid
bacillus are modified and removed and, pari passu,
phthisis is thereby rendered much less frequent. If
the time ever arrives when typhoid fever shall have
become a thing of the past it may safely be pre¬
dicted that phthisis will also have become vastly less
frequent. These observations are important in that
they show to what a large extent these two diseases
are under human control. Prevention is, therefore,
much more important than cure, and we realise that
sanitation is more important and effectual than
sanatoria. Of course the channels of dis¬
semination of the two diseases are different
though the conditions which favour their evolu¬
tion are much the same. Moreover, although it
is generally assumed that water is the principal, if
not the only, vehicle of typhoid infection, we have
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NOTES ON CURRENT TOPICS Thb Medical Press. 169
Auq. 16, 1899.
serious reasons for suspecting that there are other,
hitherto unsuspected, channels, and it is of the
utmost importance that these should be identified-
The •Bame remarks apply to tuberculosis, and here
again it is possible that public attention is too ex¬
clusively directed to certain means of infection*
others equally worthy of note being ignored. Our
motto should be the prevention rather than the treat¬
ment of tuberculosis, for our efforts must needs be
frustrated in respect of the latter so long as the
hygienic conditions of our towns offer every facility
for the development of the specific bacillus.
Some New Uses for Thyroid Extract..
In accordance with the time-honoured custom
which requires that when a therapeutical agent has
been found useful in one affection, it should be given
a ti-ial in others not presenting any obvious analogy
thereto, thyroid extract f is being experimented with
in various morbid conditions. It is already largely
employed for the relief of obesity and, in spite of its
drawbacks, with a certain amount of success. Then
it was recommended in the treatment of acute
psoriasis with results which are as yet not well-defined-
The next* thing for which it was exhibited was that
complex morbid condition described en bloc as
dysmenorrhcea. In some of the cases it is alleged to
have given great relief, while in others it proved inert.
This indeed is what one might have anticipated, see¬
ing that the causes of dysmenorrhcea are various, and
the remedy which would obviate one cause would be
unlikely to modify the condition in another. The
most recent suggestion is the administration of
thyroid extract for the reduction of fibromata of the
uterus. According to the report of a committee of the
American Gynaecological Society, based on observa¬
tions carried out on a series of cases of fibroma
uteri, presenting well-marked symptoms, the treat¬
ment was followed by distinct amelioration in a
sufficient number of cases to make it advisable, if not
obligatory, on us to give patients a fair trial of the
treatment before resorting to operative measures. It
is noted that the relief was specially marked in the
so-called “ nervous” cases, the patients becoming
calmer and more rational. It is not denied that in a
fair proportion of the cases observed an operation
became, or appeared likely to become, necessary, but
possibly further observation will assist us in distin¬
guishing the cases in which this treatment is likely
to prove efficacious from those in which surgical inter¬
vention alone can be trusted to give relief.
“Christian Science” as Applied to the
Lower Animals.
There is not much room in this country for
the “ Christian Scientists,” and the sect, the gulli¬
bility of the public notwithstanding, is never likely
to have any encouragement here. As a matter of
fact its practices are too transparently fraudulent.
Under all the circumstances, therefore, of the case, it
is extraordinary that in America the sect should be
afforded opportunities of establishing itself more or
less extensively. Indeed, a new Medical Act has jus
been passed in Illinois which contains a clause con¬
ferring upon the sect a legal status. The clause
Btates that the Act shall not apply to any person who
ministers to or treats the sick or suffering by mental
or spiritual means without drugs or material remedy,
thus leaving the door open to a barefaced system of
quackery of which it is easy to foresee that full
advantage will be taken. The prevalence, however,
of Christian Science in America is shown by the
fact that its practices are not confined to the treat¬
ment of the ills of human beings: a new phase of the
“ Science ” has arisen, that is to say, “ Christian
Scientists," are prepared to exercise their art in the
relief of the diseases of animals. In this connection
an amusing incident is mentioned in the Journal of
the American Medical Association. A Scientist”
failed to make a diagnosis in the case of a cow that
was in extremis when he arrived. However,
after three sittings of profound meditation the
cow made such an excellent recovery that it
chased the “ Scientist ” twice round the barnyard,
and he was only rescued from a perilous situation by
a hired man with a pitchfork. Possibly if the
“ Scientists ” begin to find that their veterinary de¬
partment is liable to frequent developments of this
nature they will decide to confine their attentions to
human beings. At all events in this instance it is
quite clear that the cow had no intention of being
made a fool of. We may assume that the natural
resentment which it displayed was intended as a pro¬
test against making it the medium of fraudulently
extracting dollars out of the pocket of its owner.
Possibly, however, it expected a dose of medicine,
but when it found that it was expected to get well
under the influence of the “ profound meditations ”
of a Christian Scientist, the animal at once adopted
an effectual method of showing its abhorrence of
quackery. Pity can only be felt for those persona
who prefer to be attended by the “ Scientists,” and
who fail to show the common sense which was
apparent in the cow.
Untrustworthiness of Rabies Statistics.
In the House of Commons last week Mr. Long,
answering Mr. Whitmore, said in 1896, the year
prior to the commencement of operations against
rabies, there were 438 cases in Great Britain con¬
firmed ; in 1897 151 cases: in 1898 17, and during
the present year so far as it had gone only one case.
The Department had now made arrangements for
obtaining the same security against the introduction
of the disease from Ireland, and so soon as these arrange¬
ments were in effective operation, he hoped to be in a
position to withdraw the orders from certain English
districts. While we congratulate the public on any
prospect of the repeal of the futile and ridiculous
muzzling order, we cannot abstain from expressing
strong doubt that Mr. Long’s department is entitled
to any credit for the supposed rapid reduction in the
number of cases of rabies of which he is so boastful.
If a medical scientist claimed that, in the
short spase of three years, his treatment brought
Digitized by CjOO^Ic
170 The Medical Press. NOTES ON CURRENT TOPICS. Auo. 16, 1899.
down the number of sufferers from a specified
disease from 438 to 1, the profession would
certainly sniff at his statistics and demand unques¬
tionable proofs. In the case of Mr. Long's very
gratifying figures that proof would not be forth¬
coming because he compares succeeding years which
have no analogy with each other. In 1896 and
1897 there was, practically, no verification of the
diagnosis of rabies either in dog or man. As
regards the former, the suspicions of every vet- or
policeman were, at that time, taken for gospel, and
the 587 cases of rabies then recorded were the
result, in 1898 Mr. Long's department arrived
at the suspicion that the ideas of a vet.
or policeman were not evidence of the ex¬
istence of rabies, and, therefore, not safe
basis for legislation, and an order was made that the
diagnosis of the disease should be, thenceforth, when
possible, confirmed by bacteriological investigation.
Hence the precipitatefallinthe supposed frequency of
the disease from 151 cases to 1 in two years. Mr.
Long's statistics, of which he is so proud, prove, in
fact, nothing more than that the muzzling order
was begotten of ignorance as to the prevalence of
rabies which was, itself begotten of the folly of build¬
ing up conclusions upon the ipse dixit of a vet. or a
policeman. We have pointed to that folly many a
time, but it was persisted in by officialdom and is now,
happily, coming to an end.
An Epidemic of Tetanus.
The Fourth of July celebration in the United
States has always been prolific in accidents of
various kinds, and no less than one hundred and
fourteen lives are reported to have been sacrificed as a
sequel of the last fete of the kind. It is a remarkable
fact that tetanus was responsible for no less than
eighty-three of these deaths, a prevalence which can
only be explained on the assumption of the specific
bacillus being far more widely spread in the States
than in this country for example. We may note en
passant that the serum treatment did not give very
encouraging results, and more success appears to
have .attended Bacelli’s carbolic acid treatment.
The Therapeutics of Liquid Air.
It is of interest to note that investigations have
been carried out with a view to testing whether or
not liquid air possesses any therapeutic value. In
the New York Medical Record for July 22nd Dr.
Campbell White records the results which he has
obtained from its employment in the treatment of
many forms of disease. At the outset it may be
pointed out that liquid air is not antagonistic to the
lower forms of life, and cannot therefore be regarded
as a germicide. Dr. White, however, expresses the
conviction that from his experience nothing acts so
well in promoting the granulation of varicose ulcers,
chancroids, and other specific ulcere as this prepara¬
tion. He has also used it with great benefit in cases
of sciatica, herpes, intercostal and facial neuralgia.
Again, in lupus he is able to speak encouragingly of
its use. On the other hand so far as carcinoma is
concerned his experience of it has not been sufficient
to enable him to express a positive opinion. The
mode of application to which Dr.White resorts is that
of a cotton swab, or by means of the spray. We are
not aware that any observations upon the therapeutic
use of liquid air have been made in -this country,
nevertheless it would seem from the above recorded
facts that it possesses some therapeutic value and is
worthy of a trial in certain diseases.
The Therapeutical Value of Sulphur Fumes.
A magnificent sanatorium has recently been
thrown open to the public near Naples by the
generosity of the Duchess Teresa Ravaschieri for
the benefit of persons suffering from pulmonary
tuberculosis. It is near the Solfatara, the
crater of an almost extinct volcano. Gases
and smoke still escape from the numerous crevices and
fissures, and the air laden with sulphurous fumes,
is popularly supposed to have a beneficial effect on
consumptives. If thi6 be correct our native sufferers
need not go so far afield for their treatment, seeing
that the air of the Metropolitan Railway fulfils every
indication. If the railway authorities could be per-
suaded to render available a special car for the use
of phthisical patients on the payment of a small sum
in addition to the ordinary third-class fare, no doubt
a certain clientele would be attracted. If the pro¬
spect of passing several hours daily in the depressing
darkness of these subterranean passages be held to
constitute a drawback the waste air might be pumped
into the rooms of a sanatorium constructed ad hoc.
Sulphur fumes, by the way, used to be recommended
in the treatment of whooping-cough, though we have
not, so far, heard of any cures attributed to the
methodical use of the “ Underground.”
The Suppression of Street Noises.
The life of the average citizen is becoming more
tolerable, so far as street noises are concerned, a
happy state of things which is due, not to the fact
that he has become accustomed to such nuisances,
but because the streets are quieter than they used to
be. In a certain measure a good influence has been
exerted in this direction by the London Society for
the Suppression of Street Noises. Although only in
the second year of its existence the Society, as its
report for the past year shows, has been steadily
pressing forward an admirable campaign against the
soul-disturbing costermongers and newsboys, who
make the thoroughfares hideous with their yells and
howls. Moreover, it is satisfactory to note that the
Society has a well designed programme in the pursuit
of which its members intend to expend their best
energies. For example, among their objects of
reform are included the compulsory fixing of India-
rubber tyres on all vehicles, floors of the same
material for milk-carts, the establisment of kiosks in
place of the screeching newspaper boys. But even if
all these reforms were successfully attained, many more
noises would still be left to be dealt with. The bawling
coal hawker, for instance, is an intolerable nuisance-
Digitized by Google
NOTES ON CURRENT TOPICS.
The Medical Press. 171
Aro lt>, J89 9.
and the irritating, expressionless, metallic clang of
the barrel-organ should be banished altogether from
the streets. Possibly, however, when the London
Government Act comes into force marked improve¬
ment will be noticed in regard to the prevalence of
street noises, inasmuch as the new municipalities
have been empowered to make by-laws for regulat¬
ing and suppressing such nuisances, and there is
every reason for supposing that full advantage will
be taken of the clauses in the Act relating thereto.
The Extermination of Malaria.
The etiology and prevention of malaria is one of
the most important medical questions of the day,
and, therefore, the investigations of the Commission
under Major Ross, I.M.S.. sent out by the Liverpool
School for Tropical Diseases, will be looked forward
to with great interest. Meanwhile Major Ross makes
Borne important suggestions in regard io the preven¬
tion of malarial disease in a paper contributed to the
current number of the Indian Medical Gazette. In
the first place, he claims that it is now generally
admitted that the mosquito theory of the disease is
correct, and hence he affirms that, in order to elimi¬
nate malaria wholly or partly from a given locality,
it is necessary only to exterminate the various
species of insects which convey the infection.
Investigation has shown that the insects are
always hatched from aquatic larva? or grubs
which can live only in small stagnant collections of
water, such as pots and tubs of water, garden cis¬
terns. temporary pools of rain water, and so forth ;
and thus it is suggested that in order to get rid of
the insects from a locality all that will l>e necessary
will be to empty out, or drain away, or treat with
chemicals the small collections of water in which
their larva' must pass their existence. This would
seem to be a very easy solution to the problem, but
its practicability will depend upon circumstances.
Different mosquitos invest different water localities,
so to speak, some breed in pots and tubs of water,
others exclusively in cisterns, ditches, and drains,
others again only in shallow rain-water puddles.
Therefore for practical results, Major Ross points
out that it will be essential to ascertain not only what
special mosquitos do carry human malaria, but also
the nature of the habits of the dangerous varieties.
From all these facts it will be readily gathered how
large a field of inquiry the malarial question is t
and how promising the prospect is, that we are
within a measurable distance of gaining headway
against the disease.
The Reform of the Medical Services.
It will be interesting to note the effect, if any,
which Professor Ogston’s address has upon the
Admiralty and War Office authorities, and it would
also be interesting to learn the feeling with
which it has been received by the officers
of the Services concerned. So far only one officer
has publicly expressed himself regarding the address
—namely, Surgeon-General Harvey, who proposed
the vote of thanks to Professor Ogston, in the
course of which he admitted that some parts of the
address would cause a oertain amount of criticism.
Nevertheless he agreed that in many directions
great improvements were possible in military as well
as in naval, matters. It was clearly, however, in no
hostile spirit that Professor Ogston took up the
position that he did upon this question, and we are
glad to see that Surgeon-General Harvey admits that
this is the case. The latter expressed the hope that
the address would be received in the spirit in which
it was intended—namely, as one of kindly criticism
with the object of improving the Services on which
the Army and Navy depend. We would fain express
the same hope, but at the same time we trust that
Professor Ogston’s criticisms will be acted upon. The
washing of dirty linen in public, an expression which
may be applied to Professor Ogston’s indictment,
is always a process from which to shrink. But
sometimes it is necessary, especially in the advo¬
cacy of much-needed reforms, and now that the
unpleasant duty has been discharged, every effort by
those in authority should be made to prevent any
such charge against the Services being brought
again.
Smoke Prosecution.
The question of smoke prevention is one of vital
importance to the future of town populations, yet it
cannot be said in any real sense of the phrase to be
efficiently handled in any large town in the United
Kingdom. Last week a London vestry successfully
prosecuted a well-known firm of restaurant 1 eepers
for allowing black smoke to issue from their
chimneys so as to constitute a public nuisance. The
whole question of smoke abatement demands urgent
attention. The present failure to cope with the evil
is due mainly to two facts—namely, the want of
efficient sanitary inspection and the disinclination of
magistrates to convict. The first point is only a part
of the wider question of the insufficiency of
the staff of sanitary inspectors that mars the
health administration of local authorities all
over the kingdom. The London County Council has
just issued a report dealing with the whole subject.
While the duty of enforcing the law in the first lay
with the various sanitary authorities, yet in their
default, the Council has a general power to act.
With the assistance of the Metropolitan police the
Council has procured evidence of no less than 3,(509
offences for use in prosecutions by local bodies. Of
the large number of infringements in which pro¬
ceedings were taken, the majority appear to have
been either dismissed by the Metropolitan police
magistrates, or to have been granted such long
periods in which to carry out necessary alterations as
to render conviction well-nigh worthless. From
these various considerations it iB hardly to be
wondered at if the vestries are lax in dealing with
this class of offence. Some day we may hope that
magistrates may be grounded in the first principles
of public health and of medical jurisprudence.
Digitized by t^.ooQle
172 The Medical Press.
NOTES ON CURRENT TOPICS.
Aug. 16, 1899.
Is the Plague in Oporto ?
The question as to whether plague had at length
invaded Europe was pointedly raised in the columns
of The Medical Press and Circular in our issue
of August 2nd. The subject, which is undoubtedly
of prime importance to the welfare of the Continental
population, was suggested by information of an ex¬
clusive nature that was placed in our possession from
an authoritative source. Nine days later the Globe,
a leading London evening newspaper, thought fit to
notice the “ suggestion that the cases of suspicious
illness which have recently occurred at Oporto
are in reality cases of Indian plague.” We are
glad to learn that the editor, although he does not
acknowledge the source of the “ suggestion ” agrees
with us, verbatim et literatim, in the hope that
the matter will be at once investigated, and his power¬
ful influence, coming as it does ten days after our
opening shot, should go far towards convincing the
Portuguese authorities. Ten days, however, is a long
period of delay in dealing with so acute a disease as
plague, especially when the actual bacteriological
diagnosis could be made within a few hours. So com¬
forting, however, is the support extended by the editor
of the Globe to a medical contemporary that we
cannot refrain from expressing hearty approval of
his concluding sentence, especially as it rings a
complete echo of a previous generalisation of our
own:—“ It is of the utmost importance to the rest of
Europe,” he remarks, “ that it should be known with¬
out delay, whether the plague really has or has not
made its appearance in Portugal.”
Glycerinated Lymph.
It appears that complaints have reached the
authorities of a want o£ uniformity in the action of
the Government calf lymph, and these shortcomings
were recently the subject of several questions in the
House. It is admitted that there has been some
ground for complaint, and careful inquiry has been
set on foot in order to throw light upon the cause of
the deterioration. As we are not in possession of the
allegations we cannot discuss the reasonableness of the
criticisms, but we may remark that it is idle to expect
that any lymph, however prepared, will give abso--
lutely uniform results under all circumstances. It is
surmised that the sudden changes of temperature to
which the lymph has of late been subjected may
account for certain specimens proving inert, but
apart from the varying factor of susceptibility, there
is the personal factor, that of the thoroughnesss of
the operation and the possibility of subsequent
manosuvres having for object to frustrate the success
thereof. The Government department in charge of
the distribution of the vaccine is at present barely
able to cope with the demands of public vaccinators,
the average demand being close upon two thousand
tubes daily, and, for the present at any rate, private
practitioners will be left to shift for themselves. Not,
indeed, that this is any hardship, inasmuch as there
are plenty of trustworthy lymphs on the market at
prices well within the reach of the poorest.
The Prolonged Heat.
The prolonged heat-wave that is still swamping
Great Britain has brought with it the usual train of
seasonal diseases. Diarrhoea has been steadily increas¬
ing in its death-rate for some weeks past, and is
claiming to the full its wonted tax of victims from
the baby population. The direct relation of this most
fatal malady—we are speaking of its acute summer
form—is so remarkable that it is somewhat curious
that efficient preventive measures have not arisen
from the constant presence of this remarkable condi¬
tion. As everyone knows, the prevalence of the
serious aspects of the disease closely follows
the curve of the deep - air temperature as
registered by -the three-foot thermometer. Since
the classical investigations of the late Dr.
Ballard little has really been learnt as to the
essential facts of this most devastating disease, and a
short attractive field of scientific investigation awaits
some future worker in practical pathology and pre¬
ventive medicine. Indeed, it is difficult to conceive
any subject that in our existing state of knowledge,
or want of knowledge, presents issues fraught with
greater importance to the community. In Paris the
heat-wave has been accompanied by a considerable
increase of cases of typhoid fever, happily of mild
type, which have reached a maximum of incidence
not attained since the year 1894. When the man in
the street asks what is the moral of it all, what shall
the scientific physician answer? Verily, so far, per¬
haps the most if not the only answer of any value
is to boil all milk and water before use. But what is
the traveller and the tourist to do? Well, either
cany his own little boiling apparatus, or drink wine
pace the teetotallers.
Coventry Provident Dispensary.
It is to be hoped that a conclusive phase may
now be started by the Council of the British Medical
Association in its attitude towards institutions of this
nature. Since the strong resolution passed last year
at the Edinburgh meeting it was natural to imagine
that the profession of Coventry would follow up the
matter. The Association has at a general meeting
now called on the Council by a unanimous vote to
demand from these dispensary doctors a reason for con¬
tinuing their connection with the institution. We
hope the Council will be resolute in the matter, and
not stultify itself by failing to assert and enforce its
opinion. This dispensary has been shown to be a
most offensive affair from a professional standpoint.
In many respects it is worse than any medical aid
assocfetion. A lay committee farms out profes¬
sional aid to substantial people. Funds over
which the medical staff have no control are put out
on mortgage, and managed by committee. The insti¬
tution is riddled with abuses of every conceivable
nature, and it is high time that the British Medical
Association should take steps to purge itself of men
who, in spite of repeated remonstrance, maintain their
connection with such a body. Future developments
of this matter will be awaited with considerable
Digitized by CjOO^Ic
Arc*. 16, 1899.
NOTES ON CURRENT TOPICS.
The Medical Press. 173
interest. The new President of the Council is, we
understand, in hearty sympathy with the aspirations
of the general practitioner, and it may be anticipated
that greater vigour will be infused into the future
legislation of the body.
Immunity of the Abortion Quacks.
The syndicate who trade under the name of
Madame Frain have been acquitted of the criminal
charge of selling abortion remedies. At the trial
their counsel scarcely ventured to deny that they
advertised largely to entrap married women who did
not desire child-bearing, and unmarried girls who—
for obvious reasons—entertained th$ same feeling,
having “ got themselves into trouble,” and the evi¬
dence went to show that the speculators reaped a golden
harvest by blackmailing such persons. Nevertheless,
they were acquitted, as we anticipated. Why ? The
difficulties of a successful prosecution in such a case
were explained some two years since by a veiy ex¬
plicit communication to the Medical Press from the
Public Prosecutor. He pointed out that a prosecu¬
tion might be maintained by any one of three parties 1
—(a) the Crown, for using drugs for felonious pur¬
poses ; (b) the Pharmaceutical Society, for selling
poisons without qualification; and (c) the victim,
for having obtained money under false pretences.
■Of these, the last-named only was likely to succeed
in a prosecution, inasmuch as the false pretence would
be easily proved by showing that the stuff supplied
for abortion purposes could not by any means pro¬
duce the desired effect. But it will be easily under,
stood that a private prosecutor is never forthcoming
in such a case. No married woman could be induced
to swear in the witness-box that she took drugs to
prevent conception, still less would an unmarried female
make the same confession. For this reason the prose¬
cution of such criminals devolves upon the police or the
Pharmaceutical Society, for whose case it is indis¬
pensable to prove that the stuff supplied contained
poisonous drugs in material quantity. To show this
has now been found impossible, inasmuch as the stuff
is mostly dirty water, with no abortifacient potency
whatsoever. The prosecution endeavoured to show
that it contained material quantity of “ bitter apple ”
and other enmenagogues, but it failed to show that
the quantity was enough to bring the vendor within
the grasp of the law, and an acquittal followed.
There seems to be no escape from this legal impasse
except an Act to make the felonious intention a
felony.
The Hospitality at the Portsmouth Mee ting
of the British Medical Association.
One of the most general subjects of comment at
the recent meeting of the British Medical Associa¬
tion in Portsmouth, was the excellent arrangements
made for the entertainment of the visitors, and the
lavish scale of the hospitality Upon this matter
a universal opinion prevailed that the hospi¬
tality extended was such as to make the Portsmouth
meeting always a memorable one. Not only were the
guests provided for in a manner worthy of the occa¬
sion, but also in a manner befitting the great naval
and military centre in which the meeting was held.
It would be invidious to single out any special host
whose hospitality contributed to the pleasure of the
meeting, where so many of the leading residents in
the district extended a welcome to the members of
the Association. But, perhaps, mention should never¬
theless be made of the part taken in this regard by
the Mayor of Portsmouth, Alderman Scott Foster.
Undeniably the Association is indebted to him in
various ways. In giving a prominent official lead to
the proceedings in connection with the.meeting he
set the example to others to do their best to
memorialise the occasion. Altogether, from the
Mayor downwards, the hospitality shown at Ports¬
mouth was such that the counter attractions in some
degree depleted the attendance at the sections.
Unqualified Practice under the Companies
Acts.
The executive of the British Dental Association
has issued a circular to its members, urging them to
support by all means in their power the objects of
the Companies Act of the present year, which de¬
prives commercial syndicates of the right which they
claim to practise medicine, surgery, dentistry, and
midwifery without qualification. The Association
points out that any unqualified person, who may have
got himRelf into trouble by infraction of the Dentists
Act, could escape all risk or inconvenience by regis¬
tering himself as a company, it having been decided
by the High Court that a company i6 not bound
by the same law as an individual. The Association
calls attention to the attempt of which we have some
time since given warning, of certain persons in Dub¬
lin, who call themselves the Dr. Bland Company, to
work this decision to their own advantage, and, also,
of certain other persons seeking to follow the example.
Fortunately two difficulties stand in the way of
these enterprises. An unqualified person may be
prosecuted in the midst of his medical or dental prac¬
tice if it can be proved that he represented himself
to be a registered practitioner—a statement which
it ought not to be difficult for an astute person to
get out of him. A qualified practitioner, on the other
hand, who associates himself with such unqualified
persons may, and should be brought before the General
Medical Council for covering,’’ and expunged from
the Register for “ infamoys conduct in a professional
respect.”
Ill-Health of Dublin.
The last three weeks—as reported upon by the
Registrar-General—have marked a rapid and serious
increase in the prevalence of disease in the city. In
the week ending August 5th, the total mortality had
gone up to 33.3 per 1,000, owing chiefly to the great
increase in the death-rate from zymotics. In that
week the zymotic deaths jumped from 43 to 71, in
consequence of the epidemic of measles already
referred to, and the great prevalence of children’s
diarrheea.
Digitized by
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174 The Medical Puses.
CONGRESS OF OTOLOGY.
Testimonial to Professor Purser, of Trinity
College, Dublin.
A movement, of which notice has already ap¬
peared in our columns, hus been set on foot to per¬
petuate Professor Purser’s long services to the School
of Physic as Professor of Physiology and Institutes
of Medicine. The intention is to found a Purser
medal to be offered for competition at the same M.B.
examination of each year, the award being for the high¬
est marks scored, presuming sufficient merit has been
shown. Subscriptions are limited to the Professor’s
past pupils, and to the sum of one guinea. The Hon.
Treasurer is Dr. W. S. Haughton, of 30 Gt. Fitz-
william Street, Dublin, and local secretaries have
taken the matter in hand in various English and
Irish teaching centres.
The Right Hon. A. J. Balfour, M.P., has consented
to take the chair at a Festival Dinner at the
end of November in aid of the fund in course of
being raised to provide new laboratories at King’s
College, London.
Sir Michael Foster, the new K.C.B., has been
duly invested by Her Majesty with the riband and
badge of the Civil Division of the Second Class of
that Order, a distinction which gives an official cachet
to a long and useful scientific career.
Sir Henry Frankland, F.R.3., has died in
Norway, whither he had gone on a fishing expedition.
Deceased was not in the medical profession, although
intimately connected with it as a voluminous writer
on chemistry, and as professor of chemistry at Owens
College, Manchester, and St. Bartholomew's Hospital,
London. These positions were subsequently resigned
for a Government appointment, from which he re¬
tired some time since. Sir Henry was in the seventy-
fifth year of his age.
THE INTERNATIONAL CONGRESS OF
OTOLOGY.
The Sixth International Otological Congress met
last week at the Examination Hall on the Embank¬
ment, where Professor Urban Pritchard presided
over upwards of three hundred specialists from all
parts of the world. We publish elsewhere his in¬
augural address, which gives a brief history of the
progress of otology from the dawn of history up
to date; but, in respect of the proceedings, we can
only express our regret that they are, perforce, very
meagre, owing to the want of the usual facilities.
In this respect the lay press appear to have met with
greater consideration than tlie medical press, not
even a programme having reached us.
There is a very general impression among medical
men, if not among the laity, that otology is a some¬
what limited and sterile field of activity. As is the case
with many other departments of the healing art,
otology is not to be judged exclusively by purely
curative results achieved. Once the delicate and com¬
plicated apparatus which serves to convey mechanical
vibrations to the sensorium is destroyed, art can do
little or nothing to remedy the defect. What the
science of otology does teach us is the possibility of
modifying or averting the destructive diseases which, '
if allowed to proceed unchecked, ultimately impair
or destroy the sense of hearing. Investigation of the
conditions which lead to deafness incriminates pretty
well all the adjacent cavities and structures, ana thus
the field of inquiry is widened. No one, nowadays, is
ignorant of the role played by adenoid vegetations in
the production of deafness, and defects, structural or
acquired, of the nose, are well known to tend in the
same direction. For this reason it is as difficult to
mark off the ear as a speciality as it is to study one
branch of physics without taking cognisance of the
others. It may appear that we have spoken rather
slightingly of the curative resources of the oral
surgeons, but their inability to relieve in so many of
the cases that come to them is merely due to the
fact that the mischief has been done before their
assistance is asked, With the advance of otological
science it is to be hoped that people will learn the
importance of seeking skilled advice before irremedi¬
able damage has been done, that is to say, at a stage
when science may still have something to say.
Dr. Macnaughton-Jones, as President of the British
Gynaecological Society, and one of the Reception
Committee of the Congress, gave a dinner to some
of the foreign visitors to meet the President of the
Congress and its officers. The dinner was held in
the Caf6 Monico, where about sixty guests sat down.
The Chairman gave the toasts of Our Queen ” and
“ Our Foreign Visitors.” The latter was responded
to by Professor Politzer, who dwelt on the hospitality-
shown by the British otologists, and which, he said,
could not be surpassed. He also referred to" the
teaching and practice of the great London hospitals,
concluding by proposing the health of their host.
Russia was responded for by Dr. Benni, Italy by
Professor Grazzi and Dr. Bobone, Germany by Dr.
Hartmann, Switzerland by Dr. Rohrer, America by
Dr. Ewart Norway by Professor Uchermann.
Sir Crichton Browne, in a most felicitous speech,.
S osed Otology, humorously pointing out where
departments as gynaecology and psychology
touched hands with otology, also dwelling on tne-
great advantages of such a Congress as this in.
educating the public to the need for a greater recog¬
nition of the claims of otology as one of the most
important of the special departments of medicine, as
well as drawing the attention of the Universities to
the need for enforcing a special standard of know¬
ledge in this department by making otology one of the
special subjects of the examinations for their degrees.
Dr. Moure, of Bordeaux, the President Elect of the
next Congress, which will be held in Bordeaux in
1903, responded to the toast. Dr. Luc, of Paris, pro¬
posed a greeting to the President of the Congress,
Dr. Urban Pritchard, to which the latter responded.
In addition to the foregoing, the following were
among the principal guests .—Prof. Avoledo, Milan ;
Dr. F. Alt, Vienna; Dr. Barkan, San Francisco; Dr.
Brieger, Breslau; Dr. Barr, Glasgow ; Prof. Capart,.
Brussels; Dr. Duchesne, Liege; Dr. Dench, New
York; Sir James Dick ; Prof Faraci, Sicily; Prof,
Gradenigo. Turin; Prof. Guye, Amsterdam; Dr.
Knapp, New York; Prof. Lucae, Berlin; Dr. Moore
Lindsay, Salt Lake City; Prof. MacEwen, Glasgow ;
Dr. Meniere, Paris; Dr. Sune-v-Molist, Barcelona;
Dr. Story, Dublin; and the Editors of the three
principal medical journals, the Lancet , British Medical
Journal, and Medical Press and Circular.
Most of the officers of the British Organisation
Committee of the Congress were also present, and
some leading Fellows of the British Gynaecological
Society.
Various national airs were played by a stringed
orchestral band during the evening. The reunion,
was most enjoyable, ana there was but one opinion
on the part of all who were present as to its great
success.
jyGoogl
Aug. 16, 1899.
CORRESPONDENCE.
The Medical Presb. 175
Jlnnual fleeting of British iHcbital
Association,
HELD AT
PORTSMOUTH, AUGUST, 1899.
THE ANNUAL EXHIBITION.
(Concluded from our last iaeue.)
Messrs. Fairchild Bros, and Foster (Snow Hill,
London). This firm had a handsome exhibit, prominent
among their products being Zymine Peptonieing Tubes,
Peptogenic Milk Powder, Panopepton, and Pepsencia.
Zymine Peptonising TubeB, as everyone knows, contain
powder for the preparation of peptonised milk in an
accurate and portable form. Peptogenic Milk Powder
is an excellent preparation for the modification of cows’
milk for infante. Panopepton is a bread and beef pre¬
paration in a fluid peptonised form. It is palatable and
freely assimilable, and is most valuable in sleeplessness
when this is due to excessive fatigue or malnutrition.
Pepsencia is a most pleasant preparation of pepaine in
the liquid form, is made directly from the peptic glands
of the stomach, and contains all the constituents of the
gastric juice. It is recommended for indigestion, and
makes delicious junket.
Allen A Hanbury’s showed an extensive assort¬
ment of Burgical instruments, and all up-to-date aseptic
appliances. The Allenbury’s Milk Pasteuriser, exhibited
at the Association for the first time, is of commendable
simplicity, and should certainly come into vogue as a
popular milk steriliser. We propose noticing this in¬
strument more fully in our next, with an illustration.
They also showed a new aseptic ligature box, sug¬
gested by Mr. Jordan Lloyd, consisting of a silver-
box with a porcelain reel inside, a capital and simple
sterilising chamber. A new anastomosis forceps
by Dr. Laphac, an American surgeon, suitable for
abdominal surgery. A oatheter steriliser, by which
a jet of steam is drawn through the catheter. A
new torsion spring balance for dispensing purposes scaled
to grammes and decigrammes, a delicate and durable
instrument of American origin. No weights are needed,
and it is dust-proof when out of use ; also an excellent
new centrifuge producing 6,000 revolutions per minute.
The same firm showed a collection of their renowned
pharmaceutical products. Among them were capsules,
kapeals in gelatine, coated compressed medicines, and
the well-known Allenburys Foods. Samples of the
latter were offered to the visitors in the form of ice
cream which proved most acceptable in the heated
atmosphere of the drill hall. Phosote and taphosote
were new preparations for phthisis, being phosphate of
creasote and jannophosphate of creasote in a more
pleasant and assimilable form than the crude drug.
Mr. Thos. Christy, who is specially known in connec¬
tion with the importation of new and rare medicinal
plants and drugs, had an extensive display of his
specialties. Adeps Lanae, B.P., Christia, Pictet’s ethyl
chloride. Neo-kola, (said to be the only preparation which
contains as much as 99*75 per cent, of pure kola) Stearns’
wine of cod liver oil. hsemoferrum, glandulen, Ac., all of
which have been referred to in these columns when first
introduced. As a new departure he also showed some pre¬
parations in which fluorine has been used for the first
time for medicinal purposes, and with names significant
of their uses, fiuor-rheumin for rheumatism, and epider-
min, which is claimed to be a specific in certain skin
diseases.
The Maltine Manufacturing Co. showed a large
eihibit, in which the gold medal “ Maltine ” oocupied a
foremost place. The compound preparations were also
represented, such as maltine with hydrophosphites, with
cascara sagrada, and with yerbine.
Carnrick A Co. were strongly in evidence with a large
assortment of their special food preparations. There is
no need to go through the list of these well-known pre¬
digested articles, of which the mainstay is the “ liquid
peptonoids.” The “ soluble food ” is another well-known
product of this firm, and is intended for children.
“ Maltoline ” consists of malt extract, cod-liver oil, and
hydrophosphites of lime, soda, and iron.
Maw, Son, A Thompson had a large and imposing
display of surgical instruments, including all the acces¬
sories of aseptic surgery. To go through this exhibit
systematically would be to revise the elements of a com¬
prehensive surgical education. Some idea of the size
and detail of this remarkable stall may be gained from
the fact that the mere list of its contents oocupied seven
pages of the official catalogue. The instruments re¬
quired in every branch of special surgery were shown in
latest pattern.
Messrs. Down Brothers showed an aseptic operation
theatre, fitted complete in every respect. An inspec¬
tion of this exhibit would give the modern surgeon an
object lesson in every detail of the most advanced
methods. With regard to surgical instruments, especi¬
ally those for aseptic use, this enterprising firm produced
a thoroughly practical and comprehensive exhibition.
The stall formed one of the familiar features of the
Annual Exhibition, and need not be entered into in
greater detail.
The Anglo-Swiss Milk Company had their usual ex¬
hibit of Milkmaid brand condensed milk ; of “ ideal ”
milk, »n unsweetened product 5 and of their preserved
milk combinations with cocoa, chooolate, and coffee.
The Bovril Company oocupied a good space with
their well-known food products. Their special emer¬
gency foods, as supplied to various Arctic and military
expeditions, were in evidence, as also their “ staminoids "
for tourists, cyclists, and other athletes. A good pre¬
paration is the virol, a fat food for children, and also
marrol, a similar article for adults. Liquor carais
(Caffyn’s) is known to most medical men as an uncoagu¬
lated albumen.
Burgoyne, Burbidoes A Co. had an exhibit that in¬
cluded several novelties. Acoin (Heyden) is anew local
anesthetic, which is said to be more lasting in its effects
than coca in, as well as being non-poisonous. Hyrgolum
is a water-soluble metallic mercury, which is best used
in the form of ointment. It is claimed for this drug
that it does not irritate the skin. Space does not allow
us to mention in detail several other valuable novelties
shown by this firm.
Mr. W. Mabtindale had his usual display of elegant
and practical pharmaceutical products. His bougies,
nasal and urethral, were in force, and will repay the
close attention of every general practitioner.
Jeye’s Sanitary Compounds Company had an im¬
posing show of preparations of their well-known disin¬
fectant fluid, and also of their valuable creolin.
Messrs. Scott and Brown showed their well-known
cod-liver oil emulsion, which is so appreciated all the
world over that it needs no more than passing mention
in the present notice.
Messrs. E. Archer A Co., Great Malvern, showed
their dry old cognac, which we can recommend as being
thoroughly mellow and of fine flavour. This opinion is
borne out by the published analysis of the spirit itself.
Messrs. Bayer A Co.—In our notice of this exhibit
last week we referred to one of the products of this firm
as “ Tannophen,” by a clerical error, instead of Tanno-
pine (Hexamethylenetetramin.) As the chemical name
of the product indicates, Tannopine is a combination of
Tannic Acid and Urotropin, and it was to this prepara¬
tion we referred.
(ComspunOettce,
We do oot bold onrselve* responsible for tbe opinion* of our
correspondents.
THE CONTROL OF THE BRITISH MEDICAL
ASSOCIATION.
To the Editor of The Medical Press and Circular.
Sir, —It is clearly manifest that the members will have
to take a decided stand if they mean to assert their
rights. The Council of the Association seem to be of
opinion that they are an autocratic body, and can do
exactly as they please. It must not be lost sight of that
the Council consists (or should consist) of the representa¬
tives of the branches, and are sent by the members to
Digitized by G00gle
LITERATURE.
Auo. 16, 1899.
176 The Medical Press.
represent their (the members) views. It has unfor¬
tunately been the case that numbers of branches have
not; hitherto asked their representatives to give an
account of their stewardship, and it is also unfortunate
that the members have almost invariably sent the same
men to represent them at the Council.
It may be asserted as an axiom that in all elections,
unless there is a fair amount of opposition, the repre¬
sentatives will take little trouble to consult their
constituents. We must bear in mind the fact
that the Council is simply the Medical Par¬
liament, and we must, in our individual branches,
assert our right not only to obtain the views of our
representatives, but also to have a record in the journal
of the way they vote. Until the Council ceases to sit as
a"^private committee, we shall never know the true
inwardness of its proceedings. Is there any good reason
whatever why the meetings of our Council should not
be open to the Press ? The Council could, as the General
Medical Council does, deliberate in private when neces¬
sary, but in the conduct of general business there appears
no good reason why a public body like our Council
should not have its deliberations reported both in the
lay and in the medical press.
We talk about the close corporation of the College
of Surgeons, but is that corporation half so conserva¬
tive as the British Medical Association and its Council ?
I shall at a future time have a few remarks to make
about the annual meetings, and the way the business
part of them is conducted.
I am, Sir, yours truly,
August 13th, 1899. A Provincial Member.
Xaboratorg Jlotcs.
JOHANNIS POTASH WATER.
A chemical analysis of this water, which is pro¬
duced by the addition of bicarbonate of potash, at the
Johannis Springs in Germany, to the Natural Johannis
Water, shows that the statement as to the amount of
tassium bicarbonate present is precisely accurate,
e find 7 8 grains of potassium bicarbonate per small
bottle (which is about one third of a pint). Now that
potash and soda wa er are no longer official in the 1898
edition of the British Pharmacopeia, medical men will
be’glad to know of a water that they can recommend to
their patients as of unquestionable purity and of uniform
composition, for Johannis Potash is practically a natural
water, the pure carbonic acid gas, to which it owes
its effervescence, being natural to the water itself.
Far too many of the “ potash waters ” of commerce are
very variable in the amount of potash they contain,
and many are of doubtful organic purity, being simply
made from the local town supply, which may be subject
to pollution, and is, in many of the smaller towns,
seldom or never analysed. There is a popular
delusion that an aerated water (no matter what
brand) is 3afe to drink, because the carbonic acid gas
destroys any bacteria that may be present. This is a
fallacy, and we strongly urge our readers to trust only to
well-known makes of undoubted purity, such as the one
in question.
literature.
SIMPSON’S CEREBRAL SYMPTOMS, (a)
This monograph is the result of a conscientious study
•by Dr. Christian Simpson of what may be called the
materiHl relations of mental phenomena of a morbid
kind, and the range of observation is not the limited one
of an asylum ; for the author has given us the benefit
of general hospital 6tudy and observations as well.
Cerebral and mental symptoms and their correlation to
somatic disease, amesthetics, toxic agents, traumatic
and surgical procedures is a large subject for a gradua-
(a) “ Cerebral *nd Meat'll HyrnDtoms. ' By J. C. Miupson*
M.D. London: John Hale, Sons, and Daniels on Limited.
tion thesis, and too large for anything like exhaustive
treatment in a small volume. But, as we have said,
the author has conscientiously plodded through his
work, and if the pages are sometimes dry, the matter
condensed, and the style and treatment lacking in
originality, we may commend the work for its refer¬
ences and its practical usefulness. Undoubtedly there
is a wealth of bibliographical reference, and an author
who culls largely must inevitably sacrifice style and
literary attractiveness. 8uch authors deserve thanks
for labour which is inestimable, and help which is
invaluable. The later parte are less hampered by
references, and the surgical section is of great clinical
value. The question of toxic influences is one which
stills calls for elucidation, for clinical chemistry has
much to clear up before we can be sure that we have
certainties to deal with
MORRIS ON THE SKIN, (a)
The appearance of the second edition of this work
will be welcomed by those who make a special study of
diseases of the skin. The author has a lucid literary
style, which lends to his subject an attractiveness for
which we often have to look in vain in medical text¬
books. The present edition has been increased in value
by the addition of much fiesh matter and of several
platen, while at the same time an effort has been made
to keep the book within reasonable limits.' The pathology
of skin diseases, if we take it comprehensively, must
still be regarded as being in a tentative stage. A vast
number of observations have been made, but the meat
generalisations have yet to come, or, at any rate have yet
to be accepted. For instance, the cause of so apparently sim¬
ple and definite a group of symptomatic phenomena as the
drug eruptions remains undetermined. Morris rejects the
theory of direct glandular irritation, and advances the un¬
satisfying explanation of angio-neurotic origin. Indeed,
throughout his book he adopts largely the classification
of Leloir, who appeared to attribute nearly all possible
cutaneous maladies directly or indirectly to nerve influ¬
ences. With regard to eczema he defines that term as
“a catarrhal inflammation of the skin, originating with¬
out visible external irritation, and characterised in some
stage of its evolution by serous exudation.” That defini¬
tion excludes all forms of inflammation of the skin
caused by chemical or mechanical agents. The distinc¬
tion may be convenient, but it seems to us hardly
necessary outside the class-room. All who want a con¬
cise, clear, and well written precis of our present know¬
ledge of this branch of medical practice will do well to
get this book.
PRIMER OF PSYCHOLOGY AND MENTAL
DISEASES. (6)
This email book is intended for asylum attendants
and nurses, and also for medical students. For the
latter class it is quite insufficient ; for the former it
is rather t<o much. The author has therefore fallen
between two stools. The opening pages begin with
definitions, e g., psychology, biology, physiology, life, and
a rudimentary description of animal evolution. The
attempt to give the average citizen an idea of what
mind is. has been a failure. To try to give an asylum
attendant a real working conception, by using the
language of the mental philosopher, even when simplified
by definitions, is a hopeless waste of energy. To say
that a sensation is an impression made upon an organ
of sense is misleading, the nervous reception of the
impression is physical not psychic. Then, in speaking
of the causation of insanity, it is not correct to say that
among the constitutional and evolutional causes are
pubescence and adolescence. Why, if so, are not all
young people insane ? As already indicated too much
is attempted here for attendants, the style altogether is
too pedantic, and there is a want of proportion to th©
avowed aim.
(n) “ Diseases of the Skin." By Malcolm Morria, F.R.C.8.Ed.
London : Cassell and Co. 1898. Pi ice 10a. 6d.
'Ii) “ A Primer of Psychology ard Mental Disease.” By C. B.
Burr, M.D. Philadelphia : I lie F. A. Davis Co.
Digitized by
Aro. 16, 1899.
MEDICAL NEWS.
The Medical Press. 177
^cbical
Irish Medical Schools' and Graduates’ Association.
The summer general meeting of the above Association
was held on Wednesday, August 2nd, in the To ~n Hall,
Portsmouth. In the absence of the president, Sir William
Thomson, F.R.C.S.I., the chair was occupied by Dr.
Jocelyn Swan. There was a large attendance of mem¬
bers, including Surgeon-General Cuffe, C.B., Sir William
Kynsey, C.M.G., Lieut.-Col. Boileau, M.D.. A.M.8. (Trow¬
bridge), Dr. Dolan (Halifax), Mr. O’Callaghan, F.R.C.S.I.,
Major A. S. Faulkner, I.M.S., Dr. 8. Hamilton (Newport),
Dr. T. Neville, Colonel Maturin, R.A.M.C., and the Pro¬
vincial Honorary Secretary, Dr. J. Stewart (Clifton).
The Council reported that they had had under
discussion the question referred to them from the
annual general meeting as to the best way of cele¬
brating the "coming of age’ of the Association,
which had just that day completed its twenty-first
year, and that they had determined to mark the occa¬
sion by a conversazione at the Hotel Cecil, London, on I
or about November 23rd, after the autumn dinner. The ,
provincial honorary secretary (Dr. Stewart) reported
that a considerable accession of new members was ex¬
pected from the effort now being made by the Council
to bring the Association under the notice of the two
thousand practitioners resident in Great Britain who
were eligible for membership but were not yet enrolled.
If the result was equal to their expectations, the Council
would have sufficient fundsto proceed immediately with
an attack upon another of the strongholds of mono¬
poly. Surgeon-General Cuffe said he could not
refrain from an expression of surprise that there
should be in these days, when the “open door”
was so much talked of, any necessity for the Association
to carry on this warfare against monopoly. Why should
hospital governors in London or any part of England
shut their doors against all candidates for honorary
appointments except those holding diplomas from two
specially favoured London colleges ? What right had
they to imply, as they did by this exclusiveness, that
those who had obtained their diplomas in Scotland and
Ireland were not good enough to be allowed even tocom-
pete for these appointments ? Such an implication was,
in his opinion, either impertinence or the result of gross
ignotance. He had had a large experience of scientific
and practical work done in military hospitals, and he
had n» hesitation in saying that the very best men in
the Army Medical Department were Irishmen. The
proper principle to act on in these matters was Liberte,
Egalitt, Fraternita. The medical man should not be
trammelled in his choice of a college from which to obtain
his higher diplomas; the diplomas of the same standing
in each of the three countries should be treated as on an
equality ; and thus the brotherhood of the profession, to
which they were all proud to belong, would be maintained.
How could the fraternal feeling be sincere when the Irish
College was treated as only a step-brother ? How could
the public understand that the General Medical Council
wrb a body governing impartially medical education in
all three divisions of the kingdom when they see from
time to time (in the Liverpool papers, for instance)
advertisements reading through the lines of which one
can see the cruel words “No Irish need apply”? Aftei
some observations from Dr. Hamilton (Newport), Dr.
G. Roe Carter, and others the subject dropped. One of
the rules was altered so as to provide for six of the elected
members of Council retiring each year, and being in¬
eligible for re-election for a twelvemonth. The meeting
then adjourned.
Death from Chloroform.
A child, tet. four, to whom chloroform had been
administered last week in view of an operation for
empyema at the Metropolitan Hospital, died on the
table. The risks of anaesthesia in these cases are well
recognised, so much so that many surgeons prefer to
operate without it. Unfortunately the report before us
does not give the amount used nor the method of admin¬
istration, but the child died and the usual verdict was
returned.
King ■ College Medical School.
The following is a list of scholarships, prizes, &c.,
awarded for the session 1898-99Recommended for
the Associateship—Matthew Louis Hughes ; Sam-
brooke Exhibition—Albert Angelo Myers and Harold
Benjamin Day; Medical Entrance Exhibition—Charles
Harrison Barber and Herbert Sydney Flook, B.A.;
Warneford Scholarship—Thomas Henry Jones, John
James and Eardley Lanclot Holland; Senior Scholar¬
ship-not awarded ; Second Year Scholarship —
Matthew Robert Cecil MacWatters ; Junior Scholar¬
ships—Harold Benjamin Day and Albert Angelo
Myers; Tanner Prize—William Henville Lowman;Todd
Prize—Frederick Burroughs Jefferiss ; Hygiene Prize—
Arthur Edmunds; Pathological Anatomy Prize—Arthur
EdmundB ; Obstetric Medicine Prize—Arthur Edmunds ;
Medicine Prize—Arthur Edmunds ; Surgery Prize—
William Henville Lowman; Clinical Surgery Prize—
William Henville Lowman; Professor Rose’s Surgery
Pr ze—Victor Richard F. Kroenig; Anatomy Prize—
Edward Augustine Bell; Physiology Prize—John Alex¬
ander Drake; Chemistry Prize—Matthew Robert C. Mac¬
Watters and William Wellesley Campbell; Materia
Medica Prize—Matthew Robert C. MacWatters.
An outbreak of enteric fever is reported among the
boys and girls attending tho St. John’s Road School,
Islington Between July 28 and August 1 thirteen
children of both Bexes have been stricken down, and a
large number of suspicious cases are being kept under
observation in the infirmary.
PASS LISTS
Loyal Colleges of Physicians and Burgeons of Edinburgh
and Faculty of Physicians and Burgeons of Glasgow.
At the July sittings of the Scottish Conjoint Medical
Board, held in Glasgow, the following candidates passed
the respective examinations:—
First examination (five years’ course)—Katherine Mary Chapman
'with distinction), Archibald M. Laune (with distinction), James
Robert Robinson, Alexander Glen (with distinction). William
Adams, Robert C. Blyth, James B. Parcel!, William D. Cockburn.
Alexander Allan, Patrick M. C. O'Doherty. Alexander B. Young
(with distinction!, Rudolph Baminov, Denis C. Callaghan, John
Webster, John Hutchinson.
First examination (four years' course)—William Barclay, John
Willett. John A. Aickiu, John J. O'Sullivan. James M. Campbell,
John Dunlop, 8amuel O. Kinloch, Thomas Dow, Herbert D.
Pitt.
Second examination (five years’ course)—Harry A. Lunn (with
distinction), Bobert J. Roberts. Thomas E. Hartv, David R. Wil¬
liams, Michael B. Conroy, Hugh Williams, David Moodie, Horbert
M'Master, William D. Sutherland, John H. O'Sullivan, James N.
M'Morris, Aloysius F. Fleming
Second examination (fouryears' course).—Henry J. Fryer. John
G. Welsh, John A. F. Hatch, John T. Bell, James Graham, Joseph
C. Shelmerdine, John Willett. Richard M. Wilkin, Robert G.
Wliitclaw, James James, Arthur Bryans, Matthew O'Hallaron.
Third examination—David S. E. Macnab (with distinction),
George K.Jarvie, John T. Griffiths (with distinction), Bobert Ward-
law, Donald Duff ( with distinction). John Allan, Adam Fox, George
J. Campbell, William Thomson, William Burns, Charlotte M'Creu,
James J. Lynch, Joseph O'Mahony, John J. M'Ntcholl, William J.
Healv, Frederic Wm. M'Cay, Stuart Fairies, William Mason. John
Sykes, Thomas B. Hunter, John Bygott, Winifred Nell, Walter
Hil.bert, MaryRocke, Katharine E. Gregg, George Goldfoot, Archi-
bald C. Bulfour.
Royal Army Medical CorpB.
The following gentlemen obtained commissions in the
Royal Army Medical Corps at the Recent Examination
in London:—
Harrison, I.. W.
2,875 Harvey, F.
... 2.102
Irvine, F. S.
... 2,2*4 Trimble, C. E.
... 2,086
Morton, H. M.
... 2,260 Matthews. J.
... 2,084
Bahington, M H.
2,231 McLoughlin, W. A.
... 1,940
Richards, F. G.
2,150 Siberrv, E.W.
... 1,816
Knox, E. B.
2,121 ' Wingate, B. F.
... 1,805
Roch, H.S.
... 2,115 0 Beillv, P. S.
... l,8O0
Indian Medical Service.
The following gentlemen obtained appointments in the
Indian Medical Service at the examination held last
month:—
MacGilclirist, A. C.
Goodliody. C. M. ...
Megaw, J. W. D. .
Thurston, E. O. ...
Steen. B.
Machines, J. L. ...
Gilbert. L. .
Browse, G.
Matthews, E. A. C.
Stokes, T. G. N.
El wee, F. F.
3,151
Thornelj, M. H.’
... 2,400
2.807
Stephens, L. P. ...
... 2,356
2,732
Murison, C. C.
2,335
2,618
Murphy, W. O' S.
... 12,261
1,571
Beit, F. V. O.
... 2,173
2,505
Mackenzie, H. M.
... 2,139
2,55o
Long, W. C.
... 2,"*5
2.342
Todd, L. B.
... 2,"40
2,4!>7
Corry, M.
... 1.945
2.415
Beamish, G. C.
1,943
3,410
Williams, H. A.
... 1,939
Digitized
178 The Medical Press.
^0tias txr
OTorreeponbcnt'S, Short letters, <&r.
Correspondents requiring a reply in thi« column are par'
Ocularly requested to make nee of a distinctive tignatwr* or
initialI, and avoid the practice of signing themselves " Reader/-
“ Suhscriber,” “ Old Subscriber,” 4c Much confusion will be
spared by attention to this rule.
Local Reports and News.— Correspondents desirous of drawing
attention to these are requested kindly to mark the newspapers
when sending them to the Editor.
Reading 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 passed through
the poBt.
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.
Original Artic les or Letters intended for publication should
be 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.
A CAUTION TO MEDICAL MEN.
To the Editor of the Medical Press and Circular.
Sir.— A woman signing herself E. M. Iselton and sometimes
Etheridge, has been lately appealing to members of the medical
profession in very urgent letters nsking for the means to relieve
“ with proper nourishment ” a medical man, who is sometimes
referred to as her husband rfnd occasionally as her fiance, and who
is in “great need and rapidly sinking.” Recipients of such
appeals should refer to the Charity Organisation Society at the
address below.
I am, your obedient servant,
C. S. Loch, Secretary.
Charity Organisation Society, 15, Buckingham Street, Loudon,
W.C. August 9th.
Dr. Collingwood (Birkenhead).—Communication came to hand
as we were at press.
Dr. Ewart's paper is marked for early insertion.
A Member (Portsmouth).—We fully discussed the question in a
leading article last week. We cannot again take up the subject, it is
now, or should be, in the hands of members to settle. There is,
however, the same apnthy and indifference in this as in other
matters concerning professional well-being; they appear to expect
everything done for them without lifting a hand or making an effort
themselves.
Dr. Brasset Brierlbt.— We are unable to And space for the dis'
cussion on midwives' legislation. We shall deal with this as
occasion arises, but for the moment we are disposed to allow the sub¬
ject to rest.
INCONTINENCE OF URINE.
M. R. B.—In dealing with incontinence of urine in young girls, it
is well to restrict the quantity of liquid taken after tea-time, and to
awaken them at ten or eleven o’clock to empty the bladder. If
necessary fifteen to thirty minims of tincture of belladonna Bhould
be given at bed time, according to the age. Should this fail, liquid
extract of ergot may be tried. Correct any undue acidity of urine,
and inquire os to the presence of worms.
Dr. J. E. R. - The action for libel with which we were threat¬
ened in the case referred to has not yet assumed a serious aspect,
nor indeed do we fear it. We performed a public duty in the matter
uninfluenced by any other motive and can calmly await results.
Prax. —A simple plan for the reduction of troublesome paraphi-
mosis is by the application of an elastic bandage, as tight as the
patient’s feelings will allow-. Within twenty-four hours the most
marked oedema will have subsided under pressure, and the con¬
striction can then be reduced. Failing success the only course is
to cut through the constricting band, a trivial and not very painful
procedure.
Bathtbius.— We believe that there is no foundation whatever for
any such statement.
lacattcics.
Birkenhead and Wirral Children's Hospital.—House Surgeon.
8alary £50, with board, residence, and laundry. Applications
to the Hon. Sec., 20, Chapel Street, Liverpool.
Birmingham General Hospital.—House Surgeon for six months.
Residence, board, and washing provided. Also two Assistant
House Physicians for six months. Residence, board, and
washing provided.
Brighton, Hove, and Preston Dispensary (Northern Branch).—
House Surgeon. Salary £140 per annum, with furnished apart¬
ments, coals, gas, and attendance. Apply to the Assistant
Secretary, 113, Queen’s Road, Brighton.
Aoo. 16, 1899.
Denbighshire Infirmary. Denbigh.- Honse Surgeon for twelve
months. Salary £80 per annum, with board, residence, and
washing.
Dundee Royal Lunatic Asylum. - Medical Assistant. Salary £100
per annum, with board and lodging.
Durham County Asylum, Winterton, Ferry-Hill.—Assistant Medical
Officer, unmarried. Salary £120, with apartments, board, and
attendance.
East Suffolk and Ipswich Hospital, Ipswich.—Second House
Surgeon, unmarried. Salary £60 per annum, with board,
lodging, and washi lg.
Great Yarmouth Hospital.—House Surgeon. Salary £90 per annum,
with board, lodging, and washing. No stimulants found.
Guy’s Hospital Medical School, London, S.E.—Demonstrator
of Chemistry and Physics. Apply to the Denn.
Macclesfield Gene'al Infirmary. Junior House 8urgeon. Salary £70
perannum, with board and residence in the institution.
North Staffordshire Infirmary and Eye Hospital, Hartshill, S*oke-
upon-Trent.—H use Surgeon Salary commencing at £120 per
annum, with furnished apartments, board and washing.
Paddington, London.—Assistant to the Medical Superintendent
of the Infirmpry, and Assistant Medical Officer of the Work-
house, unman ied. Salary commencing at £100 per annum, with
board, lodging, find washing. Personal application to the
M< dical Superintendent at the Infirmary, 285, Harrow Rood, W.
Rochdale Infirmary and Dispensary.—House Surgeon, unmarried.
Salary £90 per annum, with lioard, residence, &c. and laundry.
Roxburgh District Asylum, Melrose.—Assistant Medical Officer,
Salary £100 per annum, with furnished quarters, board, wash¬
ing, and attendance.
Royal Hospital for Sick Children, Glasgow.—House Surgeon and
Assistant in the Dispensary for one year. Salary of House
Surgeon £50, with loord, and salary of Assistant in the Dis¬
pensary (non-resident) £80.
University of Durham College of Medicine, Newcastle-upon-Tyne.
—Lecturer iD Midwifery and Dis- ases of Women and Children.
Victoria Hospital, Folkestone. House Surgeon. Salary £80 per
annum, rising to £ 100 , with board, residence, and washing
Warrington Infirmary and Dispensary.— Junior Resident House
Surgeon, unmarried. Salary £100 per annum, with furnished
residence and board.
Appointments.
Crompton, H. J., M B., B.Cli. Viet., Senior House Surgeou to the
Ancoats Hospi al, Manchester.
Dent, E. A., M.B., C.M.Edin., Medical Officer of the Cheltenham
Provident Dispensary.
Grerkhalgh, A., M.B., Ch.B. Viet., D.P.H., L.B.C.P.Lond.,
M.R.C.S., Medical Officer of Health for the Borough of
Accrington.
Kelly, Charles, E. M., M.D., M S.Lond., F.R.C.S., District
Surgeon to the City of London Lying-in-Hospital, City Rood.
Melling, W. T., M.B., B.Cb. Viet., Junior Surgeon to the Ancoats
Hospital, Manchester.
Mowdy, S. L. Craigie, M.R.C.S., L.R.C.P.Lond., Deputy
Certifying Surgeon for the Poole District, Dorset.
Nuttall, T. E., M B., C.M.Edin., a District Medical Officer of the
Haslingden Union.
Rimmer J. F., M.B., Ch.B. Viet., Besident Assistant Medical
Officer for the Workhouse, Birkenhead.
Satres, A. W. F„ M.D Brux., M.B.C.S. L.R.C.P., Public Vacci¬
nator for the Woodford District of the West Ham Union.
Wilkins, T. Halford, M.B.C.S., L.R.C.P.Lond., Resident Surgical
Officer to the Birmingham General Dispensary.
Adair—Godfrey. —August 9th, at the Parish Church, Redbourne,
Lincolnshire, Edward William Mahaffy Adair, L.B.C.P.I., only
son of the late Samuel Adair, Esq., H.M. Inspector of Schools in
Ireland, to Elsie Blanche Beauchamp, fourth daughter of the Rev.
George Godfrey, M.A., vicar of Redbourne.
Bruce—Dettmer.— On August 12th, at All Saints' Church, Tnfnell
Park, London, James Thomson Bruce, youngest son of the late
Roliert Bruce, M.D , to Millinda Georgina, eldest daugter of
George Frank Dcttnur, of Highgate.
Pollard- Johnson.—O n August 8th, at All Saints’ Church, Byde,
Fleet-Surgeon E. R. H. Pollard, Royal Navy, of B.N. Hospital,
Hawlbowline, Queenstown, to Mary Emma, only daughter of
Captain W. J. Johnson, Royal Navy, of Byde, I.W.
deaths.
Booth.—O n August 6tli, at Church House, Chesterfield, Charles
Booth, M.D., J.P., aged 73 veers.
Eatwell.— On August 7th, at Cnurch Road, Upper Norwood, in his
80th year, William Coverdale Beattie Entwell, M.D., late 8ur-
geon-Major Indian Medical Service.
Hunter.— On August 11th, at his residence Pilbeach Gardens, Ken¬
sington, Brigade-Surgeon George Yates Hunter, M.B.C.S., Bom¬
bay Medical Service, ret red, uged68.
Meadows.- On August 2nd, at Lancaster Road, South Norwood,
from the lesult of an accident, Brigade-Surgeon-Lieutenant -
Colonel C. J. W. Meadows, H.M. Bengal Army, retired, aged
55 years.
Richardson. On August 4th, at Melville Street, Edinburgh,
Deputy-Inspector-General W r illiam Richardson, B.N. (retired).
Winterbotham.— On August 8th. at Arundel House, Bayshill,
Cheltenham, Lauriston Winterbotham, M.R.C.8., aged 65
years.l
NOTICES TO CORRESPONDENTS.
Digitized by Google
Wtt i|lrdiral i’rrss and Circular.
“ 8ALU8 POPULI SUPREMA LEX."
Vol. CXIX. WEDNESDAY,
Original Communications.
NOTES ON A CASE OF
HEMATURIA FROM HEALTHY
KIDNEYS. (?)
By T. MYLES, F.R.C.S.I,
Vice Preaulent Eoyal College of Surgeons, Ireland: Surgeon to the
Bicnmond Hospital.
As the above-named subject has excited a good
deal of interest lately, the details of a somewhat
remarkable case of this description, which recently
came under my notice, may not be without interest
Miss L. A., mt. 26, by profession a nurse, was
brought to me by my friend Dr. E. E. Lennon with
the following history:—
Somewhere in September. 1898, she was operated
on for haemorrhoids and made an excellent recovery.
Shortly after this she began to suffer from recur¬
rent attacks of pain in the middle line and on the
left side of the abdomen, travelling down to the thigh.
She had never an attack of acute severity, such as
might fairly be called renal colic. The pain was of
a dull aching character, and the young lady herself
thought the pain was due to “ indigestion ”; in
other words, that it was due to intestinal trouble.
Yomiting occasionally occurred when pain was severe,
but was infrequent. At a later stage of her illness
the pain was practically constant, though never
agonising. With this was htematuria and progres¬
sive emaciation and ansemia, the loss of weight in
two months amounting to 28 lbs.
On examination, the patient is seen to be a girl of
fine physique and large frame, though very pale and
wasted.
On palpating the abdomen, both kidneys can
easily be demonstrated to be movable, the left being
particularly so. The right can be handled without
pain, but pressure on the left, when displaced down¬
wards and forwards, causes great suffering. The
urine is almost pure blood. An analysis of it made by
Dr. Earl shows that it contains no tubercle bacilli,
and that when freed from blood by filtration, it is
practically normal.
Examination of the bladder with the electric
cystoeeope was carried out under an anaesthetic on
several occasions. At each examination blood could
be easily seen to be ejected from the left ureter at
regular intervals, The ejection of the blood produced
an appearance, in the illuminated field of vision,
comparable to that produced by the smoko of a can¬
non at the moment of explosion. This phenomenon
I easily demonstrated to the gentlemen associated
with me in the case: Sir Francis Cruise, Drs. Lennon,
Joynt, Coady, and Elizabeth Tennant. Pressure on
the left ureter from above downwards produced a
copious flow of blood from the opening into the
bladder.
After consultation, we decided that until rest in
bed and administration of styptics had been tried, it
would not be advisable to operate.
A flannel roller was plaoed round the body, the
recumbent position was enforced, and the pharma¬
copoeia, official aud non-official, was exhausted in
AUGUST 23, 1899. No. 8.
efforts to check the bleeding. All, however, was in
vain. Day after day the urine contained blood in
large quantities ; the treatment had no effect what¬
ever.
A skiagram taken by my friend Dr. Lane Joynt
gave a negative result.
After careful deliberation we decided to expoee the
left kidney in the loin, to examine both it and the
ureter for stone or tumour, and to use the fluorescent
screen on the kidney when outside the body, after the
manner described by Mr. Hurry Fenwick. It was
further resolved, that failing to find a stone or
tumour to explain the bleeding, the kidney should
lie fixed in position, as there was a reasonable hope
that a kink in its pedicle, due to its great mobility
might be the cause of the bleeding.
Operation was performed on December 18th, Sir
Francis Cruise, Drs. Lane Joynt and E. E. Lennon
being present with me.
The usual incision below the last rib was made, and
for the purpose of delivering the kidney through the
wound, I utilised the suggestion of Edbohls, which I
found to work admirably. For the benefit of those
who are not familiar with the method, I may be per¬
mitted to explain it in a few words.
The incision being made in the lumbar region
nearly vertically downwards, a pneumatic cushion of
cylindrical shape being under the opposite ilio-costal
space, the patient is rolled into the prone posture, so
that the pillow, when distended, crosses the lower
part of the abdomen. An assistant, now grasping
the patient's feet, makes vigorous traction down¬
wards, so that the patient rolls down on the pneu¬
matic cushion. The increase in the intra-abdominal
tension thus produced of itself delivers the kidney
through the wound. The patient is then rolled back
into the lateral posture and the operation continued.
The kidney on exposure seemed somewhat larger
than usual, rather deeply congested, and of a dis¬
tinctly lobulated type.
The room was darkened, the kidney wrapped in
sterilised muslin and placed in front of the fluorescent
screen, the latter being arranged in a box, with velvet
hood, &c., so as to completely exclude all rays of
light except those from tne Crookes tube. A twelve-
volt accumulator and a coil capable of giving an
eight-inch spark was employed. The value oi the
apparatus was first tested by examining the hands of
several of those present, and very clear shadows of
bones were obtained.
On the kidney, however, the results were very dis¬
appointing. That organ itself cast a shadow as deep
as bone, and even if a calculus had been present I
more than doubt if it oould have been recognised by
this method. I do not know if Mr. Fenwick has suc¬
cessfully employed his method in the living patient,
or whether his experiments have been entirely con¬
fined to the cadaver, but unless the new interruptor
gives better results than those we obtained with the
apparatus then in use, I question if the benefits to
be got from the method compensate for the risks
which are undoubtedly added to an operation already
grave enough.
The screen having added nothing to our know¬
ledge, I opened the pelvis of the ureter posteriorly,
ana introduced a long, flexible metal bougie, No. 4
Digitized by v^ooQle
180 The Medical Press. ORIGINAL COMMUNICATIONS. Ado. 28, 1890.
size, and passed it into the bladder without an; diffi¬
culty, ana without encountering any stone or tumour.
A child’s sound was then 1 introduced and the calices
carefully examined. The opening having been suffi¬
ciently enlarged, I was able to get my finger into the
pelvis and explore the calices thoroughly. The search
proving fruitless, the exploring needle was thrust
into the convexity of the kidney in a number of
places, and a thorough and systematic examination
of the kidney was made. None of these methods of
search revealed either a stone or a tumour. A con¬
sultation was then held, and as a result of our delib¬
erations, it was resolved to fix the kidney in position.
This was effected by a method I have been practising
for the last few years, and which has given me very
satisfactory results. The wound in the pelvis of the
ureter was closed by a number of fine catgut sutures,
hardened in four per cent formalin solution, and
subsequently sterilised by boiling for three minutes
on two occasions with twenty-four hours’ interval.
The perirenal fat was thoroughly removed both
from the kidney surface and from the abdominal
wall posteriorly. The fibrous tissue capsule of the
kidney was then completely stripped from the deep
surface of the kidney, as in a post-mortem examina¬
tion of the organ, and a raw oozing surface was thus
left exposed. The kidney was now carefully tucked
back into place, taking care to push it well up into
the hypochondrium. My assistant kept it in this posi¬
tion by pressure through the abdominal wall during
the introduction of the sutures. The wound was
closed completely by a double row of cat-gut sutures,
no drainage of any kind being provided for. I deter¬
mined to rely entirely on the sutures in the ureter,
and strict asepsis to guard against leakage or its con¬
sequences. The usual sterilised dressings were
applied, retained in position by strips of rubber
plaster and a flannel roller.
The wound was not exposed till the fifteenth day
after operation, when it was found to be completely
healed, the superficial catgut sutures, as usual,
coming away with the dressings.
So far as the operation was concerned it was a
complete success, no rise of temperature, no pain, no
diminution in the quantity of the urine after the
third day, but the hsematuria was as bad as ever.
Evidently fixing the kidney had not controlled it, or
even modified it in any way.
Naturally, this was a great disappointment to both
patient and operator.
As the symptons showed no signs of improvement,
and as the anaemia was becoming profound, fearing
that further delay might prove disastrous, it was
resolved, after numerous consultations to remove the
kidney completely, as no other course held out any
prospect of saving the girl’s life.
This second operation was performed on January
10th, 1899, twenty-three days after the exploratory
and fixation operation, and proved extremely inter¬
esting.
It is not often we can expect to have an opportunity
of testing by a second operation in a human being
the result of an experimental method utilised in a
former one; but now this rare opportunity was
offered to us.
The second incision was made exactly along the
line of the former one. The scar was found to be
very firm and non-vascular. The kidney was easily
found, but dislodged with the greatest difficulty. The
raw surface of the kidney, stripped of its capsule, and
the damaged ureter were simply imbedded in a dense
mass of vascular fibrous tissue, which bled freely
when separation was attempted. Considerable force
was used, and every position tried for nearly an hour,
before I succeeded in delivering the kidney through
the wound. So difficult was the process, tnat at one
moment I almost resolved to close the wound in the
loin and make on incision in the front, so as to secure
the vessels before detaching the kidney from its bed.
However, by patience and perseverance, the firmly-
fixed kidney was at last detached and delivered
through the wound. The vessels were then carefully
cleaned and separated right up to the hilus, and each
separate branen of both artery and vein was secured
by catgut ligatures. In all, twenty-five ligatures
were employed in this manner. No doubt this pro¬
longed tne operation, and is, in consequence, a dis¬
advantage, but I did not care to use silk (for reasons
familiar to every operator), by which the entire mass
might have been tied off at once, nor did I care to
trust such large vessels as the renal artery and vein
to a single catgut ligature. By securing the small
branches separately the risk of dangerous haemor¬
rhage was diminished, as the distensile force in such
small vessels is very slight and thrombosis is very
rapid. The ureter was divided between two ligatures,
its contents being first carefully expressed. The
stump was not cauterised nor treated in any way
further. Each artery, after ligature, was held in a
forceps, so that its mouth could be carefully watched
to see that the haemostasis was complete before
letting it drop back into the abdomen.
The parietal wound, as before, was closed with a
double row of catgut sutures, no drainage was em¬
ployed. The patient made an excellent recovery, the
urine gradually increased in quantity till from 11 ozs.
on the day after operation it reached 42 ozs. on the
sixteenth day. The temperature never rose above
99 degs. F.. and on the sixth day the patient sat up
in an armchair, and on the twenty-first day left the
hospital for a drive in an open carriage. The dres¬
sings were not stirred till the nineteenth day after
operation. The young lady is now in excellent
health, has regained 12 lbs. in weight, and her colour
is nearly normal. She has resumed her professional
duties, and has quite recovered her usual buoyant
spirits. Sir Francis Cruise has tested the percentage
of urea in the urine on several occasions, and reports
that it is now normal.
The kidney has been examined for me by Professor
McWeeney, whose report I submit: —
“ I.—Naked Eye. —Kidney somewhat increased in
size : consistency very firm and solid: capsule rather
adherent, much thickened in places, especially near
hilus: thickening due to increase of fibrous tissue
and firm adherence to perinephric fat. On stripping
off capsule several dark haemorrhagic spots size of
sixpenny piece on surface of kidney which was other¬
wise smooth and pale.
“ On section ; Cortex pale, by no means diminished
in width. Pyramids also pale, otherwise normal.
“ Pelvis : The mucous membrane red, thickened and
pulpy, almost turgid-looking, covered with minute
papillffiform elevations and rug®, which gave its
interior a curiously rough appearance.
“ Vessels : Normal save that the arteries seemed a
little stiff, quill-like and gaping.
u Ureter: Norma! so far as the point of operative
division.
“II.— Microscopic. —Wedge-shaped pieces of the
kidney with a superficial area of about 2 c.m. were
embedded in celloidin and cut into sections 10 mm. in
thickness which were mounted in serial order. They
were stained in Ehrlich's hasmatoxylin, counter stained
by Van Gieson’s method and mounted in balsam.
Study of these sections soon revealed the cause of the
thickened and turgid appearance of the pelvic epi¬
thelium above noted. The sub-mucous tissue had
undergone extensive mucoid change, the intercellular
substance being swollen and hyaline and the nume¬
rous bundles of fibrous tissue and unstriped muscle
fibre dissected out, so to speak, and widely separated
boogie
ORIGINAL COMMUNICATIONS. Th* Medical Pbibs. 181
Aco. 23, 1899.
from each other. There were also very numerous
spindle-shaped cells with long, very delicate pro¬
cesses gradually tapering and disappearing in the
mucoid substratum. The thickness of this mucoid
layer was measured and found to be ‘80 to ’85 m.m.
“ Above this layer came the transitional epithelium
of the pelvis, which was in several layers and was
raised up into irregular papillary or ridge-like pro¬
minences.
“ Beneath it came a quantity of unstriped muscle-
fibre arranged in bundles running parallel to the
surface, beneath this some non-mucoid fibroid tissue
was everywhere richly supplied with blood vessels
which stood out more prominently than usual owing
to the transparency of the intercellular substance.
Here and there were patches where the vessels were
enormously increased in number and although evi¬
dently capillaries, were of considerable dimensions.
A projecting pillar of the pelvic mucous membrane
which was present in one of the slides in transverse
section, appeared as an area of mucoid tissue
crammed with huge capillaries (0‘4 m.m. in diameter)
which were distended with red corpuscles. The
margin consisted, of course, of the transitional epithe¬
lium.
“The ha'maturia for which the kidney was removed,
receives its pathologico-anatomical explanation in
the facts thus established. The case is one of diffuse
myx-angiomatous change in the submucous tissue of
the pelvis of the ureter.
“ The kidney tissue itself showed very little abnor¬
mality. The epithelium was everywhere well pre¬
served, even the striated border being distinctly
visible. Here and there a few glomeruli were
shrunken and the intra-capsular space was filled with
transparent hyaline material with an affinity for acid
fuchsin. The medium-sized arteries had their
muscular coat distinctly hypertrophied. Signs of
acute inflammation and micro-organisms were
absent.”
There are three points of great interest in this case
to which I wish to draw attention.
First, the value of the fluorescent screen applied to
the kidney outside the body. From the description
given by Mr. Hurry Fenwick (to whose persistent
advocacy of the electric cystoscope I gratefully
acknowledge my indebtedness). I confess we were
full of hope that the method would prove a useful
adjunct to us in our anxiety to acquire definite and
precise information. The result was most disappoint¬
ing, not because it did not show us a stone that did
not exist, but because of the extreme opacity of the
kidney to the X-rays. A great deal of care had been
taken to insure thorough exclusion of sunlight, by
fitting special blinds, Ac., to the windows of the loom,
the apparatus for holding the kidney- close to the
screen had been specially designed and made by my
friend, Dr. R. Lane Joynt; the efficiency of the
whole was tested thoroughly before, during, and again
after, the operation, so the discovery that the kidney
outside thehody was nearly as opaque as bone was a
keen disappointment to us.
Moreover, it superimposed an additional anxiety on
us, as antesthesia was maintained for fully five
minutes in total darkness.
Dr. Joynt and I have made repeated efforts to
obtain satisfactory photos of renal calculi, both in
the living subject and in the cadaver, and though
occasionally we have succeeded in finding a slightly
darker patch in the kidney shadow where a stone had
either been placed experimentally or had been found
in operation, it must not be forgotten that a sensitive
plate is much more delicate than the human retina,
and it is hardly fair to expect that the minute differ¬
ence of opacity registered by a plate after fifteen
or twenty minutes exposure, will be detected in- I
stantaneously by the human eye. Though it is not
fair to generalise from one particular case, still I am
inclined to think that the suggested method hardly
holds out sufficient hope of benefit to justify the time,
labour, and additional anxiety involved in its employ¬
ment.
The second point of interest is the method of
fixing a floating kidney which I employed, and the
opportunity the second operation gave us of testing
its efficiency. I need not add anything to what I
have already said on the subiect, but I would venture
to ask for a trial of the method which is so simple
and, as far as I can judge, so efficient.
The last and most important point of all, the
question—What caused the haemorrhage? has been
cleared up by the prolonged and careful researches
of my gifted friend, Professor E- McWeeney.
Prior to the receipt of his report, though
instinctively feeling; that, to a certain extent, the
result of the operation was the most potent argument
that could be urged in its justification, I confess to
having felt that the scientific basis from which the
necessity for the operation could lie logically deduced
was wanting, and until such basis was discovered, the
operation was merely a fortunate experiment. His
report, however, has removed all such feelings of
doubt, and has supplied the pathological justification
for an operation oi such gravity.
The condition described by him is, I think, unique
so far as our present knowledge goes. Is it possible
that the cases of so-called hfematuria from healthy
kidneys, which was apparently cured by incision and
fixation, were cases of this kind. It is difficult to
understand how cutting into the cortex of a kidney
and fixing it in position can control or modify
haemorrhage due to a diseased condition of the pelvis
of the ureter.
A CASE BEARING ON THE ETIOLOGY
OF RICKETS.
By CHARLES ELGOOD, M.D.Lond ,
Windsor.
Among the many theories that have been advanced
to explain the origin of rickets, the most acceptance
is undoubtedly given to that which refers the disease
to improper feeding. Amply as this cause may
account for the disease, as it occurs among the poor
who frequent the London hospitals, it is when one
meets with isolated cases occurring in districts where
rickets is less common, that one is struck with the
mystery that still surrounds the origin of this
disease. As it is the duty of every medical practi¬
tioner to place on record cases which appear to
militate against widely received opinions, no apology
is offered lor the following account of this somewhat
unique family.
M. E. C., set. 23, the daughter of a farm labourer,
living with her parents in a cottage on a small farm,
bore, in 1885, to a healthy young gamekeeper, an ille-
itimate male child, F. C. This boy, who was
rought up entirely at the breast, has been several
times under my observation, and though I carefully
examined him on different occasions in childhood, he
never presented any single symptom of rickets.
In 1886, M. E. C. married H. C., a farm labourer,
aged 25, and for about a year lived with him under
her father's roof. H. C., though dull and harmless,
was a heavy-looking, boorish fellow, of rather slight
build, standing 5 ft. 9 ins. high. He had coarse
features, a sallow skin, and a nead of a peculiarly
conical shape owing to a marked projection in the
neighbourhood of the posterior fontanelle. He had
preceding forehead and chin. There was a thick
I crop of coarse, black hair. His chest was narrow
Digitized by Google
182 Thb Medical Pbhm. ORIGINAL COMMUNICATIONS. Aug. 23, 1899.
and covered with hail. Hie legs were straight, thin,
and also very hairy. There was marked pes planus,
with the part turned outwards. In short, there was
little noteworthy about him beyond the fact that
while his cranial peculiarities were the reverse of
those that obtain in the subjects of rickets, his
general appearance suggested to the most casual
observer a lack of the average amount of intelligence.
He was, however, not only able to get his living, but
also to save a little money.
His father died some years back from pneumonia.
His mother, who is alive and well, states that he was
weakly from birth. He crawled on the floor till
eighteen months, at which age he walked.
He had no ti-ouble with his teeth and no fits. At
eight he was considered by the doctor to be in “ a
decline.”
From this union five children resulted. 1.
H. C. C., was born in 1887, in the same cottage as
F. C.
In September, 1887, the family moved to an old-
fashioned farm-house originally built for people in
better circumstances, situated about a mile from her
previous residence, and 50 feet from the top of a hill
rising gradually to 300 ft. above the sea level, on its
south-eastern face. The house stands on the
Wealden formation that is known as the Ashdown
Sand, this bed being here represented in its entire
thickness.
M. E. C. states that the symptoms, which subse¬
quently became bo familiar to ner, were present in
this child at the time of her changing houses. Of
this, however, there is no evidence beyond the
mother's statement, though, as will be seen, it is cer¬
tain that the fifth child of this marriage showed signs
of rickets at five months.
H. C C. was suckled for the first three months of
his life, and then fed mainly on condensed milk,
though occasionally cow's milk was given instead.
This child at three years of age presented a picture
of advanced rickets such as is seldom seen beyond the
wards of a hospital in a large town He was
emaciated to an extreme degree and quite helpless.
He never walked at all. He died before he had
reached the age of four - of an attack of bronchitis.
2 J. H. C. (female), was bom in 1888 in the same
farm-house, and first walked when two-and-a-half
years of age. At four-and-half she was a weak and
wasting child with a large square head, pigeon breast,
large swollen epiphyses, and mavked genu valgum.
She was fed at the breast for the first twelve months
of her age, bread sop being given in addition.
3. W. R. C. (male) was born in 1890 in the same
farm-house. At three years of age he was unable to
walk, but sat and crawled in the manner usual to a
ricketty child. The fontanelle was unclosed. The
epiphyseB were large. He had not cut his back teeth.
The tibice were bending outwards. There was a pot¬
belly, bended ribs, and pigeon breast. He was fed in
the same way as H. C. C.
4 H. J. C. (male) was bom in 1891 in the
same house. At two years of age he was
just beginning to crawl and cross his legs,
and the usual accompanying curvatures were
plainly commencing in the radii and tibia). The
teeth were very backward. There was the ricketty
chest, pot belly, and in addition a marked dorso-
lumbar kyphosis. The fontanelle was widely opened.
He was fed in the same way as J. H. C.
5. E. J. C. (female), was bom towards the end of
1892 in the same house. At five months she showed
well marked bending of the ribs, though no other
Bigns of the disease were present. This child never
subsequently presented such a picture of rickets as
did the other.
Unfortunately none of these children were seen by
me at birth, and there is no evidenoe as to the exact
date of the commencement of the symptoms.
The eldest undoubtedly suffered the most severely,
then the third, then the fourth, then the second, and
then the fifth.
H. C. in June, 1893, committed suicide by hanging
himself in a bam.
M. E. C. then went with her family to live in one
of a long row of cottages situated about midway
in point of distance between her two previous resi¬
dences, and on a soil of similar formation to that on
which her last house stood.
In 1896 she gave birth to another illegitimate child
(female), the father being a strong, young labouring
man well known to me. This chHd, M. C., now two
and a-half years of age, is a sturdy, well-made little
f irl, and presents no sign of rickets. She ran well at
6 months, and began to cut her teeth at seven
months. She was, like the others, fed at the breast
for three months, and than given the bottle, which
contained sometimes cow's-muk and sometimes con¬
densed milk and water.
Shortly after this, M. E. C. married R. G., another
labourer, and in 1898 gave birth to M. G., which
child is now nine mouths of age.
M. G., though a pale, puny child, shows no sign of
rickets. She is already suffering from an ailment
supposed to lie due to commencing dentition, though
there are as yet no teeth discernible. She sits up
well, and likes to “ feel her feet.” Her food has been
the same as that of M. C.
This woman, though it is true that her answers do
not always tally, is certain that the feeding of her
different families has never varied very much. Her
circumstances, too, have been apparently much the
same all through. She asserts most positively that
she was no poorer towards the close of her union
with H. C. than she was at the commencement,
though she was naturally more tied, having so many
children unable to run alone. There can be no doubt
that she was vastly better off in the matter of house
accommodation during the period of her residence in
the farm-house, which was large, dry, and airy, than
she was subsequently when she lived in the small
cottage. Her own health was excellent; she had
never ailed anything.
The family that preceded her in the farm-house
where the four younger ricketty children were bom,
is well known to me, and all its members are well
and strong,
Rickets is a disease by no means common in the
neighbourhood, the climate of which (for England)
is warm and dry. During several years of practice
among the poor of the district only a few examples
of the disease came across my notice, and I certainly
did not see another case approaching in severity that
of H. C. C. •
Though the district is an entirely agricultural one,
the poor as a rule give their children but little cow’s
milk, less indeed than do the poor of the towns in
which I have lived, where milk is vended from door
to door. The children are always suckled as long as
possible, and, when the mother's supply fails, bread
sop made with water is the usual substitute, to this
is sometimes added condensed milk, and less often
cow’s milk finds its way into the mixture.
In this opinion that the children of the poor in rural
districts are worse off in the matter of food than are
those of the town-dwelling poor, I am supported by
Dr. Palin, who, in an urticle on the “ Etiology and
Geographical Distribution of Rickets,” writes: “ The
English town-bred ricketty child and its mother are,
as a rule, better fed than the healthy child and
wife of the agricultural labourer.” (1)
This case suggests itself as an instance of Mills’s
oft-quoted joint method of agreement and difference.
GoogI
e
Aug. 23, 1899.
ORIGINAL COMMUNICATIONS.
We are apparently presented with five instances of
the presence of a phenomenon (viz., rickets), which
have only in common the presence of one other cir¬
cumstance (viz., the paternity of H. C.), and three
instances of the absence of the phenomenon, which
have only in common the absence of this circnm-
stance; hence we would be inclined to conclude with
von Rittershain (2) that there is a causal relation
between the father’s health and the disease in the
children.
The case, however, does little more than serve as an
illustration of the dangers inseparable from such a
method of inquiry, or rather of its unfitness to deal
with such complex problems as daily present them¬
selves before us. It is obvious that even if this
woman were to continue multiplying instances of this
kind, we could never have the assurance that they
agreed in the presence and absence of this single
circumstance of H. C.’s paternity and nothing
else. We have only to conceive it possible
that some change in the mother's health may
have occurred at or about the time of her first
marriage, and so have affected her offspring, and our
case against the father falls at once.
In view, however, of the order in which these
children were affected as regards the severity of the
disease, of the certain fact that, under very similar
conditions, she bore and brought up children free
from rickets on a diet very similar to that which she
gave to the affected ones, and when we bear in mind
that somewhat similar cases have been observed (3)
we are forced to conclude that the usual theories
that obtain in this country as to the etiology of the
disease do not cover all the ground, and we are
reminded that other theories of causation have been
formulated at Vienna and Berlin.
May not those assumed factors in the production
of rickets—bad food, and what is probably of much
more importance, want of sunlight, operate with
greater force in children who have inherited from
either parent a constitution unduly prone to be affected
by their influence ? And may it not be that in
crowded cities, where the immediate causes of the
disease (whatever they may be) must certainly very
largely prevail, a less amount of such an inherited
susceptibility is required in order that the phenomena
of the disease may be provoked ? Thus the here¬
ditary element in causation would be least patent to
those observers who have the greatest facilities for
studying the disease.
That the susceptibility to the disease is transmitted
from parents to their offspring rather than the dis¬
ease itself, is rendered still more probable by the
experience of American physicians that rickets is
more prone to attack the children of aliens than
those of parents who are indigenous to the soil.
Haven, of Boston (4), noted that the disease was
most prevalent among the coloured population, and
that the majority of white rachitics of foreign ancestry
were born of parents who came from the South of
Europe where the disease is by no means common—
thus emigrants from the “ Sunny South ’’ would
appear to transmit in more uncongenial climes the
necessary susceptibility to their offspring.
Whether this be ceded or no, we are still far from
being able to say why the assumed causes of rickets
act with such signal partiality, and why it is that in
other quarters of the globe such as New York,
where the conditions under which the children live,
cannot be so very dissimilar from those that obtain
here, the disease is said to be so strikingly less fre¬
quent. (5)
References.
(1) The Geographical Distribution and Etiology of
Rickets. Theobald A. Palen, M.D.. Practitioner.
Vol. II. 1890. P. 334.
The Medical Press, 183
(2) Die Pathologie und Therapie der Rachitis.
Ritter Von Rittershain. Berlin, 1863. P. 66.
(3) Diseases of Children. Vogel, 1884. P. 556.
(4) Lancet. Vol I. 1S86. P. 367.
(5) Practitioner. Vol. II. 1890. P. 273.
THE TREATMENT OF FEVER
FOLLOWING DELIVERY,
WITH SPECIAL REFERENCE TO SERUM-
THERAPY. (a)
By HERBERT SPENCER, M.D., F.R.C.P.,
Professor of Midwifery, University ColleKe, Ac.
This subject includes the treatment of “ puerperal
fever (i.e., fever during the puerperium caused by
microbic infection from without) and fever in the
puerperium resembling puerperal fever. From this
point of view fever in the puerperium could be
arranged in four classes. The first class had been
styled “ one-day fever ” and was characterised by a
slight elevation of temperature, rarely exceeding
120 degs. F., about the third day, and usually cured
by the administration of a mild aperient The second
class was due to complications which were not refer¬
able to the labour. Certain febrile diseases, such as
influenza, scarlet fever, acute phthisis, and typhoid
fever, closely resembled puerjteial fever and deserved,
therefore, special consideration. The diagnosis
of influenza was sometimes used as a balm
to the conscience of the practitioner who was not
thorough in his application of antiseptics. Cases
so diagnosed were often due to septic infection;
nevertheless, he had seen undoubted cases during an
epidemic and two of them terminated fatally, Septi¬
caemia accompanied by a scarlatiniform eruption was
often mistaken for scarlet fever. Acute phthisis
closely resembled septic pneumonia and both forms
of disease were equally unamenable to treatment.
Typhoid fever presented great difficulties in diagnosis
in cases in which the temperature rose in the early
days of the puerperium. He had recently seen two
cases; in both Widal's reaction gave positive results
and as both terminated fatally the diagnosis was
confirmed by the discovery of typhoid ulcers in the
intestines. The third class of fever met with in the
puerperium was due to infection from pre-existing
lesions, such as ovarian and fibroid tumours, cancer,
stone in the bladder, pyosalpinx, appendicitis, &c.
The treatment of these cases consisted in the dis¬
covery and removal of the lesions during pregnancy.
The fourth class was due to external infection and
was what they understood by “ puerperal fever.”
Recent bacteriology of puerperal fever showed that it
might have its origin in a number of micro¬
organisms ; important services in this department
had been rendered by Doderlein, Striinckman
and Wbitridge Williams. The latter in investi¬
gating twenty-six cases found streptococci in eight,
staphylococci in three, colon bacilli in six, gono¬
cocci in two, amerobic bacilli in four, diphtheritic
bacilli in one, gas bacilli in one, and typhoid bacilli
in one. Clinically, fatal puerperal fever was met
with under three forms: acute septica*mia, which
terminated fatally within a few days owing to the
virulence of the poison; lymphatic septicaemia, the
usual form, characterised by a rigor at the onset and
septic peritonitis; and venous septicaemia, charac¬
terised by a succession of rigors ana by septic phle¬
bitis, and frequently by secondary deposits. Mild
cases of puerperal fever were met with, as sapra?mia
— i.e., poisoning by the chemical products of micro-
(a) Abstract of Paper read before the British Medical Association
at Portsmouth, 185*9.
Digitized
C
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384 Thk Mbdical Pbkbb.
-organisms—and local infection of the peritoneum, the
cellular tissue, and the veins. Coming to the treat¬
ment of puerperal fever the most important element
consisted in prophylaxis. It was important to avoid all
unnecessary injury during labour by too frequent exa¬
minations or unnecessary forceps operations; while, on
the other hand, labour should not be allowed to be un¬
duly prolonged. Careful managementof the third stage
of labour was most important and it was particularly
necessary to make sure that no placenta or mem¬
branes or clots were allowed to remain in the uterine
cavity. Doderlein’s experiments showed that in
normal cases vaginal injections rather favoured the
growth of micro-organisms than otherwise, but in
every case the vulva should be washed with soap and
water, then rinsed with water, and afterwards
swabbed with 1 in 1,000 perchloriue of mercury. The
practitioner’s hands, wrists, and forearms should be
carefully cleansed in the same way. The ideal cloth¬
ing was some white washable material. The question
presented itself whether it was necessary for a medical
man who had attended a case of puerperal fever to
abstain from practice for a time. Mere abstention
from practice he believed to be no safeguard, but
thorough disinfection would immediately enable the
practitioner to attend another lying-in woman with
safety. As regarded the actual treatment of puerperal
fever the first necessity was to make a thorough ex¬
amination of the patient and of the uterus. An intra¬
uterine examination should be made in nearly every
case, and in his experience cases apparently hopeless
had been saved by the detection and removal of
putrid portions of placenta or sloughing fibroid
tumours. In making this examination be urged the
importance of wearing rubber gloveB which could be
obtained so thin as to cause little or no interference with
tactile sensation. Generally speaking, the uterus should
be completely emptied by the finger; occasionally large
blunt-ended forceps might be used, but the curette
should never be employed after labour at full term.
He had known the finger to be forced through the i
wall of the puerperal uterus, and the danger associated
with the use of a sharp instrument like the curette
must be much greater. After emptying the uterus
the cavity should be irrigated once with a solution of
iodine (one drachm of tincture of iodine to one pint)
or a weak solution of perchloride of mercury or car¬
bolic acid. The treatment of general septic peri¬
tonitis had been much discussed of late years. It had
been proposed to open the peritoneum either by the
abdomen or the vagina, and even to remove the
uterus, and a number of cases successfully treated by
both methods had been published. If the presence
of fluid could undoubtedly be recognised then he
thought the peritoneum should be opened, but he
was not in favour of removal of the uterus except in
cases of carcinoma, or of fibroid tumours which could
not be enucleated. Methods of remotely influencing
puerperal fever by the nuclein treatment (which
aimed at producing an artificial leucocytosis), saline
infusion into the celluloid tissue, and intravenous
injection of antiseptics, were not of much value. The
same must be said of drugs. Tonics and stimulants
were useful, but in his opinion antipyretics should
never be employed; cold-packing was the best method
of reducing the temperature. The administration of
food at regular intervals and in quantity as great as
the patient could take was very important, and
alcohol could be given in large quantities with bene¬
fit. Coming to the serum treatment he said that since
its introduction by Marmorek in 1895 a very large num¬
ber of cases had been treated by this method. Some
observers regarded it as beneficial, others as useless
or harmful, and, speaking generally, it might be said
that those who had the greatest experience were the
least impressed with its value. A 'priori it did not
Auo. 23, 1899.
appear to be a scientific treatment to administer, in a
disease which was by no means generally associated
with a streptococcus, an antitoxin produced by that
organism. It might be useful in cases due to the
streptococcus, which were the only cases for which
Marmorek recommended it. Yet the committee of
the American Gynaecological Society, which investi¬
gated the subject, showed that the mortality after its
use was 33 per cent. It was doubtful if the natural
mortality of the disease was greater than this. Some
observers have reported that its use was not free
from danger and had seen death apparently caused
by it. Norris had seen it followed by erysipelas.
The experience of the majority of observers was that
the serum lowered the temperature, but exceptions
even to this had been recorded. In judging of the
effect of feDy treatment they must bear in mind the
difficulty of prognosis in septic cases, the apparently
hopeless sometimes recovering. The conclusions at
which he had arrived were: (1) that as usually applied
it had no scientific basis; (2) that it had not lowered
the mortality of puerperal sepsis ; (3) that it usually
lowered the temperature and sometimes improved
the general condition ; and (4) that its use was not
free from danger. It was possible that it might
rove to be of value in pure streptococcal infection,
ut that the future must show.
URIC ACID AND THE CIRCULA¬
TION :
SOME NEW METHODS OF ESTIMATING
ITS EFFECTS, (a)
By A. HAIG, M.D.Oxon., F.R.C.P.Lond.,
! Physician to the Metropolitan Hospital, and to the Royal Hospital
for Women and Children.
High blood-pressure and defective capillary cir-
I culation are concomitant signs of the uric acid
headache.
The headache is known to be due to uric acid, be¬
cause all diet and drug treatment that relieves it
diminishes the amount of this substance in the blood
and urine. The headache is due to the effects of
high blood-pressure on the cranial circulation.
If the explanation of these observed time relation¬
ships of signs and symptoms is, as I have suggested,
that uric acid is the cause of defective capillary cir¬
culation and high blood-pressure, there ought not to
be much difficulty in demonstrating the fact, and
in this paper I shall bring forward some of the re¬
sults obtained.
In the fourth and previous editions of “Uric
Acid ” I quoted a passage from Raynaud’s writings,
in which he says that in the disease which bears his
name as much as thirty seconds may elapse before
the colour returns in an area of skin rendered white
by pressure; while in a piece of normal skin it will
return in one or two seconds.
If Raynaud's disease is due to uric acid, as I have
for years been suggesting, it follows that similar but
less marked alterations in the rate of the capillary
reflex (as I propose to call it; will be found corre¬
sponding with other and less marked alterations in
the amount of uric acid in the blood, and this is what
I now find to be the case.
After a good deal of experimentation I adopted an
instrument that would give one a constant area of
pressure, a known and measurable amount of pres¬
sure, and I measured the duration of the pressure,
and the rate of the return of the colour, by means of
a metronome beating half-seconds.
(a) Abstract of Paper read at the Portsmouth Meeting of the
British Medical Association, August, 1899.
ORIGINAL COMMUNICATIONS.
Digitized by GoOglC
Ado. 23,1899.
THE NUR8ING PROBLEM.
Thx Medical Pribb. 185
I further added to the test thus constituted an
observation of the rate of disappearance of the
“ after-image,” or fatigue image of the retina, as a
measure of the good or bad capillary circulation in
the retina. I also observed and recorded in curves
either the size of the radial artery by Oliver's arte-
riometer, or the blood pressure by the Hill-Barnard
sphygmometer, and the figures I now show were thus
obtained.
A few months of daily observation proved that the
whole of these things altered together; that slow
capillary reflux went with high blood-pressure, or
dilated radial artery, and with slow disappearance of
the “ after image ” or vice versa.
Further, it showed that these results all followed
exactly the well-known physiological fluctuations in
the excretion of uric acid, the capillary reflux being
slow in the morning and quiok in the evening, and
that these results corresponded with, and could be
corroborated by the examination of the urine, the
examination of the granules in the blood, and the
relation of surface to deep temperatures as previously
treated of in “Uric Acid.”
In reference to drug action I soon found that, just.
as I had previously known that I could control the
uric acid in the urine, the granules in the blood, and
the relation of surface to deep temperature, so now I
could control also with absolute certainty the capillary
reflux, tbe retinal circulation and the blood pressure,
either from day to day or from hour to hour.
That this could be done only by c:ntrolling the
uric acid; but that if I failed to control only the
uric acid, I also failed to control the circulation and
its results.
In pathology, again, the tests tell the same tale,
and it is now possible by observing the capillary
reflux (C.R.) to say in less than half a minute
whether the patient in front of you has a raised tem¬
perature (in which case the reflux will be 3-4 half-
seconds), or on the other hand, has high blood-pres¬
sure or Bright’s disease (in which case it will be 7-8
or 10 half-seconds) and a dose or two of salicylate of
soda will in a few hours convert the former rate of
reflux into the latter with a simultaneous increase of
blood granules.
The figures I give illustrate physiology and the
effects on it of diet, weather, sahcylates, and fever;
but it is only possible to show a very few of my
results.
Anyone can duplicate the physiological results on
their own persons, as in everyone living the ordinary
life of this country the capillary reflux is at its lowest
some time in the morning, and at its quickest some
time in the evening; but if the normal uric acid
curves are altered, the capillary curves will follow.
These tests are singly or combined indices of the
amount of urie acid in the blood and urine, and this
in the case of the capillary reflux can be estimated
bv anyone without instruments, and in ten seconds
of time, though for more accurate work the simple
instruments shown can be used.
Fever on the one hand, and Bright’s disease on the
other, are thus easily and quickly discriminated, and
in the case of Blight's disease and diabetes attention
is at once drawn to what I have long regarded as the
central factor of these diseases, namely, defective
capillary circulation and its consequence—defective
combustion.
These results show that the observed relation
between migraine with its slow pulse, high blood-
pressure. and defective capillary circulation and an
excess of uric acid in the blood and urine, is not an
accidental coincidence, but a single instance of a
general law.
Uric acid controls the capillary circulation of the
body, and any accurate record of such capillary
circulation is thus an index of the quantity of uric
acid in the blood and urine.
^he Jluraiitg ftoblem.
NURSES OF THE LATEST FASHION.
A.D. 1899.
PROFESSIONAL EXPERIENCES IN SHORT
STORIES.
By FREDERICK JAMES GANT, F.R.C.S.,
Consulting Surgeon to the Royal Free Hospital.
IV.—THE INFANTICIDE NURSE.
In one of our metropolitan hospitals, famed for the
nurses produced under its system of training, two sisters
by birth had entered at the same time as probationers ;
at the end of two years to advance to the higher grade
of full nurse or sister; when completely qualified,
either to remain as ward sister, or to enter some
nursing institution and practice her calling as a
“ certificated ” nurse, or she may hold only a hospital
certificate. It would be optional for a nurse, thus
qualified and guaranteed by either certificate, to
practice as |a private nurse on her own account. When
engaged in private nursing, something might here be
said on behalf of the public welfare, in favour of a nurse
who is still attached to an institution, rather than one
who migrates in search of a situation, bearing with her
the certificate she had earned, sometime since, and with¬
out any continued credential of what she is, as when
engaged from an institution of recognised character. A
nurse’s own character may have changed since the day
of her certificate, and iB not followed up when Bhe con¬
tinues her calling—as private nurse—unattached.
The two sisters I have in view were separated by
fifteen months only in point of age, but they differed in
nature’s gifts of mental endowments, moral nature, and
bodily temperament. As they grew to womanhood
latent inborn differences of character, nurtured in the
earth of bodily temperament, began to assert them¬
selves, declaring the duality of the Bisters, Blanche,
ardent, truthful, trustful, tine, self-sacrificing; Beatrice,
ardent, fallacious, furtive, fickle, self-loving, self-seeking,
they yet clung together with the tenacity of almost
twin-kinship; and thus it was Blanche and Beatrice
entered, at the same time, the same hospital as (nurse)
probationers.
A nurse is like some musical instrument, whose notes
are touched in harmony by an invisible hand with the
fingers of suffering humanity. And Bhe possesses no
less the qualities in common with other good women,
but which are not more specially impersonated in her
womanhood. Purity adorns her face with its own expression
of loveliness, lit up with the light of truthfulness, which
her felt sacred vocation imparts; and which are breathed
in all her conversation and womanly gestures; trustful
also is she in the confidential relationships of her office,
even as she herself is faithful in the depths of a heart
true to her calling. Self-sacrifice —in ever doing good to
others, a most essential, and the crowning qualification
of nurse-womanhood, is, indeed, quite a natural gift,
educated, however, by training, for the relief of suffering
humanity, at the cost of self, in ease, comfort, or even
health.
I am certain that this is no ideal picture of nursing
womanhood, toned down, however, in different personal
representatives. Nurse Blanche approached nearly to
the ideal in tbe course of her natural development and
“ training.’’ In another ward Beatrice is on duty, so
like a twin sister, and fashioned from childhood by the
same domestic and social circumstances up to the time
of entering the hospital as a nurse-probationer—will Bhe
develop her sister's beauteous qualities of young woman¬
hood, or not ? She is quite as devoted to her work,
sharing equally the enthusiasm of Blanche's nature.
But her ardour is not toned by sympathy, nor
freighted and tempered with those other qualities of
186 The Medical Press.
THE NURSING PROBLEM.
Ado. 23, 1899.
character which would constitute her a model nurse.
She lacks her sister’s gentleness, loving kindness, and
patience in her attendance on the sick; and with a
turbulent temper, unable to govern herself, she speaks
and acts with a domineering firmness of purpose which
cannot smooth the pillow and ease the bed of Bleepless
Buffering.
Beatrice indeed begins to feel her own unfitness for
the duties of hospital nurse, and she realises a jealous
comparison of Blanche’s perfection. The unfit sister will
never be able to honestly earn her living as a private
nurse on her own account; and with her known defects
of character, even now that she has finished her course
of training, no institution would enter or retain her
name on its list of “ certificated ” nurses. Sister Blanche
has become a model member of that order of women.
Both sisters have quitted the hospital; the one, to the
great regret of the matron, and bearing with her the
high esteem of all her fellow-workers, bound together
by that peculiar tie of affection which unites a body of
nurseB who have to share all the uncertainties of a
calling subject to many chances and vicissitudes; a
calling which cannot secure the permanency of engage¬
ment which may belong to another class of women, in
domestic service, or in houses of business. A nurse at
60 years of age, who has done honour to her calling, in
many engagements, is as much a floating, drifting
woman as one of 25 years—launched on the vast ocean of
human life.
But, with Blanche and Beatrice, their probable career
would differ as widely as their characters. Blanche was
readily recommended by her institution from one
patient’s case to another’s, but having become a private
nurse on her own account, she enjoyed a more lucrative
practice; while her sister, having failed to become con¬
nected with any Institution, she floundered with the
hope of finding some situation as a nurse, uncertificated;
but in vain she offered herself; nor could she get a
private testimonial from patient or doctor. Thus it was
that Beatrice bethought herself of an expedient, in her
dire necessity, to earn her living. Her flourishing sister,
surely needed not her certificate, and could spare tbe
document without loss to herself. The uncertified sister
stole her sister’s certificate; or rather, she forged
one in her sister's name, and by this means was enabled
to obtain employment as Nurse, bearing with her the
credential of a certificate.
But, on one occasion, in answer to an advertisement
it chanced — if by chance it was—that both the sisters
offered themselves, as nurse, for attendance in the same
case. In fact, no sooner had Nurse Beatrice with the
forged certificate, entered the house and had been en¬
gaged, subject to hearing from the lady definitely after
seeing other applicants who might present themselves,
than her sister Blanche called for a like purpose.
This might have seemed only a certain coincidence to
the patient, but it flashed across the mind of the sister as
a possibility, a probability, she knowing something of the
erring antecedents of her poor sister, and she imme¬
diately suspected Beatrice.
Those who know anything of the love-bond between
two sisters, in many such instances of blood-relationship,
will understand also the heart aching which * he would
feel, who to claim her own right must sacrifice her sister,
by fastening upon the beloved second self the personal
wrong she has done—and the crime of forgery ! Better
a thousand times to bear the heart-ache than rend two
hearts asunder, killing both. Yet, stimulated by that
curiosity which prompts or compels inquiry, Blanche
sought her sister’s present address, and the two met, face
to faoe. In the confessional of that interview, love
acknowledged the truth, a full and unreserved confes¬
sion, which penitence in the mouth of halting, falter¬
ing fear would never have told. “Not a word more,
dearest Beatrice,” said Blanche, sitting close, with both
her hands clasping the right hand of the forgerer, her
tears falling as if to wash away the iniquity from the
instrument which had done the deed, pardoned by a
sister’s love on earth and by trust in Heaven.
The beginning of evil-doing is like water spilt upon
the ground, it cannot be gathered up again. So it was ,
with Beatrice. She would not, could not, again use tbe
guilt stained certificate which personated her sister
Blanche. Thus her “ private nursing ” fell off, as she
could no longer pass for what she was not; and she felt
that to style herself nurse or nurse-attendant, without
any qualifying credential, would be no less a falsehood—
differing only in degree from holding a false certificate.
But the demon of evil still pursued her; although she
had wrenched herself from his first grasp, he caught her
again to make her his instrument in another form. The
arguments seemed most plausible. She must earn her
living, whoever might pay her wages, or starve ! On a
dark December day, when the wind whistled around,
and the flakes of snow fell fast with a dull thud on the
window panes of a little bed-room in a retired suburban
house, a young lady lay on a couch in that room, which,
with the adjoining sitting room had been hired on her
behalf by a gentleman, who then left the house. The
young lady bore, in her manner and conversation with
the landlady, the evidence of birth and culture; while
her pensive reticence and sadness of face gave expression
to a singular beauty, and won sympathy for one who
seemed to need no special sympathy.
Accompanying the young lady-lodger, there was
another young lady; whether a relative, friend, or
companion to the high-born invalid, no one could have
told. On the third day, screams in the bed-room were
heard all over the little house; and soon after these
signals of suffering, fainter cries followed. The land¬
lady alarmed, hastened to the room, but the door was
locked; all was still, save now and then the fainter
cries, no more than as crackling sparks of a fire, which
at last died out. The young lady-friend, within an hour,
quitted the house, bearing a bundle of clothes, a night
dress, &c., for the “ wash,” at a residence of which she
gave the landlady the address. It might have
seemed strange to have the washing done elsewhere;
and indeed the young lady, in delicate health, was amply
provided with dress of every kind. When the landlady
visited her in the bedroom, she gave, in explanation of
her cries, the fact that she had suffered from “ flooding ”
—to which she was subject. In a few days she felt that
she would be quite well; and as the rooms did not suit
her she must leave, paying, of course, the month’s rent,
for which time the rooms had been taken.
On the day of the young lady-friend’s departure, the
“ husband ” called to fetch his wife away. He had not
called during the ten days of her absence, as he had
received personal information from their young friend of
his wife’s health. He thanked the landlady for all her
kindness and personal attention to the invalid, and gave
her a present of a £5 note, iu addition to paying the
month’s rent.
Thus, the mysterious lodger came, and went away.
But an Unseen eye of justice, softened by mercy, had
watched the destiny of that “ bundle of clothes for the
wash.” It was traced to the young-lady friend’s domicile.
A coroner’s inquest held, for some mysterious reason,
compelled the attendance of that young lady, and some¬
how, the clothes which had not yet been washed, were
produced. Within the bundle was concealed the remains
of a newly-born child a deep furrow around the neck
betokened strangulation—as with a circle of strong
string, or small cord, which still lay in the bundle.
The inquest was adjourned for a post-mortem exami¬
nation of the infant; the lungs were found to have been
fully inflated, and floated in water; an evidence conclu¬
sive in the absence of gas generated by decomposition—
that the infant was bora alive. Hence the infant’s cries
ere it was strangled to death. The death had now
assumed the character of murder, and as the bundle
containing the little body and cord was found in the
possession of the young lady-friend, and as she was the
only person present at the birth of the infant whose
neck bore the cord mark of strangulation, the said young
lady was clearly identified as the murderess. She, the
witness summoned at the inquest, was none other than
Nurse Beatrice.
The coroner’s jury returned a verdict of murder, and
the case went for trial at the Criminal Sessions. A true
bill returned by the grand jury seemed to give the
zed by VjOOQlC
Aug. 23, 1899.
GERMANY.
The Medical Press. 187
prisoner no chance of escape. But, under the direction
of the learned, and, certainly, merciful judge, the jury
on the trial returned a verdict of “concealment of
birth.’'
But the moral of the story is this : Nurse—with lately
the forged certificate, and now guilty of murder, under¬
went a short imprisonment, and then resumed her private
nursing, with liberty to again prove that her way of
killing is no murder. And the poor bewildered mother,
driven to extremity when pregnant with an illegitimate
child, ready to risk her own life in the destruction of her
offspring, as an accessory to the crime; she escapee scot
free from the hand of justice.
What human judgment can rightly apprise the rela¬
tive guilt of the mother and the confederate nurse in
this crime of murder ? The one, in her extremity, “ to
hide her womanly shame from every eye, and give repent¬
ance to her lover, if herself to die,” the other, in her
extremity, to save herself, possibly, from the spectre of
starvation, by crime. The Unseen eye alone can adjudi¬
cate.
(Elinical Jtecorbs.
TWO CASES OF THE SUCCESSFUL REMOVAL
OF A TUMOUR OF THE SUPRA RENAL
CAPSULE.
By Mato Robson, F.R.C.S.,
Hunterian Professor of Surgery in the Royal College of Surgeons of
England; Senior Surgeon to the Leeds General Inffrumry.
At the Annual Congress of the British Medical
Association at Portsmouth this month, the author
related two cases in which he had successfully
removed a tumour of the supra-renal capsule. One
in a woman, set. 47, operated in 1891, who died of
recurrence of sarcoma exhaustion several months
after the operation.
Case II. was that of a woman, set. 62, on whom he
operated in 1897, and who is still living and welL
The tumour removed having been a struma lipoma-
tosa supra-renalis described by Virchow. In the
former case the supra-renal growth was so
firmly fixed to the top of the kidney that that
organ had to be removed as well, but in the latter
case only a wedge-shaped piece from the top of the
kidney was removed with tne tumour. In the patient
who is still living the removal of the tumour had not
been followed by any pathological phenomena.
He alBO related a third operation, in which his
colleague, Mr. Ward, had removed a sarcoma of the
adrenal from a child, set. 12 months. The child died
from shock within a few hours.
The author gave a table of nine cases, of which five
had recovered and four died. He believed these to
represent the whole operative surgery of the supra¬
renal capsule.
He said that he thought the true secret of success
lay in operating at an early stage of the growth as in
his second case.
After describing the operation cases, Mr. Mayo
Robson mentioned a case of sarcoma of the supra¬
renal capsule which he had observed throughout its
whole course in 1875, and from this case and others
that he had seen he drew attention to the following
symptoms.
(a) Shoulder-tip pain, this was so well marked in
all the three cases that he thought it could not have
been a mere coincidence, but was probably dependent
on the disease. It might be explained by the fact of
small branches of the phrenic nerve passing to the
semilunar ganglia,
( b) Pain radiating from the tumour across the
abdomen and to the back, not along the genito-crural
nerve.
(c) Marked loss of flesh.
( d ) Nervous depression with loss of strength.
(e) Digestive disturbance, flatulence, and vomiting.
(/) Presence of a tumour beneath the costal
margin, right or left, at first movable with respira¬
tion, but soon becoming fixed. It could be felt in
the cos to-vertebral angle posteriorly, and could be
pushed forward into the hollow of the palpating hand
in front of the abdomen.
(g) Absence of urinary and of gall-bladder sym¬
ptoms.
®crmanp.
[from our own correspondent.]
Berlin, August 18tli, 1889.
Soft Soap Treatment of Tuberculous Affections.
For the last thirteen years Prof. Albert Hoffa, of
Wurtzburg, has been using soft soap inunction in all
forms of local tuberculous affection, and in the Munch.
Med., Wochsch., 9 99, he reports on his experience.
The soft soap inunction, it should be said, is always
used as an adjunct to the ordinary general treatment.
The case treated consisted of spondylitis tuberculosis of
the hip, knees, foot and elbow, as well as of the glands
and skin, and he claims that the effect has been good.
It is said to be wonderful to observe the difference in
the results obtained between cases treated with and those
without the soap inunction. Under the influence of the
soft soap treatment the general condition of the patient
and the appetite rapidly improve, the tuberculous joint
swellings rapidly become smaller, fistula? close up quickly
and glandular swellings subside. Wonderful results are
seen, especially in the multiple tuberculous diseases of
bones and joints, and children already much reduoed.
As regards the selection of the preparation of soap
it is to be remarked, according to the author*
the only kind suitable is the sapo kalin -
venali kept in the shops, which is prepared
from linseed oil and crude caustic potash without spirits
of wine, and which always contains a small excess of
caustic potash and its carbonate. The author rubs in
26 to 40 grms. of this soap two or three times a week,
and lets it lie on half an hour, at the end of which time
it is washed off with a sponge and warm water.
As regards the mode of action of the soap the author
confirms the ruling view, among others, that of KoR-
mann, that under the influence of the soap treatment
the injurious lactic acid circulating in the system
becomes neutralised, and that the alkalinity of the blood
is increased. The increase in the alkalescence caused
increased tissue change, and this acts favourably on
the general condition and especially on the affected
parts.
The Thyroid as an Antidotal Organ.
At the Society for Innere Medizin Dr. F. Blum,
Frankfort a/M, gave his views and reported on his
experiments in determining the true function of the
thyroid body. Like most others he denies
that it is in any way a gland, as it possesses
no secreting organs. In his opinion investigators
have been misled in their views, and have
wrongly interpreted facts observed by them. The
course of disease after removal of the thyroid has been
the cause of much discussion. The disease varies very
much, and oscillates principally between severe attacks
and free intervals. If, when an animal is passing
through an active period thyroid preparations are given
Digitized by Cj ooqle
188 The Medical Press.
AUSTRIA
Aug. 23, 1899.
and a free interval follows, the belief obtained that
the preparation was the cause of the free interval, whilst
in reality the freedom from active evidence of disease
would have taken place as a matter of course. Dr.
Blum extirpated the thyroid from 100 dogs, 96 of which
became diseased, whilst four remained healthy. From
this it may be concluded that the thyroid body is a
vital organ, but that occasionally reserve powers are
retained in the body that compensate for its loss, four
of the dogs remaining healthy. Of the 96 animals that
became diseased not one could be kept alive by feeding
with thyroid in any of its preparations.
According to these facts, therefore, the thyroid is a
mere gland, but that it attacks something circulating
in the system and renders it harmless. This harmful
substance is a toxalbumin saturated with iodine. The
iodthyrine is not profound in the thyroid. Iodine was
found in the thyroids of all the animals. "When potaasic
iodide was given an increase in the organic iodine com¬
bination took place. The thyroid holds its iodine very
fast, aa experiments had shown. The chief purpose of
the thyroid was the imprisoning of the poisonous com¬
binative, after its removal seriouB disturbances are set
up which principally proceed from the central nervous
system. For, according to Nissl the ganglion cells show
constant changes, swelling of the cells from increase of
the protoplasm and disappearance of the granules.
JUtstria.
[from our own correspondent.]
Vienna, August 18th, 1888.
Test for Mercury Vapour.
At the meeting of Physical Medicine Kunkel drew
attention to the imperfection of the present test for mer¬
cury vapour in the atmosphere, which was performed
with gold-leaf, but owing to the condensation of watery
vapour on the gold surface a constant error arises of a
variable quantity. In addition to this error, another
deviation from the truth is found in the mercury that is
taken up by the nitric acid present and not deposited on
the leaf.
The most recent method is to pass the suspected air
over crystals of iodine when the mercury combines with
the iodine to form the mercuric iodid. The modus
operandi is to take a dry glass tube from two to three
millimetres wide, into which are put a few fine crystals
of iodine. Over these crystals fifty to a hundred litres
of the suspected air is slowly conducted. The reaction
in this test is so delicate that the one-hundredth of a
milligramme may be detected by a glance at the colour.
The mercury iodine tube is now washed out with a few
drops of a solution of the iodide of potassium, and then
filtered, which removes the iodine crystals completely.
With the object of combining all the iodine vapour,
hydrate of soda is added till all colour disappear. A
stream of H s S is then passed through the substance and
mercuric sulphide formed, which may then be estimated
by the colometric method. It should always be carefully
borne in mind that the mercuric vapour to be examined
should not be passed too quickly through the absorption
tube, or a slight error might arise.
Myotonia Congenita.
Muller demonstrated a boy, suffering from a typical >
form of this disease, which is more familiarly known as
Thomsen’s disease. It is a congenital anomaly of the
muscles, particularly the transverse striped muscle,
which becomes stiff after a voluntary effort and remains
in a state of contraction for some time before the will
can relax it again or bring it back to a position of rest.
In this case the duration of the stiffness lasts a few seconds,
and occurred in light efforts as well as severe. All the
voluntary muscles were affected as well as the tongue-
The pharynx, larynx, oesophagus, and respiratory appa¬
ratus were unaffected.
According to Erb, this disease yielded to the reaction
of electricity and mechanical friction, which might be
tried in this case.
Alcohol as a Nutrient.
The question still exists, “What influence has alcohol
on the metabolism ? ” How does it affect the nutrition
or changes in the respiratory system ?
From the various examinations it is affirmed that it
acts on the albumen and checks the metamorphosis.
According to the experiments of Bless, von JakBch, and
Strassmann, the elimination of nitrogen is reduced by
the use of alcohol; while Romeyn Keller, Strom, Stamm-
reich, Miura, and Schmidt affirm the opposite, and do
not think it a preserver of albumen. Neumann assured
the Gesellechaft that the experiments on himself did not
sustain the latter arguments, although the believers
were numerically greater.
The whole time of experimenting was 35 days, com¬
mencing after 70 days abstinence from all alcoholic
drink. This period he divides into six parts as follows:—
The first part consists of five days, in which was given
76 grammes of albuminoids, 224 grammes carbohydrates,
and 156 grammes of fat, which would be equal to 2,681
calorics of nitrogen equivalents.
The second part consisted of four days in which the
fat was reduced by 77 grammes, bringing the caloric
force down to 1,969, but this was found to be insufficient,
as the nitrogen supplied was too low.
The third part comprised ten days in which the 77
grammes of fat were supplemented by an isodynamic,
equivalent of absolute alcohol being 100 grammes. The
nutrition of the body was now found to be sufficient,
probably from the activity of the alcohol. This addi¬
tion brought the caloric force up to 2,677 again, giving
a similar nitrogen equivalent as at first.
The fourth part embraced six days of the whole period
in which were given the original amount of fat (156
grammes) with the 100 grammes of alcohol continued
as in the preceding part, which would now give a caloric
force of 3,401. The diet was now found to be exceesive,
the elimination of nitrogen not being proportionate to
the intake, or on account of the alcohol is reduced.
The fifth part comprehended four days in which both
alcohol and the 77 grammes of fat were withdrawn,
reducing the caloric force again to 1,969. The diet waa
again insufficient, as the loss of nitrogen proved.
Finally, the sixth part was continued for six days, in
which the original diet was resumed with a caloric force
of 2,681. The equivalent expenditure of nitrogen wae
now re-established as in the first part.
In a tabular demonstration of his experiments, Neu¬
mann pointed out that in the second and fifth part of
the experiment the nitrogen intake was 12 to 16 ; eli¬
mination 18 to 79. During the third part he found that
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Auo. 23, 1899. GYNAECOLOGICAL CONGRESS. The Medical Pbem. 189
between the fifth and tenth day the nitrogen was
equivalent, and must therefore be accepted as sufficient.
In the fourth part the nitrogenous intake was 12 to 19,
while the elimination was 10 to 84. It is to be noted
that the first day of the third part of the experiment
the nitrogen elimination was increased. This Neumann
explained, was probably due to the long prior abstinence
from alcohol and the sudden administration of large
quantities of alcohol, which would act at first on the
protoplasm as a poison, and thus increase the destruc¬
tion of the albumenoid material. The figures in this case
were 12 to 16 as intake, and 15 to 21 as elimina¬
tion. As soon, however, as the system became ac¬
quainted with the toxic effects the disturbance sub¬
sided, and the alcohol afterwards acted as a nutrient
or as the fat did before the alcohol was substituted.
This opinion is further supported by the facts of
the fifth part of the experiment, when both fat
and alcohol were withdrawn, which shows that the
alcohol must have supplied the deficiency of the fat.
The fourth part is unassailable as a proof that alcohol
retains the integrity of the albuminoid element.
Neuman finds that his first four days of the fourth
part agrees with those of Miura and Schmidt, who did
not continue their experiments longer. He concluded
his remarks with an expression of his own conviction
that the facts proved that alcohol was a dietetic, but he
thought the toxic effect should be reduced to the
minimum.
THIRD INTERNATIONAL CONGRESS
OF
GYNAECOLOGY AND OBSTETRICS.
rFBOM OUB OWN COBBE8PONDENT-1
Amstxbdam, August 8th- 12th, 1899.
The Congress was inaugurated in the Hall of the
University on August 8th. The President of the Congress,
Professor Hector Treub, of Amsterdam, occupied the
ohair •, whilst on the platform were the Burgomaster of
Amsterdam, the Minister of Public Instruction, and the
members of the Permanent Congress. After the intro¬
ductory address by the President, and the report of the
general secretary, Dr. Mendes de Leon, the names of the
honorary presidents nominated by the committee were
submitted to the meeting and unanimously endorsed.
The delegates of foreign Governments and scientific
societies addressed the meeting, vis., Dr. Engelmann for
the United States of America-, Dr. Jacobs for Belgium ;
Dr. Robert Barnes, Mr. Bowreman Jessett and Dr.
Heywood Smith, on behalf of England; Dr. Fargas, of
Barcelona, presented an invitation to the Congress from
the Mayor and municipality of Barcelona, to meet in
that city in 1902. Dr. Jonnesco, of Bucharest, presented
a similar invitation on behalf of Roumania ; Dr. Stockvis
spoke on behalf of the Dutch Association for the Advance¬
ment of Medicine, Dr. Westermark for Sweden, Dr.
Schonberg for Norway, Dr. de Rein for Russia, M. Pinard
for France, and Dr. Pasquale for Italy.
In the evening two receptions were held; first, by the
Burgomaster, at the Town Hall, and then by Prof.
Treub, Dr. Mendes de Leon and Meedamee Treub and
Mendes de Leon at the Maison Conturier. To the latter,
ladies were invited, and a very successful gathering took
place, enlivened by music and dancing.
Wednesday, August 9th.
The following papers were read:—
M. Delageniere (Le Mans), On the Shortening of the
Round ana Broad Ligaments in Retroversion of the
Uterus. Discussion by Messrs. Jacobs, Reed, Goldspohn,
Yineberg, and W. Alexander.
M. Doyen (Paris), The Treatment of Spontaneous and
Post-operative Gynsecological Fistulas.
Dr. La Place (Philadelphia^), Demonstration of a For-
for Intestinal Anastomosis.
. Reynier (Paris), Total Abdominal Hysterectomy
for Canoer of the Uterus. Discussion by Messrs. Doyen,
Jacobs, Jonnesco, Bowreman Jessett, Pestalozza, and
Jauvrin.
M. Heinricius (Helsingfors), On the Clinical Import¬
ance of Retrodsviations of the Uterus.
Dr. Ziegenspsck (Munich), On Operations for Stenosis,
Dr. Jonnesco (Bucharest), Total Abdominal Castra¬
tion for Adnexial Affections, whether Septic or not. Dis¬
cussion by Messrs. La Torre, Reynier, Strati, and
Hartmann.
Dr. Palmer Dudley (New York), Intra-Uterine Im¬
plantation of the Ovary.
At the afternoon Session M. Richelot, of Paris, intro¬
duced a discussion on the Relative Value of Antisepsis
and Improvements in the Technique, in the results of
Operative Gynaecology. In this discussion the following
took part: — Messrs. William Alexander (Liverpool),
Robert Bell (Glasgow), Hartmann (Paris), Jonnesco
(Bucharest), Stratz (La Haye), Doyen (Paris), De Rein
(Kieff), and Heywood Smith (London).
We append short abstracts of some of these communi¬
cations.
Thub8Day, August 10th.
Mile Catharine v. Tusschenbroek (Amsterdam),
Ovarian Pregnancy. Discussion by Messrs. Meyer and
Pinard.
Dr. Davis Edwards (Philadelphia), The Management
of Labour in Abnormal Pelves.
Dr. F La Torre (Rome), The Nomenclature of the
Oblique Diameters of the Pelves, from the point of view
of International Obstetrics. Discussion by Messrs.
Davis, Treub, Rapin, Bar, and Pinard.
Dr. F. La Torre: The Morphological Classification of
Contracted Pelves. During the discussion on this paper
it was suggested that an International Commission
should be appointed to revise obstetrical nomenclature;
M. Pinard, the President of the Section, nominated for
this purpose the following gentlemen :—Prof. Treub,
President; Messrs. Bar, La Torre, Rapin, Queirel, de
Rein, Davis Edwards, Simpson, and Freund. The com¬
mission at once elected M. Paul Bar as secretary, and it
was hoped that the report of the Commission would be
presented at the Obstetrical Section of the Paris Con¬
gress in 1900.
M. A. Favre (Chaux le-Fonds), Labour and Nephritis.
M. Coeentino (Cattania), Demonstrations of Sections
of the Cadaver.
M. F. Villar (Bordeaux), On Appendicitis in Women.
Dr. Oscar Beuttner (Geneva), (a) Experimental Re¬
searches on Castration-Atrophy; (A) the Use of Sali-
pyrine in Gynaecology ; (r) Vomiting of Coffee-ground
Coloured Material after Anaesthesia in Gynsccological
and Obstetrical cases where instrumental or operative
interference has been resorted to.
M. E. Doumer (Lille), On the Use of Currents of
High Frequency in Gynaecology.
M. J. L. Faure (Paris), Total Abdominal Hysterectomy
in Suppurations of the Adnexa.
M. H. Duret (Lille), Colpohysterectomy in the Treat¬
ment of Irreducible Inversion of the Uterus. Discus¬
sion by Messrs. Dudley and Gutierrez.
Dr. A. Goldspohn (Chicago), Indications, Technique,
and Results of the Alexander Operation in Aseptic
Adherent Retroversions of the Uterus, when Combined
with Inguinal Cceliotomy to Liberate the Organs and to
Resect or Remove the Adnexa when necessary.
At the afternoon session a discussion was held on
“ The Influence of Position on the Shape and Dimen¬
sions of the Pelvis.” This was opened by Messrs. Bu6,
Pinzani, and La Torre, and continued by Messrs.
Kouwer, Nyhoff, Pestalozza, Ziegenspeck, Engelmann,
and Pinard.
| A series of preparations was exhibited to illustrate
i Mile. v. Tusscnenbroek's paper on Ovarian Pregnancy
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Aug. 23, 1809.
190 The Medicad Pees* OPHTHALMOLOGICAL CONGRESS.
DEMONSTRATIONS.
M. Doyen (Paris), gave two demonstrations of various
operative procedures by means of the cinematographe.
The first demonstration, on August 9th, had reference to
general surgery. By this means were represented
amputation of the thigh, excision of the knee-joint,
removal of the thyroid, excision of cerebral tumour, Ac.
The second demonstration, on August 11th, illustrated
M. Doyen’s methods of vaginal and abdominal hyste¬
rectomy.
M. Keiffer (Brussels), showed a number of micro¬
scopical sections illustrating the following subjects :—1,
the structure of the normal uterus and its vessels; 2,
the development of the ovum and the corpus luteum ; 3,
the development of flbro-myomata; 4, The uterine
mucosa in successive phases of menstruation.
Friday, August 11th.
The following papers were read:—
M. Delageniere (Le Mans), Total Hysterectomy in
Cases of Fibromata Complicated by Albuminuria.
M. Gouilloud (Lyons), Force Pressure of the Uterine
Arteries in Fibromata.
Mr. Bowreman Jessett (London), On the Treatment of
Uterine Myoma.
Dr. Robert Bell (Glasgow), Medical Treatment of
Fibromyoma and Ovarian Disease, and of Incipient
Carcinoma of the Cervix.
M. Woskresensky (Kieff), The Principles of Treatment
of Uterine Myoma.
M. d’Hotman de Villiers (Paris), A Case of Total
Abdomino-Vaginal Hysterectomy for a Large Fibroma.
Mr. Doleris (Paris), The Treatment of Fibromata with
Pregnancy.
M. Duret (Lille), Certain Special Operative Proce¬
dures in the Treatment of Fbromata.
M. Guttierrez (Madrid), The Surgical Treatment of
Myomata.
M. Fargaa (Barcelona), The Surgical Treatment of
Myomata,
Dr. Treub (Amsterdam), Statistics of his Results of
Operations for Fibroma during the last three years.
M. 8chmeltz (Nice), a New Procedure for Abdominal
Hysterectomy,
In the afternoon the question for discussion was “ The
Surgical Treatment of Fibro-Myomata.” The discussion
was opened bv M. Doyen, of Paris, and the following
members of the Congress took part in it:—Messrs.
Delageniere, Reynier, Tuholske, Alexander, Carstens,
Bell, Jacobs, La Torre, Giles, Engstrom, Galvani,
Tournay, Jonnesco, d’Hotman de Villiers, Jessett,
Villar, Heywood Smith, Heinricius, Pestalozza, Sinclair.
Gordon, and Jaybe.
Saturday, August 11th.
The following papers were read:—
Prof. Treub (Amsterdam), Antisepsis in Symphysiotomy
and Ctesarian Section.
M. Chaleise-Vivie (Bordeaux), the Innocuity of Ana¬
plastic Amputation of the Cervix in relation to Preg¬
nancy and Labour.
M. Rapin (Lausanne), on Insufflation of Air into the
Uterus as a means of Prevention of Fcetal Asphyxia.
M. La Torre (Rome), the Classification of the Positions
of the Fcetus.
M. Queirel (Marseiles), Urology of Pregnancy and the
Puerperal State.
Dr. Van der Velde (Amsterdam), the Elimination of
Methylene Blue in Pregnancy.
M. J. L. Fame (Paris), Total Abdominal Hysterec¬
tomy for Cancer of the Uterus.
M. H. Hartmann (Paris), on the Operative Treatment
of Salpingitis.
M. Laroyenne (Lyons), the Treatment of Cystocele by
a New Process of Cysto-hysteropexy.
Dr. Jonnesco (Bucharest), a New Method of Sewing
up the Abdominal Wall without Varied Sutures.
M. H. Brodier (Paris), on Periodic Intermenstrual Pain.
At the afternoon session the discussion on “ The Rela¬
tive indications of Ceeearian Section, Symphysiotomy,
Craniotomy and premature Induction of Labour was in¬
troduced by Messrs. Pinard, and Pestalozza; and con¬
tinued by Messrs. Arthur Giles, L. Meyer, Cosomilas, La
Torre, Eugelmann, Nijhoff, Heinricius, Steyn Parv£,
Treub, and De Rein.
We hope to publish abstracts of the most important
papers above enumerated.
INTERNATIONAL OPHTHALMOLUGICAL
CONGRESS.
(from our own correspondent.J
Utrecht, Augrust 14th-18th, 1890.
The Ninth International Ophthalmological Congress
held its meeting last week at Utrecht under the presidency
of Prof. Snellen. There were members from different parte
of Europe and a strong American contingent, numbering
in all upwards of 200, On Monday evening there was
a public reception in the Town HaU by the municipality,
followed by a concert and fireworks at the Tivoli Gar¬
dens. On Tuesday morning Dr. Argyll Robertson,
who presided at the last congress held in Edin¬
burgh in 1894, welcomed the members in a graceful
address, paying tribute to the memory of Donders, who
was one of the founders of the International Ophthal¬
mological Congress, and who raised this branch of science
to its high position, and complimented also his sucoeeaor,
Prof. Snellen, whose rej utation extends to all countries.
It was a happy thought of Prof. Snellen to divide the work
of the Session into three sections, viz.: (a) Anatomy Sec¬
tion ; (b), Biology and Optics; (c) Clinics and Thera¬
peutics. Such an arrangement has become necessary
to meet the demand of the ever-increasing numbers of
members who offer to read papers, and to take part in the
discussions. As an instance of the important papers
may be mentioned Prof. Sattler (Leipzig) on Non
Cataract; Professor Landolt’s (Paris), Demonstra
tion of a new Stereoscope to Exercise the Eyes for
the Re-establishing of Binocular Vision; Mr. Treacher
Collins (London), Demonstration of the Anatomy and
Congenital Defects of the Ligamentum Pectinatum,
with lantern slides. Professor Dor (Lyon), On the
Treatment of Detachment of the Retina, followed by a
very interesting discussion. Dr. Guttman, Berlin, cured
some cases of detached retina by posterior sclerotomy;
and Dr. Scheffels, Krefeld, had also two successful oases
by the same operation, and maintained that now we
cannot consider detachment of the retina as an incurable
affection. Dr. Wolfe, Melbourne, late of Glasgow, was
pleased to hear that his operation of posterior sclerotomy,
which is well known in the ophthalmological literature,
is gaining acceptance in the profession, and mentioned
a case in which the successful result has now lasted
upwards of two-and-a-half years.
The papers and the discussions were in the French,
English, and German languages.
On Tuesday morning the members were photographed
and a banquet given in the Tivoli gardens followed by
a concert by the municipal orchestra
On Wednesday Dr. McKenzie Davidson (London),
who has done such excellent skiagraphio work, and Dr.
Grossman (Liverpool) gave demonstrations of localising
foreign bodies in the eyes by the X-rays. Other
lectures were given by Mr. Priestley Smith (Binning*
ham) on Strabismus; Professor Lebert (Halle) on the
Nutrition of the Eye; Dr. Panas (Paris) on Paralysis of
Different Ocular MubcIss, caused by injury.
Dr. Knapp (New York) on Rare Tumours of the Orbit;
Mr. Anderson Critchett (London) and Dr. Berry (Edin¬
burgh) on the Treatment of Conical Cornea; Prof.
M'Hardie (London), on the Designs of Hospitals.
A very important paper was read by Professor von
Hippel (Halle) on the Lasting Effects of the Operations
for High Degrees of Myopia.
Prof, von Hippel has operated upon a large number of
cases by extraction of the transparent lens, during the
last six years. Of these he has kept notes, and making
the patients return to his clinique for examina¬
tion. He finds the results satisfactory, one of the
objections against the bperatdon being that it is
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THE OPERATING THEATRES. Tee Medical Pbem. 191
Ado. 23, 1899.
followed by detachment of the retina, he maintains
that comparing the number of myopee who have
been operated on, with those not operated on, they
prove pretty equal. Prof. Sattler (Leipzig), spoke
in favour of the operation to which he reeorta
in suitable cases. He finds great advantage
in making the section with Weber’s hollow
lance. Prof. Silex (Berlin), thought the operation
required great caution as it is sure to do a deal of
mischief. He, Prof. Silex, observed during a period of
nine months in Berlin, twenty-three cases of detached
retina after extracting the transparent lens, whilst
during the same period there were only three detached
retina in non-operated cases.
Dr. Wolfe (Melbourne), late of Glasgow, said that he
operated in one case in which the lens had commenced
to be opaque although vision was not affected, and in
another case where the cataract had considerably ad¬
vanced with satisfactory result. But he oould recom¬
mend it only in exceptionally rare cases. Though
he admitted that the operation is almost safe in
the hands of Prof. V. Hippel and Prof. Battler,
operators of great experience with a precise and
splendid operative-technique, and with an immense
material to select their cases from, yet when
reading the reports of some members of the speciality,
of limited experience and less material at command,
that they have extracted so-and-so many transparent
lenses for myopia, he feels an oppression of the heart
when he thinks that so many human eyes have been
put upon the hazard, several of which must have
exchanged their spectacles for total blindness. He had
tried Weber’s lance upon rabbits, and does not
find it advantageous.
Excursions were given to members to Amsterdam,
Baern-8oeztdijk, Ac., and a pleasant time was spent,
the weather being splendid.
Next meeting of the Congress in 1904 will be at
Lausanne, Switzerland.
^he Operating theatres.
CHILDREN’S HOSPITAL, PADDINGTON GREEN.
Congenital Dislocation of the Hip Treated by
Lorenzi Bloodless Method. —Mr. Burghard operated
on a girl, a?t. 8 years, who was the subject of congenital
dislocation of the right hip. The affection had not been
noticed until the child learnt to walk, when she was seen
to waddle in the characteristic ungainly fashion. She was
then brought up to the hospital. On examination there
was a little over three-quarters of an inch shortening of
the right lower extremity, the trochanter being that
distance above Nelaton’s line; there was free mobility in
the vertical direction on pushing the limb up and down.
While making forcible extension, the head of the bone
could be felt to hitoh against the acetabulum. Lordosis
was well marked on standing, whilst the gait on
walking was characteristic of congenital dislocation.
A radiogram showed the acetabulum to be imperfectly
developed, and the head of the femur out of place. The
child was otherwise healthy and well developed. She was
fully aniBethetised, and powerful extension was applied
in order to bring the head of the bone well down opposite
the rudimentary acetabulum. For this purpose a rolled
up jack towel was passed round the perineum by means
of which an assistant made counter extension, whilst the
limb was grasped with both hands above the knee by
the surgeon, who then exerted very powerful extension,
and after a few minutes was easily able to bring the top
of the trochanter just below Nelaton's line. Forcible
traction was also made in other directions, so as to
stretch the adductors and flexors of the thigh, the limb
being abducted and somewhat over-extended with this
object, and the muscles thus put on the stretch being
forcibly kneaded to aid their relaxation. After the
muscles had thus been stretched and the head
of the bone brought sufficiently down, the latter
was got into position against the acetabulum by
fully flexing the thigh on the abdomen and rotating
the limb somewhat outwards. This procedure was
accompanied by the characteristic click as the bead of
the bone went into position. In order to prevent a
recurrence of the dislocation (which took place imme¬
diately the pressure was relaxed), the head of the bone,
after being got into position, was kept firmly pressed
against the rudimentary acetabulum by forciblyabducting
the limb (which was still kept rotated outwards) to its
utmost limit. This latter procedure occupied several
minutes, as it was necessary to perform it very gradually
and to knead and stretch the adductor muscles in order
to obviate any risk of fracture. Finally, the limb in its
position of full abduction and outward rotation was
brought from a condition of flexion to that of Blight
hyper-extension, and held there whilst a firm plaster of
Paris spica was applied, extending from below the knee
(which was kept flexed) to above the iliac crests. As soon
as the plaster had set, the patient was allowed to come
to. Mr. Burghard said that he employed this method
in preference to the open operation, because, on the
whole, the results were preferable in children
of the age of the patient in question. Pro¬
vided that the child were quite young, but still
was old enough to have learnt to walk, the prospect of
the formation of a stable joint by the pressure of the
head of the bone against the imperfect acetabulum was
very good by this manipulative method, while at the
same time the child run no risk from the shock and loss
of blood entailed by the open operation, which, after all,
only aimed at bringing about the same condition of
affaire as that produced by the operation just performed.
The objects of Lorenzi’s manipulative or bloodless
method were three in number. In the first place, the
structures, chiefly the adductors, the hamstrings, and
short flexors of the thigh, were stretched sufficiently to
allow the head of the bone to be brought accurately
into the cleft representing the acetabulum; secondly,
the limb was immobilised for a considerable time
in such a position that while the head of the bone was
kept accurately in ritu, the lax structures constituting
the hip joint were allowed time to contract, at the same
time the abductors became shortened to such an extent
that any attempt to bring the affected limb parellel to its
fellow resulted in exerting still further pressure of the
head of the bone against the acetabulum. The third
and most important object was, by allowing the child to
walk after a lapse of a certain time to bring about a
gradual deepening of the acetabulum by the constant
pressure and friction exerted by the head of the femur
against it in walking, and thus to establish a perfect
joint. He pointed out that the operation just
completed only fulfilled the first two of these ob¬
jects. It would be his intention to leave the plaster casing
untouched for about three months ; the position in
which the limb was plaoed, although irksome to the
patient and causing some pain for a day or two owing to
the stretching and tearing • the muscles had undergone,
would soon be tolerated. After three months the plaster of
oogle
Digitized b;
192 The Medical P ress.
Paris would have to be removed and a second one
applied for a similar period; in all probability it would
be possible when applying the seoond casing to diminish
the abduction very considerably without any danger
of the head of the bone slipping out of place, as it
would then be held firmly in place againt the
aoetabulum by the pressure of the contracted struc¬
tures on the outer side of the thigh, and the knee
would also be straightened so that it would be
possible for the child to put the foot to the
ground, although, owing to the abduction of the limb
the pelvis would necessarily be tilted; with the limb in
that position the patient would be allowed to walk. In
order to maintain the abducted position, a patten about
an inch in height would be put on the boot of the sound
aide. In all likelihood, at first, the child would
require crutches, but would probably soon be able to
walk without their aid. After removal of the second
plaster casing, which would be at the end of six months
from the commencement of treatment, the patient would
be allowed to walk without any splint, merely retain¬
ing the patten on the sound foot for a month or two.
During all the time the child was walking, the third object
of Lorenzi method (namely—formation of a stable joint
by pressure and friction) would be proceeding. Of
oourse, Mr. Burghard said the main essential in carrying
out this treatment was that the head of the bone should
be put accurately in place at the first sitting; should
there be any doubt about this a radiogram should be
taken, this can often be done through the plaster casing,
but should the latter be too thick the patient should be
put under an anaesthetic about a fortnight after the
first operation, when the damage to the boft parts has
subsided, the casing removed and a radiogram taken,
and if necessary any faulty position corrected and the
plaster re-applied.
Mr. Burghard afterwards showed a case which he had
treated by the same method more than nine months pre¬
viously with perfect success. The child walked with an
absolutely normal gait, and could run about and play
like other children; the hip-joint on the affected side
was stable, and movement was perfect in all directions;
the limbs were of equal length, and a radiogram showed
the heads of the bones on the two sides to be in accurate
position. This child, when operated on, was about the
same age as the other. Mr. Burghard pointed out that
the chances of success decreased after about the age of
four, and in children of seven years and upwards his ex¬
perience was that the alterations in the parts were so
extreme that the operation was almost certain to fail,
and it was better to have recourse immediately to the
open operation. Even that, however, was not likely to
be completely successful unless it were done before the
child was nine or ten years of age.
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
populations:—Calcutta21,Bombay30, Paris23, Brussels
15, Amsterdam 15, Rotterdam 18, the Hague 18, Copen¬
hagen 17, Stockholm 20, Christiania 21, St. Petersburg
29, Moscow 41, Berlin 19, Hamburg 21, Dresden 19,
Breelau 31, Munich 23, Vienna 19, Prague 24, Buda-
Pesth 23, Trieste 23, Rome 16, Turin (ten days) 16,
Venice 23, New' York (including Brooklyn) —, Phila¬
delphia 21.
Aoq. 23, 1899.
Bboistkbkd ros Tkahsmissiov Abroad.
€h* ftas srtb (Eirntlar.
Published every Wednesday morning, Price 5d. Post free. Bid.
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Jtttbical Jrtes attb Circular.
“ BALDS POPULI SUPREMA LEX.”
WEDNESDAY, AUGUST 23, 1899.
NUISANCES AND SANITARY DANGERS.
A recent case in a London polioe court has
emphasised the distinction between a “ nuisance ” and
a danger to health in a somewhat instructive manner.
In the mind of the multitude the two conditions
mentioned constitute one and the same thing—that
which is offensive to the senses must be insanitary
and injurious. To take a concrete instance, the
ordinary wood paving of the streets becomes in hot
weather a most noisome factor of town life, and the
average citizen does not hesitate to attribute to that
source a long list of more or less formidable diseases,
ranging from a mild ophthalmia up to a sthenic
pneumonia or enteric fever. For all that, it may
be questioned whether wood paving produces any
more ill-effects than those that might with an equal
amount of reason be attributed to the stone road¬
ways introduced by Macadam. To put the matter
in another way, bad smells do not necessarily imply a
danger to health. Indeed, it may be said that in
some instances an evil odour points to some degree
of safety, inasmuch as it Bhows that the aromatic
origin is open to the changes whereby nature
destroys waste and dead organic matter.
Many sanitarians are inclined to agree with
Dr. Vivian Poore’s proposition that all sewage
matter should be returned to the Boil, there to
undergo the natural process of “ humification ” and
fertilise the face of the earth. From that point of
view the modern system of removal of sewage by
water carriage is founded on a false principle, whereby
the testhetic sense of the community is saved from,
shock, but at the expense of the national wealth and
the risk of the dangers associated with drains and
Bewers. The truth of the matter appears to be some-
LEADING ARTICLES.
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Aug. 23, 1899.
LEADING ARTICLES.
Tux Medical Press. 193
where between the two extremes. Bad smells about a
collection of houses, if they proceed from excremen ti-
tious material, are offensive and a nuisance, but are
not necessarily a danger to health. If the decom¬
posing stuff be lying about op the ground there must
obviously be a risk of poisoning water and other
essentials of environment. If, on the other hand,
the offensive material be carried away, say in an
open conduit, then the inhabitants will be safe from
infection from that species of sewage disposal, how¬
ever greatly it may stink in their nostrils. From
the point of view herein indicated we heartily agree
with Dr. Poore, and should hesitate to introduce any
but open methods of sewage disposal into rural dis¬
tricts. From sewage to fried fish may seem a far cry,
but the same principle of nuisance as apart from
danger to health applies to each set of circumstances.
In the case referred to at the outset of this article,
the proprietor of what is often described by the news¬
paper reporters as a “ fried fish emporium ” was
prosecuted for carrying on a business which was a
nuisance and dangerous or injurious to health. An
attempt was made to prove both general and specific
injury to health, but apparently without any great
measure of success. In a case of this kind it would
be safer to trust to evidence, which need not be
medical, as to the existence of mere nuisance. The
aesthetic horror of a fried-fish shop would be testi¬
fied by thousands, but, no doubt, quite as many
worthy citizens would testify as to the solid comfort
to be derived from that unsavoury quarter.
THE ALLEGED INCREASE OF LUNACY.
IRELAND.—II.
In our issue of last week we skirmished in a tenta¬
tive fashion about the battle-ground of insanity,
and would now desire to come to a little closer
quarters. We are driven irresistibly to believe that
sooner or later the conclusion which will in¬
fallibly impress itself upon the public is, that
insanity is not increasing. The increase being
apparent, and not real, is due principally to the
facility of registration, the comforts, not to say
luxuries, by which of late years the insane have been
surrounded, thus leading to the accumulation and
prolonged living which congests our asylums—the
reduction which has taken place in the unregistered
by becoming registered, and thus members of the
happy family of the in-door. As to the expenses
they are truly formidable—£350,000 for 1897—of
which £68,000 was for salaries alone, and nearly
£10,000 for superannuation under the ludicrously
liberal administration of an Act, of which everyone
who can has hitherto taken advantage—no difficult
matter—as would be rendered speedily evident were
we favoured, in official shape, with the full facts and
details of all pensioned off since it came into opera¬
tion. This appears all the more unaccountable,
seeing that the grant of the Treasury towards the
total expenditure is nearly £140,000, approaching
the half of the expenditure (£183,000), the remainder
being levied off oounties, &c„ in the respective dis¬
tricts. It is true that somewhere about £7,000 is
received from the friends of a comparatively few
of the patients, which lightens somewhat the
burthen, five or six thousand from the farms and
gardens representing the much-vaunted utilisation
of the patients, and about £2,000 from “other
sources ” of revenue; but, then, on the other hand,
what, for example, is the outlay on the farm and gar¬
dens P nearly £11,000—repairs and alterations require
£17,000—and it should be well borne in mind that
this latter item is perfectly distinct from the ex¬
penditure on new structures—it is merely for patch¬
ing up and repairing the old—a regular annual
grant as a matter of course. The cost of such
buildings as the new wings and new asylums now
in progress in connection with nearly all the 22
district asylums (not including two brand new
asylums in the north, and the tremendous effort of
modern architectural genius at Portrane, near
Dublin, intended in addition to the Grangegorman
Prison to relieve the overcrowding of the Richmond
Asylum, and so divert the influx of the patients
thereto, as shall not only make it the standard asylum
as regards its erections, patients, and staff, but bury
the ghost of beri-beri which has troubled it so long),
is defrayed out of funds procured by loan through
the Board of Works, repayable by the respective
districts in half-yearly instalments extending over
50 years, with interest at 3$ per cent, per annum.
We aie speaking, of course, of the immediate past, in
regard to these distinct headings of expenditure, and
only in a cursory manner, not thinking it necessary
to give all the items—only the principal aggregates
—thus the annual cost for the simple maintenance of
the equipped asylums now reaches somewhat about
£400,000, made up of a free Treasury grant, and
levies off the districts—the estimates for which are
prepared at the Castle. On the other hand, the
entirely distinct and additional expenditure under
the headings of buildings, land, and equipments has
been always decided by the Board of Works and the
Inspectors of Lunatics in the shape of the curious
and little understood amalgam known popularly (or
unpopularly?) as the “Board of Control”—now
defunct—the District Committees being charged
with the responsibility for the future, and we do not
know at present time of writing of exactly how
much of the remaining fiscal and financial
arrangements,as differentiated, remains for the Castle
department, which, as always an inspecting one on
the best terms, should be now so, pre-eminently, if
anything. To give some idea of the magnitude
of the operations of the deceased Board of
Control, we would refer those interested to a
succinct statement appearing at page 32 in the
46th Lunacy Blue - Book, showing that during
the decade ending in 1896 the cost of providing
the already provided twenty-two elderly District
Asylums with increased accommodation still in pro¬
gress was nearly half a million, including purchase of
land. There is also supplemented a return showing
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194 The Medical Pbbss.
LEADING ARTICLES.
Aug. 23, 1899.
the increase in accommodation provided in those
asylums which have been built since 1895, and still in
progress (five new institutions including Portrane) on
an estimate of £631,600, that for Portrane alone
appearing to absorb £248,600, £10,000 having been
paid for the Portrane demesne. The expenditure
is given to January 1st, 1897 (nearly 100,000 on
the five works) and we believe the operations
are still “ progressing ”—and as regards Portrane, we
believe not yet finished—like a ball of snow gaining
bulk, perhaps with the progress. We hope the com-
mitteee, whose predecessors created such a storm,
will finish it! Now all this (the purpose of the
present article), as bearing on the increase of
insanity—a very elastic subject obviously—and
equally obviously its numerical condition may be
compressed or expanded, just as you think proper to
deal with it. Mr. Corbet is going on the broad
ground of a crusade in the cause of humanity. We
recognise it simply as a question of expenditure and
common-sense. Are we in Ireland rich enough for
all this expenditure ? The figures given above were
given, we suppose, not so much—or not at all to
show the cost—but to show the “improvements ” under
the new regime. Here we leave the question for
this week.
HOSPITALS AND OUT-PATIENTS.
The dead season for the newspapers having come
with the prorogation of Parliament, various discus¬
sions are being started by the editors in order to fill
the columns of their journals, and the Times has led
the way by giving prominence to a question, the
debate upon which will not fail to be profitable in
many ways. We allude to the correspondence which
is now taking place upon “Hospitals and Out-
Patients.” It was commenced by a correspondent
drawing attention, in terms of high praise, to the
system of visiting hospitals and reporting upon them
adopted by the Prince of Wales’s Hospital Fund.
This correspondent asserts in proof of his statements
that the hospital with which he is connected was
visited by three representatives of the Fund,
who were distinguished for philanthropy, medical
eminence and finance respectively. Of the letter itself
nothing need be said, save that it must have excited
a good deal of envy among the hospital authorities,
whose experience of the “inspection” accorded to their
institutions had not been that of the writer’s. We
fear, moreover, that the tendency of the letter was to
lead the public to assume that all the “ inspections ”
carried out under the authority of the Fund were of
the type to which the correspondent referred. As a
matter of fact, however, we know of one important
general hospital at which the inspection was of a
most perfunctory character. At this “ inspection ” we
believe the medical representative failed to put in an
appearance at all. While of the two others, one was
a stockbroker who could be scarcely expected to know
much about hospitals, and the other was the chair¬
man of a similar institution who could be scarcely
expected to approach bis task of inquiry with aai
unbiased mind. Nevertheless, we merely mentio n
these facts for the purpose of expressing our entire
agreement with the correspondent in question as to
the value of the method of inspection adopted by the
Prince of Wales Fund if it be properly carried out.
Undeniably hospitals whose managers do their utmost
for the institutions have everything to gain by court*
ing the fullest inquiry into their concerns. Again, it
would be the worst policy imaginable upon the part
of the managers to resent such inspections. But on
the other hand they have the right to claim when
their Institutions are visited, with a view to being
reported upon, that the inspectors shall discharge their
duty thoroughly and not in a perfunctory manner.
Obviously, unless this be the case throughout, some
institutions must suffer at the expense of others.
Presumably the object of the inspection is not
merely to draw attention to instances of mal¬
administration, and to expose faults, but also
to give credit for matters worthy of favourable
notice, and to commend where commendation is due.
Unless, therefore, the inspectore do their duty in all
instances, it is clear that well-deserving institutions
might be unfairly reported upon. This point is one
which we deem to be of great importance, and we
trust that it will not be lost sight of by those respon¬
sible for the management of the Fund. In this con¬
nection it may be safely assumed that the more
thorough and painstaking the work of the inspectors
is, the greater value and respect will be attributed to
their reports by hospital managers. Furthermore,
there is no doubt that as soon as the public begin
to understand that the Prince of Wales’s Hospital
Fund has by this means gained the confidence of
the hospitals—a matter, be it said, of no little im¬
portance—the prosperity of the Fund in the future
is certain to be assured. All, therefore, depends upon
the manner with which the officers of the Fund dis¬
charge their duties; clearly their aim should be to
honestly and without favour establish a regime for
the benefit of hospitals which both the managers of
the latter and the public can equally commend and
endorse. There is only one other point to which
allusion need be made, and that is with reference
to the use made of the Inspectore' reports.
Assuming that much time and thought is ex¬
pended upon their production, we think that the
documents should, after having been accepted by
the authorities of the Fund, be handed to the various
institutions to which they refer. Such documents
would then be available for publication in the annual
reports of the hospitals concerned, and could other¬
wise be made use of, under favourable circumstances,
to bring the needs of the institutions under the
notice of the public. By this means, no doubt, both
the Fund and the various charities would eventually
profit. At all events, this suggestion is one which
might well be considered by the Fund. We shall
refer to other matters in the Times correspondence in
our next issue.
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Aro. 23, 169©.
NOTES ON CURRENT TOPICS.
Thb Medical Pbkss. 195
&QU& oil Current topics.
The Plague in Oporto.
The exclusive information we were able to publish
in our issue of August 2nd, as to the probable presence
of the plague at Oporto, has been unhappily borne
out only too fully by the result. Within the last few
days many cases of this terrible malady have been
reported, and the local civic authorities have failed in
their attempts to hush up the matter by suppressing
telegrams and by keeping up a cordon of special
secrecy. Our paragraph of August 2nd was founded
on first-hand information from a high official
quarter, and referred to cases of fatal sickness
that had occurred at least a fortnight previous
to that date. It is. therefore, somewhat interesting
to note that the Daily Mail on the 16th August
announces, with much pomp and circumstance, the
fact of the plague having reached Oporto. The
Olobe rediscovered this important item of news on
the 11th. and thus anticipated the Daily Mail by five
days. For our own part both journals are heartily
welcome to the use of any news that may appear in
the columns of the Medical Press and Circular,
although, under similar circumstances, it is our own
rule to acknowledge the source of the information. As to
the gravity of the general position there can be no doubt.
Oporto is a place where the most elementary canons
of sanitation are set at defiance. The invasion of so
highly infectious a disease as plague, therefore, can¬
not fail to be the forerunner of a disastrous epidemic.
In our own country, happily, there is little need of
alarm, because we have so set cur sanitary house in
order that there is no prospect of filth diseases like
cholera and plague gaining any real footing upon our
shores. It is far otherwise, however, with the hun¬
dreds of insanitary portB scattered along the sea¬
board of Turkey, Italy, France, Spain, Portugal, and
Belgium. We fear that the outbreak at Oporto is
simply ringing up the curtain for a greater tragedy.
Tuberculosis and Syphilis.
It is generally admitted, on clinical grounds, that
syphilitic infection in an individual already suffering
irom tuberculosis tends to aggravate the prognosis,
but this is not invariably or necessarily the case. In
a recent number the Gazz. degli Ovpedal, Dr. Monte¬
verdi relates the case of a young man who presented
well marked physical and bacteriological evidence of
pulmonary tuberculosis. The patient subsequently
developed a syphilitic rash, and the interesting
feature of the case is that as the syphilis followed its
evolution, the pulmonary symptoms subsided and
ultimately disappeared. Six years have now elapsed,
and no return of the lung trouble has taken place.
As this is not the only case of the kind which has
come under the author's observation, he urges that
the generally received view, even if in the main cor¬
rect, must not be accepted as absolute. Observations
of this kind present a special interest, because it is
quite possible that the human organism may prove
the battle-field of antagonistic microbes, one of which
is destined to oust the other. In this connection we |
may recall the suggestion, several times put forward,
that an intercurrent attack of typhoid fever arrests
the evolution of a previously existing attack of
syphilis. We ourselves can recall one case in which
this appeared to have happened, although the clinical
evidence was not sufficiently conclusive to place the
observation beyond the reach of criticism.
The Insanitary Pantry.
The too frequent repetition of late of fatalities
attributed to the action of alimentary toxins gives a
special interest to some remarks by Dr, Stainthorpe
on the subject of prevailing defects in the install
tion of the pantry in the modern household. The
pantry is usually located in a spot where it is readily
accessible to dust, and the wire gauze or perforated
zinc walls which admit fresh air and exclude flies,
afford no protection against its entry. In many
houses any odd corner which cannot be turned to
some other useful purpose is allocated to the storage
of food, and the space under the stairs or some
equally ill-lighted and ill-ventilated place is thought
good enough for the purpose. It is often damp, and
has a characteristically mouldy odour. Frequently
the closet, the dust-bin. and the coal cellar are close
at hand, and every facility is thus offered for the
prompt action of the agents of decomposition. This
is a point which curiously enough does not appear to
have received anything like adequate attention by
sanitarians, but as recent events have given unenvi¬
able prominence to the question of food decomposition,
architects may perhaps be induced to devote a little
more attention to a not unimportant detail of house
construction.
Hospitals as Matrimonial Bureaux.
A discussion which ought by rights to have been
relegated to the silly season, has been carried on in
one or more of the New York newspapers concerning
the matrimonial propensities of the nurses employed
in the large general hospitals of the metropolis,
though it is not pretended that the practices com¬
plained of are by any means limited to this milieu
The allegations in the main do not impugn the
morality of the nursing fraternity, or shall we say
sisterhood, but it is asserted that Durses and
doctors “ flirt and carry on,” and that many
nurses regard the hospital as a field for the
matrimonial campaign. There is doubtless a certain
amount of truth in this, for most of us can call
to mind numerous instances of marriage between
medical residents and nurses and even between nurses
and their patients. Whenever a young man of pre¬
possessing appearance is brought into daily and even
hourly contact with a comely young woman, shown
to advantage in a neat attire, who is not on principle
averse from matrimony, there is always the possibility,
Dieu merci, of a matrimonial sequel, and although a
hospital ward is not an ideal milieu for Cupid's
ravages, the very community of purpose and emotions
paves the way to tenderer feelings. The rules at
most institutions err, if anything, on the side of
severity in the direction of repressing and reproving
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Aug. 23, 18tt9.
196 The Medical Press. NOTES ON CURRENT TOPICS.
any intimacy between medical officer and nurse, but
though they may hinder flirting pure and simple,
neither they nor any rules that female ingenuity, as
represented by the matron, may devise, can be relied
upon to stamp out this very human instinct—nor
should we approve them if they did.
“ In Charge of Women Lunatics.”
Such is the title of an article in Cassell's Saturday
Journal which is evidently meant as one of a serieB
of educative articles on asylum management, and the
life that is lead therein by nurses. We are not pre¬
pared to say that the articles are at all trustworthy,
indeed, there is a tone of exaggeration in the one
referred to which gives a very wrong conception of
the real life that is lead in asylums by nurses. What
is stated here may he perfectly time of one asylum
in particular, but the manner in which the informa¬
tion has been obtained, expressively described by
the writer, hb the “ hack stairs ” approach, iB not,
perhaps, the most trustworthy for information, and this
may explain why a request for particulars has been
refused by some well-known asylum. We cannot quite
underetand this, however, for nothing is more desirable
perhaps in connection with asylum management than
that the public should be fully informed as to the
nature of asylum nursing, its advantages, and dis¬
advantages. It would be well if the public could be
brought to take a sympathetic interest in this work,
and by judicious descriptions of asylum life, without
any exaggeration or extenuation, something might be
done to make the service more popular. In the article
referred to in Cassell's Saturday Journal, we are told
that the young woman interviewed remarked, “ They
call us nurses, but in many instances our position is
more that of a wardress.” (Perhaps she is in one of
the old-fashioned asylums.) She observed also,
“ Many times have patients threatened to kill
me. Said [one big, raw-boned woman the other
day, ‘I’m only waiting; I shall be the death
of you yet. I’m going to strangle you when
the opportunity offers—but very, very slowly.’
Have I ever been assaulted ? Oh, some dozen
times. Besides that, some lunatics take a
fiendish delight in administering most cruel pinches
whenever they get the chance. Of course, we all
carry whistles to summon assistance in case of need.
Sometimes a spirit of rebellion seems to break out all
over the house, and you will hear the whistles going
day and night.” We think all this is exaggeration.
We can scarcely conceive of such an asylum. It
would be a perfect pandemonium from end to end.
While there are Borne statements in the article,
especially regarding strength of nerve and tem¬
perance required in nurses of the insane, which
are perfectly correct, it is well to point out
that hospital nursing is harder and a more severe
strain on the nervous system than asylum nursing.
In asylum nursing there is so much of the time in
the wards fairly quiet and bearable, and there is not
always the same severe tax of attention, observation,
and intelligence as there is on the part of hospital
nursing. The hours are oertainly not any longer, and
the relaxations and the leaves of absence are more
frequent and appreciable than in hospitals. On the
whole, therefore, we do not think this article is quite
up to the standard that such an article should attain
but it certainly will not be likely to do much harm
though it will not do much good.
A Police Magistrate on Sanitation.
Police magistrates have upon many occasions
made use of their official positions to give sound in¬
structive advice to the persons attending their courts,
and we think that the opportunity in this regard
which Mr. Cluer had the other day of showing the
necessity of sanitation might have been taken. But
we regret to have to note that be not only failed to
rise to the occasion, but he has also made it perfectly
plain that upon this question he is himself sadly
lacking in information. A house-owner was sum¬
moned by the local vestry for failing to provide a
ventilating shaft to a soil pipe, and in the couree of
the case Mr. Cluer said that he understood that this
arrangement was one of the prime requirements of
modern sanitation, “ but there,” he added, “ no one
knows where we are in this so-called sanitary
science.” Again, after the sanitary inspector had
pointed out that in consequence of the soil
pipe not being ventilated sewer gas escaped
into the house the magistrate remarked, “ But you
have to show me that the gas is dangerous to health-
In twenty years time we may have the ‘ sewer cure *
In the district in which I live they ventilate sewers
with gratings in the roadway, so that the gas
blows into our windows and doors, and yet the
district is considered healthy.'’ It is really
remarkable that anyone occupying the position
of a police magistrate should inquire “Is sewer gas
dangerous to health ?’ How can the lower classes,
for whom abundant excuses can be admitted,
be expected to pay regard to the ordinary rules of
health, when a magistrate to whom, no doubt, they
naturally look for instruction, expresses himself as
Mr. Cluer did the other day upon the question of
sanitation. Surely, Mr. Cluer cannot believe that
sewer gas is harmless to life. But if he does think
so we fear that some day he may find himself sadly
mistaken.
The Nuisance of Dust Carts.
The present antiquated dust cart used by con¬
tractors in London is a fertile nuisance for two rea¬
sons, in tbe first place should there be any wind much
of its contents are apt to be blown into the thorough¬
fares intothefaces and down the throats of tbepassers-
by, and secondly, at this time of the year especially, the
loathsome odours which generally emanate from it
are beyond description. Only quite recently the
stench emitted by a dust cart was such as to render
a fashionable street in the West End almost impass¬
able. In view, then, of these facts, we are glad
to see that the London County Council have
taken some action in the endeavour to remedy
the nuisance. A short time ago they offered
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Aug. 23, 1899.
NOTES ON CURRENT TOPICS
The Medical Press. 197
a premium of £25 for the best design for a
covered dust cart. We understand that the
competitors for the prize numbered no fewer than
325. In the end the design approved of was one in
which the vehicle had four sliding covers with longi-
tudinal and transverse wind guards raised about
eight inches above the covers, with screw tipping
gear. A box seat is also provided for the driver,
which is regarded as a great improvement. We
trust that the County Council will lose no time in
seeing that this improved dust cart comes into prac¬
tical use all over the metropolis. The wonder is
that the old dust cart, with all its abominations, has
been tolerated for so long.
Professional Etiquette in France.
A counterpart to the remarkable subversion of
ordinary, social, and judicial amenities which
has of late disturbed public and private life in that
country is to be found in what is now known as
the Rennes Doyen incident. On the occasion of the
cowardly assault on Maitre Labori, at Rennes, M.
Reclus, who is a distinguished surgeon and a
member of the Academy of Medicine, was called
in by the family and took charge of the case-
Among those who shared in the excitement on
the news of the attempted assassination reach¬
ing Paris was M. Doyen, a surgeon who, if
not exactly famous, is certainly well known*
thanks to his ubiquitous and assertive personali ty-
On the strength of a chance acquaintanceship with
the victim M. Doyen seized his case of instruments
and took the next train to Rennes, where he arrived at
4 a.m. Later on he managed to obtain access to the
patient, but the brief interview was not allowed to take
a professional turn, though, in taking leave,“ he placed
himself at the patient’s disposal.’’ As may be imagined
under the circumstances, M. Reclus availed himself of
the earliest opportunity to express his forcible opinion
of M. Doyen’s curious conduct, in fact, he absolutely
refused to recognise him or to allow him to examine
the patient, either alone or in consultation. In
fact, he administered a well merited snub to the
too enterprising Parisian surgeon. If we allude
to this matter at some length it is because M.
Doyen is a not infrequent visitor to our shores,
where he has hitherto been received with un¬
failing courtesy in English medical circles. After
such a flagrant breach of professional usages
however, it behoves us to consider whether,
in justice, this gentleman should not be received with
diffidence. Certainly an English surgeon who owned
to such conduct in a case of peculiar difficulty and
responsibility, would be ostracised by the profession,
and we have no reason to condone it in a foreigner.
A highly successful Health Exhibition has been
held in Lincoln, and has attracted such crowds as to
be inconvenient, and sometimes, uncomfortable;
23,000 people passed the turnstile, and many hundreds
were turned away.
Local Precautions against the Plague.
From provincial correspondents we learn that
th e local authorities in the seaports throughout the
country are fully alive to the necessity of taking
precautions against the possible inroad of plague
infection. In many cases special vigilance is already
being shown in the inspection of incoming vessels, and
where the latter have come from plague-infected
ports, a searching examination is made by the port
medical officer of the crew and ships with a view to
detecting any illness among the men which could be
attributed to plague. Inspectors, also, of the Local
Government Board have been detailed to make
special inquiry into the arrangments obtaining at the
various ports. It is evident, therefore, that even if
a case of plague were to reach this country, every¬
thing would be in readiness to deal with it, both as
regard detection and isolation. Some doubt, however,
may be expressed whether the disease could, for
climatological reasons, be conveyed to these shores.
“Tuberculous’’ v. “Tubercular.”
Our contemporary, the Lancet, has very usefully
opened its columns to a discussion upon the differ¬
ential use and significance of the terms “ tuberculous”
and “ tubercular.” Till this correspondence began
we were under the impression that a general agree¬
ment had at length been arrived at to the effect that
“ tuberculous ” was a term to be exclusively used in
connection with processes caused by the tubercle
bacillus, while “ tubercular ” was only to be applied to
diseases the physical conformation of which could
be otherwise described as nodular. In other words,
that tuberculous meant a specific pathological
condition, and tubercular a physical one. The
matter having apparently been thus satis¬
factorily settled, it was with much surprise
that we read in our contemporary that a correspon¬
dent took exception to this application of the terms
in question. In his letter he contended that “ tuber¬
cular ” and “ tuberculous ” should be used synony¬
mously, and solely as expressive of disease caused by
the tubercle bacillus, basing his argument in this
regard upon philological grounds. It really
makes no difference what philology or philologists
have to say upon the matter. A philologist is
not a pathologist, and pathologists have decided
that for convenience, and in order to avoid con*
fusion the word “ tuberculous ” should be exclusively
limited to the description of diseases whose origin is
due to the tubercle bacillus. Clearly it is obvious
from this that the word “ tubercular ” then becomes
free to be applied to the description of other diseases,
not dependent upon tubercle, whose physical confor¬
mation is “ tubercular,” or nodular. The matter of
nomenclature is thus usefully simplified and,
philology, notwithstanding a confusion of terms, has
been pacified. We may also add that to appeal
to dictionaries in such a case is futile and pedantic.
It is not to be doubted that if philological purists
were to expend their energies upon criticising the
names of diseases, which long usage has rendered
convenient, their fault-finding would possibly not be
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of a limited description. But, after all, is there anj
reason why we should strive after philological purism
in regard to medical terms ? All that is really
required is a nomenclature which shall be thoroughly
understood by medical men, leaving, as far as pos¬
sible, no grounds for confusion, and in fulfilment of
this object we consider that a great advancement
has recently been made in differentiating the terms
“ tubercular ” and “ tuberculous.”
The Baby Incubator Again.
In spite of repeated protests, the rearing of babies
in incubators at public exhibitions is being carried
on with unabated and unabashed vigour. Another
warning has come to the Earl’B Court authorities in
the shape of an inquest upon a child, one of triplets
reared at their show. The manager of the company
that provided the incubator asserted that the parents
were dissatisfied because no money was paid to
them. The deceased infant was eleven weeks
old, and had been three weeks in the incubator.
Medical evidence pointed to marasmus and inflam¬
mation of the bowels as the cause of death, and in the
face of that finding it woifid be interesting to learn
what diet is used for infants in the incubator. It is
to be hoped that the Earl's Court authorities will in
future do away with this most objectionable feature
of their entertainment. The exposure of children
under Buch circumstances we regard as a pandering
to a morbid craving for sensation on the part of the
public that is indecent, indefensible, and, moreover,
open to a suspicion of inhumanity.
Restraint for Lunacy.
In an interesting inquiry held on the 10th inst. in
the High Court in London, it was decided that a
lady who had been confined in a private asylum at
Stoke Newington was, at the same time, mad and
not mad. Her hallucination took the very usual and
not unreasonable form of a ljelief that her relatives
had shut her up in order to get her property. The
evidence on their behalf showed that they could not
have any such motive, inasmuch as her property was
insufficient to support her in the asylum, and they
had to subsidise her out of their own pockets. The
eventual verdict was, that while she was too mad to
manage her own affairs, and should not be allowed
to do so, she was rot mad enough to be put under
restraint, and she was accordingly discharged.
Trade Roguery in Army Drug Contracts.
In the Government Laboratory a series of exami¬
nations of samples sent in from the Army Medical
Stores throughout the kingdom, have been conducted
by Dr. Thorpe. He states that many of the samples
were “ markedly inferior.” In one case ether sup¬
plied for anaesthetic purposes turned out to be quite
inefficient, and, on examination, was found to have
been made from methylated Bpirit, though the label
bore a guarantee that rectified spirit was used. If
there lie no satisfactory organisation for the testing
of Army drugs before acceptance there can be little
doubt that drug frauds are being perpetrated, and
that, when we come to war we may find the soldier
in the same unhappy condition as regards medication
as he was in the Crimea.
A Peril of Counter Practice.
Last week an attempt to rob a South London
open surgery was happily frustrated by the alertness
of the medical man concerned. Two men were seen
to peep into the surgery, and a little later one of them
came in and said he had been advised by a friend to
consult the doctor. He was invited into the con¬
sulting room, and the doors being open he was
examined for the “ severe pain ” and swelling on his
left side, of which he complained. At that moment
the doctor heard a suspicious noise in the surgery,
and looking out saw the second man in the act of
rifling the till. The bogus patient prevented his
medical adviser from rushing out, but he himself was
promptly secured and handed over to the police, who
are giving the case their careful consideration.
Alcohol in Aerated Waters.
For many years past it has been a notorious fact
that not a few of the herb beers and kindred drinks
sold as non-intoxicant, nevertheless contain a variable
amount of alcohol. One of the latest forms of the
fraud, for that is the practical outcome of the posi¬
tion, has been recently denounced by the Medical
Temperance Review. The plan of campaign is as
follows :—Each bottle of a certain extract of
herbs, which is in reality a concentrated infusion
of hops, is accompanied by instructions to add
so much sugar, water, and yeast, and then to
set the mixture aside to ferment. Clearly the
result must be an alcoholic beverage, and every
fair-minded man, be he temperance advocate or
otherwise, will at once endorse the energetic pro¬
test entered by the editor of the journal referred to.
We should be inclined to go a step further, however,
and to summon the aid of the excise authorities in
dealing with this palpable evasion of the law. What¬
ever the rights of private individuals in the matter
of brewing may be in their own houses it is open to
serious question whether any firm can legally act in
the manner adopted by the herb-beer makers. At
any rate the temperance party would do well to bring
the matter to an issue by a test case. A little action
of that kind would outweigh a ton of temperance
theory.
Boracic Acid in Milk.
Some time ago Dr. Alfred Hill pointed out a fact of
considerable importance with regard to the use of
boracic acid as a milk preservative, namely, that the
drug may be added successively and independently
by various persons, A case of the kind has been
reported by Dr. M. K. Robinson, Medical Officer of
Health of East Kent Combined Sanitary District. He
was called upon to investigate a sudden epidemic
which affected five out of seven inmates of a certain
household. The attack was traced to a blancmange,
and it was found that the cook had added to both
morning and evening milk supply a preservative con-
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NOTES ON CURRENT TOPICS. Th. Medical Pbibb. 199
Apq 23, a899.
taining boric acid. Furthermore, the milk delivered
by the dairyman was found to be protected in a
similar way. The cumulative strength of the acid
was thus considerable, so much so that five out of
nine fowls died when fed with a portion of the blanc¬
mange. In the face of such facts, it is difficult to
avoid the conclusion that the addition of boric acid
to milk constitutes a serious menace to health. It
would be a valuable contribution to practical pre.
ventive science if some authority would make an
exhaustive inquiry into the immediate and remote
effects of boracic acid upon man.
Coming Congresses.
The meeting of the British Association for the Ad¬
vancement of Science opens early in September, at
Dover, under the presidency of Sir Michael Foster. A
special feature of this meeting will be an interchange of
courtesies with the French Association, which meets
at Boulogne at the same date. The members from
France will be officially received at Dover on Septem¬
ber 16th, and the return visit will be made by the
Britishers on the following Thursday. The municipal
and military authorities at Dover and the scientific
institutions are united in the effort to make the meet¬
ing a success. The various sections will be repre¬
sented by the British and foreign scientists
most distinguished in the subject. Marconi’s
wireless telegraphy and the Rev. Mr. Bacon's
ballooning will be special features. The Congress
of the Sanitary Institute will be held in
Southampton from August 29th to September 2nd,
under the Presidency of Sir William Preece, K.C.B..
President of the Institute of Civil Engineers, the
Chairman of the Reception Committee being Mr.
G. A. E. Hussey, Mayor of Southampton, and its
members include the whole of the medical profes¬
sion and the leaders of the other professions in the 1
locality. The Secretary is Mr. White-Wallis, F.S.S.,
who may be addressed at the offices of the Institute
at the Parkes Museum, London, or at the Municipal
Offices, Southampton. The members attending will
be received on the 29th by the Mayor, in Hartley
College, and a public luncheon will follow,
after which the President will deliver his
address and the Health Exhibition will be opened.
Wednesday, Thursday, and Friday will be devoted to
the work of sections, and on the evening of Thurs¬
day, Mr. Malcolm Morris, F.R.C.S., will deliver an ;
address on Tuberculosis, and on Friday Mr. Bailie
Dick will lecture on the Glasgow Infectious Hospi¬
tals. On these days there will also be a water trip
round the Isle of Wight, and an evening reception
by the Mayor, and on Saturday excureions through
the New Forest and other places of interest.
Dr. F. 0‘Mara has been appointed Resident
Medical Superintendent of the Ennis District Lunatic
Asylum. Dr. 0‘Mara was for nearly seven years
Assistant Medical Superintendent of the Limerick
District Asylum. There were five candidates, of
whom three were from England.
M. Labori’s Wound.
The fertile resources of modem surgery are no¬
where more welcome to the world in general than
when they are called upon to counteract the deadly
work of the assassin. At the present moment the eyes
of Europe are fixed upon the distinguished French
lawyer, Monsieur Labori, who, last week was shot in
the back by a would-be murderer. Although the re¬
volver used in the attempt was fired at close quarters,
yet happily there is little fear of Berious consequences.
The immediate effects of shock and htemorrhage were
soon overcome, and the bullet has sinoe been located
by the aid of the Rftntgen rays. In the hands of
the French surgeons there is no room for
doubt as to the early extraction of the bullet and the
avoidance of septic processes in the wound. Under
the circumstances, one may confidently predict the
speedy return ot the distinguished advocate to his
duties. An interesting parallel case is the shooting
of the late President Garfield. After death the
bullet was found lodged in his spine, and had the
Rontgen ray and aseptic methods been available at
the time, the United States need not have been
plunged into grief at the lingering and fatal illness of
their President.
Medical Men and Repayment of Income Tax.
There is no difficulty in medical men obtaining
the repayment of income tax. All the necessary in¬
formation in connection therewith will be furnished
by the surveyor of taxes for the district. It is true
that the matter can be placed in the hands of agents
who will apply for the money direct, but the charges
of the agents amount to at least twenty per cent,
exclusive of postage. We know of one instance, at
all events, in which a practitioner obtained a repay¬
ment of £18, but the agents deducted £3 from the
sum as their commission. Medical men, therefore,
would be well advised to make the claim themselves
and so save cost.
The Coming of Age of the Irish Medical
Schools’ and Graduates’ Association.
The above flourishing Association has just attained
its majority, and the Council has decided to mark
the occasion by a conversazione at the Hotel Cecil on
or about Nov. 23rd next, after the annual dinner.
Judging from the great success of the previous social
functions of this Association, it may be assumed that
special efforts will be made by the officers thereof to
add still further to their laurels by making the con¬
templated “coming of age” conversazione a record
entertainment.
The London Gazette announces the appointment of
Fleet Surgeon Alfred Gideon Delmege, M.V.O.,
M.D., to be Honorary Physician to H.R.H., the
Prince of Wales, vice Sir Alexander Armstrong,
K.C.B., deceased.
All Egypt has been declared infected with the
foot-and-mouth disease. According to the veterinary
report there have been 1,827 cases since the 18th ult.
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CORRESPONDENCE.
Aao. 23, 1899.
200 The Medical Press
(EomBpmtOcntt,
We do not hold ourselves responsible for the opinions of oar
correspondents.
THE NORDRACH AND FALKENSTEIN
TREATMENT OF TUBERCULOSIS.
To the Editor of The Medical Press and Circular.
Sir, —The leader on this subject in your issue of
May 31st la9t might well have provoked more discussion
than it has. When it is considered how important are
the points raised—important not only in view of the
many hundreds of persons who to-day are seeking sana¬
torium treatment, but also of the immediate prospect of
a large crop of sanatoria in this country. For these
latter it is especially urgent that some definite idea should
prevail as to which school of treatment should be taken
as a model.
If we analyse the comparison which your leader gives
us we find there are not any differences in theory. We
must however, first eliminate some errors into which the
writer has fallen in describing the Nordrach system.
First, the statement that windows are removed.
This Dr. Mander Smyth and Dr. Walther himself have
denied.
Second. That wet clothes are allowed to dry on the
body. This is only a partial truth, the fact being that Dr.
Walther teaches that it is less serious for a patient to get
wet than to hurry to avoid rain, and I believe I am cor¬
rect in saying that he does not advocate the re'ention
of the wet clothes, bs your leader-writer would have us
believe.
Third. The obligation of patient* to eat what is set
before them. This is true of only iwo meals a day on
week days, and of none on Sundays, and it must be read
altogether in the light of the fact that Dr. Walther
judges of each case on its own merits, is at the table
himself, and supplies each patient with the quantity he
considers desirable. These constitute the “ Spartan ”
character of the Nordrach treatment.
It is greatly regrettable that your leader-writer
should have mentioned under the “ Falkenstein ” method
“ the giaduated walking exercise, to medical order,”
and *• absolute rest in bed when temperature is above nor¬
mal,” and ignored them when summing up the
Nordrach treatment; because these are especially two
points in which the teachers and followers of “ Nordrach ”
are in advance of the “ Falkenstein ” school. Dr.
Walther insists upon absolute physical and mental rest
till fever has all gone, whereas the “ Falkenstein” school
hold that some cases do well to be up and outside, even
when the temperature is still above normal. I should
like to add here that the latter teaching did not hold
good in my own case, nor in any other of the number I
watched.
Further, it is the " Nordrach ” school which lays so
much stress upon graduated exercise, and gives specific
directions as to distance and pace ; whereas the “ Falken¬
stein ” authorities are apt to dismiss the question with
“ Oh! walk a quarter of an hour twice a day.” So
analysed it amounts to this, *hat both schools advocate
fresh air, plenty of food, graduated exercise, and rest
for fever.
Let us inquire how these are carried out in the two
classes of sanatoria. Fresh air at the Hohenhonnef, e.g.,
is taken on lounges placed within four feet of one
another, in Liegenhalle, which are roofed over and per¬
manently closed in on three sides, and often more or lesB
on the fourth. How the dining halls are closed at meal
times, your leader-writer has told us correctly. I might
add that I have seen all the windows closed on a warm
summer's day.
Food. —Plenty of good food is, truly, placed before
patients in the sanatoria of the Falkenstein class, but
who sees that it is eaten ? Who encourages the weak
appetite, who regulates the quantity offered ? Nobody,
and I have often seen the trays removed with the food
almost untouched.
Graduated exercise and rest tor fever have already
been mentioned.
The graphic description in your leader of the airiness
of the “Nordrach ” dining-'oom needs no comment. One
may add that closely placed lounges in closed-in Liegen¬
halle are unknown, while as to the fo'-d the personal
influence exercised by Dr. Walther and his school is all
in favour of food being consumed, not sent away un¬
touched.
The sneer that patients at Nordrach must if sick go
outside to vomit and return to more food is hardly fair,
because it the first place many patients lose their sick¬
ness with their fever.and in the second place it is true that,
as Dr. Walther teaches, plenty of good nourishing food
is the cure for sickness. I have proved this on my own
person, and I think that great credit should be given
to him for what is a distinct advance in our methods of
feeding in phthisis.
If then, sir. these are the essentials which go to make
up th i so-called sanatorium treatment, I submit that in
addition to what your leader-writer has confessed as to
the failure of Falkenstein and Hohenhonnef to carry out
the fresh air rule, my own observations during an ex¬
perience of several months in a sanatorium of the Falken¬
stein class show that the other three rules are not
thoroughly observed. The balance of evidrnce seems to
show that all four point* are well attended to at Nor¬
drach, and I cannot refrain, therefore, from expressing
my hope that the managers of the sanatoria now being
built and designed in this country will carry out all the
principles laid down at both classes of sanatoria with a
thoroughness and enthusiasm imitative of Dr Walther,
and not of that policy which your leader-writer so
deliciously calls the “ milder regime," which might, how¬
ever, equally justy be called the “ go-as-you-please ” or
'• happy-go-lucky ” regime.
I enclose my card.
I am. Sir, yours truly,
Another M.D.Lond.
MODERN IMPROVEMENTS IN DIAGNOSTIC
APPARATUS.
To the Editor of The Medical Pbbss and Cibculak.
Sir, —With many of the statements contained in your
leader of the 16th inst. upon the above subject every
open-minded practitioner will probably agree. It would
be well, however, to accept with some amount of caution
your emphatic assertion that “ Fortunately the anti-
pyretio wave has passed its apogee, and practitioners are
beginning to employ these powerful and even dangerooa
drugs with caution.” Passing over the editorial lapsus
calami that leaves to the acuteness of the reader to find out
by inference what drugs are meant, we may pass on to
consider what was evidently the writer's intended pro¬
position, namely, that antipyretic drugs are not only
dangerous. but are actually falling into disuse.
Now, after nearly a score of years passed in the active
practice of medicine, I can only say that for my own
part I should feel myself deprived of a trusty weapon
at the bedside if my antipyretic drugs were taken away.
Everyone knows that long-continued high temperature
is invariably fatal. Everyone knows, also, that quinine
lowers temperature quickly and safely, and I can recall
at least half a dozen severe cases of enteric fever in
which recovery was to be attributed, so far as human
judgment can decide, to prompt and full dosing with
quinine.
At the same time I admit that of late years I have
trusted far oftener to antipyretic measures, such as the
bath and cold sponging.
The old system of dosing patients with narcotics I
condemned from an early period of practice, as it
seemed to me illogical to narcotise the nerve centres
while leaving the fons et origo mali untouched. The use
of antipyretics, however, is founded on a rational
system, for it checks the ill effects of high temperature
condition upon the muscular structures of the heart and
other important organs.
Trusting you will pardon these few words from one
who is content usually to play the part of an onlooker,
I am. Sir yours truly,
Medicus Ignotus.
Folkestone, Aug. 20th, 1899. \
Die
Laoogle
Aug. 23, 1899.
MEDICAL NEWS.
The Medical Press. 201
[We are afraid our correspondent has been inclined
to devote his criticisms rather to one particular sentence
than to the drift of the whole article to which he refers.
In the main we have no difficulty in endorsing his views-
—Ed.]
(Dbituart).
PROFESSOR BUNSEN.
Robert William Bunsen, of Heidelberg University,
passed away on the 15th inst., at the ripe old age of
eighty-t ight. His name and reputation are perpetuated
by the universally used Bunsen burner and the electric
battery which he invented, but his chief work and
success were in the field of chemistry. He it was who
discovered that precipitated ferric hydroxide is a certain
antidote in arsenical poisoning, and his work on Cacodyl
compounds of ammonia and arsenic opened up a new
area for the inquirer. His great work was in spectrum
analysis, which, with the aid of his colleague Kirchoff,
he brought almost to perfection. He was born at Got¬
tingen in 1811.
Xiterature.
MEDICAL GYMNASTICS, (a)
This handbook is the second edition of a work which is
already well known to those who make this subject a
special study. It has been translated into several lan¬
guages and has been adopted as a standard at many insti¬
tutions where attention is devoted to the treatment. The
author first describes the principles which underlie the
various coordinated movements described in detail, and
explains the simple apparatus required for them. He
then proceeds to discuss the diseases and deformities in
which carefully graduated gymnastic exercises have
proved beneficial, and it is to this part of the work that we
would especially direct the attention of our readers. It
is indispensable that the medical adviser should be in a
position, not only to select cases likely to be benefited
thereby, but also to direct the nature and degree of the
movements required in each individual case. That is
especially the case outside our large towns, because in
country districts skilled assistance is not usually
available, and the medical man must not only advise
but must himself teach the attendants to carry out his
instructions. From this point of view Dr. Wide’s book
will be found exceedingly useful. The author points out
incidentally that the benefits accruing from methodical
exercise of th's kind are not limited to actual disease or
deformity, but may advantageously be had recourse to
as a means of overcoming the tendency to plethora and
obesity which characterises persons addicted to seden¬
tary occupations, and too generous a dietary. The illus¬
trations are numerous, and are sufficiently explanatory,
though they can hardly claim to rank as works of art.
The English, too, is occasionally haltingand ambiguous,
in fact, the “ get up ” of the work is not altogether on a
par with the value of the work as a guide and a valuable
method of natural treatment. It is published by Samp¬
son, Low, Marston, and Co., at 10s 6d. net.
NEW BOOKS AND NEW EDITIONS.
The following have been received for Review since the
publication of our last monthly list:—
Bail lure, Tindall and Cox (London and Paris).
The Bontgen Rays in Medical Work. By David Walsh, M.D.
Second edition. Pp. 258, with 103 illustrations. Price 10s. 6d.
(a) “Handbook of Medical Gymnastics.” By Anders Wide, M.D..
of Stockholm. 8vo.. 381pp. Pricel0s.6d.net. London: Scunpson, j
Low, Marston, and Co. 1899.
Cure prompts et Radicals de la Syphilis. Par le Dr. J. F. Larrien,
Laureat de la Faculty de Medecine, Paris. Pp. 134. Price
4 francs.
Bale, Sons, and Danielsson, Ltd. (London).
Essays and Nature Studies. By W. J. C. Miller. B.A.Lond.
Edited by H. Kirke Swann. Pp. 220. Price 10«. 6d. net.
Blakiston, Son, and Co. (Philadelphia).
Pulmonary Tuberculosis, its Modern Prophylaxis and Treatment.
By S. A. Kropp, M.D. Pp. 342. Price 3 dole.
Cassell and Co., Ltd. (London).
The Cerebro-Spinal Fluid: its Spontaneous Escape from the Nose
By St. Clair Thomson, M.D., M.B.C.P.Lond., F.R C.S. Pp.
140. Prioe 5s.
Intestinal Obstruction, its Varieties and Treatment. By Frederick
Treves, F.B.C.S. New Edition. Pp. 565. Price 21s.
Hexrt J. Olai8HEB (London).
Asthma: Recent Developments in its Treatment. By Ernest
Kingscote, M.B., L.B.C.S., Ed. Pp. 184. Price 5e.
Charles Qripfin and Co., Ltd. (London).
Atlas of Urinary Sediments, with Special Reference to their
Clinical Signifies nee. By Dt. H. Rieder. Translated by Dr. F.
C. Moore, and edited by A. S. Delepine, M.B., C.M.Ed. Price
18s.
Lewis, H. K. (London).
Extra-Uterine Pregnancy: A Clinical and Operative Study. By
John W. Taylor, F.R.C.S. Pp. MB. Price 7s. 6d.
Skis graphic Atlas of Fractures and Dislocations. By Donald J.
Mackintosh, M.B. Demy quarto, 12s. 6d. net.
Enlargement of the Prostate, its Treatment and Radical Cnre.
By C. Mansell Moullin, M.D.Oxon., F.R.C.S. Pp. 212.
Longmans, Green and Co. (London and Bombay).
The Value of Electrical Treatment. By Julius Althaus, M.D.,
M.B.C.P.Lond. Pp. 165. Price 3s. 6d.
Macmillan and Co. (London).
A System of Medicine by many Writers. Edited by Thos. Clifford
Allbutt, M.D.. LL.D., F.R C.P.Lond., F.R S. Vol. VII. Pp.
937. Price 25e. net.
Keoas Paul, Trench, Trubser and Co. (London).
Evolution by Atrophy in Biology and Sociology. By Jean
Demoor, Jean Maasart, and Emile Vandevelde. Translated by
Mrs. Chas. Mitchell. Pp. 322. Price 5s.
Young J. Pentland. (Edinburgh and London).
The Relation of the Nervous System to Disease and Disorder in
the Viscera, By Alexander Morison, M.D., F.B.C.S.Ed.
M.B.C.P.Lond. Pp. 132.
Bivinston, Messrs. (London).
The Essentials of School Diet. By Clement Dukes, M.B.,
B.S.Lond. Pp. 212. Price 6s.
Scientific Press (London).
Medical Gymnastics. By Axel v. Grafstrom, M.D. Pp. 138.
Vital Statistics.
The deaths registered last week in the thirty-three great
towns of the United Kingdom corresponded to an annual
rate of 24 3 per 1,000 of their aggregate population,
which is estimated at 11,404,408 persons in the middle
of this year.
Birkenhead 18, Birmingham 27, Blackburn 14, Bolton
19, Bradford 20, Brighton 23, Bristol 17, Burnley 26,
Cardiff 19, Croydon 19, Derby 21, Dublin —, Edin¬
burgh —, Glasgow —, Gateshead 21, Halifax 16,
Huddersfield 13, Hull 21, Leeds 21, Leicester 20, Liver¬
pool 33, London 23, Manchester 32, Newcastle-on-Tyne 22,
Norwich 23, Nottingham 28, Oldham 21, Plymouth 36,
Portsmouth 27, Preston 24, Salford 28, Sheffield 30,
Sunderland 17, Swansea 17, West Ham 28, Wolver¬
hampton 19. The highest annual death-rates per
1,000 living, as measured by last week’s mortality,
were : —From measles, 2 6 in Sheffield, 2'8 in Burnley ;
from whooping cough, l'O in West Ham; from fever, 12
in Wolverhampton ; and from diarrhoea, 5 2 in Leeds,
5’3 in London and in Hnll, 5.4 in Derby, 5'7 in Croydon,
5*8 in Bristol, 6.1 in Leicester, 6 4 in Norwich, 6'5 in
Sheffield, 6'8 in Birmingham, 7'0 in Nottingham, 8 3 in
Burnley, 8 4 in Manchester, 8'7 in Bolton, 9 3 in Liver¬
pool, 9‘8 in Plymouth, 10'4 in Portsmouth, 11*1 in West
Ham. andll'2 in Salford. In none of the large towns
did the death-rate from scarlet fever reach 1-0 per 1,000.
The 75 deaths from diphtheria included 26 in London, 8
in West Ham, 8 in Sheffield, 6 in Leeds, 3 in Leicester, 3
in Salford, and 3 in Blackburn. One dea'h from small¬
pox was registered in Hull, but not on9 in any other part
of the United Kingdom.
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202 Thx Medical Press.
NOTICES TO CORRESPONDENTS.
Auo. 23, 1899.
4lotiC£B to
CorrtBpotibnttB, Short ^Letter*, &c.
•V Correspondents requiring a reply is this oolumn are par¬
ticularly requested to make use of a distinctivi tignatwr* or
initial*, and avoid the practice of signing them selves ** Reader,*'
“Subscriber," “Old Subscriber,” Ac. Much confusion will be
spared by attention to this rule.
Local Reports and News.—C orrespondents desirous of drawing
attention to these are requested kindly to mark the newspapers
when sending them to the Editor.
Reading 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 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.
Original Articles or Letters intended for publication should
be 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.
K. K. W.—1. Wliat is the exact nature of the malady ? In a cise
of the kind you describe it is impossible to advise merely upon
general information. 2. Ton had betterconsult a specialist. 3. We
can supply you with a list of books, but you will do better to con¬
sult the Librarian at the Royal College of Surgeons when next you
visit London.
Dr. Hartrop.—S ea-bathing is not likely to do any harm under
the circumstances you mention.
W. D. (Bacup).—We cannot give medical advice, but may sav
that a good pbin of administering cod-liver oil is to give it in milk
just before going to bed. Why not try Scott's, or some other good
emulsion 't
JUST TO SPITE THE DOCTORS!
Champbaudet had a doctor friend who had formally forbidden
him to smoke in the interest of his health. The two friends fell out,
as so many others have done, over the Dreyfus business, and now
whenever Champbaudet meets his doctor friend he ostentatiously
lights a gigantic cigar—just to spite him.
Qcjerens (Folkestone).—The late Sir George Humphry re¬
ported some observations that bear on your questions. He made
notes on forty-six centenarians, of whom one only consumed alcohol
in large amount, whereas fifteen of them were total abstainers,
and twelve of the fifteen had not taken alcohol at any period of their
lives. Of the remainder, twenty-four took very little, while six
were moderate drinkers. It is hardly necessary to point out that
statistics of this kind want careful handling. Much injury has
always been done to the cause of temperance, which is in itself most
excellent, by over-statements on the part of zealous advocates.
Vtrbum tap.
ALLY SLOPER IN STRANGE PASTURES.
We have not, so far, included “ Ally Sloper ” among our ex¬
changes. Judge then of the editor's surprise at receiving by post,
franco, a certificate conferring upon him ’he membership of
Sloper’s Club,” which, we gather, meets on the pavement in frout
of the office. In addition to other privileges, membership of this
club confers the right to make use of the letters M.O.8.C., but we
have doubts as to the admission of this “ distinction ” to the pages
of the “Medical Directory.”
Latman.—T he preparation is a secret one, but any analytical
chemist would doubtless be prepared to analyse it on payment of
his fee.
THE LEICESTER GUARDIANS.
The forty-five Guardians of Leicester,
Have plainly determined to fester—
In the heat and the gaol
Of the town whence they hail,
Their conscience, 'gainst vaccine's a tester.
Westrallan.— Human rumination is a well-known condition, but
no constant anatomical lesion has been found to be associated with
t. Forthemost pnrt.it is neurotic in its origin, while heredity
plays an important roie in this connection. No special treatment of
the disorder has proved of use, though when it depends upon indi¬
gestion lavage may lie strongly recommended.
Guardian (Calcutta).—Every information will be found in our*
forthcoming students' number, to be published on September 13th
next.
House Phtsician. — We shall be glad to have the notes of the
case.
Surgeon.— The man mi. lit possibly be able to recover some sum
as damages under the Workmen’s Compensation Act.
F.R.C.8.—Our correspondent will find the information which he
seeks in our editorial columns.
P -ychologist. —We are not aware that such a work lias been
published, but will cause inquiries to lie made into the matter.
Locum Tenenb.—O ur correspondent must first be sure of his
facts; but if he has trustworthy reasons for supposing that the
gentleman named is unqualified, and is yet in sole temporary charge
of the practice, we think that his duty would be to report the
matter. He should communicate the facta to the secretary of the
Medical Defence Union.
Z^omtmzrds.
Bisset, E., M.B., Ch.B., has been appointed Resident Physician to
the Aberdeen Royal Infirmary.
Coates, C. .1. A., L.R.C.P. Edin., L.F.P.S.G., Medical Officer for
the Tenth -sanitaiy District of the Wycombe Union.
Cotton, William, M.A.,M.D.,C.M.Edin., D.P.H. Cantab., pro tern..
Honorary Medical Officer to the Royal Victoria Home, Brentry.
Clayton. W. A., L.B.C.P., L.R.C.S., L.F.P.8.Glasg., Medical Officer
for tne Sharis ton and Crofton Sanitary Districts of the Wake¬
field Union.
Dodd, A. M., M.R.C.S., L.R.C.P.Lend.; Assistant Surgeon to the
Liverpool Dispensaries.
Gorman, E. S , M B., Ch.Irel., Assistant Resident Medical Officer
to the Workhouse Infirmary of the Parish of Birmingham.
Hodson, T. G., M.D.Durh., L.R.C.P.Lond., M.R.C.S., Medical
Officer for the Fourth 8anitary District of the South Stone-
ham Union.
Jotce. Dr., Officer and Public Vaccinator for the Cymmer Sanitary
District of the Pontypridd Union.
Meakin, Ethilda B., M.B.Lond., Assistant Medical Officer to the
Grove Hospital, Lower Tooting (Metropolitan Asylums Board).
Msldrum, W. P., M.B., Ch.B,, B.Sc.Edin., Assistant Surgeon to
the Liverpool Dispensaries.
Millard, C. Killice, M.D., D.Se. Pub. Health, Medical Officer of
Health for the Borough of Burton-on-Trent.
Moreton, E., L.R C.P.Lond., M.R.C.S., Medical Officer for
Wymondham Sanitary District of the Melton Mowbray Union.
O’Mara, F., L.R.C.P..'L.R.C.S.Irel., Resident Medical Superinten
dent for the District Lunatic Asylum, Ennis, co. Clare.
Pboudfoot, F. G., M.B., C.M.Edin., Medical Officer for the Sanitary
District of the Oxford Incorporation.
Rowland, F. M., M.D.Cantab., L.R.C.P.Lond., M.R.C.8., Medica
Officer for the Workhouse of the Lichfield Union.
Storrs, R., L.R.C.P.,L.R.C.S.Edin., L.F.P.S.Glasg., Medical Officer
for the Thomcombe Sanitary District of the Bedminster Union,
Sutherland, A. W. M„ M.B., Ch.B., Resident Surgeon to the Aber¬
deen Royal Infirmary.
Itacnnricfi.
Belmullet Union, Knocknalower Dispensary District.—Medical
Officer Salary 4130 n year, with 410 a year as Medical Officer of
Health, together with Vaccination and Registration Fees. (See
advertisement'.
Berry Wood Asylum, Northampton.—Senior Assistant Medical
Officer for five years, unmarried. Salary 4200, rising to .4250,
with board, lodging, and washing, Ac.
Brighton and Hove Lying-in Institution and Hospital for Women.
76, West Street, Hrighton.—House Surgeon, unmarried. Salary
4 SO per annum, with furnished apartments, board, gas, coals,
and attendance.
Denbighshire Infirmary. Denbigh.—House Snrgeon for twelve
months. Salary 4100 per annum, with board, residence, and
washing.
Durham County Asylum, Winterton, Ferry Hill.—Assistant Medical
Officer, unmarried. Salary 4120, with apartments, board, and
attendance.
Manchester Children’s Hospital.—Junior Resident Medical Officer
for six months, unmarried. Salary at the rate of £90 a year,
with board and lodging. Apply to the Secretary, Dispensary,
Gartside Street, Manchester.
Metropolitan Asylums Board.—Assistant Medical Officers at the
Fever aud Small-pox Hospitals, unmarried. Salary £160 per
annum for the first year ana, subject to the direction of the Hos
pitals Committee, £180 the second year, and £200 the third and
subsequent years, with board, lodging, attendance, and washing
subject to statutory deductions). Applications to the Clerk to
the Board, Norfolk Street, Strand. (See advertisement.)
Rochdale Infirmary and Dispensary.—House Surgeon, unmarried.
Salary £90 per annum, with board, residence, and laundry.
Royal Halifax Infirmary. Assistant House Surgeon, unmarried.
Salary £50 per annum, with an extra allowance of £9 2s. 6d. per
annum, and residence, board, and washing.
Tubercurry Union.—Analyst to the Board of Guardians. Applies
tion to the Clerk of the Union, (See advertisement).
Victoria Hospital, Folkestone. House Surgeon. Salary £80 per
annum, rising to £100, with board, residence, and washing.
Westminster Hospital, S.W.—Pathologist. Salary £250 per a nnum ,
and £80 ]>er annum will be allowed for expenses, including the
services of an Assistant.
girths.
Taylor —August 18th, at Kidlington, Oxon, the wife of Frederie
H. A. Taylor, M.R.C.S., L.R.C.P.Lond., of a son.
Scathe.
Herron.—O n August 11th, at Southwark Bridge Road, Jame.
Herron, M.D , Medical Officer of Health for the parishes of St.
Saviour and Christ Church, Southwark, aged 42 years.
Hicks.— On August 14th, at Longmead, Buntingford, Francis Edward
Hicks, F.R.C.S., in his 90th year.
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ORIGINAL COMMUNICATIONS.
Aug. 30, 1809.
204 Thi Mxdical Pe*88.
that there is practically no difference in the two sexes.
In the growths met with in childhood girls would
appear to be a little the most liable. As to the in¬
fluence of sex in connection with the various forms of
growth our present data are comparatively worthless.
The influence of age is very striking. From an
analysis of 160 collected cases I find that 84 or over
52 per cent, were met with below 10 yeajs of age, and
of these no less than 74 were met with below 5
years. It has been conclusively shown that renal
growths may arise during intra-uterine life.
From the standpoint of age renal growths may be
conveniently classified into:—
1. Fcetal or congenital growths.
2. Growths in infancy and childhood.
3. Growths of active adult life.
4. Growths arising in declining life.
The pathological importance of this division will
be evident later.
Little need be said here respecting the general
character of renal growths. These are best referred
to when the individual forms are under consideration.
As regards actual size there is every variety. The
sarcomata often reach immense proportions. The
oaroinomata are usually much smaller. The average
weight of sarcomata in twenty-four whose average
age was three years, was over 124 ozs.
In perhaps the majority of cases the reniform
shape is retained. The variations in colour are mainly
dependent on the varying vascularity of thegrowth
or the occurrence of degenerative changes. The con¬
sistency also varies greatly, the sarcomata and malig¬
nant trabecular cystomata being usually soft and
friable, while the adenomata and carcinomata are
generally more or less firm and dense. There is prac¬
tically no difference in the frequency with which the
different kidneys are affected; in the sarcomata par¬
ticularly the striated forms met with in infancy a
bilateral involvement is frequent.
Growths of a Connective Tissue Type.
We may now proceed to consider the different
growths which are conveniently classed as those of
connective tissue type. These may be divided into
—(1) the simple or so-called benign forms, and (2) the
malignant forms or sarcomata.
Simple or Benign Growths.
These are extremely rare and of little or no
practical importance. They are usually of a fibro¬
lipomatous nature.
A Fibroma occurs as a firm, small rounded nodule.
Some of those recorded may possibly have been
adenomata. Several cases are on record where large
fibro-cystic or fibro-lipomatouB growths have been
removed by operation. Probably some of these were
really peri-renal in origin.
A true lipoma of the kidney is exceedingly rare.
Some of the so-called lipomata have been shown to
be developments of aberrant adrenal tissue. Un¬
doubtedly some of the fatty renal growths on record
have been developed from circumrenal structures.
Curious angiomatous growths are occasionally met
with. In some instances they closely resemble in
g eneral structure the cavernous angiomata of the
ver. Occasionally more complex forms are met
with. Some of the trabecular cystomata may present
a strikingly vascular appearance. The other forms
of simple growths of the so-called connective tissue
type are mere curiosities, and call for no special note.
The Renal Sarcomata.
The great bulk of growths of the kidney belong to
the malignant connective tissue type. These sar¬
comata may perhaps most conveniently be divided;
1. According to the age of the subject in which
the growth develops.
2. According to the seat of origin. ,
3. According to the histological characters.
They vary greatly in their form and general'
appearance, Some are solid throughout, but others
tend to a cystic formation. Usually they grow rapidly
and tend quickly to destroy life.
Sarcomata considered with regard to Pbrioi>
of Life.
Foetal Sarcomata. —It is now generally recognised
that renal sarcoma may originate during intra-uterine
life. Probably a number of those met with early in
infancy commence their development before birth.
The rhabdo-myomata, as they are called, certainly
often commence their growth at a very early
period.
The Sarcomata of Infancy and Early Childhood .—
The first five years of life are peculiarly liable to
malignant disease of the kidney, and I believe the
form of tumour is nearly always of a sarcomatous-
type. From an analysis of a large number of cases
I find that over 46 per cent, of those met with in
childhood occur under three years of age. My num¬
bers also tend to show that girls are a little more
liable than boys. If this proves to be the case it
raises an interesting embryological point. In about
half of the cases the kidneys are involved bilaterally,
thus conforming to wbat seems to be more or less &
general tendency as regards paired viscera. They
grow rapidly, and often assume enormous dimensions.
Usually they give rise to but little pain, and urinary
symptoms are generally inconspicuous. The ureter
is not often invaded, but the veins are almost always
encroached upon, and secondary deposits may occur
in the lungs, liver.and lumbar, mesenteric and vertebra 1
glands.
The Sarcomata of Adult Life. —Although specially
associated with the first few years of life, sarcoma
may develop at any age. Strange to say it is very
rare during the period of youth when general develop¬
ment is rapid. The years from five to thirty are
peculiarly free from the tendency to malignant renal
growth. From my collected cases I find adult females
distinctly more liable than adult males.
Sarcomata Considered according to Seat os*
Origin.
This is a practical grouping, and one of much
interest both to pathologist ana to the surgeon.
I think we may recognise the following
1. Capsular and sub-capsular.
2. Intertubular.
3. Hilum.
4. Peri-renal tissue.
1. Sarcomata arise in connection with the renal
capsule in much the same way as they do in connec¬
tion with the capsule or periosteum of bone. Unlesa
a renal sarcoma is met with in an early stage it may
be difficult to venture an opinion as to its precise seat
of origin. There, are, however, Severn cases on
record and several in our public museums which
conclusively show a growth originally in the capsule,
and with the kidney displaced or flattened and some¬
times separated from the growth by fibrous tissue.
In these cases the growth may spread beneath the
capsule, encroach on the renal cortex, or perforate
the capsule and envelope the kidney.
2. The intertubular sarcomata arise in the connec¬
tive tissue of the cortex and medulla, or perhaps
in some cases from the peri-vascular and peri-lym-
phatic structures.
In this form the growth infiltrates the kidney sub¬
stance. The capsule in early forms can be readily
seen covering the growth. Often kidney tissue can
be detected surrounding or extending over the
tumour.
The sarcomata met with in adults seem generally
to belong to this class.
Digitized by GoOglC
Auo. 30, 1899.
ORIGINAL COMMUNICATIONS. Th« Mmjical Press. 205
3. The growths originating in the hilum constitute
a most important and interesting class. The connec¬
tive tissue around the pelvis and calyces form the
starting-point. A large number of the sarcomata in
children develop from these elements. This class has
been more particularly studied by Mr. Targett.
The growth at first lies without the renal sub¬
stance, and it is only after some time that the kidney
becomes encroached upon, expanded, replaced, or
flattened out so as to be rendered almost unnotioe-
able.
4. The peri-renal sarcomata although strictly extra-
renal, may perhaps be best briefly referred to here.
Clinically they very closely resemble true renal
growths. They originate in connection with the
connective tissue elements of the fatty capsule of the
kidney, and often consist in great part of lipomatous
tissue, with variable amount of fibrous tissue, but
generally presenting more or less evident sarcomatous
cells. They usually develop slowly, often reaching an
enormous size.
Sarcomata Considered in Relation to Their
Structure.
This is perhaps the most interesting and instructive
division, and certainly the most fascinating to the
student of morbid histology. It saggests relation¬
ships and affinities, and already we can recognise
clinical differences according to structural arrange¬
ment. The complicated com binations not infrequently
met with still make the question one of considerable
perplexity and uncertainty.
1. The majority of the sarcomata consist of round
and tpindle cells in varying proportion. The round
seem to be the most rapidly growing and malignant
in character.
2. The striated cell sarcoma often spoken of as the
rhabdo-myoma is met with almost exclusively in the
foetal forms and those arising during infancy.
Indeed, this variety is by some spoken of as “ con¬
genital sarcoma.” Mixed with the round cells are
elongated and transversely striped cells. They are
generally smaller and thinner than true muscle cells
and have no sarcolemma. Much variation in size and
degree of striation occurs.
It has been suggested that this peculiar form of
cell arises from inclusion of muscle elements, due to
faulty segmentation of the primitive muscle plates.
Some believe that the striated cells are derived from
the muscle tissue of the renal pelvis. Others think
the fibres are not to be looked upon a muscle ele¬
ments at all but merely ribbings in the surface of a
tissue which is not contractile. It is suggestive to
note that this type of oell is met with especially in
hilum growths.
These growths as already indicated are very fre¬
quently bilateral, although one kidney may be much
more involved than the other. I recently had the oppor¬
tunity of carefully investigating a striking example
met with in a child one year old. The right kidney
formed a huge mass 9 ins. by 8J ins., and weighed
108 ozs. The left kidney was much smaller and
weighed 28 ozs.
In many of these so sailed myo-sarcomata curious
duct-like structures are met with. In some cases
they appear like sections of tubules lined with
columnar epithelium. Apparently they are derived
from the renal tubules, and some observers have con
sidered them as stranded uriniferous tubules en¬
croached upon or surrounded by sarcomatous tissue.
3. Very vascular growths or angio-sarcomata are
occasionally met with. I am inclined to believe that
they arise more particularly in connection with the
perivascular tissue. They sometimes seem to arise in
the hilum and encroaching on the pelvis give rise to
profuse hsematuria.
4. A certain number of the sarcomata present a
distinct although variable amount of glandular
like tissue mixed up with the true sarcoma oells.
These adeno-sarcomata constitute a very definite
variety. The gland-like elements usually occur as
groups of tubules, lined by well defined cubical or
columnar epithelum, and more or less closely
resemble the tubules of a fatal kidney, but some¬
times the epithelial elements have a less definite form
and arrangement. They certainly occur in young
subjects. Striated cells are also sometimes present.
5. Complex forms presenting a complicated arrange¬
ment occasionally occur.
Alveolar sarcoma has been described, and is thought
to arise in connection with the endothelial lining of
lymphatic or vascular channels.
Myxosarcoma is simply one of the ordinary forms
in which myxomatous degenerative changes have
occurred.
Liposarcoma has been described, but I am
inclined to think that most of these are really of
peri-renal origin.
Melanotic sarcoma is always secondary. The
kidneys are frequently involved when general dis¬
semination takes place.
Growths of an Epithelial Type.
These include the adenomatous growths and true
carcinomata.
The simple adenomata form a small and unimport¬
ant class. They may be met with as single or mul¬
tiple nodules, limited in extent and usually in size.
According to their structural arrangement solid or
grandular and cystic forms may be recognised. Some
pathologists further divide them into papillary and
alveolar varieties.
They occur as small nodules in the renal sub¬
stance, varying in size from a pin's head to a small
marble. The proportion between amount of oells and
stroma is variable.
The trabecular cystomata are perhaps best classed
in this group. Transitional forms are not infrequent.
Some nave thought that they have affinities to the
growths of adrenal origin, but this seems doubtful.
These simple forms appear as an aggregation of
minute cysts. Each cyst is lined with cubical or
columnar epithelial cells.
The papilliferous cystomata present malignant
characters, and must be regarded as closely related
to the true carcinomata. They show more or less
extensive papillary ingrowth, each covered with a
single layer of columnar or cubical epithelium. The
varying complexity of the papilliferous formation
depends probably upon rate of growth, and adapta¬
tion to the adjacent tissues. The vascular character
is often very conspicuous. Sometimes an almost
angiomatous appearance is assumed. They appear to
originate in connection with the convoluted tubercles,
ana are liable to degenerative changes. Dissemina¬
tion occurs. I recently had the opportunity of
examining such a growth in a woman, set. 33. The
liver presented enormous masses of growth which
closely recapitulated the structure of the growth
in the kidney.
Carcinomata.
Until recently our nomenclature has been so in¬
definite that it is exceedingly difficult to make any
use whatever of the old records respecting “ cancer"’
of the kidney. Undoubtedly many of these were
really sarcomatous. Of recent years the sarcomata
have almost monopolised the attention of patho¬
logists. The study of the carcinomata has been
greatly neglected. We are thus left with inadequate
material for satisfactorily classifying the varieties or
forming anything like a complete description of this
class of renal growth.
Indeed, at the present time, it is almost hopless to
oogle
206 The Medical Press. ORIGINAL COMMUNICATIONS. _Aug. 30, 1899.
attempt to do more than indicate approximately the
general characters of the carcinomata.
They probably never occur in early life. Certainly
they are uncommon before middle age. After 50
they increase in frequency.
They seem to occur in two chief forms. (1) The
glandular type or true carcinoma, originating in con¬
nection with the urinary tubules; and, (2) the surface
form or epithelioma, springing from the lining epi¬
thelium of the pelvis and calyces.
The true renal carcinomata may assume either a
nodular or an infiltrating arrangement. Usually
they are of a soft cellular variety, although scirrhus
and colloid varieties are described. In the most
typical forms an adenomatous arrangement is most
marked. There is irregular proliferation of the
tubular epithelium and other irregular accumula¬
tions of cylindrical cells. Degenerative changes
seem to be of common occurrence, but extreme cystic
formation is not often met with. In size they are
generally much less than the sarcomata, and seem
usually to develop more slowly. They tend to
extend into the pelvis, and hence hsematuria is
usually a marked symptom. They are always uni¬
lateral.
Secondary deposits are not generally formed until
late.
The papillomata occurring in the renal pelvis seem
to be almost always of a malignant character. A
number have been met with associated with calculi.
They generally appear as very vascular villous growths,
much resembling the forms met with in the urinary
bladder. As might be expected severe heematuria
occurs often associated with attacks of pain resem¬
bling renal colic. Squamous-celled epithelioma has
also been described. Sometimes the pelvic growth
leads to the production of a certain degree of hydro¬
nephrosis.
A number of these growths have been subjected to
operation of recent years.
Renal Growths and Adrenal Inclusions.
Hitherto I have not referred to the intensely in¬
teresting but most perplexing class of growths which
it is supposed originate from included supra-renal
tissue. Adrenal “ rests ” have been found in the peri-
adrenal fat, in the tissues around the solar plexus, in
the mesentery, in the broad ligaments, and within the
kidney capsule.
Is there a relationship between certain forms
of kidney tumour and aberrant adrenal tissue?
This is answered by many pathologists unhesitatingly
in the affirmative. It certainly is a fascinating view
but the factR on which it rests are still meagre, and-
I cannot help but think that the judgment of some is
only too apt to be captured by a suggestion so attrac¬
tive. We have need for diffidence and caution in
treading on such new ground.
Still one is compelled to admit that there is un¬
doubtedly a group of renal growths which present a
structure closely resembling the zona fasciculata of
the supra-renal. Although of adenomatous appear¬
ance they have affinities with the sarcomata rather
than the carcinomata.
The number of cases on record which may fairly
be considered as belonging to this class are probably
under 40 in number, and hence it is dangerous to
attempt any conclusions.
We are quite in the dark as to the influences which
leads a so-called “ rest ” to take on indefinite
growth.
The growths are commonest in males, and usually
occur in elderly adults. In 32 cases the ages
averaged, males 50, females 45. Tumours considered
as belonging to this class have been met with in
children. Certainly curious adenomatous growths
do occur in young subjects, but I have not been able
to convince myself that they are of adrenal origin.
Usually only one kidney is affected. Generally they
seem to develop slowly, and long remain local.
Secondary deposits occur in many of the cases.
Several believed to belong to this group have been
removed, and not followed by recurrence.
Some pathologists consider that the so-called endo-
theliomata and endothelial sarcomata and probably
certain forms of angio-sarcoma are closely related to
this class.
There is certainly no group of renal tumours need¬
ing more thorough investigation than the adenoma^
tous group.
Adrenal Growth.
Closely associated with the consideration of true
renal growths are the tumours of the adrenals.
Clinically they are more or less indistinguishable
from renal growths proper.
Pathologically they closely resemble some of the
growths met with in the kidney, and by a Btudy
of the one light is thrown on the character of the
other.
The benign or simple growths occur as the so-called
“ Adenoma.' They occur either as (1) multiple
nodules or (2) large single forms.
Microscopically they present a structure closely re¬
sembling the normal adrenal tissue. There is gene¬
rally an abundant fine fibrous stroma with epithelial-
like cells arranged in masses or in colu mna r form.
Sometimes spaces occur lined with cubical cells, and
occasionally presenting papillomatous ingrowth.
Fibroma, lipoma, ana angioma have been described.
The malignant growths, or sarcomata, I have fully
described elsewhere, (a)
In these necessarily condensed remarks, while
endeavouring to indicate what has been accom¬
plished, I have more especially desired to insist
on what yet remains to be done—the necessity for
additional unravelling of the structural details of these
growths. Each genus must receive individual study,
for since each has its own particular structure it may
be reasonably expected that each will present more
or less definite signs and symptoms. Possibly the
time has arrived when a collective investigation
might do much to further our knowledge by the
gathering together of specimens, the comparison of
cases, the consideration of possible relationships, the
correlations of clinical histories with exact patholo¬
gical features, and the sifting of literary material.
Of this we may be certain that if any true progress
is to be made in the early recognition and effectual
treatment of renal growths, more precise patholo¬
gical information must he forthcoming, especially
regarding the consideration of structural features in
association with clinical manifestations. Only by the
accumulation of precise data can we hope to formu¬
late rules whereby the surgeon may know when he may
hopefully undertake surgical interference, or when
he will most benefit his patient by staying his hand.
TWO CASES OF PTOMAINE POISONING
FOLLOWING THE INGESTION OF
MEAT.
By G. BURBIDGE WHITE, M.D. Univ. Dub.,
F.R.C S.I., Dipl. State Medicine, T.C.D.
History repeats itself in medical as well as other
mundane affairs; unfortunately records of ptomaine
poisoning are of late years too frequent. Not long
since I described in these columns cases of severe ana
continued illness resulting from the ingestion of
(a) “Renal Giowtha: Their Pathology, Diagnosis, and Treat¬
ment.” 1898. Chapter XVI., pp. 162-186.
Digitized by G00gk
Auo. 30, 1899.
ORIGINAL COMMUNICATIONS.
The Medical Press. 207
lamb in hot weather, which proved to be New
Zealand lamb, which is considered a luxury at
the present time. Now I have to record one case of
poisoning from New Zealand lamb, and another case
from eating tinned corned beef :—
Case I.—On Sunday. June 4th, 1899, Mr. C. and
his family, resident in Dublin, partook of forequarter
of New Zealand lamb for dinner at 2 p.m. Mrs. C.
again ate the lamb cold on Monday following. The
members of the family afterwards suffered from the
following symptoms, and in the following order:—
First, the cardinal common symptoms were prostra¬
tion, general malaise, vomiting, vertigo, headache,
diminished action of kidneys, and others. Second,
they were affected in the following order: Mr. C. was
affected on the Sunday afternoon and next Monday ;
the governess was affected the Monday following and
next Tuesday; Mrs. C., Tuesday following (and, it
may be added, she was most severely affected); lastly,
the children suffered from diarrhcea. The history of
the cases and the order in which the different por¬
tions of the meat were eaten explain the foregoing
facts, thus : Mr. C. was first helped and ate the out¬
side ribs; the governess the next portion; the
children got in order the next portions ; and, finally,
Mrs. C., who carved, ate the neck part. On considera¬
tion it will be seen that those partaking of the most
exposed portions were most quickly and severely
affected, and more is to be learned from the idiosyn-
cracies of the individuals themselves. Mr. C., who
has a most irritable stomach, suffered first; the
governess, who is a chronic dyspeptic, was second to
succumb ; Mrs. C., not dyspeptic, was not affected for
three days : and the children, whose power of elimina¬
tion is so much quicker than adults, were the last
to be affected. Mrs. C., who took in most of the
poison, was laid up for a longer period and has Dot j et
completely recovered. A careful inquiry as to the
articles oi the diet previously, and at the time, led to
a negative result as to whether the illness was caused
by anything else.
At what period of its transit decomposition set in
in this lamb cannot be determined, it may have been
before shipment, or after arrival in England. The
antiseptic gauze wrapper may have been torn, or
some such accident. Tne finger of caution is pointed
towards this class of meats, viz., imported dead meat,
especially lamb, as a food, and the question as to
whether these meats are safe and wholesome food is
one that should be solved in the interest of public
health.
Case II.—Mr. H., an English gentleman, set. 54,
passing through Dublin on the night of Saturday,
June 24th, 1899, ate for supper some tinned corned-
beef, bread, and a little salad, and drank some ale
with the supper. Next day, Sunday, I was sum¬
moned to see him as he felt very unwell and had not
been able to take breakfast. I found he suffered from
prostration, general weakness, irritable stomach ; he
had no headache, but later on he had, physical ex¬
amination revealed furred tongue, quick, irritable
pulse, tympanitis and dilation of the stomach, with
feeble cardiac action—the most remarkable sign
was to be seen in connection with the skin. An
eruption of a patchy character, varying from the
size of a finger nail to that of a small plate, covered
the trunk and extremities, of a deep purple hue, and
very itchy. Next day oedema of the eyelids and oedema
of the mastoid and cervical regions supervened, and
temperature ranged to 101 degs. F. There was also
maraed diminution of urine, which was not, however,
albuminous. He put his attack down to some salmon,
which he had three days before, but on a careful con¬
sideration of the food he had partaken of, up to
the onset of his illness, there was nothing
to the charge of which it could be laid.
save to that of the tinned meat. Under suitable
treatment and diet, the poison which had evidently
gained access to his system was gradually eliminated,
and the rash and oedema very gradually disappeared,
but, nevertheless, were very persistent, and alter an
interval of about ten dayR the patient was pronounced
convalescent. Numerous coses of poison by these
tinned meats have already been recorded. It seems
that there is still room for improved methods of pre¬
serving this class of aliments, so as to effectively
prevent incipient decomposition, wherein lies the
occult danger, as a bad smell is seldom present in
this stage to act as a warning, and the taste, if such
be present, is generally concealed by condiments, Ac.
THE 8URGICAL TREATMENT OF
FIBROMYOMA. (a)
By Professor SCHAUTA,
Vienna.
Schauta contributes the result of his personal ex¬
perience founded on 424 cases of operative treatment
of myoma uteri with opening of tne peritoneum, in
a number of 2,263 peritoneal operations performed
by him.
General Indications. —Tumours are only to be
treated surgically in cases where all other treatment
has failed. When they merely exist without causing
pain or any other symptons it is not justifiable to
operate.
Palliative Operations. —Curettage and castration.
These should he generally set aside as inefficient and
very often dangerous, and only be resorted to in
cases of very small intramural tumours that cause no
plastic changes in the uterine cavity.
Schauta performed castration 45 times with three
deaths, two from interior haemorrhage, after the
ligature had slipped off. and one from peritonitis.
Vaginal Radical Operations. —Removal of sub¬
mucous pedunculated tumours, or of those with broad
implantation, through the dilated cervical canal.
There is little to remark about the first, the way
being clearly shown. It is always a legitimate treat¬
ment, even in cases where there is evidence of
tumours in utero, on account of its absolute freedom
from danger and pain, and because haemorrhage’
ceases after the ablation.
With broad-based submucous myomata it is
necessary to dilate and sometimes to cut open the
cervix. Enucleation is only indicated when part of
the tumour is born. The operation must on no
account last longer than one stance, on account of
the danger arising from possible Bepsis or gangrene.
Interstitial or sub-peritoneal tumours, when isolated,
and not larger than a man’s fist, may be treated by
vaginal oceliotomy and enucleation, the bed of the
tumour being stitched up afterwards.
This operation forms the transition to intraperi-
toneal treatment for tumours, which consists in dis¬
cission of the cervix, detachment of the bladder,
opening of the peritoneal cavity, sections of the cap¬
sule, enucleation of the tumour and stitching-up of
the wound and the uterine wall. The uterus can also
be left alone, or if there is any danger to be feared
from secondary haemorrhage or infection treated
extraperitoneafiy between bladder and vagina.
Vaginal Total Extirpation.—By principle this
should be preferred to all other operations for myoma.
The suitability for this operation should be determined
by the upper limit of the tumour, which should not
extend above the umbilicus, and upon whether it can
be pushed into the small pelvis; 148 cases with five
deaths, of which two could not be considered as result-
fa) Presented to the International Congress of Gynaecology and
Obstetrics at Utretch, Angus* ‘*99.
Digitized by G00gle
208 The Medical Press.
ORIGINAL COMMUNICATIONS.
Aug. 30. 1899.
ing from the operation, i.e., one from intestinal ste¬
nosis, and one case of pntrid myoma; of the remain¬
ing three, two were lost by secondary haemorrhage,
and one by peritonitis.
Schauta's technique is so far different from the
usual method, that after anterior and posterior
opening of the peritoneum he stitches their edges to
the corresponding edges of the vaginal walls. The
broad ligaments are secured by ligatures, and he then
amputates the cervix as high as possible. He does not
employ forcipressure.
Abdominal Radical Operations. Abdominal Enu¬
cleation for the Removal of Pedunculated Myomata by
Laparotomy. —Enucleation is called for, only in cases
of isolated tumours, not larger than a man’s fist;
the indication is therefore of rare occurrence. The
same is to be said for pedunculated tumours, as they
are seldom found isolated, and their removal demands
amputation, either supra-vaginal or total extipation.
Schauta performed enucleation 25 times with five
deaths of which three were from embolism and pneu¬
monia.
Supra-vaginal Amputation. Extraperitoneal Treat¬
ment of the Pedicle. —Schauta, formerly a partisan of
this operation, practises it now only, in exceptional
or urgent cases. About the technique need only be
mentioned, that amputation of the uteruB does not
take place, before having stitched the peritoneum of
the pedicle, underneath the ligature, to the parietal
peritoneum of the lower angle of the wound, as a
preventive to infection of the peritoneal cavity by the
contents of the uterus. On 78 similar cases, 13 deaths,
two from pneumonia, one from fatty degeneration of
the heart, and one from rupture of a pyosalpinx with
peritonitis.
Intraperitoneal Treatment of the Pedicle. —As an
advocate of abdominal total extirpation Schauta only
applied three times intraperitoneal treatment of the
pedicle, twice with fatal results. He admits the
primary advantages of this method, but considers
the frequent occurrence -of exudation, and the possi¬
bility of malignant degeneration of the stump, of far
too great importance to be overlooked, and therefore
searched for a better method.
Abdominal Total Extirpation. —The only objection
to this method is its difficult technique, whilst it may
also be considered that the rate of mortality is slightly
higher than with extraperitoneal treatment.
Schauta obtained the following results:—On 106
operations, 12 deaths, i.e., 15 per cent. There were,
however, but 10 of the number that could be con¬
sidered as the direct result of the operation, bringing
the percentage to 9 4 per cent., the others were due
to complications, as paralysis of the vagus, serious
aneemia, embolism, &c.
Schauta employs the following technique :—After
eventration of the tumour, the broad ligaments are
secured on either side by forceps, two on each side;
he then makes the incision of the serosa and detaches
the bladder as far as the insertion of the vagina, the
parametria, quite near the uterus, are clamped and
the incision of the uterus made. Two clamps are
likewise placed right and left of the lateral vaginal
pouches, and the vagina opened right and left. The
tumour now hangs to a narrow bridge formed by the
anterior and posterior vaginal walls. This bridge
being in a similar way secured by two curved vol-
sellse, the uterus is severed. To the clamps are
substituted ligatures, which are not cut short, to be
uaed for drainage, and finally the peritoneum of the
bladder is united with that of the posterior vaginal
wall. Whether the ovaries should be removed or not,
is a question which gives rise to great difference of
opinion, and which requires a long course of careful
observation in order to be solved.
Schauta is no advocate of forcipressure, having
lost seven patients on the forty cases, when they had
applied this method to vaginal operations, nearly all
the deaths being due to secondary haemorrhage after
removal of the clamps.
Drainage is recommended, as well as in cases of
total abdominal extirpation. The supravaginal
wound cavity is for this purpose left open towards
the vagina, the threads, which are left long, perform
the drainage.
Conclusions.
1. Operative treatment for fibroid tumours is not
legitimate except, when they are the cause of troubles
that are not to be conquered by other means.
2. Vaginal total extirpation should be considered
as the safest, and in the long run, most successful
operation. It should be performed in all cases when
the tumour does not extend above the level of umbi¬
licus, and when it can be easily drawn into the small
pelvis.
3. For large, not easily movable tumours, wholly
or partially intraligamentary, abdominal total extir¬
pation should have the preference.
4. Supra-vaginal amputation with intra-peritoneal
treatment of the stump, gradually should be set aside
in favour of abdominal total extirpation, although the
immediate results of the former are sometimes more
favourable; it has been proved that there are more
chances for absolute recovery, when no part of the
cervix has been allowed to remain.
5. In emergency cases, supravaginal amputation
with extraperitoneal treatment of the stump, may be,
as it affords facility for speedy and absolute extra¬
peritoneal execution, an advantage not to be under¬
rated, in cases of extreme ansemia, asphyxia, weakness
of the heart, and suppuration or necrosiB of the
tumour.
6. Vaginal enucleation of broad based, submucous
tumours, either by way of the dilated cervix, or by
the vaginal fornix, after anterior or posterior colpo-
tomv, with or without opening of the peritoneum,
should be only resorted to in cases where there are
special indications. Myomata being generally mul¬
tiple, it would not be likely that the operation would
afford durable results, and therefore cannot be con¬
sidered as less dangerous than the radical operation,
with removal of the uterus.
7. Curettage should be looked upon as an uncertain
mode of treatment, neither is it wholly free from
danger, and should be limited to rare cases of
beginning myomatous development.
8. Castration should be strictly objected to on the
ground of its not bearing comparison with the
radical operations, with regard to reliability and
immunity from danger. In quite exceptional cases,
when it is not possible to perform supravaginal
amputation with extraperitoneal treatment of the
stump, it may now and then be resorted to.
9. It is not to be thought that the methodical use
of forcipressure affords the patient advantages super¬
seding the use of ligatures, except in so far, as they
facilitate a speedy operation, in typical cases. In
cases of emergency or danger their use is certainly
to be justified.
10. The full value of drainage of the supravaginal
wound for furthering throughout the chances of
asepsis, and for the avoidance of exudation, in
abdominal as well as in vaginal total extirpation,
should be always kept in mind.
11. The question, if removal of the ovaries should
be performed, with vaginal or abdominal total extir¬
pation is not yet decided. “ Ausfall-erscheinungen "
fClimacteric Symptoms) have been observed either
way.
If the ovaries are removed they appear immediately,
if left back, after weeks and sometimes months.
Digitized by G00gle
Au«. 30, 1899.
ORIGINAL COMMUNICATIONS. The Mxdical Pbbm. 209
INTESTINAL ANTISEPTICS, (a)
By BURNEY YEO, M.D., F.R.C.P.Lond.,
Professor of Medicine at King's College, London ; Senior Physician
to King's College Hospital.
Intestinal antiseptics and evacuants have for a
long time been in use without the rationale for their
use being known. The old blue or calomel pill,
together with the black draught which dissipated the
spleen and the vapours for our forefathers are in¬
stances to the point. I intend to consider the sub¬
ject under four headings: (1) What is the scope of
antiseptics ? (2) What is the scientific basis -for
-their use? (3) Under what conditions are they
applicable ? and (4) what are the means of applying
intestinal antiseptics ? With regard to (1) the
medical use of antiseptics is different to the surgical
use. The surgeon nowadays aims rather at asepsis
than at antisepsis. But in medicine, as ‘concerned
with the intestinal contents, asepsis is impossible.
We must, if possible, prevent, or at any rate anta¬
gonise, auto-intoxication— i.e., intoxication of the
organism with the products of digestion. With regard
to (2) it must be remembered that certain bacilli are
only harmful in the presence of putrefaction or other
abnormal condition. The bacillus coli, for instance,
is a. normal inhabitant of the intestine, and
under ordinary circumstances is harmless. If, how¬
ever, the bowel becomes abnormal in any way owing
to catarrh, long-continued constipation, or sometimes
injury, the bacillus coli seems to take on a virulent
action. When associated with the bacillus typhosus
it has the power of intensifying the virulence of the
latter. The experiment of Dieulafoy with the bacillus
coli when taken from an appendix, the cavity of which
had got shut off from the rest of the bowel, and the
same organism when taken from the normal mucous
membrane of the bowel, show that the former is
virulent, the latter not so. As, then, the virulence of
intestinal bacteria depends upon their environment,
so by niodifying that environment it is reasonable to
suppose that we can modify their virulence. With
regard to (3) intestinal antiseptics are indicated in
gastric catarrh and fermentative dyspepsia. Grange
recommends in cases of summer diarrhoea the use of
plain boiled and cooled water. He claims that the
use of this dilutes the toxins. There are many other
conditions to which fermentative dyspepsia and auto¬
intoxication give rise. Such are dyspepsia, chest
pain simulating angina pectoris, vertigo, aphasia, and
anemia. Even pernicious anemia had been con¬
sidered by some observers to depend upon some
toxin which exerted a hemolytic action. There are
three other diseases in which the use of intestinal
antiseptics is rational - namely, cholera, dysentery,
and typhoid fever. Of the first two I have had no
practical experience, but with regard to typhoid
lever L have for some years advocated and practised
the use of intestinal antiseptics. Typhoid fever
often exhibits symptoms of being due to a mixed
infection, and this may explain the extraordinary
variations in the severity of cases. I can recall
instances in which the use of a chlorine and quinine
mixture given every two or three hours has been
attended with most marked results for the better in
cases of typhoid fever. So, also, in some cases of
indefinite febrile affections accompanied by rise of
temperature, furred tongue, and foul-smelling stools
the use of thymol by the mouth, together with irriga¬
tion of the large bowel by eucalyptol, olive oil, and
soap-and-water administered in the knee-chest posi¬
tion, had rendered the patients well. I am not able
to say to what exact disease this condition was due,
but I think that whether the original infection
had been by typhoid fever or influenza that the con-
fa) Abstract of paper read before British Medical Association,
Portsmouth, August, 1899.
dition which I was called upon to treat was due to the
action of the bacillus coli in an abnormal environment.
With regard to (4) the various intestinal antiseptics
are: water boiled and cooled, calomel and salines, both
of great value in the early stages of typhoid fever.
Salicylate of bismuth and carbolic acid are both
useful. As to the latter I remember a case published
recently in the Lancet by Dr. G. Williams, where a
patient suffering from typhoid fever took by mistake
one ounce of carbolic acid. He had, of course, to be
treated for the toxic effects, but recovered from them
with his typhoid fever symptoms much lessened.
Salol is very uncertain. Eucalyptol and thymol are
both good and irrigation of the large bowel in such
cases as I have mentioned was a necessity. Patients,
especially in typhoid fever, must not be overfed. I
would conclude with a warning against the production
of the modern manufacturing chemist who sets up to
teach the clinical physician.
ON THE
PREBALNEAR TREATMENT OF
HEART DISEASE,
AND ON THE
USES OF THE INHALATION OF CARBONIC
ACID IN CARDIAC DYSPNCEA AND
ANGINOID PAIN (a).
By WM. EWART, M.D.Cantab., F.R.C.P.Lond.,
Physician to St. George'* Hospital, London, and to the Belgrade
Hospital for Children.
The treatment carried out during the last two
years consists in the inhalation of carbonic acid for
varying periods (from five to twenty or thirty minutes)
three or four times daily in cases of broken compensa¬
tion with heart huny, cardiac dyspnoea, angina, or
pain, Ac., and in cardiac neuroses or neurasthenia,
at stages when the Nauheim treatment is inapplicable.
Carbonic acid, as is well known, being harmless when
inhaled for limited periods in proportions less than
15 per cent., relief to the heart and respiration and to
the subjective distress is gained without any risk, the
action of the remedy being mild as well as immediate,
and the after effects of any overdose (a contingency
which has not come under observation) being purely
transitory.
By reason of this mildness and of the ease with
which the amount can be regulated (by watching the
bubbling of the gas through the water of a wash
bottle) there are hardly any cases of cardiac distress
in which it may not be tried; and there have been
but few in which it did not afford relief either when
inhaled alone or in association with oxygen.
As implied by the name, the treatment is in many
cases a preliminary to the Nauheim treatment, for
which it prepares the way when used independently,
or in association with medicinal adjuncts. It is a test
for the suitability of doubtful cases for a course of
the baths, and for some cases which are absolutely
unsuitable for the latter, it is a valuable substitute
and instalment of treatment. When cases have so
far improved as to be submitted to the Nauheim
treatment, the inhalation as a separate measure
becomes superfluous, carbolic acid continues to be
inhaled in a modified way in connection with the
baths. The action exercised upon the rate and
strength of the pulse being relatively slight the
inhalation of CO, is specially welcome in the treat¬
ment of aortic regurgitation, of mitral stenosis, of
cases with four valvular murmurs and in anginoid
conditions or angina, where digitalis is either inad-
(a) Abstract of a paper rtad in the Section of Medicine at the
Annual Meeting of tne British Medical Association, Portsmouth,
August, 1899.
Digitiz
oogle
THE NURSING PROBLEM.
Apo. 30, 1899.
210 The M edical Press
missible or subject to caution. Notes of some of the
many cases which have been treated with benefit,
including cases of mitral regurgitation, of tricuspid
regurgitation with cyanosis, and of dilatation of the
right side of the heart, &c., were submitted with the
paper.
^hc JtorsiitQ Jrobknt.
NURSES OF THE LATEST FASHION.
A.D. 1899.
PROFESSIONAL EXPERIENCES IN SHORT
STORIES.
By FREDERICK JAMES GANT, F.R.C.S.,
Consulting Surgeon to the Royal Free Hospital.
Y.-NURSE GOSSIP AND SCANDAL.
The first-named species of nurse may not be a dis¬
tinct character, apart from some other nurse-forms of
“ the latest fashion ”; but she .is specially distinguished
by her confidential communications—that, “they do
say ”—of others; whatsoever probably she knows her
own self to be—as if in them.
Nurse-scandal, sometimes taking form as the “ obscene
nurse,” the latter species is more often distinctly
specialised, and more surely a disclosure of the woman’s
own depravity.
But an unbridled tongue is a traitor to more than its
possessor. A high authority on nurses and nursing,
Georgina Scott, late matron of the Sussex County Hos¬
pital, writing on the golden beauty and value of silenoe,
remarks that “ Perhaps no one is more behind the soenes
of life than is the sick-nurse; perhaps no one else comes
into Buch close contact with the Bacred and secret con¬
cerns of life as she does. Doctors, lawyers, and clergy¬
men have many revelations, many insights into the
recesses of family secrets. They know of sins and
strange complications little dreamt of by the outer
world. Still, their visits are limited compared to those
of a nurse, who spends day after day and night after night
in the house of sickness, hearing much and seeing more
than many may at first sight suppose. Much is tola to the
doctor, lawyer, and clergyman; but the sick-nurse has
even more confidence given into her oharge. She can
see, as well as hear, many details of many a sad and
complicated life. Nurses should keep these confidences
as faithfully as they would have their own private
affairs treated. They must hold all such knowledge
gained in their work as sacred, oovering it with silence.
“ Again, it is hardly good taste to talk to patients of
our (nurses) professional work, or to give them details
of cases and their treatment; nor is it honourable to
discuss the merits of one medical man compared with
those of another. Recluses we may not be. Careful
conversation, or discreet silence need not strip us of
sympathy, nor make us lack interest in the joys and
sorrows of our fellows creatures. But secrets, once
discussed, must take their course; there is no
calling them back tgain; penitenoe has no power to
make good a broken faith. Regret for hasty and foolish
words, sorrow for gossipy and scandalous conversations,
remorse for having given into the confidence of anocher
the secret thoughts of our own soul, come to us alike ;
and in the darkness and stillness of the night, with no
one to see or hear, we have blushed and then grown
cold with the recollection of the weak and erring utter¬
ance of our tongue.”
VI.—MASSEUSES.
Quite modern medicine has demonstrated the remedial
efficacy of friction, rubbing, and kneading various parts
of the body in the treatment of diseases to which they
are subject. This method of mechanically relieving pain,
restoring muscular power and movements, and of regain¬
ing sensibility—in many nervous and muscular affections,
especially, has received the name of massage. The
advance of women all along the line of human progress,
and notably in the march of medicine—like a huge wave
on the ocean of our social life—has brought up a con¬
siderable number of women-*aue«ri, whose profession
is massage.
When propel ly trained in the school of medicine, it
cannot be doubted that such women are valuable adju¬
vants to the practitioner of medicine and surgery. The
manual dexterity, combined with firmness ana lightnesa
of touch, with which the hand of woman is endowed,
and when perfected by practice, will enable any such
feminine manipulator to exercise a mechanical ait more
effectively than most male competitors. And, if in
addition, a naturally womanly character, coupled with
the delicacy and refinement of culture, movee with the
hand in the performance of her duties, the masseur-
woman will be a valuable member of Society.
She is akin to the properly qualified nurse, in her
professional relationship; and like her is fitted to
attend private cases (of massage) under supervision of
the medical practitioner; or the two callings may be-
united.
It is easy, however, to imagine the woman, the lady-
masseur or masseuse as she styles herself, whose un¬
trained hand, and defective tone of moral character,
would reverse the picture of the rightfully named
masseuse. Which may be most harmful, her hand or
her heart, when its resources are brought into play in
private practice ?
The public, in many cases, oould answer this question
from personal experience of the masseur-woman, and
the unpublished memoirs of family life. The dis¬
closure would traverse most of the careers of which
glimpses have been seen in the private nursing of the
untrained and uncertificated, unregistered; or some
other "Nurses of the Latest Fashion." If we could
not track “ Satan in Petticoats ” in some portions of her
dark life history, we might certainly discover the
“ husband-huntress and trapper ”; or find the “ husband-
seducer masseuse ”; or encounter the “ breaeh-of-promise
lady-rubber.” She rarely appears, perhaps, as the “ dan¬
gerous widow ”; nor does the said lady ever belong to any
“ religious order of women.” Nor can the species of wom&a
known as masseuse be classed with the “ unfortunate ”
nurse, who mostly commences her career as a hard-driven
exile from home, more sinned against than sinning. The
fair but frail masseuse is a distinct species, having a
double occupation in a life whioh lends itself to both. In
her proper professional capacity the lady masseuse passes
for a sort of “ doctor-nurse.”
Nigh round the corner of a fashionable square at the
West-end of London, where luxury and rank smile, each
admiring the other’s beauty, stands a small house which,
as a lean-to to the adjoining mansion, seems to be an off¬
shoot from that abode of bliss—not perfect, of course, as
no human oondition can be.
A lady-rubber took the useless small tenement for one
year’s trial in the practise of her art. Painted of a
cream-white colour, like the tenant, it looked a pretty
little box, with its large brass-handled door, and the
pure white lace curtains drawn across the window, ex¬
cept at an interval formed by two blue satin sashes,
which presented an almost oomplete blind to any intru¬
sive gaze over the railings of the little area. This room
was the lady-masseuse’s first sanctum; a recess at the
back, without any window, and which was furnished
with a luxurious couch, provided accommodation for any
elderly or crippled patients to derive the benefits of
rubbing without having to ascend the stairs to a bed¬
room above. The lady herself rivalled the remaining
upholstery in her dress, that of a nurse, but more
expensive, if not more becoming.
She distributed her “ card ” all over the neighbour¬
hood, announcing herself “ Mias-, Masseuse, P-
Place. Her hours, “ at home ” in the morning, 11 a.m.
till 2 p.m., “afterwards by appointment,” as she had
her out-patients to attend at their houses. She drove a
brougham hired from the livery stables attached to the
stabling of the Bquare.
Occasionally, some elderly gentlemen, or it may be a
lady, called, and the hall door having been opened by a
well-appointed maid, the patient was taken in and done
for by the massage treatment. Each sufferer’s rubbing
in the hands of this skilled manipulator, as she seemed
Digitized by GoOglC
Aug. 30,1899.
FRANCE.
The Medical Press. 211
•to be, would occupy an hour, more or less, ere the fee,
7s. 6d. or half a guinea was duly earned; and as a
course of treatment was generally recommended, the
practice was not unremunerative. 8o massage, in hands
which the owner knew how to work, might have grown
into a flourishing concern.
But, besides the patients who came and went, the
domicile was visited by others who might have been
grateful recipients of the treatment, who called just to
show themselves as trophies of the system which had
restored them to health and strength ; there were gentle¬
men in the prime of life, whose vital powers needed no
replenishment; they bore the steady-going manners of
middle-aged married men, for whom loving eyes would
watch their coming home to dinner, and look brighter
when they came; and besides these “ patients ”
there were elderly clubbites, who called on the
way to their home. All these visitors to the
lady masseuse called in hansom cabs — never in
private carriage — and they never drove up to
the door, but alighted round the comer in the square.
So altogether a pretty deal of business went on in the
white cream-coloured little domicile; the lady at home
had her hands full of subjects for rubbing, <tc.
Whisperings from the wagging tongues of neighbours
began to report their suspicions. That massage cases
were treated by her in her elegant sanctum, and in the
bedroom overhead, there could be no doubt from the
testimony of those who had undergone the cure, and
who moved in the best society. Still the whisperings
grew into something like a complaint that the house
was a sort of nuisance. Then the attention of the Vestry
was directed to the business of the fair masseuse. The
Board were very reluctant to interfere, unless some
definite oomplaint was brought to their notice; and by
a written application, signed by some half-dozen neigh¬
bours. They, however, declined the invitation. Then
the Board sent two vigilant policemen ; but they saw—
nothing.
The lady having beard, somehow, of some imputation
against her skill as a masseuse, or her manner of using
the treatment, she threatened any informant with
woman, or one of a kind never to be known.
The wave of rumour still rising, and spreading; or
say, the Are smouldering, at length broke out into a
blaze; until the house, and the lady oocupant would
have been sacrificed to the clamour of her neighbours
in the side street. The noble inmates of the house
immediately adjacent dwelt serenely unconscious of
their neighbour; two young daughters sitting |in the
conservatory, separated only by a partition wall twixt
them and the massage oouch, and bed-room above;
could they have dreamed of anything wholly outside the
happy experience of innocent young womanhood ?
The lady masseuse was about to flee away from her
uncongenial surroundings, and open a modett establish¬
ment elsewhere, in some fashionable watering-place, the
resort of London’s rheumatic, or nerve-worn, invalids,
and other break-downs, in the battle of pleasure and
C , among those who live too much in the charms of
sty and its atmosphere.
But the lady’s career, in her present locality, had now
reached its climax. The landlord was informed that the
house was not so clean and pure as it looked. He
knocked at the door, and an unsuspected visitor was in¬
stantly admitted by the maid, as probably another case
of her mistress’s art. He passed the lower sanctum,
and made direct for the bedroom. There lay the lady
masseuse, and there also what he saw he believed.
Within an hour the tenant was ejected; her luggage
following this accomplished feminine-rubber up to date.
VII.—THE MIDWIFE AND THE MONTHLY NURSE.
In concluding the present series of representative
“Nurses of the Latest Fashion,” there yet remain
Beveral other types whose living portraitures lie in a
state of suspended animation in my escritoire.
Thus, only to mention the “ Night-brawling Midwife,”
with one of her nurse-girls of the same breed; the one
bolding a “ three months’ certificate ” of qualification
from a certain lying-in hospital; the other, “one month’s
qualification” for her duty. Here is an authoritive
description of the latter nurse-species, as expressing
her personal qualities.
“ She has not in her the making of a nurse; she is
utterly selfish and cruel. Whenever she would have a
holiday she would leave her charge in a dying state to
keep her appointment with her man, who is waiting
round the corner.”
She sallies forth, wearing an unfortunat? dress from
head to foot. Having doffed her nurse attire, see her
thus: Hat surmounted with huge white ostrich (?)
feather, <fcc., purple blue cloth gown, bespangled with
silver filigree; an open, frilled chemisette, arranged to
disclose that which the wearer affects to conceal. A
front longitudinal fold in the dress, buttock-tightened,
guides to her conformation below; while nameless shoes
with buckles invite attention to her ankles.
This midwife-nurse returns to her patient too late for
duty; and being shut out (to call again in the morning),
she reappears, armed with the aforesaid brawling mid¬
wife. After repeated thundering rapping at the street-
door, accompanied with bell-breaking ringing, the mid¬
wife’s voioe is heard under patient’s bedroom. The
husband, alarmed for his poor wife’s safety—and
himself a great sufferer, as she with the hat and feather
well knows—the husband in his night dress is now at the
dining-room window, shutters and window fly open,
a crowd with a hundred midnighters, headed by a
polioeman (388 F.) meet his dazed eyes. “This job”—
shouts the midwife—“ will cost you some pounds, besides
a good hotel bill for this girl’s bed and breakfast ” (at
the house of the deliverer from the pains and perils of
cnild-birth).
A small fee—half-a-crown, ready money—at onoe
sufficed to discharge all the husband’s liabilities, and
silence the threate of this lying-in woman.
Note. —this glimpse of a midwife, and of her girl, both
up to date, will supply any additional evidence touching
the Registration of Midwives, for the next deputation to
lay before the Lord President of the Council.
<ifrance.
fFROM OUE OWN CORRESPONDENT.!
Paris, August 26th, 1889.
Fibroma of the Uterus.
M. Doyen read a paper before the International
Congress on Gynaecology on the treatment of uterine
fibroma. Those tumours, he said, should be removed
each time that they increased in volume and that they
prOduoed grave accidents—phlebitis, albuminuria, intes¬
tinal occlusion, malignant degeneration of the uterug
far from being oounter indications, constituted, on
the contrary, imperative indications to operate. Abla¬
tion, of an isolated tumour, either through the vagina
or by laparotomy, with preservation of the uterus, was
only indicated in very rare cases. Hysterectomy should
be performed when the fibromata were numerous.
When the uterus was mobile and could be easily drawn
forward, the operation might be done through the
vagina. The same method should be followed in case of
great obesity which rendered laparotomy particularly
difficult. In every other case the abdominal operation
should be preferred.
Since the speaker employed the eerase ur and subfti-
tutod ligatures for forceps o demeure, he had operated
fifty-two cases of hysterectomy for fibroma, of which
twenty-seven were through the vagina, all successful,
while of the remainder he only lost one case, that of a
patient who had suffered from phlebitis of the lower
limbs and from appendicitis.
Die
G ERM ANT.
Atjg. 30, 1896.
212 Thu Medical Press.
M. Villars Baid that he believed that certain fibroma
ehonld be respected, for it was abundantly proved that
those tumours were frequently well supported.
Dr. Giles (London) thought that it was not necessary
to operate tumours provoking no morbid manifestation-
On the other hand heemorrhage, compression, degene¬
ration of the tumour necessitated radical interven¬
tion. Palliative treatment was not only useless but
dangerous.
C.£sahian Operation.
M. Pinard established a comparison between the
Cesarian operation and symphyseotomy, craniotomy and
artificial delivery.
The abdominal section, he said, was a simple operation,
easy to execute and the dangers of infection and
hemorrhage were greatly diminished, thanks to the
application of antiseptics and of sutures. As to the
child, it was placed beyond the reach of all trau¬
matism. While -the Cesarian operation permitted
the immediate termination of the delivery, section of the
pubes with consecutive dilatation of the pelvis constituted
a preparatory intervention permitting the child to
traverse the outlet without having to struggle against
the osseous wall. The soft parts, vagina and vulva,
should be afterwards dilated so that the child could be
expelled or extracted per vias naturales. Symphyseotomy
was also an easy operation, as the statistics of the
Baudelocque Clinic proved, for out of 100 cases
practised between 1892 and 1899, 88 mothers
recovered and 87 children were born alive. Twenty-
two of these women became pregnant for the second
time, and sixteen were delivered naturally, while
the remaining Bix had to submit to a second operation.
Craniotony in which the child was considered as a foreign
body was rarely sufficient in itself, crushing and disloca¬
tion of the head were nearly always neceseary. Out of
eighty-one craniotomies practised in his wards within the
last fifteen years, seventy-two of the patients recovered.
Premature artificial delivery, which consisted in the inter¬
ruption of the pregnancy at a period where the fcetus is
viable and at the moment when its dimensions do not ex¬
ceed that of the pelvis, should suppose a precise know¬
ledge of the age of the'pregnancy, of the degree of the
narrowness of the pelvis, and of the dimensions of the
foetal head. These desiderata were rarely realised in
clinical practice, if one were to judge by the best
statistics by which were shown that the foetal mortality
exceeded 30 per cent.
As regarded the indications and counter indications,
the principle should be laid down that the accoucheur
should be a doctor in all his acts; the obstetrician
had always before him the duty to protect
the child as well as the mother. Applied to
the therapeutics of pelvic deformity, that doctrine
excluded provoked delivery as well as embryotomy on
the living child. If before the era of antisepsis, at a
period when the Ccesarian operation or symphyseotomy
were usually followed by death to the mother, prema¬
ture delivery had been recommended and adopted, it was
no longer the case in these days. When a woman can¬
not be delivered on account of malformation of the
pelvis, and the child was living, two operations alone
were possible, dilatation of the outlet or abdo minal
section.
M. Pestalozza said that premature artificial delivery
was without danger to the mother when the rules of
antisepsy were scrupulously observed, but it exposed the
child to several aocidents immediate or remote.
It was particularly indicated in young women in their
first confinement.
Symphyseotomy should be reserved for those who had
borne several children on account of the inextensibility
of the tissues iu the primipara.
(Snmtattg.
[from OUR OWN C0RBX8P0NDXNT.]
Berlin, August 25th, 1890.
Guaiacol Carbonate and Creosotal in the Treat¬
ment of Diseases of the Respiratory Passages.
From the proceedings of the Tuberculosis Congress
held in Berlin, we note a paper on the above-named
subject by Dr. Fr. Holscher, of the DreikSnigen Hos¬
pital, Miilheim.
Dr. Holscher, who is physician-in-chief of the hospital
named, claims that these two allied remedies have
already taken the first place in the treatment of all pul¬
monary diseases. A dietary rich in albumenoids is
desirable, as the guaiacol and creosote absorbed from their
carbonates effect an increase in the decomposition of the
albumens of the body. The remedies further this rich
dietary by increasing the appetite and stopping abnor¬
mal putrefaction processes.
In giving full doses of these remedies, the urine is
often observed to become dark, but this it is claimed is
no sign of any poisonous action.
The remedies are said to effect a largely increased
body weight, disappearance of fever and night sweats
after several weeks’ treatment, diminution of cough and
expectoration, and their final disappearance. Thb
tubercle bacilli are also said to diminish in number
Creosotal is also extremely useful in pneumonia, causing
a fall of temperature within twenty-four hours of its
first administration; if the drug is continued the tem¬
perature is said to remain normal.
Modern Myoma Operation.
At the Medical Society Dr. Czempin read a paper on
this subject, prefacing his remarks with the observation
that operations for myoma were not looked upon with
great favour by the practitioner, and that this view waa
partly due to an over-estimate of the harmleBsness of
such tumours; and to the possibility of their sponta¬
neous retrogression after the menopause.
As regarded the latter point, he observed that
among his seventy-two cases of operation, eight of
them were in women between fifty and sixty years of
age.
Palliative treatment wae insufficient. Currettement
of the mucous surface, which was very proper in haemor¬
rhage from myoma, gave good results frequently, but he
had had two disagreeable experiences.
Operations were of two kinds, one in which the
myoma was removed and the uterus left, and the other
ih which the uteruB was removed along with the tumour,
and the operation for either form might be vaginal or
abdominal. Dilatation with laminaria, and attempts on-
the tumour by this route he rejects, and if adopted*
everything should be in readiness for proceeding by the
abdomen in case of need, as where the uterus wall is per-
Digitized by
Google
Aug. 80, 1899.
AUSTRIA.
The Medical Press 213
forated or tom. In twelve of his cases the tumour was
partly expelled. In case of firmly seated myoma in virgins
Duhrsaen had proposed a new way. The uterus was
separated from the bladder. After carefully ascertaining
the exact site of the tumour it could then be cut down
upon and enucleated. The wound was then closed. He
showed a preparation obtained in this way. In cases of
multiple tumours, all of whioh could not be removed
vaginal total extirpation of the uterus was called for*
The morcellement invented by Plan, of Paris, and intro¬
duced into Berlin by L. Landau, was a distinct advance.
The speaker had, however, been less fortunate with this
operation, which demanded great dexterity, The patient
died of sepsis from a misfortune occurring through
tearing out of the vulsellum foroepe. Since then he had
abstained from morcellement.
The abdominal method could be either conservative
or radical. In six cases he had cut down upon th« tumour,
shelled it out, and closed up the wound with sutures
with a good result. Up to a few years ago the mortality
of hysterectomy for myoma was 30 to 83 per cent. Using
all the modern means for prevention of sepsis he had
operated in eighteen cases with seven deaths. Martin
extirpated the uterus along with the tumour from the
abdominal cavity. This was the most ideal method; it
afforded the safest technique, avoidance of accident and
rapid recovery. He had in this way operated twenty-two
times without a death. The vessels were ligatured or
clamped, the tumour rolled out, the round ligaments
cut and ligatured. The bladder was treated next, an
anterior flap was formed on the uterus, and the bladder
separated. If the bladder were now pushed away the
uterus would only have on it the remains of the ligaments.
Some authors took no notice of the uterine artery.
Landau always ligatured and severed it. The
speaker always sought for it and ligatured it. After
cutting through the vagina and removing the uterus,
nothing was left but an anterior and posterior flap
which should be brought together and uniced by suture.
The results of this method were positively brilliant.
Care must be taken in selection ; tumours growing in the
broad ligament, and which necessitated extensive,
opening of the connective tissue, often did not do well
on account of infection. In the speaker’s five cases
general infection of the peritoneum took place in three.
He had never seen good results from castration ; even
in old women the haemorrhage does not quite cease.
His conclusions as a whole were: The prognosis in case
of myoma when no bleeding was present was upon the
whole favourable. Myoma should not be treated lightly
in view of possible malignant degeneration, and of the
troubles that frequently attend them. On the other
hand, operation affords a better prognosis than it did ten
years ago, especially the new vaginal and abdominal total
extirpations gave ground for favourable results. One
could, therefore, persuade patients to have the operation
performed before they fell victims to permanent illness
that always follows in the wake of typical hemorrhages.
Vomitus Gravidarum Perniciosus.
Hyperemesis gravidarum, according to Sajaitski,
Deuttch. Med. Zeitung, 60/99, is not a neurosis but a
simple reflex phenomenon caused by irritation of the
peritoneal coating of the uterus from enlargement of
its cavity. It oocurs in cases in which the lower segment
of the uterus does not increase in size pari pattu with
the upper portion, where the hyper-extension is too
rapid, as in the cases of hydatid mole, hydramnios, Ac., or
when some hindrance to normal development is present,
as from chronic metritis, interstitial or submucous
myoma, &c. In addition to the local irritation of the
peritoneal covering of the uterus, which is always the
original cause, increased irritability of the nervous
system contributes largely to its occurrence.
As regards the infrequency of the affection the author
observes that the wombs in which it would be likely to
occur are generally sterile, and that many of the diseases
that cause it improve on pregnancy taking place.
The treatment of hyperemesis gravidarum is as
varied as its aetiology. Most of the remedies employed
or recommended for the disease are useless, the sole
remedy lying in the appropriate local treatment of the
affection of the womb that causes the vomiting. If this
does not succeed nothing remains but to interrupt the
pregnancy. In some desperate cases this radical measure
takes place spontaneously. When it has to be resorted
to artificially it is without danger, if carried out in
accordance with the principles that govern modem
surgery.
Profesbor Auo. Bier, of Kiel, gives an account in
the Zeitsch. f. Chirurg, of attempts he has made to pro¬
duce extensive areas of local anaesthesia by injecting
cocaine into the spinal canal His attempts were made
on himself, his assistant, Dr. Hildebrandt, and five
patients. Quincke’s lumbar punctures of the cord were
made when the cooaine solution was injected, the
largest amount given being 01 grm. The result was
said to be mostly satisfactory, or rather satisfactory in
one direction. The local anaesthesia desired was pro¬
duced, so that the whole of the lower half of the body
was rendered insensitive to pain, and in this condition
major operations were performed on his five patients,
but the bye effects were by no means satisfactory. Even
with the doses given headaches were caused, which
lasted a whole week, whilst nausea, vomiting, and giddi¬
ness were so severe as to oompel a horizontal position
in the bed. Whether his intended further investiga¬
tions on animals will shed further light on the subject
is rather doubtful. Enough has been determined to
show most surgeons that the game is not worth the
candle.
Austria.
[FROM OUR OWN CORRS8PONDSNT.]
Vienna, August 35th, 18W>.
“ Heilserum.”
In the last two sanitary reports issued by the Imperial
Offloe the kingdom of Galatia has been represented as
only using the anti-diphtheritic serum in 10 per cent, of
the cases, which was given as a reason for the high
death-rate in chat country.
Latest reports prove that the serum has been more
widely used than in other places and are pointed to as
examples of the "heilserum.” The complaint now is that
the serum has been indiscriminately used, which accounts
[ for the high death-yate! These revelations have
all been disclosed since the Kassowitz discus¬
sion in the “ Gesellschaft,” when this country
was jubilantly pointed to as conclusive proof of the
efficacy of the serum. Raczynski (who is an authority
Digitized by LjOOQle
SOUTH AFRICA.
214 Thb Medical Press.
Aug. 30, 1899.
on diphtheria) contributes an article to the “Przeglad
lekarski ” to show how difficult it iB to diagnose a
truly diphtheritic case from an ulcerous prooess
in the pharynx, and relates how every clinical
feature was so well marked in this case, that every
expert declared it to be a genuine case of diphtheria—
even the bacilli diphtheritically proved the case to. all
observers, and the serum was used. Raczynski cultivated
the alleged bacilli and found them nothing more than
those met with in any case of angina sclerosa !
From this he reasons that many of our so-called cures
accomplished by the use of serum, are fanciful and not
real. He is inclined to lean more on clinical facts than
bacteriological examinations for a differential diagnosis.
Dustals or Guaiacol [Carbonate.
The drugs prescribed for tuberculosis are now so
numerous that the more scientific must resort to feeding
on air alone under she shadow of a big company con¬
cern. Still there are a few who cling to the real article
yet and deprecate the company promoter as a charlatan.
Eschle confidently believes in attacking the disease
internally and locates his operation to the correction of
the alimentary canal. Some believe in the treatment of
our ancestors, others are content with disinfecting the
lung, others again would attack the blood, while Eschle
assures us on scientific proof that no treatment of tuber¬
culosis can be successful that does nbt aim at the first
cause—viz., the changes that takes place in the bowel.
He has devoted several years to the examination of the
carbonate of guaiacol (Duotals) and concludes that it is the
most effectual disinfectant of the alimentary canal extant
and therefore an antidote for tuberculosis. The advantage
of Guaiacol is that it plays a double part in disinfecting
the blood as well as the contents of the alimentary
tract by simply increasing the dose till the drug is
eliminated by the rectum, which can be accomplished
without danger, detriment, or any disadvantage to the
patient. When given in small doses the drug is ab¬
sorbed in sufficient quantity to disinfect the blood, but
the bowel is not completely aseptic till the drug is
passed unchanged.
CureB in abundance are adduced to prove the correct¬
ness of Freund’s theory long since announced that the
low state of nutrition in consumptive patients is due to
the decomposition usually present in the bowel which
forms the pabulum and induces the growth of the
bacilli in all tuberculous conditions.
Tetantjs and Serum Injections.
•
Leyden relates an interesting case of a woman, tet. 29,
who fell on the cellar steps and produced an abortion,
which was followed by tetanus on the tenth day. On the
sixth day of the disease she was taken to hospital, where
a subdural injection of 1*0 gramme of Behring's serum
was made, along with one subcutaneous injection of 2'0
grammes of Tizzoni’s serum. With these injection 01
of morphia and 2 - 5 grammes of chloral were given during
the first 24 hours. In the second 24 hours after admis¬
sion a subcutaneous injection of Tizzoni’s serum, con¬
sisting of 8 0 grammes, was administered. On the third
day two subdural injections of 0'75 gramme of Behring’s
serum was injected. On the sixth day 2 0 grammes of
Behring’s serum were used.
The subdural injections were borne favourably
although the temperature rose very high. The patient
is certainly better. Though Leyden considers this a
success he is unwilling to speak in favour of the treat¬
ment.
Infective Character of Abticular Rheumatism
and its Connection with Chorea.
Wassemann and Malkoff relate the history of a young
woman, set. 19, who was suddenly attacked with chorea
at the close of a severe illness from articular rheumatism.
Shortly after the chorea commenced she became
delirious, the temperature rising to 41 - 2 degs. C. (106’16
deg. Fah.), and subsequently collapsed and died.
A few hours later the post-mortem revealed general
hypersemia of all the internal organs with a fine endo¬
cardial deposit on the mitral valve and very recent
parenchymatous nephritis. Nowhere was pus to be
found. In the blood, brain, and cardiac valves a strepto¬
coccus was present, which, when cultivated and injected
into animals produced high fever and multiple joint
affections mostly ending in death.
This seems to be the first clinical testimony of demon¬
strating a micro-organism in chorea immediately after
rheumatism and its affinity with chorea.
§outh ^frira.
[from our own correspondent.]
Caps Town, Aog. 12th, 1899.
False Death Certificates.
The case of Dr. Anthony, the American sanatorium
practitioner referred to in my last communication, who
was charged with giving certificates of death for the
purpose of covering one Tate, an American negro, con¬
victed of illegal practice, was decided at the late session
of the Supreme Court. It was made clear that Dr.
Anthony had, in several cases, given certificates for
cases which had been attended by Tate, bnt had not
been seen by himself. In defenoe, however, it was urged
that these cases being coloured children, and Dr.
Anthony doing a large dispensary practice among that
class, he could not be expected to remember the cases
for identification, and that he had been under the
impression that he had seen them. In support of
this it was sought to prove that medical men
in the Colony are largely in the habit of giving
certificates for cases they have seen only once, and
that perhaps a considerable period before death. A
number of certificates given on these lines by medical
men in the neighbourhood were adduced in evidence,
and this view weighed with the jury, and the prisoner
was acquitted. It is only fair to mention that all medical
men find great difficulty in fulfilling the strict require¬
ments of the Registration Act, especially those who
practice much among the lower classes, or do out¬
patient work at hospitals. The callousness of many of
the colonial people, white as well as black, about the
ailments of their children is remarkable, and they con¬
stantly have recourse to the medical man solely for the
purpose of relieving themselves of legal responsibility.
A child is suffering from bronchitis or gastroenteritis.
It drags on without help for some time; then the parent
takes it to an out-patient department or to a consulting
room. It is prescribed for, and despite the warnings
of the medical man, that is the last he sees or hears of
Digitized by LjOOQLC
Ado. 30, 1899.
it until, perhaps, three weeks afterwards somebody turns
up, says a child is dead, and that a certificate is wanted.
Prolonged inquiry and search in your case book (if you
have one, which is too often not the case) elicits the
fact that on a certain day a child with a particular name
was attended for such a disease. You cannot in such a
c ase give a certificate that is worth anything, and yet
it is difficult to refuse. The general practice, however,
is to decline to sign the regulation certificate, and to
give a note stating the facts, which the registrar may
or may not acoept, as it pleases him. As a matter of
fact, some, at least, of the “certificates” quoted in
defence of Dr. Anthony were simply these informal
letters, and it was unfair to the proseoution that this
was not stated, and grossly unfair to the writers. The
local branch of the British Medical Association has
appointed a committee to go into the whole of the case,
as it is felt that, apart from the certificate business,
grave suspicion of flagrant “ covering ” lies against Dr.
Anthony.
Failure or the Nsw Medical Bill.
The Premier’s amended Medical and Pharmacy Bill,
from which much was hoped, has proved an abortion.
Its most important clause, one stating that the fact of a
man being a licensed chemist and druggist should be no
defenoe against a charge of illegal medical practioe, has
been abandoned in deference to action taken by the
chemists, and now we are face to faoe with the extra¬
ordinary anomaly that whilst the " practice ” not merely
the assumption of a title implying the right of
practioe, of medicine, is illegal for eveiyone else, a
chemist can practioe medicine to his heart’s content-
In deference to the same trade, a provision insisting
on every shop being under the “constant” super¬
vision of a licensed chemist, has been altered by sub¬
stituting "bona fide” for “constant.” Altogether
the Act now contains only one provision of any import¬
ance, the imposition of a penalty for wilful uncleanliness
or neglect on the part of all persons who attend mid¬
wifery. Under the old Act, the medical man or the
licensed midwife was subject to punishment, the un¬
qualified woman could do what she liked. It is remark¬
able that only one medical member of the House spoke
on the Bill, and he very feebly. As a matter of fact,
although we have quite a large proportion of our
fraternity in the Legislature, they quickly lose all fellow-
feeling with the profession. Perhaps it is not to be
wondered at. As a medical legislator said to me the
other day, medicine in South Africa, whatever it may be
elsewhere, is not the sort of thing to command the
devotion of any man of intellectual calibre and honour¬
able instincts.
The War Scare and the Medical Profession.
The Medical Congress which was to have been held
here in September, has been postponed to next year, on
aooount of the war cloud hanging over the oountry.
Nursing at the Cape.
The Medical Council has lately commented in very
strong terms on the lack of training given to nurses at
the New Somerset Hospital. At the last examination
not one nurse got near half marks, and this is not to
be wondered at when we are told that the only training
they get is obtained from the Matron.
Tee Medi cal P ress. 215
^Ehc Operating theatres.
CHELSEA HOSPITAL FOR WOMEN.
Separation of Adhesions and Vkntro Fixation of
the Uterus in a case ok Chronic Retroversion with
Fixation.— Dr. Arthur Giles operated on a married
woman, tet. 40, who had been under his observation for
nine months. Her symptoms were chronic pain and
menorrhagia. When first seen the uterus was found
bound down in a position of retroversion. A course of
treatment by means of glycerine tampons and vaginal
douches failed to lessen the immobility of the uterus,
and the symptoms persisted. She had been curetted
four times at different hospitals, but these procedures had
not diminished the menorrhagia. In the opinion
of the operator, therefore, the bleeding was due
not so much to a pathological condition of the
endometrium as to the fact that during menstrua¬
tion the normal uterine contractions were interfered
with by fixation. In view of the failure of palliative
treatment Dr. Giles advised freeing the adhesions and
ventro-fixation of the uterus by abdominal section. This
operation was eventually carried out after a preliminary
curettage. On opening the abdomen the fundus was
found lying in the pouch of Douglas, and firmly attached
there by adhesions, the appendages were likewise bound
down, but were otherwise normal. With a little diffi¬
culty the uterus and appendages were freed and brought
up into normal position. By means of two silkworm gut
sutures passed through the anterior surface of the body
just below the fundus the uterus was attached to the
margins of the abdominal incision, the suspensory ligatures
passed through peritoneum and fascia on each side.
The wound was closed in three layers. Dr. Giles pointed
out that the alternative to the treatment here per¬
formed was simply to let the patient continue with her
symptoms unrelieved. As regards other operations for
the purpose of curing uterine displacements he remarked
that they would not have been applicable in this cate,
for instance, Alexander’s operation was only practicable
when the uterus was free because traction on the round
ligaments would probably result in their rupture when
the fundus was held down; vagino-fixation had its
advocates, but he thought that especially when adhe¬
sions were present it was better to operate through
the abdomen partly in order to more clearly see the con¬
dition of the appendages, and partly in order to work
by sight as well as touch in the freeing of adhesions.
Unless the separation were carried out in such a case
with the greatest care, there was considerable risk of
injury to the rectum or to the sigmoid flexure. With
regard to the question of the influence of the operation
on subsequent pregnancy, he said that many cases had
now been reported in which such pregnancy had gone
on normally to term and ended in natural labour; this
result was favoured by passing the uterine stitches
through the anterior surfaoe rather than through the
fundus. When passed in the latter position the uterus
was hindered from rising into the abdomen in the
first half of pregnancy, and miscarriage might
occur. Theoretically it might be supposed that the
attachment of the uterus in its new position would
lead to bladder disturbances, but this was not found to
be the case in practioe; evidently the bladder readily
adapted itself to its new conditions and distension took
THE OPERATING THEATRES.
Digitized by vj oogle
216 Thi Medical Paras.
LEADING ARTICLES.
Aug. 80, 1899.
place laterally rather than vertically. Among the
benefits resulting from the operation was, he remarked,
to be noted the frequent improvement in the condition
of the bowels; in its faulty position the uterus often
increased the tendency to constipation or led to irrita¬
tion and straining; the pressure once removed it was
nearly always found that the action of the bowels showed
marked improvement; some patients stated that for
years they had not experienced a satisfactory action of
the bowels until after the operation.
It is satisfactory to record that the patient left the
hospital three weeks after the operation quite well and
with the uterus in good position.
Registered roB Trarsmissios Abroad.
JfUbical fxt&z mb Circular.
Published every Wednesday morning, Price 5d. Pcet free, 5id.
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Fob a Series or Ibsertiors Whole Page, thirteen insertions
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&c.—Seven lines or under, is. per insertion; 6d. per line
beyond.
Letters in this Department should be addressed to the Publishers.
^hc JEebical Jkcss anb Circular.
“ SALUS POPDLI SUPREMA LEX.”
WEDNESDAY, AUGUST 30, 1899.
DEATH CERTIFICATION.
The value of a well devised system of certification
of death to the community is none the less essential
because, it is to a great extent, self-evident. One of
its primary functions undoubtedly tends towards the
protection of the life of the individual. Another
result of vital importance to those engaged in the
scientific study of public health is the furnishing of
detailed statistics of mortality whereby the incidence
of disease and the progress of preventive measures may
be ascertained with some considerable approach to
accuracy. In the columns of a medical journal
however, it is hardly necessary to enter into the
advantages accruing from a well considered system
of death certification, for the subject in its practical
aspects is constantly before every medical mun during
the whole of his active professional career. It will
be noted that we have spoken of the good to be
derived from a sound system of registration of
deaths, and have carefully abstained from alluding
to specific lawB as at present imperfectly adminis¬
tered. To make a short statement, the atti¬
tude of the medical profession towards the
system as t stands is one of strong con¬
demnation. The death certificate is unsatis¬
factory as an evidence of decease, because there
is no obligation on the part of the medical prac¬
titioner to view the body, and the identification of
the deceased is of a superficial character, or is abso¬
lutely wanting. One of the chief causes of laxity is
the readiness on the part of the local registrars to
accept certificates from midwives, chemists, and
other persons who are not legally qualified to prac¬
tice medicine By issuing stringent directions to
refuse all suoh testimony the Registrar-General
would by a stroke of the pen do much towards
perfecting the present system. At the same
time, however, something would have to be done in
order to make inquiry by the coroner, and a post¬
mortem examination obligatory in all cases. Official
discretion is a valuable thing in its way, but in the
matter of death registration there is reason to think
it has gone a long way towards pithing the marrow
of the whole proceeding. In cases of illegitimate
children the danger of accepting a midwife’s certifi¬
cate is increased a hundredfold, and abundant oppor¬
tunity is thereby afforded to the child murderer.
A simple way out of the difficulty would be to insist
that no corpse should be buried without the certifi¬
cate of a duly qualified medical practitioner. If he
has not attended the deceased during life then he
shall grant his certificate on the strength of a post¬
mortem examination, and in the latter case his evi¬
dence shall always be given before a coroner’s-
court. The only further essential needed is that
the death certificate should be paid for by
the State. There is no other profession that
could be induced to grant responsible documents
without recompense in the shape of a suitable hono¬
rarium. There is some reason to hope that within
the next few years some amount of attention will be
bestowed upon medical matters by the Legislature.
If so, the question of registration is one of the most
urgent, and every medical man in the United King¬
dom will do well to make himself acquainted with
the bearings of this issue, which, although compara¬
tively simple, yet has a wide influence on his pro¬
fessional career.
HOSPITALS AND THE OUT-PATIENT
INQUIRY SYSTEM.
The method of appointing inquiry officers in the-
out-patient departments of hospitals is at present on
trial in London, and some remarks upon the subject
by Mr. C. S. Loch, Secretary to the Charity Organi¬
sation Society, published in the Times, seem to
call for consideration. It was in 1897 that the Hos¬
pital Sunday Fund intimated to the various hospital
authorities that they were desirous of seeing the
inquiry system adopted, and in fulfilment of this
expression of opinion many hospitals proceeded to
appoint inquiry officers in the out-patient depart¬
ment with a view to the detection and oheoking
of abuse. Mr. Loch in his communication refers
to the last annual returns in this regard,,
which the officers have furnished. These are not-
Digitized by Google
Ado. 80, 1899.
LEADING ARTICLES.
Thk Mkdical PB1S8. 217
without interest. Perhaps one of their most notice¬
able features is the diversity which they show. For
example, at one hospital with an annual roll of about
109,000 out-patients, the inquiry officer was only able
to discover, during last year, fifty-four out of this
number who were unsuitable for charitable relief. On
the other hand, at another hospital which deals with
nearly 37,000 out- and casualty-patients in the year
out of 12,562,1,069 were inquired into and 335 (or 31
per cent.) were rejected. Again at a third hospital
the rejections reached 28 per cent. We doubt, how¬
ever, if Mr. Loch iB quite fair in these percent¬
ages, assuming that they are his. It seems to
us that the percentage of abuse should not be
based upon the cases of rejection, among those
especially inquired into, but upon the whole number
of patients who present themselves for treatment.
The aim and intention of the inquiry system is to
ascertain the extent of the abuse, and obviously the
only way of arriving at a definite conclusion upon
the matter is to furnish the figures showing how
many patients attended at a hospital, and how many,
out of that number, were deemed to be unsuitable for
charitable relief. According, however, to Mr. Loch’s
estimate, only the percentages are given, which show
the rejections among those into whose circum¬
stances special inquiry was made, and it is clear
that these figures are destined to give a false
impression of the abuse which existed. But in
discussing these figures of the inquiry offioers,
Mr. Loch complains that they show the inadequacy
with which the system is being carried on, apparently
basing this opinion upon the fact that the returns
indicate that it is not usual to inquire into the circum¬
stances of every applicant who comes for relief. In
this connection he maintains that if in all the cases
attending at the hospitals dealt with in the returns
investigation had been made, the rejections would
have been very considerable. Surely however, it
is not the intention to make this inquiry system
develop into a “ detective method of procedure ”
by which the deserving poor will be called upon to ren¬
der a full account of their domestic affairs whenever
they present themselves at a hospital. We cannot
believe -that it is at all necessary to carry the system
to any such extent, nor can we believe that Mr. Loch
is correct in his assumption that if inquiry were
made into every applicant’s affairs that a large
increase in the number of rejections would be the
result. It seems to be quite possible that a com¬
petent and experienced inquiry officer should be able
to tell at a glance whether an applicant at a hospital
was or was not seeking to abuse the charity; in short,
in all cases in which applicants are clearly poor persons
no inquiries should be made into their circumstances.
It is not to be supposed that the poor are insensitive to
the demand made upon them to divulge their
domestic affairs ; they would not be human if they
did not feel resentment under the circumstances.
Clearly, therefore, they are thoroughly entitled to
consideration in the matter, and we submit that to
injure their feelings by asking unnecessary questions
under the inquiry system, is equivalent to carrying
that method to an unwarrantable and mischievous
extent. There is no doubt that abuse of medical
charities exists, but a greater abuse of another kind
would soon come into existence were every hospital to
become the arena of detective procedures compelling
the poor to divulge in all cases when applying
for relief the privacy of their homes. Again, this
system, conducted upon these lines, would further, we
believe, have another deleterious influence. It would
undeniably tend to destroy the self-respect in the de¬
serving poor, for whom, after all, hospitals are main¬
tained. Altogether, we think that much harm may be
caused both to hospitals and the community unless the
newly introduced inquiry system be conducted
reasonably, with circumspection, and upon lines of
expediency.
THE ALLEGED INCREASE OF LUNACY.
IRELAND.—III.
To resume from last week. At page 31 of the
Inspectors’ 46th Report, these gentlemen state
with considerable self - gratulation: “ The ac-
“ commodation, when first constructed, was little
“ better than in prisons—they are now comfortable
“ plaoes of abode with easy provision for the proper
“ care and treatment of the inmates, and, so far
“ as is reasonable for their comfort and recreation,
“ to the influence of which attractions may he ascribed
“ in no small degree the increased population of
“ these Institutions .” The italics are ours, as em¬
phasising an admission of permanent significance,
and is corroborated by their statistics—the number
of lunatics set down as resident during the gloomy
epoch of decadence in the District Asylums being
13,000 (round numbers), and 19,590 in 1897—that
is as much as saying we suppose that the living
therein is bo pleasant and attractive—the ideal of
the dolce far niente, that not only will the inmates
accumulate but the outer ones will be attracted.
Now as we inquired before, how are the 5,000 at large
known to be lunatics—and is it a certain fact that
the 20,000 are all insane, fairly chargeable to their
respective Districts, especially to the Metropolitan,
upon which we have shown such huge sums of money
have, and are being expended. Where is the Treasury,
or other actuary to ascertain this P A report was printed
some years ago pointing out means by classification
of asylums and otherwise for putting things on a
right basis. Why, at least, was not so much of that
report enforced p The assumption that lunacy is not
really on the increase in Ireland is further favoured
by the fact that its registered increase among the
better classes remains practically stationary, the
stock causes alleged in producing it being the same
in variation as in those in the Public Asylums (see
pages 52 and 84 of the last published Report—the
47th). Further, while the “ causes ” are common to -
both classes, the modes of admission and antecedent
circumstances are quite different. The average now
standing in the Private Asylums would appear to be'
677, based on the returns of the last three up-to-
Google
Diqiti.
NOTES ON CURRENT TOPICS.
Auo. 30, 1899.
218 Thk Mem cal PBK88.
date years, being registered respectively as 663, 676,
and 691, as derived from the Blue-Books — so far back
as 1880 the number was 622, and the average,
based on the series of years, subsequently to 1895,
is 632, so that for twenty years the number regis¬
tered has not got out of the six-hundreds—we
think a deduction, unless shown to be inaccurate,
showing most conclusively that the development of
the public asylums is responsible for the registered
increase; in other words, that they are luxurious
refuges for the poor and destitute, fortunate to escape
there from their squalid surroundings and the
opposite being the rule in the better classes. We
have already expressed our doubts as to the ac¬
curacy of the deductions drawn from official
statistics upon abstract subjects, respecting which
all sorts of ingenious and complicated group¬
ings may be devised, especially as regards insanity
by faddists, having a turn that way. It seems
to us almost as difficult to reduce its kaleido¬
scopic manifestations to figures, as those of genius,
poetry, or any other mental determination. In justice
to the compilers of some of the recent Irish
Lunacy Blue-books, it should be admitted that
they present the various registrable aspects of in¬
sane statistics through the old grooves in the
fullest and clearest manner, witholding nothing cal¬
culated to enable students of the subject to see how
it actually stands and form their own opinions—cer¬
tainly affording a marked contrast to the jumbled
and incoherent statistics presented through the
medium of the voluminous Blue-books of some pre¬
vious decades, which were utterly destitute of point
or method, and looked as if they were dis¬
tilled from the seething brain of a person mad
with figures. But these are occasionally spontaneous
admissions, apparently the outcome of an enfant
terrible. We only regret that, as pointed out
in a letter to the Nation of 3rd last April, the prac¬
tical subject of expenditure is not fully given under
the headings of salaries, allowances, and pensions, as
showing all the consequences in addition to those
we have touched on, of the tremendous increase in
registered insanity. There would then be a nearer
approach to a complete case being stated. It must
certainly be also admitted that so far as we have
searched we cannot find that the inspectors commit
themselves to a positive opinion, or indeed any
opinion at all, as to whether insanity is really increas¬
ing or not; they give full data, according to their
light, and apparently leave others to find conclusions.
There are in Ireland 20,000 registered and 5,000 un¬
registered lunatics, or thereabouts. We therefore
presume that the latter are as dangerous to society
as the former, and have as much nght to asylum
treatment, that there are in the asylums many who
have no right to be in such costly structures, and many
outside who have. What therefore should be
done P It is a question for intelligent physio¬
logical experts, men of the world with a profound
knowledge of human nature, and single-mindedness,
not for Commissions, Treasury economists, with their
complacent second-hand utterances in the best
Queen’s-printere’ type, or self-seeking place hunters.
All the alleged lunatics both inside and outside
should be subjected to some filtering process, and
as stated in the Nation letter, we think sugges¬
tively, such tests should be applied by zealous
and competent authority, as would indicate indivi¬
dually the exact stage below the “ sound mind in
the sound body” where such insanity begins and
responsibility ends as warrants the restraint and
treatment of its victims in expensively equipped insti¬
tutions. If this were practicable it would bring the
whole matter to such a test as would produce definite
results, and we think the attempt should have been
made before the shekels were expended. Within
the last twenty years a Commission took the view
that lunacy directly under the Local Government
Board, would have met every exigency of the case.
There were then special personal reasons. It had no
result. Some years later an ardent Scotch specialist
changed all this, and inspired different views, equally
futile as regards a settlement of the question. Now
we have the new Local Government Act essaying
to deal with it as best it can on an entirely financial
basis, with meagre data, instead of having it under
its own Board of Administration, so that we suppose
insanity will go on increasing, until the exigency of
the money question becomes acute. We have already
referred to the appearance of the English Report;
we await its Irish reflection.
$otz& mt Currmt topics.
Golf and Neurology.
It has been said that every other man in America
is now so addicted to Scotch ways and habits that he
wears heather-tweeds, plays golf, drinks “Scotch,**
and says “ Hoot’s mon.” Of such must be Dr. Irving
C. Rosse, Washington, who contributed to the Ameri¬
can Neurological Association a paper on golf from
a Neurological view-point. Medical men have their
hobbies in sports and pastimes, and these are some¬
times regarded with a professional eye and with a bias
in their favour which is largely due to the man’s own
aptitude and predilections. We are told that
here we have a royal road to physical exhila¬
ration in a game that can be played all the year
round, independently of atmospheric vicissitudes,
during all the seven ages of man, by delicate young
girls as well as by strong athletes, and even by
decrepit old men, whose declining powers do not
admit of severe exertion. We must, however, dissent
from the statement that there is absolutely no danger
attached to the game, and that consequently no
accidents ensue. Dr. Rosse is evidently new to the
game and knows little of its history, even its latest
history, or he would know that fatal accidents have
occurred, at least in Scotland, from golf ball
strokes. There is a great deal to be said in
favour of golf for those suffering from heart lesions,
arterial calcification or certain hysterical conditions,
and undoubtedly as a medical adjunct it is not to be
Aug. 30, 1899. _ NOTES ON CURRENT TOPICS. The Medical Press. 219
despised. Dr. Rosse, while enjoining moderation,
alleges that benefit has been derived in some cases of
cough, nervous asthma, and in affections of the
bladder and prostate; but it is pre-eminently in
functional nervous disease that our great Anglo-
Saxon game is to be recommended both as a pro¬
phylactic and curative. As to its being a certain
remedy for insomnia, there may be some doubt as
we have met, within the last few days on the golf
course, a goifee, who despite his golf exercise, sufEered
from insomnia. A great deal might be said in favour
of golf as a mental and nervous tonic, but not to the
exclusion of other sports which have many of the
same advantages. Undoubtedly it is a good thing
for the physician to know from his own actual
experience the physical requirements of different
games, and their physiological uses. The use of golf
as a remedy in the treatment of nervous ailments of
a functional character, whether they affect the mental
or visceral spheres, is worthy of all consideration.
The Workhouse Doctor as Undertaker’s
Help.
It will be recollected that the guardians of North
UUt, in Scotland, had got themselves into serious
trouble by their persecution of their medical officer,
Dr. Lamont, whose case was brought before Parlia¬
ment and elicited most sympathetic assurances
from the Lord Advocate. The guardians have
now retorted on him by charging him with
savage conduct in coffining the body of a
pauper. At present we are not concerned with the
truth or falsity of these charges, but we should like
to know whether in North Uist or elsewhere it is any
part of the duty of a medical officer to act as under¬
taker’s help in coffining deceased paupers. It seems
incredible that any self-respecting medical officer
would allow such a filthy function to be imposed
upon him.
The Block Against Domestic Legislation.
We have frequently commented upon the difficulty
—the almost impossibility—of obtaining reforms of
the laws or system which govern domestic or class
interests unless the objects aimed at seem to be large
enough for the Government to take them up as part
of their political programme. Legislation on the
initiative of private members is practically dead, and
as all the bills which affect the medical profession are
of this class, progress or reform in onr laws is prac¬
tically blocked. This fact is illustrated by a recently
published return of the number of bills promoted in
last Parliamentary session. Out of the total of 117
days during which the House sat, the Government
seized 98, leaving only 19 for consideration of all
private bills. Needless to say, not more than one in
a dozen of such bills ever got beyond a first reading,
and not more than one in fifty got through
its stages. Really, as the phrase goes, some¬
thing should be done to afford a chance for
legislative reform of defective laws on domestic sub¬
jects. The Government, we submit, has not dis¬
charged the whole of its duty by passing one or two
great contentious bills in the Session. If the time
expended in debating the London Government Bill,
for which the nation cared little or nothing, had been
given to domestic legislation, a host of such bills
which never had a chance could have been disposed
of. As the matter stands, the *• hope deferred ” has
made the heartB of private members sick, and they
are giving up even the demonstration of principle
implied by the introduction of a bill.
Enteric Fever in the Indian Army.
The subject of typhoid fever in the Indian Army
like the poor, is always with us. Early in the present
month a brief and unsatisfactory statement upon the
point was made by Lord George Hamilton in the
House of Commons. The main fact of the position
is that of late years the disease has increased rather
than diminished. An experience of that kind is
directly the reverse of what usually happens in any
community of average sanitary enlightenment. What
preventive administration could explain away the
awkward fact that in several Indian stations
enteric fever is now admitted to be endemic ? With
practically no limit to the amount of reason¬
able expenditure within their command the long
continuance of enteric fever in a particular station
brands the responsible local administration as hope¬
lessly incompetent. The truth appears to be that
the Indian Medical Service is lamentably behind the
times. The spirit of militarism regards advanced
scientific methods with suspicion, and woe to any
junior officer who attempts to advocate the latest and
most approved plans of investigation and prevention.
At the recent Portsmouth meeting of the British
Medical Association an Indian Medioal Officer was
able to boast of the fact that three distinguished
scientific civilians had been given official posts. The
concession is doubtless a forecast of coming events, but
the candour of the speaker would have been more con¬
spicuous had he not omitted to add that the appoint¬
ments had been made only within the past few months.
The Superstition of Spitting.
The habit of promiscuous expectoration is an
uncleanly, disgusting one, but how curious it is that
it should be environed with so much superstition.
In days of antiquity spitting was resorted to in order
to ward off dangers, and up to the present time luck
is wooed and misfortune avoided by the pro¬
cess of spitting. Newborn children are treated
to a lavish expectoration by midwives in certain
parts of the country; fishermen spit upon
their hooks after baiting them, and it is
considered to be absolutely essential before washing
in the same basin in which a friend has washed, to
spit into it, for otherwise a quarrel would be sure to
follow. But it is on the Continent that the supersti¬
tion of spitting seems to reach its worst degree. In
Oldenburg, for example, the loathsome custom
prevails of always spitting three times into the
kneading trough. Again, babies in Hungary are
especially singled out as objects of the super¬
stition; the custom there is to spit into the
I babies’ faces in order to bring them good luck.
Imagination almost fails to picture the filthiness
Digitized by Google
220 The Medical Press.
NOTE8 ON CURRENT TOPICS.
Aug. 90, 1899.
and danger of such a disgusting act as this. In
Silesia and Bohemia, persons generally spit three
times when they meet an old woman, but it is quite
difficult to conceive why the presence of an aged
female should thus call for such a profligate evucua-
-tion of the salivary secretion under these circum¬
stances. Again, in Sweden, a great deal of
-superstitious spitting seems to take place. Persons,
^for example, spit into their beds before retiring;
playing cards are spat upon when the luck is bad, and
every new suit of clothes is made the object of a gross
.expectoration, but for what reason it is quite impos¬
sible to imagine. Superstitions are said to die hard ;
and it would seem, from the above facts, that the one
under discussion has been endowed with a pheno-
-menal vitality. Despite its absurdity, filthiness, and
unhygienic character, it has still survived; whereas >
.on sanitary grounds, it should, without further loss
of time, be “ coffined ” and confined beyond all reach
of resuscitation.
-The Operative Treatment of High Myopia.
One of the special features of the recent Inter¬
national Congress at Utrecht was the grave warning
given by Dr. Wolf of Melbourne (formerly of Glas¬
gow) and Professor Silex of Berlin against the indis¬
criminate extraction of transparent lenses for the
cure of high myopia. Passing by the consideration
that the operation destroys the accommodation, and
pro tanto, injures near vision, these very capable
critics pointed out that of itself the operation of
removal of the normal lens has always been recog¬
nised as a specially difficult and dangerous one. The
.chief ground of objection is the probability of detach- i
ment of the retina as the result of the manipulation
in an eye which for years had been subjected to
chronic sclero-choroiditis. Dr. Wolf considers this
danger so real that he warps the profession that a
wholesale performance of the procedure would mean
a wholesale sacrifice of eyes, and he urges that it
should only be done in exceptional cases. Professor
Silex confirmed this warning by the statement that in
an experience of nine months he had observed twenty-
three cases of retinal detachment after extraction of
the normal lens, and only three eases without such
operation. On pathological grounds the contention of
Dr. Wolf and Professor Silex seems to be justified.
. Cockle-Typhoid.
A simultaneous outbreak of enteric fever in
different quarters of Exeter has recently been in¬
vestigated by the Medical Officer of Health. As a
result of his inquiries, it was ascertained that all the
persons included in one group of notifications had
visited Exmouth and there had eaten raw cockles
gathered from the mud-flats close to a sewage outlet.
In the absence of other apparent source of
infection, the local authorities seem convinced
that the origin of the epidemic may be traced to the
infected shellfish. It has been suggested to the
Exmoutb Council that the sale of cockles taken from
that particular part of the foreshore should be in
future prohibited. Fortunately for the public,
cockles are rarely eaten in an uncooked state,
or infection from that source would be doubt¬
less a far more common event. In the case of
oysters, there are solid gastronomic reasons why
they should be eaten raw. Who that has known the
delicate English “ native ” fresh from his watery lair
would thereafter hear of that toothsome tit-bit being
stewed or roasted ? Suoh devices of the kitchen may
be needed for second-rate foreign oysters, but not for
the aristocratic British mollusc. But henceforth let
every sane inhabitant of the United Kingdom who
wants to eat cockles Bee that they are boiled.
Sunbonnets for Horses.
It is now two years since the above subject was
introduced into the columns of The Medical Press
and Circular. Our remarks thereanent com¬
manded the widest popularity, and were even immor¬
talised in the pages of Punch. The suggestion was
at the time received with some amount of sarcasm
and incredulity, but the summer covering for the
horse’s head is now an established fact. At various
English seaside places this year the equine bonnet
has been in evidence, and has ceased to attract any
more special notice than a motor cycle or a lady
rigged out in the most rational of “ bloomers.” It
was at first hoped that the horses’ bonnet, if intro¬
duced, would materially assist in the revival of the
straw hat trade at Luton, but we note that not a few
of the new hats are made of a thick glazed- calico
material. The effort to protect horses against the
effects of the sun may be regarded as humane rather
than scientific. It is doubtful if heat stroke, in the
ordinary sense of the term, ever attacks the horse.
Sudden syncope in hot weather may usually be
ascribed to over-work and want of water. A horse
naturally wants more to drink in the hot weather
than in cold. How many horses, private and other¬
wise, are provided with an extra supply in summer ?
Metropolitan Workhouse Administration.
From time to time incidents occur in the work-
houBes of the metropolis that prove the urgent want
of reform. If we mistake not, Stepney has earned
an unenviable reputation in that respect, a sus¬
picion that tempts one to urge the necessity of a
searching inquiry into two recent “scandals.”
In the first instance a father called to see his
child, a patient in the Stepney Union Infirmary
at Bow, and was told that the boy was asleep,
whereas he had been dead for a period of time it is
impossible now to determine. From evidence ten¬
dered to the Coroner it appeared that two night
nurses were expected to look after six wards con¬
taining one hundred patients. This under¬
staffing is nothing less than a scandal and a disgrace
to London. The Coroner remarked that at one time
there was only one nurse to 800 patients in the work-
house, but there were now six, the increase being mainly
due to representations by juries. Where is the
Local Government Board, and what have the
Digitized by Google
Axto. 80, 1899.
NOTES ON CURRENT TOPICS.
Thx MxdicjlL Press. 221
official inspectors to say to the continuance
of that state of affairs? The second occurrence
was the death of a young man who was placed in a
straight waistcoat by an attendant, and died appar¬
ently without having been seen by a doctor. Death
was due to pneumonia. If the facts are as reported,
we have no hesitation in saying the affair is a dis¬
grace to civilisation, and reflects no little discredit
upon the controlling administration of the Local
(Government Board, with whom the responsibility
ultimately rests. Will the Board kindly look up the
reoords of Stepney Workhouse, with special refer¬
ence to inquests held upon inmates during the past
dozen years in and out of the padded room ?
The Law Regarding Death Certificates.
The law is very clear upon the point that a
medical man is bound to give a death certificate in
the case of patients whom he has attended during
their last illness. Moreover, on failing or refusing
to do so he is, on conviction, liable to a penalty. A
Birmingham practitioner was, therefore, clearly in
the wrong by refusing a certificate of death to a
parent whose child had died under his care. Never¬
theless the facts of the case are not without interest,
and, as disclosed at an inquest, are as follows :—A five
days’ old infant of a labourer died.'and the medical man
who had attended its mother in her confinement
refused a certificate of death on the grounds that
the father had broken his promise to pay the
midwifery fee of fifteen shillings. Ultimately the
coroner for the district was communicated with, and
an inquest was directed to be held. It then tran¬
spired that the practitioner had, without giving
notice to any one, forwarded the required certificate
of death to the local registrar, a course which
would have been sufficient to have removed
all the difficulties in the case if only those con¬
cerned had been informed thereof. However, the
coroner pointed out that three offenoes had been
committed by the practitioner under the Act.
First, he refused a certificate ; second, he wrongfully
sent a certificate direct to the Registrar; third, he
failed to report to the father what he had done. In
defence of his action the medical man desired it to be
known that he had done a great deal of gratuitous work
in his neighbourhood among the poor, and that he re¬
fused the certificate because the husband of his patient
had not kept his promise in regard to the payment of
the reduced fee of fifteen shillings. He regarded, there¬
fore, the action that he took in the matter, although
illegal, as a punishment to the man for his failure
to discharge the debt. Reference was further made
to the fact that the class to which the husband
belonged, not infrequently made use of “ medical
certificates "—surely not death certificates—for beg¬
ging purposes, and it was for the purpose of avoid¬
ing such a contingency that he sent the certificate of
death direct to the Registrar. While, however, we
can quite sympathise with the medical man at the
shabby treatment which he received from the hus¬
band of his patient, nevertheless, it is impossible to
defend the steps which he took in the matter. More¬
over, it was scarcely a dignified method of showing
his resentment by doing that which was perfectly
illegal. However, it is satisfactory to note that the
jury took the very sensible view that the case did
not call for any expression of censure on their part.
The Malarial Mosquito.
The Liverpool School of Tropical Diseases has
scored a distinct triumph through Major Ross, I.M.S.,
one of its staff. Major Ross telegraphed from Sierra
Leone to the chairman of the school last week,
“ Malarial mosquito found, ask Government to send
at once men.” The expedition to the Gold Coast,
organised by the Liverpool School of Tropical Dis¬
eases, has thus proved already successful in attaining
its object, namely that of discovering the malarial mos¬
quito. But further investigation, of course, is needed,
and more assistance is required for carrying on the
work, hence the request in the telegram for aid from
the Government, There is every reason for believing
that in this discovery a notable advance has been
made in the etiology of malarial disease. It is too
early yet, of course, to speculate upon its value and
the beneficial effects in which it is likely to result;
but we trust that the Government will realise the
importance of the discovery, and will not fail to
comply with the request for further assistance to
prosecute the researches which have still to be made.
As a commencement in this direction the Liverpool
School have selected Dr. Fielding Ould to go out to
Sierra Leone. Dr. Ould will start from Liverpool on
the 2nd prox.
Prescribing Chemists.
Some correspondence lately in the British and
Colonial Druggist seems to indicate that prescribing
chemists do not wish to usurp the duties of medical
men, and that they would only be too glad to
cease prescribing over the counter if medical men
would cease dispensing their own prescriptions. “ We
only prescribe," says a correspondent, “ in the
interests of self-preservation; the doctors usurp our
functions, so we have to prescribe to get a living.”
This statement throws quite a new light upon the
matter, in claiming that chemists in order to carry on
their trade and gain a livelihood have to resort
to a procedure in regard to which they cannot
admit that they possess any legal qualification.
Moreover, the argument advanced is not a
sound one. Medical men who choose to dispense
their own prescriptions are acting strictly within
their legal rights; on the other hand, chemists who
prescribe are doing that for which, under certain
contingencies, the law will hold them responsible.
Furthermore, we question the correctness of the view
that chemists suffer so much loss of trade at the
hands of medical men If, instead of prescribing for
his customers’ ailments, a chemist referred such per¬
sons to a neighbouring medical man, it is certain that
the latter would refer them baok again with prescrip¬
tions to be dispensed by the tradesman. Such reci-
Digitized by GoOglC
222 The Medical Press.
SCOTLAND.
Aco. 30, 1896.
procity would only be natural. Again, it is well
known that medical men have often owed
their introduction to good patients through the
agency of chemists, and under these circumstances
both tradesman and professional man mutually sup¬
port the interests which belong to the calling of each.
We think that it is altogether a mistake for chemists
to suppose that they serve their own interests best
by trying to compete with the medical man. What
they should aim at is cultivating the goodwill of
practitioners, with a view to securing their custom 5
the statement is doubtless quite true that many amedi-
cal man would send his prescriptions to be dispensed by
a chemist if the assurance were forthcoming that only
the dispensing would be done. Possibly chemists may
“ self preserve ” themselves for the time being by the
practice of counter prescribing, but they are never
likely, so long as they continue doing so, to add much
to their business through the help and recommenda¬
tion of members of the medical profession.
The Boom in Sanatoria for Consumption.
One of the most noticeable features in the con¬
sumptive crusade is the present development of the
idea of the open-air method of treatment. In all
parts of the country we read of schemes being
launched for the erection of sanatoria. If the Prince
of Wales has done anything in this tuberculosis
movement, he has certainly been the means of pro¬
viding a new outlet for capital among those who
possess it. To be financially connected with a sana¬
torium has proved in several instances, so far, to be
an excellent thing. Now is the time to embark upon
such enterprises, if the desire is to make money out
of them. The supply by no means yet equals the
demand, nor is this likely to be the case for some
time to come, judging from the large number of
hapless victims of phthisis in this country, who will
probably be only too eager to profit by the new treat¬
ment, as soon as facilities exist for the purpose.
Methodical Suicide by Inhalation of
Illuminating Qaa.
A case of poisoning under unique circumstances
was investigated at a London inquest last week. A
man in a respectable position in life took a lodging
for one night, and shut himself up in his bedroom.
He was found in the morning—eight or nine hours
after death—seated in a chair with one end of a
rubber tube in his mouth, the other end being fixed
to the burner of the gas&lier, which was turned full on.
Dangerous Adulteration.
Perhaps the most dangerous and evil form of
adulteration practised by dishonest tradesmen is
that of imparting an artificial green colour to pre-
served vegetables by the use of sulphate of copper.
The British Food Journal has just drawn renewed
attention to the extent to which this practice prevails.
Our contemporary asserts that enormous quantities
of tinned and bottled peas, beans, and spinach,
“ greened ” by this artificial method are now in the
market and command a ready sale. The only way
that the public can protect themselves against pur¬
chasing these poisoned products is to exact a guaran¬
tee that the products which they purchase are free
from this abominable adulteration. The risk, how¬
ever, is so great of being poisoned by this means that
it would be much the best to avoid buying tinned or
bottled green vegetables altogethei.
The High Death Rate.
It was only to have been expected that the long con¬
tinued drought would have an evil influence upon the
public health, and as a matter of fact the death-rate-
throughout the United Kingdom last week was
higher than it has been for the past two years. The
deaths registered in London alone numbered
2,208, being an excess of 473. and equal to an annual
rate of 25'3 per 1,000. The chief, almost half, the loss
of life, occurred among the youngest infants, among-
whom the cause of death was mainly acute diarrhoea
Of the other causes of death, it is satisfactory to note
that there was a decline in that of measles, while the
other 29 zymotic diseases were below the average, and
the mortality from diseases of the respiratory organs
was the lowest recorded during the past twelve
months.
The Vaccination Contest in Leicestershire-
The Lutterworth Guardians, having been called
upon to appoint a vaccination officer, did so, but
under the condition that he should institute no pro¬
secution without their special sealed authority, which-
every one knew that they were determined never to
give. The English Local Government Board has
intimated to the guardians that they are advised by
the law officers of the Crown that any such limitation
or condition is totally illegal, and that any appoint¬
ment made thereunder is void, and the Board re¬
quires that a valid appointment shall be forthwith
made. If the guardians still refuse—as they probably
will—the Local Government Board can proceed to
make the appointment themselves.
gartlattfc.
["from our own correspondent.J
The Late Dr. John Duncan, M.A., M.D., LL.D.,.
F.R.C.S.Ed.—M embers of the medical profession in
Edinburgh, without doubt, medical men throughout all
Scotland, were shocked to hear of the sudden and un¬
expected death of John Duncan. Those familiar only
with his personal appearance, and aware of his devotion
to and skill in all that appertains to sport and to games
of endurance, would hardly be expected to know that
his strong frame had of late years been handicapped by
a weakened heart. His more intimate friends knew
more about the danger which threatened him, and,
although surprised and taken aback by his sudden
decease, had been for some time disturbed by his con¬
tinued display of muscular energy and enduranoe, which
seemed to exceed the bounds of prudence. Dr. John
Duncan died from cardiac failure after, it is said, a day
on the moors of Skye, where for a year or two he has
rented a shooting and deer forest. For some time back
he had Bhown signs of gouty invasion of his cardiac
structures, although unaccompanied by any very notice¬
able deterioration of pristine muscular powers. His
Digitized by Google
Aro 30. 1699.
CORRESPONDENCE.
The Medical Press. 223
iftattchestcr.
grandfather, the founder of the well-known firm of
chemists in Edinburgh, Duncan and Flockhart; his
father. Dr. James Duncan, a prominent surgeon in Edin¬
burgh in his day ; John Duncan selected medicine for his
future profession. But before becoming a medical student
he attended the arts classes in the University of
Edinburgh, and obtained the degree of M.A.
Hia progress through the medical curriculum was
marked by various successes. His fellow-students
elected him Senior President of the Royal Medical
8ociety as a token of their esteem; he filled various
junior surgical posts in the Royal Infirmary in succes¬
sion ; became an Assistant Surgeon to the same, where¬
upon he relinquished all practice save surgery ; lectured
on Surgery in the Extra-Mural School of Medicine, at
first to a handful, before relinquishing the post to large
numbers, of students; and, in short, beoame one of the
foremost surgeons of Edinburgh. The work for which
he was best known dealt with the method of application
of electrolysis, and the advantages connected there¬
with, in the treatment of aneurisms and nsevi. To
him also should be accorded the credit of an
early appreciation and advocacy of Lister’s anti¬
septic doctrines, and of successful action taken
on behalf of the Extra-Mural School of Edinburgh
for more extended privileges being allowed to Univer¬
sity undergraduates in their choice of teachers. Dun¬
can’s work for the M.A. degree endowed his mind with
a culture which it never altogether lost His tempera¬
ment was philosophical, cautious, inclining to action
upon second thoughts rather than at once -, his judg¬
ment was sound, as a rule, but was apt to err from his
tendency to base it upon too many possibilities, especially
upon too optimistic hopes. To the thoughtful student
all that he said in class or clinique was full of instruc¬
tion ; to ordinary parrot trained types his words conveyed
butlittle meaning beyond the actual naming of facts, hazy
in form because their minds lacked the more general know-
ledge presupposed to be in their possession by the lecturer.
The same might be said of him as an operator. Careful,
skilful, but cautious; thorough, but hardly daring
enough; when resolved upon operation he did his work
well; but he was hindered often by his natural tendency
to delay, to hope for the best, to trust nature to accom¬
plish in the case what she had done in some other
instanoe known to him. Especially in abdominal cases
was this hesitancy shown.
It was a common secret that he declined more than
once a seat in Parliament, as representative of a Scottish
University constituency; the hurry and excitement of
active politics were distasteful. But as member of
the Edinburgh University Court, of the Council of
the Colleges’ Medical School, an active partici¬
pator in the proceedings of the Royal College
of Surgeons of Edinburgh (he was President of
the College in 1894), as a manager of the Royal
Infirmary, and member of many other public and semi-
public posts, his calm and reasoned opinions were often
invaluable.
In all games of endurance and skill, and in all kinds
of sport, John Duncan was prominent. His strength of
muscle was great; his accuracy of eye unfailing ; in his
day the best wicket-keeper among Scottish cricketers; a
prominent rifle shot; an adept at casting a line tor
salmon, his achievements in this way were phenomenal;
a first-class shot at grouse or in deer-stalking; a noted
curler (perhaps his most favourite game); and latterly
a golfer of no mean merit. He had also an artistic
bent, and many oil-paintings of Highland scenes, of
considerable power, graced the walls of his infirmary
wards and side-rooms, the products of his brush.
When medical men in Edinburgh were at a loss about
anything of importance, as to what they should do, it
was generally suggested, “Ask John Duncan.” Now,
alas, his help can no longer be sought for; his judicial
mind will never again aid or advise his brethren in
medicine.
The Colonial Office officially reports that for the week
ending August 28th there were fifteen fatal cases of
/plague in Hong Kong.
[from our own correspondent.]
Royal Infirmary.— The battle of the sites still con¬
tinues The difficulty in arranging for the future of
this, the leading medical charity of Manchester, seems
insuperable. A special committee, consisting of mem¬
bers of the City Council and Infirmary Board, recom¬
mended a scheme, the chief features of which arranged
for the payment by the Corporation of £250,000, the
collection by the Corporation from the public of £60,OCX),
and an annual payment by the city of £2,500 for twenty
years, thus making a total of £350,000. For this the
city was to be allowed to acquire the present site,
admittedly the finest in the district, provided they
reserved an area of 3,000 square yards for a
receiving and out-patients department, and that not
more than 7,216 square yards of the whole site be
covered with buildings. This scheme of compromise
when presented to the Council on Wednesday last met
with but little favour. Many objections were made to
removing the infirmary from its present central position.
An amendment proposing to allow the consideration of
the question to be adjourned indefinitely was lost by the
casting vote of the Lord Mayor. Finally, it was decided
that the whole subject be referred to the Special Com¬
mittee for further consideration. And so the matter
rests apparently as far off a satisfactory settlement as
ever.
Owens College. —Once again the time honoured
custom of opening the Session with an “ Introductory
Address” is to be adopted. Sir J. Crichton Browne,
LL.D., M.D., F.R.S., has accepted the invitation to fulfil
this pleasing task Members of the profession have been
invited to attend. The address will be given in the
Physiological Theatre on Monday, October 2nd, at 4 p.m.
Southern Hospital.— The south side of the city will
before long be provided with an elegant and well-equipped
hospital for women and children. Plans are now com¬
pleted, and it is hoped that sufficient funds will shortly be
obtained to permit of the erection of the hospital in the
Whitworth Gardens as proposed.
Summer Diarrhcea. —The heat has been very oppres¬
sive during the past week. As might be expected,
diarrhcea has been very prevalent. The deaths num¬
bered 105. Of these 89 were infants under a year, and
of the 873 deaths from diarrhcea and English cholera
registered during the last eight weeks, 297 were under
twelve months.
Water 8upply. —In spite of the enormous consump¬
tion of water during these hot summer months, Man¬
chester has no anxiety regarding its supply. Lake
Thirlmere will not run dry just yet. The daily con¬
sumption iB estimated at 40,500,000 gallons. Sixty-four
days’ supply still remains.
QTorrespmtOena,
We do not hold ourselves responsible for the opinions of our
correspondent*.
THE CONTROL OF THE BRITISH MEDICAL
ASSOCIATION.
To the Editor of The Medical Press and Circular.
Sir, —I referred last week to the necessity of making
the meetings of our Council open to the press and the
members. Further consideration of the subject induces
me to lay more stress on this point than I was in a posi¬
tion to do at that time. When our representatives are
present at our branch meetings we find them anxious to
fall in with the views of their constituents; when, how¬
ever, they are present at the Council meetings they
apparently forget their constituents, and only vote
as they are directed by their leaders. Take the
question of medical defence as an instance. It
can hardly be denied that several of the members
> of the Council were decidedly in favour of the propo-
Diq
224 Thb Medical Phkss.
CORRESPOfc DENCE.
Ado. 30, 1899.
8ition that the matter should be referred to the indi¬
vidual members of the Association , and on the propo¬
sition of (I think) Dr. Myrtle, it was resolved that
certain questions should be sent to all the members
asking for their opinion on oertain points. Did any
member of the Council vote in favour of that proposal ?
Unless I am seriously mistaken there was not one
member of the Council who voted in favour of it. This
may be said to be ancient history, but it appears to me
a typical example of the Proceedings of the Council.
Respecting the publication of the Proceedings of the
Council; it is well known that at the Portsmouth
meeting the Council were sharply divided as to the
merits of the two candidates for the important office of
President of Council. I venture to say that the
members should be made acquainted with the details of
the votes given. Personally, I am of opinion that the
Council have chosen a very excellent man to preside
over their deliberations; at the same time I cannot help
feeling that a gentleman who has held the office of
President of the Association should not have sought
after any further distinction.
With respect to the conduct of the business of the
Association at the annual meetings, it may be truly said
that the Association has, through its permanent officials,
got into a groove, and not all the King’s horses will ever be
able to get them out of that groove. It is for the mem¬
bers to try and see whether their power is greater than
that of the officials. Year in, year out the old and bad
system remains. The Association tries to do more work
in four days than it is possible to aooomplish in twice
that time.
If we are bound to meet at the end of July or the
beginning of August, for heaven’s sake let us try and see
whether the actual routine business of the Association
oannot be got through with less worry to the members
and lees irritation to the Council.
We are, no doubt, a God-fearing and a religious body,
but is there any good reason whatever why we should
devote a whole morning to religious exercises ? Let us
take a common sense view of matters, and get through
our necessary routine business on Tuesday, and not
spread it over three days as we do, and have continued
to do for the past twenty years.
The absurdity of expecting members to remain and
transact business after they have listened to an oration
on medicine or surgery of an hour’s length is too much
to expect at any time, but more especially when the
thermometer usually stands at 80 degs. in the shade !
The East Anglian men are well able to look after
themselves, and I therefore do hope and expect that they
will not blindly follow the precedents of other meet¬
ings, but will make such arrangements as will conduoe
not only to the better transaction of business but will
add to the comfort af all those who wish to see the British
Medical Association become a greater power in the land
than it has ever been before.
I am. Sir, yours truly,
A Provincial Member.
To the Editor of The Medical Press and Circular.
Sir, —Owing to my absence from home, your com¬
ments upon my letter of apology read at the general
meeting on Wednesday, August 2nd, have only reached
me to-day. That letter was written with reference to
the discussion upon the action of the Editor of the
British Medical Journal in excluding oertain matters
from the journal, which I expected would oome up on
Thursday, after I had left Portsmouth. I can only
express regret that I was not present on Wednesday to
defend the action of the Council.
I am, Sir, yours truly,
Robert Saundbt.
Grand Hotel de l’Etablissement, Contrex6ville
(Vosges), August 20th, 1899.
TALLERMAN r. DOWSING RADIANT HEAT CO.,
LIMITED.
To the Editor of The Medical Press and Circular.
Sir,—R eferring to the report of the above case, which
appeared in your issue of the 2nd inst., and to the judg¬
ment subsequently delivered, will you allow me to state
that the offer of the defendants was not accepted, and
the matter will again go before the Courts on appeal ?
I am, Sir, yours truly,
C. E. Lsese, Secretary.
60 Wei beck Street, W., August 22nd, 1899.
THE ETIOLOGY OF RICKETS.
To the Editor of The Medical Press and Circular.
Sib. —I received from the late Sir Andrew Clark the
following letter when I sent him a copy of a short-
treatise on the Precedent Cause of Rickets, in which *1
gave the results of many years’ observation at the hospi¬
tal in Great Ormond Street, where about 8,000 cases of
rickets had passed under my care :—
“ Cavendish Square, W.,
“ January 23rd, 1890.
“Dear Dr. Robert Lee,—I have received the copy
which you have been kind enough to send me of your
very able, interesting, and suggestive essay on the
Precedent Cause of Rickets. It reminds me of the
best manner of Halford and of Holland, and I am much
obliged to you for your consideration.—Believe me, yours
faithfully, “ Andrew Clark.”
When I read in this week’s number of The Medi¬
cal Press and Circular Dr. Elgood's remarks on
a case bearing on the Etiology of RicketB, I felt some
surprise that bo little progress seems to have been made
since the days of Glisson in the general knowledge of the
cause of rickets.
I am quite certain that any of us with the evident good
sense of Dr. Elgood, and with the same experience that
was afforded me, will arrive at the same oondusion as I
have. Those conclusions were stated some years ago in
The Medical Press and Circular, as well as in my
lectures at Great Ormond 8treet, and during the past
ten years I am glad to find subsequent observation has
confirmed in my own mind the opinions I then formed.
I am, Sir, yours truly,
Robert Lee.
89 Gunterstone Road, West Kensington, W.,
August 23rd, 1899.
HOSPITAL REFORM.
To the Editor of The Medical Press and Circular.
Sib, —Will you kindly allow me to inform your readers
that the Hospital Reform Association are making
arrangements to hold a Conference in London during
the second week in October f
The subjects which will be set down for discussion
are—
1. The Inquiry System.
2. Payments by Patients.
3. Provident Dispensaries.
As it is most desirable that the conference should be
in possession of the facts relating to hospital administra¬
tion in the United Kingdom I shall feel grateful if
gentlemen who are interested in the subject will com¬
municate with me at their earliest convenience. I may
add that papers from laymen will be quite as acceptable
as those from medical men.
I am Sir, yours truly,
J. Garrett Horder, Hon. Sec.
Cardiff, August 19th, 1899.
TWO DANGERS.
To the Editor of The Medical Press and Circular.
Sir, —The profession at this moment is beset with two-
great perils to which no attention is, I am Borry to say,
being directed. The first and graver of these is the
flood of medical preparations with whioh the profession i»
daily deluged. I say, that if a stop be not put to this,
the treatment of disease will be taken out of our
hands altogether. The publio come to know what
is ordered for them, and then proceed to order
it for themselves. This is so apparent, that the
fatuity which can go on sustaining this system in
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oogle
Ado. 30, 1899.
LITERATURE.
Thk Mkdical PbKS8. 225
something incredible. Worse than all, only the merest
fraction of these much-vaunted preparations are of any
value, and thus the profession are simply lending them¬
selves to downright quackery on the mere strength of the
maker’s rhetoric. It seems to me to be indispensable
that a small body of experts should be appointed and paid
by the medical authorities and organisations combinedly,
and that to them should be entrusted the task of investiga¬
ting or superintending the investigation of every new
preparation brought out, and that no physician should
be permitted to prescribe anything until its precise
value should be first certificated by this new board. It
is mere nonsense to allege that busy practitioners can
investigate for themselves, and that their certificates
consequently can be of the slightest value. Such
investigations can only be carried out in hospi¬
tal wards by practitioners whose entire time
is at their disposal, who have the patients con¬
stantly under their eyes, and who are adequately
assisted by intelligent and industrious pupils. Is it not
time that our beautiful governing bodies and the heads
of our medical societies and associations should address
themselves to the remedy for a state of things which is
injurious alike to the public and to the profession. The
other peril, which is the nursing peril, I shall reserve
for a future letter.
I am, Sir, yours truly,
Thomas Laffan.
Cashel, Ireland, August 2nd, 1899.
SIR CHARLES LENNOX PEEL, K.C.B.
The death of Sir Charles, who, for very many years
filled the influential and responsible position of Clerk to
H.M. Privy Council, may be regarded as an event of
special interest to our profession, inasmuch as no man
had so prolonged and intimate experience of the making
of the medical law of the last forty years. He was the
confidential adviser of all the Ministers who attempted
such legislation, including the Marquis of Ripen, the
Duke of Richmond, and Lord Carlingford, and was the
intermediary through whom were passed to these
Ministers the representations of the educating and
qualifying bodies, and of all classes of the public
interested in medical affairs, and many of the
details of the successive medical Acts were sug¬
gested by him. The experience of all who came in
oontact with him in this connection was that he was a
most excellent chief officer of the Council, clear-headed,
discreet, businesslike, practical, and industrious. His
official manner was urbane, and that of a perfect gentle
man with no leaven of the dog-in-office style so com¬
monly assumed by officials in his position. It will be
well if a successor as amenable- to suggestion and so
considerate for the opinions of others can be found to
assume the official oontrol of the Privy Council Depart- 1
ment. I
JCitcraturc.
THE ALIMENTATION OF INFANTS, (a)
L This is one of the most carefully thought-out and
practical treatises on the alimentation of infants that we
nave seen for a long time. The high infantile mortality
which obtains in France, grafted on to a diminishing
birthrate, has excited the grave interest of philanthropists
and medical practitioners, and this volume represents a
serious attempt to grapple with a very urgent question.
In France, as elsewhere, digestive troubles are the
principal cause of the enormous mortality of the first
year of life, accounting for something like 96 per cent.
(a) “ Traits de l'Allaitement et de l'Alimeatation dea Enfant* du
Premier Age." Par Dr. A. B. Marfan. Paris: Steinheil. 1899.
of the total deaths. As might be expected, this mor¬
tality affects more particularly infants not brought up
at the breast, hence the importance of educating the
public—and may we say the profession—in the risks in¬
separable from artificial alimentation, and the means of
obviating them.
This work iB divided into two parts —one, theoretical,
which deals with the chemistry of milk, and the func¬
tions of digestion and nutrition in young infants ; and,
seoondly, a practical part in which the author discusses
the rules of normal alimentation. The latter part will
probably be found of the greater importance by his readers,
inasmuch as the author's own extensive experience
enables him to supplement the observations of others
by his own.
Special interest attaches to the chapter on the means
of securing milk for infants’ food free from disease-pro¬
ducing contaminations. He points out that boiling,
however carried out, cannot render hygienic a milk that
has already undergone partial decomposition, because
though the organisms themselves have thereby been
destroyed the milk still contains toxins elaborated by
them which are capable of determining grave sym¬
ptoms of irritation in the sensitive alimentary canal of the
very young. As it is impossible for dwellers in towns
to secure milk within a reasonable time after its leaving
the oow (eight to ten hours in winter, two hours in the
summer) domestic sterilisation is necessarily a delusion
and a snare. As the author, for what appears to him to
be good or sufficient reasons, deprecates the use of con¬
densed milk, sweetened or unsweetened, he recommends
the exclusive use of milk sterilised by approved methods
on a large scale on the spot, that is to say, before there
has been time for decomposition to have set in. He
describee with great wealth of detail the various methods
of wholesale sterilisation and the apparatus employed,
and reviews the advantages and drawbacks of each.
We have nothing but admiration for the admirable way
in which the author has done his work, whioh we have
read throughout with the greatest interest and instruc¬
tion. We can cordially recommend it to those of our
readers to whom the French language does not consti¬
tute a barrier.
PURDT’8 URANALY8IS. (a)
The importance which urinalysis has attained as a
guide to diagnosis may be gauged by the size of this
volume, and the fact that a fourth edition has been
called for within the space of four years. Chemists have
devoted considerable attention to the problems which
urinary analysis has brought to the fore, with a oert&in
measure of success, though the souroes of fallacy are still
many, and erroneous deductions still menace the incau¬
tious or too confiding observer.
The author has adopted the very convenient plan of
classifying urinary abnormalities into large general
groups, a plan which greatly facilitates the study of
substances more or lees olosely allied, either chemically
or pathologically. Under the two great heads of pro-
teids and carbohydrates, we have all the analytical pro¬
cedures of any value for their detection and diffe¬
rentiation, with an estimate of their respective
convenience and trustworthiness. Abnormal sub¬
stances not falling under either of these two
heads—and they are many—are dealt with in
a separate chapter. The chapters on “Urinary Sedi¬
ments ” and “ Anatomical Sediments ” are particularly
worthy of commendation.
The second part of the work is styled “Urinary
Diagnosis,’’ and here the prooees is reversed. We are
invited to take cognisance of the various diseased con¬
ditions of the various segments of the urinary apparatus
and then, step by step, we are instructed in the urinary
modifications associated therewith and dependent there¬
upon. The physician is thus enabled to direct his
inquiry (a) into the means of identifying a given abnor¬
mal substance; (b) its pathological significance; and
-—- 1
(a) " Practical Uramtlysia and Urinary Diagnosis." By Chariot
W. Purdy. M.D., LL.D., F.BC.S.P. and 8. (Kingston), Profeaaor o.
Clinical Medicine at the Chicago Post-Graduate medical School, Ac.
Ac Fourth edition. Detroit: The F. A. Daria Co. 1898.
ized by Google
226 The Medical Press.
LITERATURE.
Aua. 30, 1899.
■(c) the effects on the composition of the urine of a given
morbid condition, local or general.
The volume concludes with an instructive chapter on
the examination of urine for life assurance, and a de¬
scription of the reagents and apparatus for qualitative
and quantitative uri-analysis.
In the present state of medical science, with its
demand for precise and accurate observation, such a work
is indispensable to every conscientious practitioner.
THE CHEMISTRY OF DAILY LIFE, (o)
This is the second edition, revised and augmented, of
a work which is deservedly popular both here and in the
country of its author. The work embodies the substance
of a course of lectures delivered before a society at the Uni¬
versity of Kdnigsberg. These lectures cover a great variety
of topics, as will be seen by a glance at the table of con¬
tents. The author’s plan has been to show how intimately
our daily lives are concerned with chemical phenomena,
and he has succeeded in making chemistry, thus treated,
one of the most fascinating of sciences. It is just the
book for the intelligent adolescent or inquiring adult.
There is not a chapter from which the reader will not
glean unexpected and interesting information, whether it
be the subject of incandescent gas-lights, ur the manur¬
ing of land, questions of diet or the manufacture of
explosives. No one can read without interest an account
of the evolution of photography, and even the cyclist
will not despise news of acetylene, its properties and
peculiarities.
As the lectures are essentially for popular con¬
sumption, we should not be justified in yielding to
the temptation to cavil at sundry of the author’s
statements. The translator has done his work pretty
well, but we meet here and there with slips of grammar
which surprise us, coming from an M A. Some of his
sentences, too, read rather funnily—as for instance, when
speaking of sleep-producers, he Bays, “they produce
sleep, it is true, but they also produce many unpleasant
effects; and for this reason the number of those that are
of practical utility have greatly diminished, although it
is still certainly quite large enough.”
MY INNER LIFE. (i)
The author gives us in this volume what he calls a
chapter in personal evolution and autobiography. The
title is one to draw, and we naturally expect between the
covers to see the author depict his evolution with some¬
what more of the frankness than an autobiography, and
with a physiological and psychological detail which shall
make the sequences of his evolution clear and distinct,
and preserve to us a picture of scientific value. As an
autobiography the work is interesting, so far as it goes;
but one cannot help feeling disappointed that the author
is apt here and there to confound the evolution of
philosophy with the evolution of himself. Even a
E hilosopher is something more, and we should
ke to know something of him in his more
human and material character. The data of human
evolution can only be postulated as milestones so to
speak, but between these milestones there is much to
fill up, and many comparisons are required between man 1
and man. When we come, however, to the subject
matter of the volume, without regard to the precise aim
and scope of the work as indicated by the title, we must
confess to an uncommon interest in the author’s descrip¬
tions and views. The style and descriptive power of the
author are very good; but, still more, he is most instruc¬
tive and suggestive. The work is divided into five parts,
Boyhood, Early Speculations, The Lost Ideal, The
Search for the Lost Ideal, and Literary Experiences. The
chapter on Boyhood, though not without interest by
reason of the author’s style, serves chiefly as the
threshold of the real purpose of the book, and brings
(a) “ The Chemistry of Daily Life." By Dr. Lassar-Cohn. Trans¬
lated hy M. M. Pattison Muir, M.A., Fellow of Gonrille and Cains
College, Cambridge. London: H. Greveland Co. 1899.
(6) “My Inner Life.” By John Beattie Crozier. London:
Longmans, Green, and Co.
ub to the author’s early speculations, the fascina¬
tions of objective study, phrenology accepted and
discarded, and, later, the evolution to a higher
plane, viz., the subjective and introspective. When the
author comes to the question, A Law of the Mind—
what is it ?—and attempts to answer the question, we
feel that a gift of definition is wanting, though his illus¬
trations ore quite intelligible and certainly helpful.
Particularly helpful is his comparison of mind and body,
tbe one fighting against the circumstances that would
subdue it, the other keeping the erect posture against
the forces of nature that would bring it to the ground.
“ As the object of the action of the musoles is to restore
the bodily equilibrium, so the object of the play of
thought and passion is to bring the mind back to its
original equanimity.” The author’s philosophic doubts
ana criticisms arc well put forth, his explanation of the
“ lost ideal" and his history of hie search after it are
interesting studies in philosophy. His views on men
and conduct, and manners, as seen in this country are
narrowed by his own prejudices, range, study, and expe¬
rience. The work altogether is worthy a prominent
place in the literature of philosophy and psychology.
BURNS AND THE MEDICAL PROFESSION, (o)
We question if any literary work outside of medicine
will appeal more strongly to medical men than this.
Burns’s relations with our profession, if limited, were
cordial and appreciative. The doctors of his day, to
n 'e the author’s words, never “boggled” over his
ties, but exhibited a wise toleration and charity,
and the highest regard and enthusiasm in estimating the
poet and his work. The author is himself a good type
of his profession in this respect, and one reads his esti¬
mate of the reviews and critioisms of others—Currie,
Carlyle, Wordsworth, Wallace, &c.—with thorough
S t. The material for this work is Bcanty, but the
r has made the most of it. He has had to introduce
in the text the names and writings of not a few of the medi¬
cal men who, while only knowing Bums by tradition, were
able to deal with his life in no narrow unkindly spirit.
Of these, the palm must be given to Dr. James Adams, a
veteran Glasgow practitioner, who in the words of the
author, has been “an ardent and enthusiastic Burns
scholar all his life.” To him we owe “ Burns’s Chloris:
A Reminiscence,” and we might add a justification. Of
Burns’s medical contemporaries Dr. Findlay gives several
interesting glimpses, including Dr. John Mackenzie,
Manchline, who introduced the poet to the philosopher
Dugald Stuart, Dr. Gregory, Dr. Wood, and other
medical dons of the time in Edinburgh, Dr. John Moore,
the father of the hero of Corunna, and several others.
The author's work has been conscientiously done; and he
has produced a work of uncommon interest, well got up,
and containing some excellent portraits.
WINSLOW’S MAD HUMANITY (b)
This book is written for the general public, and the
argument, or raison d'etre of the author is, that a question
which has so often been foroed upon the notice of the
House of Commons—viz., the alleged alarming increase
of insanity, calls for the instruction of the public on the
matter. When the author proceeds to assert in the teeth
of opposite statements by official authorities in the three
kingdoms - England, Scotland and Ireland—that the
increase of insanity is real and not apparent, we must
express the doubt whether he really is a safe guide in
the matter for the general public. He admits that he
differs from the Commissioners in Lunacy; but he gives
no data—merely a general statement—in support of his
contention. Dealing with the causes of insanity, the
author gives us the stereotyped psychic and physical
causes as if they were distinct and definite factors
with a direct potency of their own. Causation is
not quite so simple a question as he would have
the general reader believe, and many potent influences
(a) ” Robert Burns and the Medical Profession." By Wi lliam
Findlay, M.D. Paisley and London : Alexander Gardner.
(k) “Mnd Humanity.” By L. Forbes Winslow, M.B., D.C.L.
London: C. A. Pearson, Limited.
Digitized by G00gle
Aug. 80, 1899.
LITERATURE.
The Medical Press. 227
are left oat of acooant in his calculation. Heredity is
left oat of account altogether. The Strain of Life ” is
belittled as a cause, but a few pages farther on we are
told that the solution of the problem is to be foond in
“oar own life of constant agitation, looomotion, and
restlessness.” The author treats of many matters, old
and new, especially old, and already more than thrice
told, respecting lunacy; but his aim throughout is
evidently to cater to the ouriosity of the general reader,
and to provide sensational pabulum. The book might,
with advantage, be boiled down to a quarter of its pre¬
sent size, and much irrelevant matter left out altogether.
It is by no means up to date in its information, and oan
only be regarded by means of its title, its examples of
strange mental aberration, and its illustrations as of
interest more to the morbidly curious than to the better
class intelligence of the general public.
HISTORY OP MEDICINE""^).
Ik the preface the author draws attention to the fact
that a second edition of the book has been called for
within a year, and looks on the demand as an indication
of the interest the medical profession takes in the history
of the development of the healing art.
With all this we agree; but we wonder if the interest
will be sustained if no better pabulum is supplied than
this poor stuff.
The usual method of writing a history of medicine
is to give a series of short biographical sketches of the
men who advanced the progress of the science and art
of medicine, men whose thoughts moulded the opinions
of succeeding generations. This is probably the most
interesting way and the most readable. It fixes great
names in our memory, and we feel proud of the pioneer
who hews his way through the jungle of prejudioes and
superstition illuminating the dark places with the lamp
of science. The fault in this method is that it too often
ignores the extrinsic circumstances that so largely in¬
fluences medical thought. We think a good history of
medicine should oombine both methods. The masters
of medicine have always reflected the spirit of the age
to which they belonged. Medicine, like otner sciences, has
been promoted and retarded by the prevailing spirit of
the age, and from time to time men have beoome
prominent who were unworthy of high plaoe, and whose
influence was inimical to the science.
The narrator of history should note the evil influence
of the incompetent quite as carefully as he tells the
vivifying influence of the divinely inspired.
Holding these views, we come to examine this book of
Dr. Park, and we confess to a feeling of utter disappoint¬
ment. He seems to have provided himself with some
petty biographical dictionary, and to have arranged his
little biographical sketches chronologically, and plaoed
the product before the profession as an epitome of the
history of medicine. We are all the more surprised at
this, for the author publishes a list of the principal
works consulted for the making of his book; works rich in
information. Yet the author’s volume seems little better
than a filter which has retained the dregs and allowed
the generous wine to escape.
In the first ninety pages the history of medicine among
the Hebrews, Egyptians, Orientals, Chinese, and early
Greeks is told. And as the reader finishes the pa^es he
is forced to acknowledge that he has learnt nothing of
the wonderful impetus to Greek medicine that resulted
from the conquests of Alexander the Great; nothing
of the introduction of Indian drugs into Greek practice,
nothing of the evil influence of the science of the Chal¬
dean astrology, nor of the influence for good of Baby¬
lonish clinical observation.
We search in vain for any account of the fall of the
great school of Alexandria. What was the fall of that
great school due to ?
Phcenecia and Carthage, with their daring navigators
and great commeroe, very materially promoted the
science and art of medicine and the fact is not even
mentioned. _
a ) “An Epitome of the History of Medicine,” by Boswell Park, .
.. M.D., Profeesor of Surgery in the Medical Department of
the University of Buffalo. Second Edition. Philadelphia, New I
York, Chicago: The F. A. Davis Company, publishers. 4899.
Of the early days of Christianity, when its disciples,
wishing to accentuate their separation from the Heathen,
the Jew, and the Moslem, ignored the laws of sanitation,
and looked on plagues of their own creation as Divine
punishments, the author seems ignorant of its evil
influenoe. We get platitudes and generalities when we
seek concrete facts.
The sick Christian sought not a physician. He
sought in Divine mercy a remedy, and to a cleric be told
I his grief, trusting the clerical experience to relieve both
I psychical and physical ills. Greek science was forgotten-
and the writings of the great masters, effaced as far as
might be by pumioe-stone. The parchment, became the
palimpsests for the lives of saints, the great majority of
whom retarded sanitation in their own day, and who are
happily forgotten in ours.
The strength of the age of superstition lay in
the homocentric theory, so firmly believed in that
to doubt it was to incur the penalty of death.
The stars rose and set to warn or encourage. The
whole firmament it was believed was engaged in influ¬
encing the most trivial of human affairs. Science could
not make progress in such an age. Here and there some
few lovers of truth sought out natural causes for super¬
natural seeming8, and the lamp of scienoe was not wholly
put out. Of these students of nature were the founders
of the University of Salerno, and how it tells us of the
effect of superstition on the Christians of the period to
learn that none of them had hand or act in the glorious
work. The Commonwealth of Amalphi protected the Uni¬
versity in its early days from its Christian enemies,
more particularly from those who felt instinctively
that in the light of truth their insulting practices would
be too manifestly absurd to live.
The rise of Moslemism, the capture of Constantinople,
and the Crusades did much to promote medical scienoe.
The cleanly, sober, educated Moslem made the Christian,
in time, ashamed of his filthiness, his drunkenness, his
ignoranoe. The wealthy traders of the Italian common¬
wealths soon came to copy in their buildings the light,
airy, well-ventilated homes of the Moslem, and in time
the Northern Barons dwelt in a house, not a dungeon,
and swept out the stinking mass of rushes and excre¬
ment that littered the baronial hall. Gunpowder finally
swept those dens of disease and vice from the land, and
its civilising influenoe indirectly promoted medical pro¬
gress.
The rediscovery of glass and brickmaking revolu¬
tionised the conditions of social life; the mud hovel was
replaced by a brick house, the materials of which
readily lent themselves to the beautiful architectural
design of the glorious days of Elisabeth. The homes of
the people now became light and dry.
How the fearful plague of black death in England
improved the condition of the peasant and promoted
better tillage, draining of marshes, the getting rid of
malaria, the lengthening of the average of life is not
even referred to.
Superstition was dying out, the poor preachers of
Wycliffe were going through the length and breadth of
the land inculcating reason, and a little later Regi*-
nald Scott showed once for all the absurdity of crediting
poor, feeble old women with the power of sending sick¬
nesses.
Dr. Park misses altogether the influence of Caliphate
on medicine. He refers in no way to the scrupulous
cleaulinets of the Arab surgeons in dressing wounds;
the well-lit, well-ventilated hospitals; their children’s
hospitals; their insistence on fresh air and light, and on
suitable clothing and personal cleanliness. We td-day are
doing no more than reverting to the surgical maxims of
the Western Moslem, and even now our hospitals have
nothing comparable to the enolosed platzas, with their
fountains, palm trees, and covered walks. On light
bamboo frames suitably covered, the patient too ill to
walk, was carried into the open air, where he was waited
on by nurses. In those Moslem hospitals fevers were
treated by cold water douches and baths, and in the hot
plains of Spain fans were kept constantly at work to
renew and oool the air.
Ferdinand swept the Moslem from Spain, and with
228 Thb Medical Press. LITERARY NOTES AND GOSSIP.
Ado. 30, 1899.
them went all that made the country great. The treasure*
which their sobriety and industry accumulated were dis¬
sipated in the wars of Charles and Philip, and the science
taught in their universities made possible the deeds of
her navigators.
The most casual reader of modern medicine must feel
that the discovery of America had a great influence on
medicine, if for no other reason than that it spent a
blow to authority—liberated thought.
How the study of chemistry and of mathematics in¬
fluences medicine is almost untold. In this connection
we should expect to find honourable mention of Priestly
and Beddoes, to whom we are really indebted for modern
anesthetics.
We cannot give further space to pointing out the
many deficiencies of the book. It may, however, assist
our readers to find that the author includes among
great men of the past Barnsby Cooper, “ who achieved
an eminence that is only dimmed by that of his uncle
(Sir A. Cooper).” Sir B. Brodie, is also included, a man
who did more to Btay the progress of surgery than any
other surgeon: every page of Brodie’s writings tells of his
lack of surgical knowledge. He was one of the sycophants
of the “booing” class, whose incompetency for the
honourable position he was elected to became very
evident on his promotion.
Guthrie is also included. We may charitably con¬
clude Dr. Park never read the “ Commentaries.”
John Bell is dismissed in a few lines, no mention is
made of his opening the cavities of the body or teaching
E. McDowell. Ireland fares badly. Bellingham, who
describes the “ sledge hammer ’* pulse, wrongly called
Corrigan’s in the Medical Press is omitted. The
Brothers Griffin, whose book on spinal diseases is so
often copied, and so seldom acknowledged, are unnamed.
O’Hallaron, the pioneer in cerebral surgery, the pupil of
Percivall Pott and friend of John Hunter, is not even
named.
The discoverer of the membrane Jacobi, who as a boy
was elected a member of the Royal 8ociety for original
research, is unnamed.
Mackeever who removed successfully eighteen inches
of the ileum from a woman in the beginning of the cen¬
tury, finds no place.
Kane, whose investigation of the composition of white
precipitate powder, which preceded Gerhardfs studies in
the formation of substitution products, and laid the
foundation for the production of synthetic products, is
ignored.
Mary Donnelly's wonderful Ccesarean operation per¬
formed in a little Irish town more than one hundred
years ago, is worth mention if only to show that necessity
develops unexpected powers.
Of lesser faults time and space forbids our writing.
We may, however, mention that Willis is mentioned in
connection with the “circle of Willis” alone, and of
Astruo the historian, simply records that he was a
syphilographer. This of the man who equalled Erasmus
in learning, and Luther in boldness of expression.
Siterarg JtotEB anb Gossip.
Part III. of “The Catechism Series” (E. and 8.
Livingstone, Edinburgh) contains examination questions
in the practice of meaicine, with answers. This method
of instruction had its vogue many years ago, at a time
when Sandford and Merton came to the fore. It appears
that it is still appreciated by students, as some of them
are said to be anxious to level up their knowledge
and remedy any blanks. For the really industrious this
little book will be but of scant value.
• •
•
Under the title “ Newer Remedies" (Blakiston, Phila¬
delphia) Dr. Virgil Coblentz has compiled a handy little
synopsis of remedies of more or less recent introduction.
He gives synonyms, sources, methods of preparation,
taste, solubilities, incompatible*, properties, and doses,
thus constituting a reference manual for physicians and
pharmacists. The number and varieties of these new
agents are calculated to inspire awe, but fortunately
many, if not most of them, are stillborn, and are not
likely to vex the soul of the prescribes This is a con¬
venient book to have in one’s library, for it does occa¬
sionally happen that one experiences the need of some
information concerning one or other of the new remedies
that have come to stay.
V
We have just received the volume—January to June,
1899—of Braithwaite’s “ Retrospect of Medicine,” form¬
ing the 119th volume of the series. The high reputation
of the latter for usefulness is well maintained in this
latest issue. The abstracts, as usual, are excellently
done, and the busy practitioner is thus provided with a
rich mine of information concerning all the newest facie
and features in medical science. In addition, the volume
contains a complete general index of the previous issues
from 113 to 118 inclusive.
V
Ov the " Hygiene of the Mouth,” by R. Denison Ped-
ley, F.R.C.S.Ed., L.D.8., we have little to say by way of
praise. The author’s object is professedly to call atten¬
tion to the serious effects upon the general health of
dental diseases, and to show how such diseases may be
controlled or prevented. We are not satisfied that he
has done either, and his English is open to criticism,
as, for example, when he speaks of “preventative
disease," “ disqualified from,” &c. As a plea for closer
dental supervision the book may pass muster, but as for
the rest the less said the better.
V
The “West London Medico-Ohirurgical Journal,”
though comparatively young in years, has shown a
steady and indeed remarkable upward growth. The last
number, for instance, contains no less than 127 pages of
matter, headed by the brilliant Cavendish lecture on
Cerebro-spinal Fever, by Professor Osier, a full abstract
of which has already appeared in our own journal. The
West London Medico-Chirurgical Society is conducted
on decidedly progressive principles, audits representative
organ deserves the suocess to which it has attained.
Vectit is an elegant and artistic weekly illustrated
journal of literary and general interest for the Isle of
Wight, and is edited and conducted by a medical man,
who can boast also of being poet, novelist, and dramatist.
Dr. Dabbs, the family doctor of the late Lord Tennyson,
is, judging from his journal, a versatile and talented
member of our profession. The current number of
Vectii is of peculiar interest to us, as with it is presented
an admirable portrait of the late Dr. J. Sinclair Coghill,
who has done so much to perfect our knowledge or the
treatment of phthisis, and who has laboured so earnestly
to develop the National Consumption Hospital at
Ventnor.
# # #
. Students will welcome any aid to the study of materia
medica for examination purposes. Much time and
labour is often spent in getting sufficient grip of this
tedious, though all important subject. Miss Giffen’s
method of tabulation, (“ The Student’s Practical Materia
Medica,” E. A 8. Livingstone, Edinburgh, 1899) will be
helpful to many, and the mastery of her little book of
about 90 pages would give the student a foundation on
which he could build a future efficient knowledge of
materia medica. It does not attempt to treat of the
action and uses of drugs, and must, therefore, be used
as an aid to, and not as a substitute for, the larger text
books. %*
Those of our readers who cultivate a knowledge of
shorthand may be interested in the fact that Vol. III. of
the Phonographic Medical Library oontains a very in¬
teresting monograph by Sir Wm. Thomson, F.R.C.S.I.,
on “ Some Diseases of the Rectum and Anus." Of the
lecture proper we prefer not to speak, inasmuch as, in
shorthand matters, we see as through a glass, darkly.
We note that it is considered desirable to give the
headings of chapters and of sub-divisions in ordinary type,
wkich appeals to our sensorium much more directly than
do the ornately artistic hieroglyphics which (form)
obscure the light shed by the author on an important
chapter of practical medicine.
Dig
GoogI
e
Auo. 80, 1899.
NEW MEDICAL APPLIANCES.
The Medical Pbess. 229
Few new books on medicine and surgery are published
during what is called “the dead season,” and the present
is no exception. A couple of large atlases, however,
have made their appearance, one under the authorship
of ^Dr. Donald Mackintosh, a “ Skiagraphic Atlas of
Fractures and Dislocations,” and an “ Atlas of Urinary
Sediments,” by Dr. Beider, translated by Dr. F. C. Moore.
A good many new books and new editions are promised
for the autumn. That by Sir Wm. Broadbent on
*• Diseases of the Heart,” being nearly free ef the Press,
and a revised edition of Bose and Carless's popular
“ Manual of Surgery," is announced to be ready next
month.
The publication of Dr. Walsh’s “ Bdntgen Bays in
Medical Work ” in 1897 marked an epoch in surgery. It
was the first book that enabled the surgeon to practi¬
cally grasp the technicalities of Professor ROntgen’s
marvellous discovery and to fix the date of a new depar¬
ture. That such a work was needed, is evidenoed by the
appearance this week of a new and greatly improved
edition, the science becoming so rapidly progressive
that it had to be mostly re-written and illustrated with
many additional plates. As hon, secretary of the Bontgen
Society since its foundation, the author has had excep¬
tional opportunities, of which he has not been slow to
avail himself, if we may take the book before us as an
example.
V
The College of Physicians of Philadelphia ask us to
announce that the Fifth Triennial Jenks Prize of five hun¬
dred dollars, under the deed of trust of Mrs. William
F. Jenks, will be awarded to the author of the best essay
on “ The Various Manifestations of Litbsemia in Infancy
and Childhood, with the Etiology and Treatment.” The
prize is open for competition to the whole world, but the
essay must be the production of a single person, and
be written in the English language, or, if in a foreign
language, accompanied by an English translation. It
should be sent to the College of Physicians of Philadelphia,
Pennsylvania, U.S.A., before January 1st, 1901, addressed
to Dr. B. C. Norris, Chairman of the William F. Jenks
Prize Committee. Each essay must be typewritten,
distinguished by a motto, and accompanied by a sealed
envelope bearing the same motto and containing the
name and address of the writer. No envelope will be
opened except that which accompanies the Bucoessful
essay.
• •
Anti-natal therapeutics are beginning to find a place
in our medical literature, their obvious aim being to pro¬
duce a race strong both in intellect and physique. The
consideration of “Health in the Nursery,” by Henry
Ashby, M.D., F.B.C.S. (Longmans), is of importance,
and a book such as that before us is welcome as
being a help in the right direction. The first chapter,
“Training in the Nursery,” will oommend itself to
most thoughtful minds. Such training, if carefully
followed, would do much to lay the foundation of
habits which would make the future man or woman a
more reasonable and a healthier being. The book is
readable, being simply and dearly written and requiring
very little medical knowledge to enter fully into its
teaching. It may be safely recommended for wide circu¬
lation among those who have either medically or
otherwise, the charge of the young.
The critic is disarmed in presenoe of a work on the
ubiquitous baby whioh has reached a sixth edition,
finch is the fate that has overtaken Mrs. Langton
Hewer’s " Our Baby ” (Wright and Co., Bristol). This
is not merely a guide-book for mothers and nurses in
respect of the alimentation of infants, the advice given
is for the most part such as we oan oordially approve,
but the author adds a good deal of very sound counsel
oonoeming the physical and moral training of the child,
to which tne thoughtful will give due heed. The author
is not always quite up-to-date, witness the advocacy of
“ arm-to-ann ” vaccination, a practice which has de¬
servedly fallen into disrepute. As in most works of the
kind there is a large amount of technical information
which cannot by any chanoe prove useful to the average
mother or nurse, but after all there is no objection to
describing diseases provided the reader be warned
against attempting diagnosis and a fortiori treatment.
$eto iftcbital Appliances.
THE “ALLENBUEY” MILK PASTEUBISEBS.
The evidence that has gradually been accumulated
during the last few years of the wholesale spread of
disease by milk has brought into prominence the import¬
ance of effectually sterilising this valuable but unstable
article of food before using it as such. Simple boiling,
though a procedure not to be despised, has been shown
to fall short of perfect sterilisation, and it is necessary to
educate the public in the technique of the process,
whereby milk may be effectually divested of any disease-
producing organisms which it may and often does con¬
tain. The public, or the intelligent section thereof at
any rate, are very willing, very anxious, to acquire this
knowledge, and this has created a demand for a simple,
cheap, and trustworthy apparatus for the purpose. Such
an apparatus is the “Allenbury's ” Milk Pasteuriser.
It consists of a jacketed vessel, or container, with a
supporting plate for the milk cans. These having been
filled with milk, the container is filled with boiling water,
the cover placed in position and the apparatus left un¬
disturbed for about half-an-hour. The milk is then ready
for use, but it is of advantage at this stage to pour cold
water through the container so as to secure prompt
refrigeration of the milk.
When this process can be carried out on fresh milk,
effectual sterilisation is probably secured, but it must be
clearly understood that this treatment of stale or par¬
tially decomposed milk, though it may kill all living
organisms, will not oonvert it into a commendable article
of food, seeing that the milk .till contains the soluble
products of bacterial activity—the so-called toxins,
which account for so much of the gastro-enteritis of
infants. In any case it is desirable to consume the milk
as soon as possible after sterilisation, or else the process
should be repeated. Full directions accompany the
apparatus,’ which ought to find a place in every house¬
hold mindful of their health.
Digitized by GoOglC
230 Thk Medical Pbwb. NOTICES TO CORRESPONDENTS._ Ado. 80,18&9.
Notices to
dorreoponbmto, Short 'fetters, &t.
tBf " Correspohdsnts 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,"
Bubecriher," “Old Subecriber,” Ac. Much confusion will be
spared by attention to this rule.
Dukcah, T. -Out correspondent has no redress, assuming that
his statements are oorrect. The law presses very hardly in cases
such as he describes.
Bpes writes:—“ I should be obliged if you could tell me if there
is any publication which gives the composition of quack medicines.”
—Our correspondent would probably find all that he wants in
“ Exposures of Quackery," published by the Savoy Press, 115,
Strand, W.C.—Ed. M.P.& C.
Hispaxia (London).—Our correspondent had better write to us
again in October, when the vacation is over, since the present
meteorological and other conditions are not favourable for the die-
mission of the matter referred to in his letter.
FLIES AND TYPHOID FEYEB.
Ths Medical Commission, appointed to inquire into the cause of
the severe epidemics of typhoid in the American camps during the
war with Spain, reported that the disease was undoubtedly spread
by flies, and that had it not been for these insects there would have
only been a few isolated coses.
Visitor (Eastbourne).—Our correspondent should bring the facts
under the notice of the Medical Officer of Health for the town.
8. T. O. (Birmingham).-The clause appears to us to be quite a
reasonable one ; it would, of course, be binding upon both parties.
Sehex.—Out correspondent has omitted to enclose his private
card.
Alpha (Luton).—The district which you describe is evidently in
urgent need of a competent Medical Officer of Health. It is ridicu¬
lous to expect any efficient health administration from a bugy
medical practitioner, who is paid a small sum to look after the sani¬
tation of a large and sparsely populated area. Indeed, as a rule it i s
against the interests of such an official to interfere with the property
of the councillors who govern the district. Until a radical reform
is made by the legislature there will be little prospect of anything
like a national system of public health. Co mb in wi sanitary areas
and security of tenure of medical offloershrps appear to oner the
beet way ottt of the difficulty.
Exophthalmia (Beds).—Try thyroid gland: five grains of desic¬
cated gland at first once a day. increased up to three or four times
that amount. Regulate dose by effects. The “ trinity of sym¬
ptoms " in exophthalmic goitre are the enlarged thyroid gland, the
“ Vardy " eyelid, and the emotional, irregular heart. We fear your
case is to advanced too offer any prospect of permanent relief, but
treatment should not be given up on that account. The best pallia¬
tive measures are those that deal with general nutrition, especially
in the form spoken of at the outset of our reply.
A BACTERIOLOGICAL TRAGEDY.
A oat Bacillus, to gain him glory,
Once gave a ball in a laboratory.
The fete took place on a cover glass.
Where vulgar germs could not narass.
None but the cultured were invited,
(For microbe cliques are well united)
And tightly closed the ball-room doors.
To all the germs containing sports.
The Staphylococci first arrived—
To stand in groups they all oontrived—
The Streptococci took great pains
To seat themselves in graceful chains.
While somewhat late, and two by two.
The Diplococci came in view.
The Pneumococci, stern and haughty,
Declared the Gonococci naughty
And would notcare to stay at all.
—Texas Med. Journal.
Erratum.— In report of International Ophthalmolo fieri Congress
in our last issue, for Dr. Settler (Leiprig) on Non-cataract read
/ron-cataract, caused by iron splinters.
Uacanties.
Armagh Union.—Medical Doctor (temporary). Remuneration two
guineas per week. Application to Clerk of Union. See Advt.
Berry Wood Asylum, Northampton.—Senior Assistant Medical
Officer for five years, unmarried. Salary £200, rising to £250,
with board, lodging, and washing, Ac.
Birkenhead Children’s Hospital, Birkenhead.—House Surgeon.
Salary £75 per annum, with board, residence, and laundry.
Dundee Royal Lunatic Asylum.—Medical Assistant.—Salary £100,
with board and lodging.
Durham County Asylum, Winterton, Ferry Hill.—Assistant Medical
Officer, unmarried. Salary £120, with apartments, board, and
attendance.
East London Hospital for Children.—Two Clinical Clerkships. Also
House 8urgeon. Board, residence, Ac., are provided, and an
honorarium of £25 at the completion of six months’ approval
service. , _
Horton Infirmary, Banbury.—House Surgeon and Dispenser. 8alary
£80 per annum, with board and lodging.
Manchester Children's Hospital.—Junior Resident Hedical Officer
for six months, unmarried. Salary at the rate of £80 a year.
with board and lodging. Secretary, Dispensary, Gartaide
Street, Manchester.
Manchester Hospital for Consumption and Diseases of the Throat
and Chest.—Resident Medical Officer for the In-patient Depart¬
ment, Bowdon, Cheshire. Salary £80 per annum, with board,
apartments, and washing.
Metropolitan Hospital, Kingslond Road.—House Physician, House
Surgeon, Assistant House Physician, and Assistant House Sur¬
geon. Appointments tenable for six months. House Physician
and House Surgeon £40 a year. Assistant House Physician and
Assistant House Surgeon £20 a year.
New Ross Union.—Analyst to the Board of Guardians. Salary £10
per year. Applications to Clerk of Union. See Advt.
Parish of St. Giles, Camberwell.—Assistant Medical Officer, either
sex, for one year. £50 and apartments, board, and washing.
Royal Halifax Infirmary.—Assistant House Surgeon, unmarried.
Salary £50 per annum, with an extra allowance of £9 2s. 6<L per
annum, ana residenoe, board, and washing.
Royal Surrey County Hospital, Guildford.—Resident House Sus-
geon. Salary £80, board, residenoe, and laundry provided.
St. Luke’s Hospital, London, E.C. Clinical Assistant for six
months. Board and residenoe provided.
Stroud General Hospital. — House surgeon. Salary £80 per annum ,
with board, lodging, and washing.
Western General Dispensary, Marylebone Road.—Second House
Surgeon, unmarried. Residence at the Dispensary. Salary £75
per annum, with board and residence, and 10s. a month allowed
for wMhing._
^jpointnuitis.
Adams, E. W., M.B.Lond., House Physician to the Northern
Hospital, Liverpool.
Best, P., L.8.A., M.B.C.S., L.B.C.P., Medical Officer for the Third
District, Penzance Union.
Dohrrtt, J. D., M.D.Edin., House Surgeon to the Northern
Hospital, Liverpool.
Fro ah, Johx F., L.B.C.S.Irel., L.A.H.Dub., Medical Offioer to the
Oldcaatle Dispensary.
Johhs, A. T., M.B., B.8., M.D.Dub., Medical Officer for the Gropredy
District, Banbury Union.
Kihset-Morgah, A., M.B.C.S., L.R.C.P., House Surgeon to the
Royal Victoria Hospital, Bournemouth.
Khowles, Miss B., M.B., B.S.Lond., Second Assistant Medical
Offioer at the Waterloo Road W orkhouse, St. Matthew, Bethnal
Green, vioe Mr. G. Gatenby.
Mrachsr, J. H., M.B.C.8., L3.C.P., Mr. Medical Officer for the
Second District, Bodmin Union..
Moore, S. C..M.B., Ch.B.Vict, Assistant House Surgeon to the
Northern Hospital, Liverpool.
Old, J. E. 8., L.S.A.Lond., House Surgeon to the Branch Hospital
of the Seamen’s Hospital Society in connection with the London
School for the Study of Tropioal Diseases.
Reid, Hush, L.B.C.P.AS. Edin., Dispensary Medioal Offioer of the
Montiaght District, near Portadown.
Utley, C. H.. M.B.Lond., Assistant Medioal Officer at the Infirmary,
Salford Union.
girths.
Brah.—O n August 23rd, at Clapham, the wife of Louis C. Bean,
M.B.C.S.Eng., L.R.C.P.Lond., of a son.
Blaber. —On August 22nd, at “Snnnybank,” Shoot-up Hill, West
Hampstead, the wife of Percy L. Blaker, M.B.C.8., LJB C.P.,
of a son.
Davidsom.— On August 20th, at Riverside Lodge, Teddington, the
wife of Harold Davidson, M.R.C.S , L.R.C.P., of a son.
Duooh.—O n August 22nd, at 17, Dderton Road, Rotherhithe, the
wife of Francis Dugon, M.R.C.S., L.R.C.P., of a son.
Feoah.—O n August 22nd, at Fair View, Westcombe Park, Black-
heath, 8.E., the wife of J.H. C. Fegan, L.R.C.P.,M.B.C.8J:ng ,
of a son.
Stocker.— On August 23rd, at Pinehurst, Clevedon, the wife of
E. Gaved Stocker, M.R.C.S., L.R.C.P., of a son.
Wildiho.— On August 22nd. at The Hawthorns, Hindley, Wigan,
the wife of Writer F. W. Wilding, M.B.C.S., LJt C.P., M.O.H.^
Hindley, of a daughter.
Babihgtoh—Loko.- On August 22nd, at Christ Church, Down
Street, London, W., by the Rev. A. Babington, father of the
bridegroom, Stanley Noel Babington, M.R.C.S.Eng.,
L.R.C.P.Lond., to Sarah, second daughter of Thomas Long, of
Bracknell.
Mabtih -Bartlett.— On August 22nd, at the Baptist Church,
Westgate Road, Newcastle upon-Tyne. Albert M. Martin, M.B.,
of Dene House, South Shields, to Mary Winifred Bartlett
(Maimie), younger daughter of J. M. Bartlett, Esq., of New¬
castle-upon-Tyne.
JeathB.
Charles.— On August 21st, at Bradmore Road, Oxford, David
Hughes Charles, M.D., J.P. for co. Tyrone, in his 81st year.
Clarke.— On August 23rd, atHoniton, Lilian Sophia Clarke, wife of
George Saunaer Clarke, M.B.C.S.Eng., L.R.C.P.Lond., agedSl.
Fitz-Hehrt. —On August 22nd, at Wellington Hotel, near Camber-
ley, Edward Henry Fitz-Henry, M.D., formerly of Mentone and
Waterloo.
Glover. —On August 16th, at Blandford Road, Chiswick, William
James Schoedde Glover, M.R.C.S., L.S.A.
Hadow.—O n August24th, at 4, Clarence Place, Penzance, Gerald
Elliot Hadow, M.A., M.B., after a long illness, aged 28 years.
Latham.— On August 23rd, at Enderlie, Torquay, after four days’ ill¬
ness, Diana Franoe8, elder daughter of the late Peter M. Latham.
Esq., M.D., Physician Extraordinary to the Queen, aged 64.
Die
She 3|WiIi(iil i’rrss and Cwtular.
** 8ALU8 POPULI SUPREMA LEX."
Vol. CXIX. WEDNESDAY, SEPTEMBER 6, 1899. No. 10.
Original Communications.
ALBUMINURIC RETINITIS, (a)
By SAMUEL WEST. M.D., F.R.C.P.,
Awiitant Physician to St. Bartholomew's Hospital; Senior
Physician Boyal Free Hosj>ital.
In its typical form albuminuric retinitis is charac¬
teristic and pathognomonic. Yet upon many import¬
ant points the statements of different authorities are
venr conflicting and difficult to reconcile.
Kidney diseases fall into two great groups accord
ing as dropsy is a prominent symptom or not; and
the kind of albuminuric retinitis most frequently
met with in these two groups will, I think, be found
to be different.
The lesions of albuminuric retinitis consist in
white patches, haemorrhages, and exudation variously
combined with each other, and lastly quasi-inflam-
matory conditions.
The Exodative (Inflammatory-Extreme)
Form.
In this form the changes are widespread and
extreme, and closely resemble what is seen in other
forms of acute neuro-retinitis. Dropsy is not very
common in granular kidney, so this form of albu¬
minuric retinitis but rarely occurs in this disease, but
is more frequently met with in the other group, viz.,
that of parenchymatous nephritis.
Complicated as the question is, we seem to be
testified in drawing these conclusions:—That this
form of albuminunc retinitis is of an exudative
inflammatory type, that it is probably of toxic origin,
and related rather to the cellular degeneration than
to the interstitial fibrosis.
If the view I am expressing prove to be correct, it
follows not only that the kind of albuminuric retinitis
which prevails in the two forms of renal disease is
different, but that it has a different diagnostic value
in the two cases. In parenchymatous nephritis the
diagnosis of the disease is obvious, and the albumin¬
uric retinitis is an interesting by-phenomenon only.
In granular kidney the diagnosis may be uncertain
until all doubt is dispelled by the discovery of the
characteristic eye-changes. It is to this group that
some of the cases of albuminuric retinitis belong.
On the other hand many more of these cases in preg¬
nancy belong to the degenerative group, ana are
evidence of granular kidney.
Puerperal eclampsia occurs in either form, in the
former rarely without dropsy, and in the latter not
infrequently without.
The Degenerative Form.
The degenerative form of albuminuric retinitis con¬
sists in white patches and haemorrhages. Of these
the most characteristic are the white patches. There
are, I believe, two kinds of white spots, the one form¬
ing bright spots glistening like fish scales, the other
not so glistening or so sharply defined, but woolly in
appearance. The former are the result of degenera¬
tive changes, and their brilliancy depends upon the
presence of minutely refractive oil-drops or even
cholesterine crystals; the latter are often small
(a) Abstract of Paper read at the Aiumal Meeting of the firitiih
Medical Association at Portsmouth, August, 1899.
patches of exudation only. The former are of slow
development and unlikely to disappear at all or only
slowly and after a long time; the latter, however,
may come and go rapidly.
In parenchymatous nephritis the diagnosis of renal
disease is. usually obvious whether there be white
spots or not. In granular kidney, however, the
diagnosis may be uncertain until the eye-changes are
discovered. The white spots, whether they be really
exudative or degenerative, have therefore in granular
kidney a diagnostic value which they do not possess
in the other forms of nephritis. Early as the white
patches or degenerative changes are, they precede
and result from still earlier changes in the vessels
(silver-wire arteries).
Although the silver-wire arteries are no doubt oph¬
thalmoscopic evidence of the vascular degeneration,
as are also the heemorrhages and white spots, it does
not follow that the vessels necessarily show the white
silver-wire streaks before the other lesions are
visible.
Of the hemorrhages which occur in albuminuric
retinitis it is not necessary to say much. Similar
hemorrhages may occur in both tne exudative and
in the degenerative forms, but they are probably pro¬
duced in different ways in each case. In the latter
they are the consequence of the vascular degeneration
and are due to the rupture of the diseased arteries in
the retina, as in other parts of the body. In the
former they are generally due to the rupture of over
distended veins, consequent on the pinching to which
the veins are subjected as they pass through the
swollen disc.
Paradoxical as it may seem, it is in the so-called
extreme forms of albuminuric retinitis,or as I should
call them, the exudative forms, that the prognosis
both in respect of life and in respect of sight is not
nearly so grave as it might appear to be, for if the
kidney mischief recover the eye-lesion may resolve
and the sight be completely restored. If, as in
pregnancy, the cause return, the retinitis may also
return, and with each succeeding pregnancy the
prognosis in respect of sight of course becomes worse,
In respect of life the prognosis is that of the renal
disease, and all that I think the albuminuric retinitis
in these cases does is to show that we have a form of
parenchymatous nephritis to deal with of a somewhat
unusual severity. The white patches of granular
kidney rarely disappear; but they are often present
without much defect of sight.
The ophthalmoscopic changes in the vessels are
important as evidence of an arterial degeneration
which is a visual evidence of the risks to which the
patients are subject from the disease of the vessels
elsewhere, e.g., in the brain.
Summary.
I may bring this communication to a conclusion by
summing up the facts which I think justify the draw¬
ing of a sharp distinction between the two forms of
albuminuric retinitis, the degenerative and the
exudative. They stand in strong contrast with each
other in the following respects :—
1. Of the form of disease with which they are
usually associated : the degenerative with granular
kidney, the exudative]especially with parenchymatous
nephritis.
Digitized by CjOO^Ic
232 The Medical Press.
ORIGINAL COMMUNICATIONS.
Sept. 6, 1809.
2. Of their nature and cause : the exudative being
inflammatory and probably toxic in origin, the de¬
generative consequent on vascular changes and more
or less mechanical in origin.
Of sight: for the exudative, even in the extreme
forms, may recover, with little or no defect of sight,
but with the degenerative, if there is any impairment
of sight, it is usually progressive.
4. Of diagnostic value : the exudative being an in¬
teresting by-phenomenon of chronic parenchymatous
nephritis, an affection the existence of which is
obvious enough, while in granular kidney the degene¬
rative often makes the diagnosis certain in cases
which have been hitherto obscure.
5. Of risk to life: for while in both cases it indi¬
cates a grave form of renal disease which may of
itself prove fatal, in granular kidney it indicates in
addition all those dangers to which arterial disease
exposes the patient.
I think, therefore, that the distinction is not only
justified by the facts, but explains many of the appa¬
rent contradictions which are made by different
authors.
ON CHRONIC FOLLICULAR
PHARYNGITIS, (a)
By ROBERT H. WOODS, M.B., F.R.C.S,
Throat Surgeon to the Richmond Hospital, Dublin.
Chronic pharyngitis, or, as it is sometimes called,
clergyman’s sore throat, is one of the commonest
affections of the upper respiratory tract. It is not
as its alternative name would imply, confined to
public speakers, nor does it in my experience occur
with much greater frequency among people with
whom public speaking is an essential part of their
profession.
Though the best marked examples are to be found
among adults, and in men rather than women, yet it
is met frequently among the young of both sexes.
That the disease has long been known and repeatedly
described is not surprising, sinoe a large portion of
the region involved can be well inspected without
any other aid than that of a common spatula.
Patients generally complain of the throat being
sore and tired, and the voice is a little husky espe¬
cially after prolonged speaking or singing, and
occasionally of slight difficulty in swallowing, this
difficulty being more pronounced when the bolus is
small, as when saliva is swallowed, than when large
as at meal times. Arising from a feeling of mucus
being constantly present there is a persistent desire
to hawk and clear the throat, hardly less annoying to
their neighbours than to the sufferers themselves.
They find the state of the weather largely influences
their comfort, a moist, cold day being less tolerable
than a warm dry one.
On inspection the pillars of the fauces, soft palate,
and posterior pharvnx wall, and in severe cases the
larynx, are seen to be redder than normal. The super¬
ficial vessels are dilated, and the mucous membrane
slightly roughened. These appearances are better seen
at the upper part of the throat, especially on the
faucial pillars than further down. The lymphoid
follicles on the posterior pharynx wall are enlarged
and prominent, and it is this item among the physical
signs that lends to the disorder its distinctive name.
In some cases a thick red cord of swollen tissue runs
from above downwards on both lateral pharynx walls
immediately behind the tonsil, disappearing from
view behind the palate above, and hidden by the
tongue below, quickly tailing off in the mucous mem¬
brane. The cause of these well-known conditions
has been variously attributed to repeated attacks of
acute inflammation, overetraining of the voice, exces¬
sive smoking, unhealthy occupations, especially those
where employes are crowded in an impure and dusty
atmosphere, &c,
The treatments adopted have been, in addition to
getting rid as far as possible of the apparent cause,
thermal or chemical cauterisation of the hyper¬
trophied lymph follicles on the posterior pharynx
wall, and of the masses on the lateral wall, avulsion
of the follicles by sharp forceps, brushing the pharynx
twice a week for several months with astringents,
such as six per cent, silver nitrate or zinc chloride,
glycerine of tannin, borax and a host of other anti¬
septics and astringents, and finally an infinity of
gargles varying from plain water to elaborate con¬
coctions containing a great variety of drugs, in the
hope that if one did not do good another might.
In my earlier days as a laryngologist I conscien¬
tiously tried all the more rational of these methods,
and though I often succeeded in temporarily curing
the patient. I know of no case treated by me on these
lines which remained free from the symptoms for
moie than a few months ; nor was it until a consider¬
able number of these cases had passed through my
hands that I saw I was only treating an effect and
not a primary cause.
In my opinion and experience, chronic follicular
pharyngitis is, in the vast majority of cases, the
result of nasal obstruction, or, more immediately,
mouth breathing.
It will be convenient at this place to say a word or
two about the functions of that neglected, though
highly important member, the nose.
By the majority of people, and among them are
some whose duty it is to know better, the nose is
looked upon merely as the organ of smell and as an
aid to the sense of taste. The nose is not an organ
but a member, and smell is the meanest of its duties.
Its really important work consists in preparing and
modifying the air, so that it may be fitted for entry
into the delicate respiratory passages below, and this
it does in three ways.
First, by warming the air. Anyone who has dis¬
sected a nose can hardly fail to have been impressed
with the extent and richness of its blood supply, a
richness out of all proportion to the need of the
part, and which finds expression in the ease with
which its lining membrane is made to bleed. It is,
indeed, a beautiful hot water system, where the heat
of the circulating fluid is transferred to the air
with which it is in contact, the rate of transference
being increased from what it would be were the nose
a single plain tube, by the exra surface exposed,
not only on both sides of the septum but also on the
turbinated bones, especially the inferior and middle.
So perfectly is the air warmed, that elaborate and
careful experiments have shown that by the time the
air reaches the naso-pharynx its temperature is prac¬
tically that of the blood.
Second, by moistening the air. The watery mucus
with which the walls of a normal nose are constantly
smeared, readily gives up its moisture to the passing
air, the great blood supply to the soft parts aiding in
two ways; promoting by its heat the surface evapo¬
ration, and by its constituents feeding the secreting
parts with the necessary watery elements. Experi¬
ment has here too shown that the air when it reaches
the naso-pharynx is all but saturated with moisture.
Third, by filtering the air. If impure dusty air be
blown through a tube the sides of wnich are smeared
with glycerine or any similar substance, it will be
found, especially if the tube is not quite straight, that
it comes out pure at the other end, the dust being
caught and held by the slimy surface.
This is precisely what happens in the nose.
moist surfaces act as a most efficient trap for solid
Die
oogle
(a) Read before the Medical Section of the Royal Academy of
Medicine in Ireland, April, 1899.
Sept. 6, 1899.
ORIGINAL COMMUNICATIONS. The Medical Press. 233
particles suspended in the inspired air; thus they are
first caught and afterwards expelled in the periodical
blowings to which all normal noses are subjected
We have only to look at the motes in the sunbeam,
in order to be convinced of the great importance of
this factor in the struggle for health, especially to us
who live in cities and crowded places where purity is
the rarest attribute of the atmosphere ; and
especially also, when, as our bacteriology teaches us,
these motes are so many rafts for bacteria, patho¬
genic and saprophytic.
There are reasons, too, for suspecting that the nose
exercises a destructive effect on bacteria. This has
not yet been put beyond dispute, but waiving this
claim, there is more than evidence enough to show
that on d priori grounds the efficient, discharge of
the functions of the nose must be of prime importance
to the welfare of the respiratory tract.
If, from any cause, the nose is obstructed, breath¬
ing must be carried on through the mouth, and inas¬
much as the alteration of the inspired air from con¬
tact with moist warm surfaces, is largely a purely
physical process, and that the air will go on absorb¬
ing both neat and moisture until its saturation points
are reached, and that these cannot be attained in the
mouth, it follows that the throat is compelled to take
on the functions of the nose, and part with heat and
moisture sufficient to satisfy the demands of the air,
at the same time freeing it from dust. It follows,
too, that the first, or highest, portion of the throat
is where we must expect the severest effect of the
abnormal condition to evidence itself, for this is the
part struck by the stream of air when at its driest,
coldest, and dustiest.
In these cases of pharyngitis from nasal obstruc¬
tion, when the cause is as just shown primarily a
mechanical one, it is to be expected that if any por¬
tion of the mucous membrane were unexpoeed to the
irritation of the air that part would remain normal.
And this I have found to be the case. If the back of
the pharynx be illuminated, and the soft palate raised
with a probe, it will be seen that the pharyngeal wall
above the level of the palate is unaffected; while
immediately below that point where it is unprotected
by the palate, the other condition obtains, the line of
demarcation being quite sharp and coinciding with
the lower level of the palate.
I regard this fact as of great importance in the
proof of the condition being a result of nasal obstruc¬
tion.
In obedience to the demand for heat and moisture
from the pharynx, the superficial vessels dilate, and
by a continuance of the irritation for a sufficient
time, a chronic low form of inflammation is set up,
mucus is poured out, and as it yields its moisture it
thickens and becomes more tenacious, and pari passu,
the mechanical irritation of its presence and the
difficulty of its removal increase.
The comparative narrowness of the nose enables a
forced expiration to send the air through its cavity
at a velocity sufficient to expel mucus, however,
tenacious, with comparative ease; but the pharynx,
being more open, allows of no increase in the velocity
of the air, and to overcome the difficulty and dis¬
lodge the glutinous material, the pharynx is volun¬
tarily narrowed during forced expiration, and hawking
results.
The difficulty in swallowing is contributed to in
two ways.
The presence of tough mucus provokes acts of
swallowing. Now the exertion required varies
within limits in adverse ratio to the size of the sub¬
stance to be swallowed, and therefore the smallness
of the bolus demands that the effort must be vigor¬
ous in order that the wave of contraction may not
ail to lay hold of and push the matter before it. If
he mucus were more watery a single effort might
entirely remove it for the time, but when it is
remembered that its natural toughness is increased
by evaporation, and that it is adherent to the walls
by which it is secreted, it is not hard to understand
how futile must be the attempts to remove it, though
from its tickling, those attempts must necessarily be
made. The muscles of swallowing must therefore
become overworked and painful, and a condition in
many ways analogous to writer’s eramp established.
Again, the inflammation of the pharynx wall,
above referred to, is not always confined to the mucous
membrane, but extends into the muscles, and this, no
doubt, contributes to the discomfort attending
deglutition in many of these cases.
That the larynx, even when affected, is not always
complained of, is intelligible, since the brunt of the
evil is borne by the pharynx, and the further down
we go the more nearly is the air to the ideal condition,
and therefore the less it irritates the surfaces with
which it comes in contact. When the larynx is
involved, as it always is in severe cases, the conditions
which obtain are almost identical with those described
in the pharynx. The vocal cords are injected,
thickened and nodular, and impurity of the voice, if
not actual hoarseness, results.
The evil effects of smoking, in this, as in most
other affections of the throat, have, I am convinced,
been greatly over-estimated.
I do not believe that the pipe or the cigar are ever
in themselves injurious. When consumed in the
ordinary way, the smoke never passes the cavity of
the mouth, for during the act of sucking the soft
palate and the dorsum of the tongue must necessarily
be in contact, and so the throat is completely cut
away from the influence of the fumes. The case of the
cigarette is different, for cigarette smokers, not con¬
tent with the amount of absorption of the active
principles of the drug that goes on in the mouth,
inhale the smoke, to the very great detriment of the
air passages. In the same way pipe and cigar
smoking, if done by a number of persons in a small
room may, by creating a fog, prove harmful both
to the non-smoker and the smoker, but with
proper ventilation, and <1 fortiori in the open air, the
practioe can have no hurtful effect on the throat of
either.
Among the causes to which chronic pharyngitis is
attributed comes that limbo of disorders, gout. I have
more than once had congestion of the throat pointed
out to me as the sole evidence of this disease. That
gout may possibly cause such a primary condition in
the throat I am not prepared to deny, but I have
seen no case in which this physical sign, even when
looked on as an evidenoe of gout, was not associated
with, some form of nasal obstruction, or which was
not relieved by nasal treatment.
In some cases of chronic pharyngitis, as in all
other abnormal conditions of the throat, the nose
should be thoroughly examined.
This advice is usually given with the tacit impli¬
cation that it can be followed by anyone. For my
own part, I must say that I found it many times
more difficult than either retinoecopy or laryngo¬
scopy. Examination through the nostril, simple as it
looks, demands for its efficient performance the
power of concentrating the attention on one retinal
image only, and the most perfect control over
accommodation in the observing eye in order to see
anything at all, and when seen the character, 3ize,
and position of the object and its relation to
neighbouring structures have to be determined.
I do not here intend to treat obstructive diseases of
the nose at all exhaustively, but inasmuch as the
radicalcureof chronic pharyngitis involves,in general,
putting the nose in working condition, a few words on
the subject will not be out of place.
The causes of nasal obstruction are sometimes
Die
oogle
ORIGINAL COMMUNICATIONS.
S*pt. 6. 1899.
234 The Medical Pkkss.
anatomical, more often pathological. Among the
anatomical causes, spurs, or deflections of the septum,
are in adults very frequently met with.
In these cases the obstructed side is small, and the
tissues thin and atrophic, while the opposite side is
large, and the tissues hypertrophic, the result partly
-of overwork, and partly of repeated acute inflamma¬
tion to which such cases are liable. These are as a
class best treated by removal of the offending portion
with a knife, or if the cartilage be calcified, a fine saw.
Post-nasal growths are, of course, among children
•the most frequent causes of obstruction, and it will
always be found that whether the child complains of
the symptoms of chronic pharyngitis or not, the
physical signs will be present m the old standing
cases.
This in itself would be sufficient to justify the
.removal of adenoids, even if their presence were not
baneful for so many other reasons; Dut in this imme¬
diate connection it is well to point out that in an
unrelieved case, though it is usual for the growths to
atrophy and leave the passage clear in early adult life,
stenosis still remains. The cause of this is easily
seen. If, for any reason, a member of the body is
not used for many years, it will, if the owner be an
adult, atrophy, or, if a child, remain undeveloped.
Examples of this are common enough. It will be
sufficient to remind you of the diminutive propor¬
tions of the leg in a neglected case of hip disease,
where the thigh has been allowed to ankylose in a
position such as to prevent the foot touching the
ground. The leg ana foot are quite healthy, lacking
nothing except exercise in order that they should be
developed as on the opposite side ; but physiological
idleness has effected an anachronism, and we have a
child’s leg on a man’s body, In a precisely identical
way, the persistence of nasal obstruction from ade¬
noids, enforces in an unrelieved case a similar physio¬
logical idleness with the parallel result of a child’s
nose in an adult’s head. Partly, therefore, from the
fact that the nose in such cases is not equal to the
demand put upon it when at length the post-nasal
space is clear, and partly no doubt from the diffi¬
culty of shaking off a bad habit acquired in infancy,
and practised night and day during adolescence,
month breathing persists with its attendant evils.
A trained eye can recognise such people in the
street.
Examination of such a person shows, in addition
to the characteristic facies flattening from side to
side of the nose and the nasal fosses, prominence of
the front teeth, an abnormally hi^h ana narrow arch
to the bony palate, diminished distanoe between the
molars of the right and left sides, chronic pharyn¬
gitis, and other signs which we need not stop to
mention.
Chronic follicular pharyngitis in people with an
abnormally small nose is a very difficult condition to
cure, because we are more or less limited by the outer
bony wall of the nose from enlarging the air space to
the requirements of the individual. But still much
.can be done by sacrificing a small quantity of the
tissue on the outer wall, especially the soft parts
.covering the inferior turbinated bone.
Chronic hypertrophic rhinitis is readily recognised
■by the swollen and turgid condition of the inferior
turbinated bodies.
With it is commonly associated post-nasal thicken¬
ing and its resultant post-nasal catarrh. These are
best treated with the electro-cautery, by laying down a
linear scar along the enlarged bodies which, when
it contracts, will brace up the tissues out of the way,
and so free the air space. In severe cases reduction
of the hypertrophied bodies with the electric snare,
may be called for.
One wall only of the nasal fossa should bo caute¬
rised at a time, otherwise two points may adhere
and synechia result, leaving matters worse than
before. With ordinary care this should not occur,
but I have known the accident happen.
As a fairly common cause of cnronic pharyngitis,
polypi of the nose deserve mention. The distress of
the primary disease is, however, so great that the
throat is rarely complained of. Their removal should
be accomplished with the snare, and not the forcepe.
The snare properly used removes them more com¬
pletely; it leaves the normal tissues untouched, it
does no violence to the bones of the nose, and there¬
fore the patient suffers but a fraction of the pain and
none of the damage caused by the forceps. Further¬
more, it is not as well known as it deserves to be, that
when the polypi have been well snared the judicious
use of the electro-cautery on the ground from which
they grew will often effect a radical cure.
To those of us who, having seen polypi removed by
the forceps in the old way, have ourselves adopted
the snare, it is astonishing that the more improved
method should not have beaten its once respected
predecessor out of the field, but unfortunately the
forceps in many places is still the only instrument
used.
In a number of cases of chronic pharyngitis, how¬
ever, examination of the nose shows no obstruction,
the patient is able to breathe quite naturally, and
yet, what I venture to call, the characteristic sym¬
ptoms of nasal obstruction, are present. Inquiry
will elicit that these patients snore, or waken in the
morning with a dry tongue. Some of them may
deny it, but if you send them away and ask them to
take observation on themselves, they will tell you at
their next visit that your suspicion was well founded,
and that they find their nose so stopped at night that
they cannot breathe through it without a sense of
suffocation, but after getting out of bed a few
minutes suffice to make it quite clear again.
This story has been told me so often that the con¬
dition must be a veiy common one. We have here
evidently an engorgement of the erectile tissue of
the nose; whether, as seems most likely, it is due to
mechanical congestion, the result of the head being
lower in the horizontal position than the upright, or
whether it is a vasomotor phenomenon predisposed
to by some local condition, and determined by sleep,
I cannot say; but at any rate we have the condition,
and fortunately the cure too. The electro-cautery
properly used along the inferior turbinated bodies,
will, when the scars heal and contract, i.e., in from
six to eight weeks, most probably cure the patient.
If in a couple of months he still complains, it shows
too little has been done. I think i may without
offence call this condition nocturnal obstruction.
Though the vast majority of cases of throat irri¬
tation result from nasal obstruction, yet there are
still to be found a few in whom this condition, still
the result of not using the nose, is unassociated with
obstruction. There are teachers or others who talk
a great part of the day, often under very unhygienic
conditions, such as overcrowded and dusty school¬
rooms. The special liability of teachers to this form
of sore throat, is due to the fact that people, when
speaking inspire through the mouth, even when the
nose is quite free, and when this is done persistently the
throat sooner or later suffers, for the effect is of the
same kind, if not to the same degree, as when the
nose is stopped. The remedy is simple, provided the
nose is healthy. The patient should be directed to
speak deliberately, and, instead of gulping in the air,
to inspire through the nose between tne sentences, a
habit not difficult of acquisition.
In conclusion, let me say that the gravity of
dieases of the nose in general is very much under¬
rated. We have in chronic pharyngitis a perfectly
definite and tangible effect of abnormal nasal con¬
ditions on the respiratory passages. It is only step
Digitized by GoOgle
Sept. 6, 1899.
ORIGINAL COMMUNICATIONS. The Medical Press. 235
by step that we can hope to father effect on cause.
The necessity for rhinoscopy in throat disease was
only pointed out a few years ago, and it will not be
surprising if some of the chest troubles now believed
to be idiopathic should, when our knowledge is
riper, prove to be preventible by the endowment of a
functional nose.
We have the very best grounds for believing that
phthisis is often caused by the inhalation of pul¬
verised tuberculous sputum, and for my part I am
convinced that the victims of consumption would be
much fewer if normal noses were more common.
THE GENERAL PRINCIPLES OF
SANITATION, (a)
By Sir WILLIAM HENRY PREECE,
K.C.B.. F.R.S.,
President Inst.C.E., Ac.
After some introductory remarks, the President
said:—
The human frame is a little world in itself,
inhabited by different nations and by different races,
born, living, and dying in us as we ao on this earth,
perhaps in peace, generally in war, and fortunately
tor us not yet free from cannibalism. There are
many millions of living micro-organisms flourishing
in every body in this hall. As long as we are in
health they live in peace, and we remain unconscious
of their existence; but let some external bacterium
force the ramparts, then there is bitter war, and
either the invader is destroyed by our friends, or we
ourselves succumb to cholera, typhoid, diphtheria, or to
the growth of some other inimical but victorious
bacterial race.
The principal object of modern sanitary science is
to develope this new empire of bacteria, and to dis¬
cover its raoes and their peculiarities. The chief
function of the sanitary engineer is to defend the
human frame from its invisible and insidious external
foes.
The greatest sanitary engineer the world has ever
known was Moses. The Book of Leviticus is a
treatise on hygiene. For 3,400 years the world stood
still, and only one race followed the doctrines and
teachings of that Great Master. The Christian
threw his tenets to the wind—the Mahometan, to his
great benefit, has continued to practise some of his
principles to the present day. The Jew remains
faithful, and is the healthiest and longest-lived type
of humanity. The doctrines of Moses can be summed
up as the objects of sanitation to day :—I. Pure air.
II. Pure water. III. Pure food. IY. Pure soil. V.
Pure dwellings. VI. Pure bodies.
There are three important principles under¬
lying all practical applications of sanitary engi¬
neering : (1) Energy or the ability to do work; (2)
chemistry or the power to transform matter; (3)
life.
(1) The principle of energy affirms that this
capacity for doing work is a fixed quantity in the
universe. Energy can neither be added to nor
destroyed. It can only be transformed from one
kind of motion to another—material or ajtherial.
The motion of matter can be converted into the
motions of the aether or vice vcrsd. Sound, light,
electricity, and heat are mere forms of energy.
(2) The principle of chemistry affirms that the
quantity of matter in the universe is also a fixed
quantity, and that it can neither be added to nor
destroyed. Matter is reducible to about seventy
elements, and it is found in three states, solid, liquid
and gaseous. All that the chemist can do is to
(a) Abstract of inaugural address delivered before the Sanitary i
Institute Congress at Southampton. 1
transform matter from one state to the other.Jand
from one compound to some other by linking, de¬
linking, and relinking the atoms and moleculesjin
various combinations.
_ (3) The principle of life is beyond our comprehen¬
sion. All we know is that, by expending energy*on
matter, life in the very tiniest germ that moves, so
small as to be beyond the reach of the senses, per¬
forms with unfailing accuracy the duties of the engi¬
neer and the chemist. Life plays some important
function in the economy of Nature, and if we cannot
divine the reason of its existence, it is because we are
able to read the book of God only as through a glass,
darkly.
I.—Pore Air.
The supply of pure air to those who breathe it, is
the object of ventilation. Moses did not legislate for
ventilation, for the Israelites dwelt in tents, but he
showed how to prevent the pollution of air by the
decomposition or refuse, for he ordered it to be car¬
ried out without the camp into a clean place, and
there be burnt. We are only now learning to follow
Moses' lead, for refuse destructors are quite a modern
and up-to-date “ invention." We are even utilising
their heat for the generation of steam for electric
lighting generating stations, and we are thereby eco¬
nomising waste, the highest function of the engineer.
In cola climates where dwelling indoors and with
closed windows is imperative, it is essential for health
that air vitiated by breathing should be periodically
replaced. Thus the whole theory of ventilation is
circulation of air maintained at a proper temperature,
for cold air may be injurious. The British legisla¬
ture has taken care that lunatic asylums, workhouses,
and gaols shall be provided with proper air space per
person, and supplied with effective ventilation, but
churches, chapels, theatres, and other places where
people most do congregate are neglected and remain
sinks of discomfort. In a dining-room where I
recently dined with four gas burners alight, taking
each burner as equivalent to five persons, the cubic
space was 160 ft. pei head, and this air remained
stagnantfor two hours. In a third class railway car¬
riage, when full, it is only 47 cubic feet per passenger.
The problem is to promote thorough circulation
without draught, and without affecting the tempera¬
ture or the humidity of the air. Is the circulation to
be promoted by natural or by mechanical means ?
Is the outlet to be at the ceiling or floor level ? Is
the pure air to be forced in by pressure, or the foul
air to be drawn out by vacuum ? Is the admitted
air to be warmed in winter and cooled in summer,
and how P Is it to be filtered and freed from dust ?
Every system of ventilation needs intelligent super¬
vision. What is the standard of purity of air P Some
define it by the quantity of carbon dioxide it contains.
This should not exceed 8 volumes per 100,000, but
there are other and greater impurities in used up
air that cannot be defined.
Electricity has fortunately come in to simplify
our difficulties. It has the great merit that in the
glow-lamp it does not vitiate the air. It supplies u»
also with a convenient form of energy for artificial
ventilation.
II.— Pure Water.
It is a moot question whether absolutely pure water
is healthy, and hence we have not yet secured a
universally accepted definition of practical purity. I»
purity to be determined by the quantity of organic
matter in suspension or in solution, by its hardness,
by the amount of micro-organisms it contains, or by
the amount of injury it inflicts on human life P Sir
Edward Frankland found in Thames water 160,000
bacteria per cubic centimetre. Good drinking water
should, however, contain not more than twenty
bacteria per cubic centimetre.
C
Digitized by
236 The Medical Press. ORIGINAL COMMUNICATIONS.
Sept. 6, 1899.
Rivers are polluted not alone by the exoretions o*
humanity, but by the refuse of trade and of manu¬
facture. Pollution has not yet been made a penal
offence. The Chinese are in advance of us. In that
country, sewage—the chief cause of pollution—goes
to benefit the land, not to pollute the river.
Getting good water and maintaining it good is the
chief work of the sanitary engineer. Polluted water
is now purified and softened mechanically bv sand
filtration, an imitation of nature; chemically by pre¬
cipitation and by the action of vegetation; and
biologically by the chemical activities and cannibal
habits of living organism.
While two or three gallons per head are sufficient
for simple dietetic purposes, many more gallons are
used for watering streets and gardens, flushing closets
and drains, extinguishing fires, washing carriages and
for general stable work, and factory purposes. The
consumption of water is thus very variable. While in
most English cities it rarely exceeds 25 gallons per
head per day, in New York it reaches 60, and in
Philadelphia 90 gallons. It would seem as though
carefully purified water is misused when it is applied
to such public purposes as to lay dust, to generate
steam, and to flush the public sewers—processes
which lead to repollution without any benefit what¬
ever. Should there not be a duplicate supply, one
for domestic and the other for public purposes ? This
is already done at Richmond and St. Helens. Sea¬
water is used at Great Yarmouth and Bournemouth.
Indeed, the use of sea-water fas an auxiliary supply
for public purposes deserves the serious consideration
of all local magnates at our seaside resorts. It is
well worth the consideration of the London County
Council, for it would practically more than double
the Metropolitan supply for domestic use. It is
better for them to go to the sea, which is near to
them, than to go so far to gallant little Wales that
does not intend, in spite of its gallantry, to let
London rob it of its water. Birmingham and Liver¬
pool have taught it experience. The Thames Valley
ought to supply London with excellent drinking water
for the next 50 years—even with its present works.
The death-rate in London, a good practical standard
of the purity of water, is well below the average.
III.— Pure Food.
It was in the regulation of the food supply of the
Israelites that Moses displayed his profound know¬
ledge of hygiene. It is by adhering to these regula¬
tions to the present day that the Jews live such
healthy lives. HiR division of beasts into clean and
unclean was mainly a separation of the digestible
from the indigestible.
Parliament does not prescribe our daily food, but
it does legislate against impure food. Cold storage
has rendered possible the importation of meat from
our most distant colonies, and few of us know
whether the tender saddle of mutton on our table is,
as asserted, from Wales or from New Zealand.
The most important and general form of food is
milk, for it affects all ages and both sexes, especially
young children. The danger from milk is infinitely
greater than from meat. It is unfortunately a great
medium for the transmission of the germs of disease,
especially of the bacillus of typhoid fever and of
tuoerculosis. Unclean milk is too common, and,
unfortunately, inspection and examination of cows,
cowsheds, dairies, and milk cans is, in many districts,
thoroughly inefficient. It is not at present under the
control of the proper sanitary authorities.
The milk business of this country, especially of the
metropolis, is fortunately falling rapidly into the
hands of large public companies, who are well able to
protect themselves, and who do protect their clients,
the public, but in small urban and country districts
it remains in the hands of the farmer, often a member
of the very local authority that should enforce regu¬
lations which it is his own interest to ignore. It is
a misfortune that the co-operative system of Denmark
has not been introduced into this country. There a
large central dairy is managed by a small board,
elected from the contributing farmers, who are
scattered over the district, and who send to this
establishment their milk, to be inspected, measured,
and treated, and each of whom draws bis pro rata
share of the profits. Curiously enough their beet
customer is England.
Legislation, as affecting adulteration of food, the
importation of meat, the sale of drugs, fruit, fish, Ac.,
is probably ample. It is the enforcement of regula¬
tions, the control of supervising powers, the appoint¬
ment of inspectors that is weak.
IV.—Pure Soil.
The purity of the ground upon which our dwell¬
ings are erected, upon which our plants, fruit, and
vegetables are grown, where our kine and flocks
feed, where we take our daily walks, upon which the
air that we breathe rests, and whence our water is
often drawn, depends upon the care exercised by
ourselves upon the disposal of our excretions and
refuse. Many beasts of the field are wiser in their
generation than many a human race, even of the
present day. Carnivora cover up their dung with
earth. The cat, though domesticated, retains this
instinct. The badger has its run to its own latrine.
The fox will not pollute its own hole. The Persian,
it was reported, polluted even the rooms ut Bucking¬
ham Palace.
Mosos, in prescribing “ a place without the camp,
whither thou shalt go forth abroad," enjoined the
covering up of all excreta with earth. This was the
first known disposal of sewage, and was a natural
and effective system.
The system of treating and disposing of 6ewage can
be considered under three heads:—1. Mechanical.
2, Chemical. 3, Biological. The first system deals
with the removal of all the organic and inorganic
matter in sewage. The second includes various plans
for the precipitation of solids, the filtration of liquids,
and the formation of artificial manures. The third
extends the second to the aeration of the clarified
sewage, so as to secure the nitrification of the organic
matters in suspension or solution by bacterial
agencies, and then to enrich the land, and to purify
the effluent for further use.
Chemical treatment is well illustrated in the
case of London, where it has hitherto been in opera¬
tion without any supplementary process, but where
recently some important experiments have been con¬
ducted to determine the conditions that would justify
the introduction of the biological system. The crude
sewage is admitted into precipitating tanks, where it
is treated with lime and sulphate of iron in definite
quantities. These cause the chemical transformation
ofthe elements and compounds in solution to form
solids, which with those already in suspension slowly
settle by gravitation as sludge. The effluent flows
into the river at Barking and Crossness. Over
2,000,000 tons of this wet sludge are conveyed every
year 50 miles away to sea. The improvement of the
Thames has been very marked. It is a misfortune
that the sludge cannot be made a useful and saleable
article, but the most careful inquiries have shown
that it is practically impossible with such an enor¬
mous population—now over 5,000,000—to treat it
economically in any other way.
Mr. George Chatterton is carrving out works for
Dublin similar to those in London, but the sludge
will have to be carried away only 10 miles into the
Irish Channel. It now goes direct into the river
Liffey, which flows virtually as an open sewer through
the city, causing an almost intolerable nuisance.
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Sept. 6, 1899.
ORIGINAL COMMUNICATIONS.
The Medical Press. 287
Unfortunately, sewage farms, as a rule, do not pay.
It will be a great relief to get rid of them. We have
seen during the past Session of Parliament how the
Camp Sewage Farm at Aldershot has been violently
attached. The new biological treatment may modify
the views of this Board. It is a department extremely
well advised and ably administered, and we may be
sure that if the experimental success of the new
system be followed by a sound, practical result, it
will carefully safeguard the public requirement and
health.
The new biological treatment is a return to Nature.
“ Nature never yet betrayed the heart that loved her.”
That wonderful micro-organism that has eluded
man's observation for all these millions of years is
divided into two classes— (a) bacteria which work
with oxygen, and (b) those which do not. The sewage
first reaches the settling-tanks, where the inorganic
matter, such as sand and grit, is deposited. The
albuminous and organic matters and urea which are
found in all sewage are then transformed by bacteria
into forms of ammonia. The decomposition of
animal and vegetable matter, which is invariably due
to the action of these bacteria, is thus utilised to
liquefy organic solids, and in this way to simplify
their removal. Other bacteria gradually, in special
filters, transform the ammonia, by the aid of oxygen
and other elements present, into nitrates. The pro¬
cess of filtering is intermittent, for air is essential to
maintain the supply of oxygen to the nitrifying bac¬
teria ; but an air Dlast, in some cases, is used to main¬
tain a continuous 'action. The nitrifying effect is
enhanced if the air be warmed to about 100 degs.
Fahr. The filters must have porosity and resistance
to flow to retard the passage of the sewage through
them, for time is essential for the bacteria to grow
and to act. In sandy ground Nature does this, but
on clay formation, coke-breeze, and even coal, is found
to be very effective. In this way bacteria first liquefy
the solid matters in the sewage, and then nitrify
them, simultaneously purifying and enriching the
affluent, and preventing the formation of that waste¬
ful product, sludge. The biological system has clearly
come to stay. It is, however, still in the experimental
stage.
Biological methods may be divided into two
classes : — (a) Those which deal with sewage, clarified
by precipitation and filtering ; and ( b) those which
attempt to deal with crude sewage. The former plan
appears so far to be the most effective. The second
plan has the merit of greater simplicity; and if the
action of the different bacteria be simultaneous, and
not'successive, it may possess the method of practic¬
ability, as well as of economy. A Royal Commission
is now sitting considering the whole question.
The London County Council are making valuable
experiments at Crossness, and their conclusions will
have a far-reaching influence in the country generally.
Pasteur, the father of the germ theory, taught us
how the yeast germ produced fermentation, how
another micro-organism takes up oxygen from the
air and unites with the hydrogen of alcohol to form
acetic acid and water. The actual mechanical pro¬
cesses through which bacteriolysis pass, expending
energy, transforming matter, and promoting life,
form one of the most interesting pages of the history
of evolution ever narrated. The intermittent benefit
of filtration was discovered in the laboratory by
Frankland in 1870.
Y.— Pure Dwellings.
People suffer not alone from ignorance, but from
carelessness and filth. The Legislation of recent years
by which local authorities can improve the dwellings
of the working classes, and inspect and control com¬
mon lodging houses, has had a beneficial influence
upon the community by clearing away slums and con¬
structing new streets. But unfortunately authorities
are hampered by the restrictions of the Act of 1890,
and they are checked by the greed of vested interests.
Edinburgh, by spending £560,000 on improving the
housing of the poor, has brought down the death rate
from 28 to 17 per 1,000. The responsibility of main¬
taining pure dwellings rests now very much with the
sanitary authorities.
VI.— Pure Bodies.
Broadly speaking, every section of this address has
reference to nealth. Hygiene is the most important
knowledge for everyone to possess, but it is, perhaps,
the least acquired. The wealth and strength oi a
nation rest with the health of its people. Is it not
something to have reduced the death-rate 30 per cent.,
and to have added at the same rate to the growth of
the nation ?
Cleanliness is next to godliness; thie is the key¬
stone of hygiene. Moses prescribed cleanliness above
everything. Lepers were to be washed, shaven and
cleansed with blood, cedar wood, scarlet and hyssop.
Their garments were to be rent and burnt. They
were to be isolated outside the camp. Their houses
were to be shut up, disinfected and cleaned, and even
in serious cases to be pulled down, the materials re¬
moved out of the city and destroyed by fire. The
Cleansing of Persons Act, 1897, is a great lever in
the direction of cleanliness, but much remains to be
done.
Conclusion.
, The chief function of the Sanitary Institute is not
only to disperse knowledge but to dispel ignorance.
The resistance to progress is not so much ignorance
itself, but the determination to remain ignorant.
There are none so obstructive as those who will not
learn. “ What was good enough for my grandfather
is good enough for me,” is the cursed dogma of the
British stay-at-home. Travelling knocks this non¬
sense out of him, for he sees that Americans and
Germans are beating him in toe race.
Step by step engineering progress and scientific
research are bringing us face to face with the "grand
generalisation that Nature is only another term for
God, that Nature's laws are His thoughts, and that
everywhere, the stars in their courses and the bacteria
in their operations follow one fixed and settled design.
“ One God, one law, one element.
And one far off divine event,
To which the whole Creation moves.”
ALCOHOLISM IN ITS RELATION TO
HEREDITY, (a)
By GEO. ARCHDALL REID, M.B., C.M.Ed.,
Honorary Physician to Nazareth Home.
Drunkenness is unquestionably a terrible thing,
but it is as yet unproved that parental intemperance
afflicts the offspring in such wise as to produce in
them an increased craving for drink, not to mention
such effects as insanity and epilepsy. It is true that
the offspring of drunkards are sometimes epileptic or
insane and very often of intemperate habits, but to attri¬
bute these evils to the influence of parental indulgence
acting through heredity is to confuse post hoc with
propter hoc. Every drunkard has in his nature a
marked capacity for enjoying alcohol and in addition
to this a keen memory of the delights conferred by
previous acts of drinking. This primary capacity
for enjoying alcohol is an inborn factor, and thus,
in harmony with the teachings of biological theory,
it may be transmitted. The other element, however
—viz., the keen memory of the delights conferred by
(») Abstract of paper rend at the Annual Meeting of the British
Medical Association, Portsmouth, August, 1899.
Dig itized by
Skpt. 6, 1899.
238 The Medical Press. ORIGINAL COMMUNICATION S.
acta of drinking—is a later trait, an acquired tion to the past racial experience of alcohol. The
character, and this cannot be transmitted to the off- race that has been longest, familiar with alcohol is
spring of the drunkard. The question of the trans- generally found to be the most temperate. This
mission of acquired traits has been one of the burning shows that the effects of intemperance as acquired by
questions of the age, and though the whole plant ancestors are not transmissible, for were it the case
and animal world had been ransacked yet no then the constant accumulation of such effects gene-
single instance of the transmission of ac- ration after generation would render the race that
quired characters has been proved. A priori, had longest used drink the most inclined to drunken-
therefore, it is most unlikely that the acquired ness. As regarded epilepsy and insanity, it may be
effects of alcoholism —in the forms manifested to us argued that these may apj»ear in the progeny of non¬
in drunkards—are transmitted to the offspring. Men inebriates as of inebriates; and if it be further
differ very much from one another in the depth or objected that the offspring of inebriates are thus
intensity oc their craving for drink. Some men are afflicted in higher proportion, it may be retorted that
abstainers or are temperate because their innate it is precisely from those having a primary tendency
desire for drink is small or practically nil. Others, to epilepsy that one would expect tendencies towards
per contra, relish drink so greatly and crave it so inebriety. The tendency to epilepsy, however, may
greedily because having once had experience of it a not manifest itself as such, though in the children it
very intense pleasure is felt and strong desire experi- may appear as distinct epilepsy. The drunkenness
enced. It is from the ranks of the latter that the of the parent will mask liis epileptic tendency which,
army of drunkards is recruited. Between these two however, may reappear in the child in more obvious
extremes are all shades of drinkers. As individuals fashion and without inebriety being the causal
thus differ, so do nations and races. The Jews and element in determining epilepsy in the offspring.
Southern Europeans generally are very temperate, The temperance reformer's plan of abolishing drinic
while the Northern European races are much less is not the true method of reform. Were such a
temperate. Races and nations crave for alcohol in procedure to come into force for a time the result
inverse proportion to their past familiarity with it. would be that the race now removed from alcoholic
Present-day savages, such as those of America, Aus- selection would revert to the ancestral type in which
tralia, and Polynesia, who have never manufactured the tendency to excessive drink was greater, and
alcohol (as history shows) even in dilute form, delight directly the opportunity recurred would drinkalmostto
so intensely in this novel drink that, given the oppor- extinction, like savage man unacquainted in the past
tunity, they drink to extinction. Other savages, such with alcohol. Nature’s plan has, on the other hand,
as those of Africa, who have been able to manufacture brought about the result ti nt all communities which
alcohol in dilute solutions and in limited quantities, were anciently given to drink are now relatively
though more intemperate and leasable to resist drink sober, and that in proportion to their past sufferings
than Europeans, are much less prone to such extreme in- from drink. Were alcohol withheld some other
temperance than the savages of North America. These stimulant or narcotic, such as opium, would take its
facts establish the conclusion that the inclination to place —as is shown in the present history of certain
alcoholic excess is for a given race in inverse propor- Eastern nations.
Invalid’s Convertible Bed-Support and Chair.
A NEW BED SUPPORT.—“ THE
CARD >TTA.”
By E. BLAKE, M.D.Aberd., M.R.C.S Eng.
‘ I should like to draw the attention of the profession to an i
ingenious invention (see illustration above) by a patient, t
for supporting the back after an illness. It is a clever con- !
trivance, and is calculated to diminish the misery of in- I
validism and to promote comfort during convalescence. I
This invention consists of a wooden frame in four
pieces, which can be put together on the bed, round the
patient, the side pieces being near the centre and for the
length of 4 ins., 6 or 7 ins. in height, diminishing to 1 in.
at each end; the four pieces of the frame are made fast
together by thumb screws.
To each of these side pieces at the part where they are
highest are attached by a double hinge two wooden bars,
rising vertically, one forming one side of a frame for the
Digitized by v^ooQle
Sept. 6, 1899.
CLINICAL RECORDS.
The Medical Press. 239
seat and one the frame of the back of the bed support,
which can be raised or lowered by means of legs hinged
to the under part of the frame of the seat and the back,
and which fit into racks cut in the side pieces of the first-
named frame. The bars forming the frame of the seat
and the back of the bed support are respectively con¬
nected and strengthened by curved iron rods, fitted into
grooves, fixed under the ends of the wooden bars of the
seat and back. The seat of the bed support is formed of
strong webbing, bound at each side with leather, and
having three leather straps strongly sewn on each side.
This webbing being passed under the thighs of
the patient lying on the bed, the straps are hooked
on each side by means of holes on to brass pegs
fixed in the sides of the bars forming the seat
of the bed support, the legs under the seat are raised
to the desired neight, and the thighs of the patient are
thus raised slightly off the level of the bed. The back is
formed of webbing in the same way as the seat, and
passed under the shoulders of the patient and attached
in a similar way to the bars of the back. The supporting
legs under the back are then adjusted, and the patient
will be found to have been raised into a sitting position
without any exertion on his part.
An important point in the formation of the seat is the
arrangement of the webbing, by which a space is left
between the seat and back, in order to avoid any pres¬
sure on the spinal column of the invalid, and which also
allows for convenient use of the bed-pan without any
change of position. A movable headpieoe, consisting of
a slight frame of wood covered with canvas, slips into
sockets screwed on to the ends of the bars of the frame
of the back. Arm rests of wood are connected by thumb
screws, one end to the side of the frame of the seat,
the other to the side of the frame of the back, and
being of two pieces hinged together, move with the
movement of the frame of the bed support when raised
or lowered. A wooden rest for the feet is slung from the
front of the first-named frame by narrow bands of web¬
bing, adjustable as to length, by a buckle. The bed
support would be made in dimensions proportionate to
the size of the invalid.
A comfortable bedroom chair can be made by placing
this bed support on an invalid bed table made in propor¬
tions to carry it. The invalid bed table is made with a
top which can be raised or lowered, and with legs which
can be unscrewed for packing, and which are fitted with
ball castors.
The invalid bed table is merely an adjunct of the bed
support, and is not claimed as a novelty. It is claimed
for this invention that this bed support can be used on
any bed, and provides a simple and effective mode of
raising into a sitting position a helpless invalid. That
by means of this arrangement of the seat it provides a
comfortable chair in bed which also allows of attention j
to the needs of the invalid, or of his being lifted put of
bed without change of position. This is the only kind
of back support, with which I am acquainted, that can
prevent the constant tendency of the patient to glide 1
down towards the foot of the bed. Messrs. Arnold and j
Sons, of West Smithfield, E.C., are the manufacturers. I
Clinical Jlecotbe.
A CASE OF PARATHYROID TUMOUR CAUSING
SYMPTOMS OF MALIGNANT DISEASE OF
THE LARYNX — OPERATION AND RE¬
COVERY. (a)
By Philip P. W. dk Santi, F.R.C.S.,
Senior A win tan t Surgeon and Aural Surgeon to Westminster
Hospital.
A retired major, tet. 58, was sent to me by Mr. Eliot,
of Southampton, in June, 1895, with a history of ten
months’ persistent hoarseness, some stridor, and a
“ brassy ” cough. He had had his chest examined by
Dr. Mitchell Bruce, but nothing abnormal was dis¬
covered. There was no pain or dysphagia, no expectora¬
tion, and no loss of flesh. The patient denied syphilis.
(a) Abstract ol paper read before the British Medical Associa¬
tion at Portsmouth, 1S®9.
On elamination I found marked unpaired mobility of
the light vocal cord and limited abduction. The right
vocal cord was uniformly red and swollen, there was no
nlceration or neoplasm visible, no glands palpable in the
neck; old scarring of right face and cheek suggestive of
old syphilis; voice very hoarse and feeble. I considered
it most probable that the case was one of early malig¬
nant disease of the larynx with an alternative of syphilis
or mediastinal tumour pressing on the right recurrent
laryngeal nerve. I ordered rest of the voice, no smok¬
ing, and iodide of potassium.
In September, 1895, the patient’s voice was almost a
whisper. He had gone downhill rapidly, having lost
much in weight. The right carotid artery pulsated
visibly and seemed pushed forward by a smallish, indefi¬
nite, probably glandular swelling deep in the neck and
about the level of the second or third ring of the trachea.
In December, 1895, the swelling in the neck was
smaller, the voice better, the right vocal cord a little
more movable, and there was a gain in weight.
During 189G the patient was in very fair health, had
gained weight, the voice though hoarse was stronger,
and the swelling in the neck movable, softer, and more
defined ; the right vocal cord was in statu quo.
In February, 1899, patient had an attack of flatulence
and dyspepsia ; this was shortly followed by difficulty in
swallowing solids and later, liquids. He lost flesh
rapidly, half a stone between February 6th and March
29th. At the same time a very marked increase in the
size of the cervical swelling was noted. There was
regurgitation of food and sensation of obstruction at the
level of the cricoid cartilage.
Examination of the larynx showed the right vocal cord
more fixed but otherwise the same. I passed a No. 18
■esophageal bougie and met with some obstruction about
level of upper part of sternum. No blood or pus on
withdrawal.
The lump in the neck felt to be the size of a Tangerine
orange It seemed elastic and not stony hard. I took a
grave view of the case, and advised exploratory incision
in the neck, as I considered from the whole course of the
events the main trouble extra-laryngeal.
I made an incision over the anterior border of the right
sterao-mastoid down to level of sternum, and exposed a
large tumour situate in the lower carotid triangle
extending underneath the stemo-mastoid outwards and
downwards under upper part of sternum and upwards to
level of cricoid cartilage.
I carefully defined the tumour and found it en-
capsuled ; the carotid artery and jugular veins were
pushed far over to the outer side ; the whole tumour
was very vascular. I eventually clearly isolated it, the
chief difficulty being with the right recurrent nerve
which was attached to the tumour and flattened,' and
with the inferior thyroid artery. The right innominate
and part of left innominate veins were exposed.
The oesophagus was distinctly compressed by the
tumour ; the latter had no connection with the thyroid
gland, bnt there was some fibrous infiltration of the
oesophagus opposite the seat of pressure.
A cross cut and partial division of stemo-mastoid had
to be made to thoroughly get at the tumour. The right
dome of the pleura, the right phrenic nerve, and the
right subclavian artery were seen at the time of the
operation.
Recovery was uneventful and swallowing powers
improved almost at once.
Microscopic sections showed parathyroid tissue
essentially innocent. • The growth was encapsuled, and
contained centrally a large cyst. The case is of interest
because at first everything pointed to early malignant
disease of the right vocal cord: i.e. the age of the patient,
the uniform redness and impaired mobility of the cord, the
hoarseness, and later the presence of a lump like a glaud
externally. On the other hand the duration of the
trouble and its stationary condition did not resemble
carcinoma. Later, i.e., February, 1899, everything again
pointed to malignant disease, though more of the neck
than the larynx.
The patient now, August, 1899, is in very good health,
and his swallowing powers are excellent.
Digitized by G00gk
240 The Medical Press.
GERMANY.
Jrattce.
TfEOM OUB OWN CORBE8PONDENT.1
Paris, September 3rd, 1888.
Varicose Ulcers.
Prof. Chipault read a paper before the Biological
Society on the treatment of varicose ulcere by stretching
the sensitive nerves of the leg. The nerve, he said,
chosen for the operation, should be that on the territory
where the nicer was situated, and more particularly the
internal saphena or the musculo-cutaneous nerves. The
treatment of the ulcer itself consisted of one of two
methods. If it were small he advised total ablation ;
if, on the contrary, it were extensive, which was gene¬
rally the case, he counselled the use of the rugine to
convert a foetid wound into a healthy one, and obtain its
healing by appropriate applications.
Acne Vulgaris.
M. Gaucher spoke on the nature and treatment of acne
vulgaris, so frequently seen on the face of young persons.
These pimples were comprised of papules or pustules.
In theory, they were found everywhere where sebaceous
glands existed; in reality, they were found in preference
on the face, the neck, the shoulders, and the back ; cer¬
tain authors gave to it the name of juvenile acne. The
element was a red papule with indurated base, painful
and turning yellow in two or three days, the result of
injection from without due to the presence of staphylococci.
But this injection was not an absolute rule, for it did not
exist in subjects who had not a natural tendency to
suppuration. Consequently one of two things happened :
the pustule broke, giving passage to a little pus, and dis¬
appeared without leaving a trace, or the pus dried up
forming a crust which sometimes fell off, and
sometimes left after it induration caused by
retention of the inflammatory products. Miliary acne
was constituted by small granulations of the size of a
pin’s head, the result of accumulation of sebum in the
glandular cavity; enucleation, the only means of cure,
revealed the presence of fatty matter and a few crystals
of cholesterine. Punctuated acne was still more frequent;
black points occupying the orifices of the sebaceous
glands, composed of concrete sebaceous matter, and
which owed their colouration to dust; it was the type of
acne by retention.
The etiology of acne, in M. Gaucher’s opinion, was
lymphatism, and bad working of the digestive functions,
which is generally accompanied with dilatation of the
stomach.
The therapeutics of the affection were more simple than
was supposed. No internal treatment could be con¬
sidered as a specific for acne; ichthyol and cod-liver oil
should be avoided; but the regime should be attended to
particularly, fat as well a« fermented aliments were
hurtful, laxatives should be ordered frequently.
The external treatment consisted only in frequent
washings with soap and water, and the application
of sulphur ointment.
(Semump.
[from our own correspondent.]
Berlin, September 1st, 1399.
Discussion on Czempind’s Paper on Modern Myoma
Operations.
Hr. Simmons said that long before Landau, operators
advocated separate ligature of the vessels in such opera¬
Sept. 6, 1899.
tions, among others v. Herff, in a publication in the
Munch. Med. Wochemchrift. Years ago he bad had the
opportunity of seeing v. Eosthom operate, who had ex¬
pressly said that he always operated in that way. In
the vaginal method, when the ligaments were very tense,
the clamps were liable to slip. In the face of several
good methods he hoped that one would be able to say
before operation whether the clamp or the ligature
would be most suitable. In order to have a basis it was
desirable that complete reports should be furnished,
especially from Landau’s Klinik, with technical details.
Hr. Duhresen said that the small walnut-sized
myomata, that often caused the most pain, were the
mesonephric. The expression “ substituting ” myoma
(substituirendes myom) (Landau) was a very happy one,
but the speaker did not think total extirpation necessary
for them. This opinion was based on a case treated in
1896. A lady, an authoress, set. 81, had an uterus reaching'
to the navel, and upon the retention of this the patient
insisted, as she might possibly oontract a marriage.
He treated the case in such a way that a later examina¬
tion showed a large and normal uterus, and the speaker
believed that the authoress in her oelebrated novel
would not have been capable of its glowing diction if
the uterus had been removed. He was opposed to the
view of the necessity of extirpation in the case of meso¬
nephric and mucouB adenomata; the tumour could very
well be cut out of the substance of the uteruB, and the
uterus and adnexa retained, and in the case of myomata,
not above the size of the first, by anterior cceliotomy.
That in many cases the important method of treatment
by curettement had not been considered, lay in the fact
that the myoma had not been understood. He was
opposed to Landau’s view as to the atrophy of the
mucous covering. The speaker had seen myomata with
quite “ colossal ” growth of the mucous surface. Here
transient or even permanent good results might be ob¬
tained, as also by vaporisation. He dilated with
laminaria, palpated the uterine cavity, curetted, and
first satisfied himself that there was no malignant new
growth.
Czempin was responsible for the idea that curettement
stimulated the growth of myoma, but there were other
stimulants, especially the menopause. Retrogression
was rare in the menopause ; rapid growth and degenera¬
tion frequent. His estimate of morcellement was higher
than that of Czempin. In Plan’s operation he ligatured
the ligaments instead of clamping them, but no ligature
material should be left in the abdominal cavity.
PuERFXRAL ECLAMPSIA IN ITS PRESENT FORM.
This subject is treated, from a practitioner’s point of
view, in a pamphlet of forty pages, by Dr. Siegfried
Flatau. By the term "eclampsia" is meant an auto¬
intoxication coming on during the reproduction process,
which suddenly comes to an outbreak, its most important
and striking phenomenon being a heightened excitability
of the spasm centres. Of 100 cases 60 begin at or about
the time of labour, 23 during the pregnancy, and 17 in
childbed. Primiparae are preponderatingly attacked.
Twin and triplet births predispose, and above all nephritis
or the kidney of pregnancy. The affection leads to death
in a relatively large number of cases, partly by apoplectic
disturbances in the brain, by cardiac failure, cederna of
the lungs, by pneumonia from swallowing, by sepsis.
The prognosis of eclampsia in childbed is more favour¬
able than that sub partu, and experience^has'shown com-
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Sept. 6, 1899.
AUSTRIA.
Tux Medical Press 241
pletion of labour cut* off the attack in 85 per cent, of
the cases ; those cases are the most serious when the
attacks commence early, when labour is slow and there¬
fore in primiparte. The prognosis is had when the
attacks follow in quick succession, and worse in those
cases wheD the attacks continue after the birth of the
child.
In cases where the attacks begin before the normal
end of pregnancy the foetal mortality is, according to
Schauta, 41 - 8 per cent. If the child is dead the attacks
usually cease, but not always.
Of children actually born a large number die—
between 20 and 40 per cent. Many factors, the more
or less active treatment, the frequency of the attacks,
Ac., affect the death rate. It is probable that the child
in utero suffers from the disease as well as the mother.
The pathological anatomy of the disease in the form
of a completed systematically built up system was
first presented by Schmorl. The lesion of the kidneyB
is generally very severe. The urine in 64 per cent, con¬
tains albumen or acid, the quantity diminished,
and occasionally there is anuria. The kidneys contain
fat emboli, characteristic haemorrhages, and necrotic
patches, in association with thrombi of the vessels, and
the changes of parenchymatous or intestinal nephritis.
Bnt there are cases in tchirh there is no albumen nor, indeed,
any coarse changes in the lcia'ney. Dilatation of one
ureter is not rare. In the liver also there are hcemor-
rhages and necroses, in the thromboses of vessels, and
fatty emboli ; in the brain anemia, oedema, with flatten¬
ing of the gyri, and hemorrhages, the latter often
microscopic; in the lungs, besides thromboses and
hemorrhages, there are liver and placental emboli.
The fact first determined by Bouchard that the urine
of eclamptics was three times less poisonous than that
of healthy individuals, and, on the other hand, the
certainly proved greater toxicity of the blood of eclamp¬
tics, raises the view that eclampsia is an auto-intoxica¬
tion during the reproductive process, to the dignity of an
axiom. What the nature of the poison (creatine, creati¬
nine, carbaminic acid globuline ?), and why it is formed
and becomes active during pregnancy, form questions
for further inquiry.
As regards therapeutics, the author lays great Btress
on a milk diet as a prophylactic, baths, diuresis, Ac. If
nephritis gravidarum already exists, interruption of the
pregnancy should not be entertained.
During an attack the head should be placed on its
side in order to avoid inspiration of saliva. The chief
aim during an attack, viewing the case as one of auto¬
intoxication, is excitement of the se- and excretions, wet
packings, sweatings, diaphoretic and diuretic measures;
venesection is not a palliative only: it lowers the blood
pressure, it prevents cedema of the lungs, it prevents
apoplexies, but it acts setiologically in removing along
with the blood a portion of the toxic material. Perhaps a
large number of practitioners will scarcely agree with
the author when he says that narcotics, morphia, and
chloral hydrate are of no use in eclampsia. As the con.
vulsions cease in 85 per cent, of the cases after the birth
of the child, he urges rapid delivery, especially in cases
of deep coma and rapidly recurring attacks. Mechanical
dilatation of the uterus, Diihrssen’s cervix-vaginal-
perineal incisions are not for the general practitioner.
Caesarean section comes in only as an uliimum re/ugium.
In some casesCasarean Eecticn in moribunda or mortua •
may save a child's life. All operations should be per¬
formed under an anaesthetic, and he prefers chloroform to
ether on account of the action of the latter on the
salivary and bronchial glands. Buckling may be allowed
as soon as circumstances permit. The hydropathic treat¬
ment is to be continued so long as the urine contains
traces of albumen.
Austria.
[VEOM ODE OWN CORRESPONDENT.]
ViiBNi, September 2nd, 18SP.
AtMOCACSIS OB ZK8TOCAU8I8.
At the Yersammlung Deutcher Naturforcber, Guerard
showed Pincus apparatus for the treatment of climacteric
haemorrhage by means of hot vapour at the boiling point
Ever since 8neguirew declared to the profession that
a high temperature was the best remedy for checking
hemorrhage, Pincus tells us that he has laboured assidu¬
ously to design an apparatus for practical use, which he
considers is accomplished in the instrument exhibited.
The principle of the instrument is to conduct a stream
of hot vapour into the uterus without scalding any of the
outer parts of th9 channel, at the same time securing the
safety of the operator against any personal injury from
burning or scalding. "With this instrument lhe boiling
hot steam is confined to the interior mucous membrane
of the uterus alone, he recommends it to be continued
for ten seconds to half a minute, which will obviate many
an operation for extirpation of the uterus due to intract¬
able haemorrhage during the climacteric period. In senile
catarrh of the uterus two minutes will be required. He
adduces many cases of obstinate haemorrhage which
have been relieved by this form of treatment ranged
from 100 degs. Cent, to 115 degs. Cent. (212 degs. to 239
degs. Fahr.). Young persons are not able to bear this
high temperature as long nor so easily as the old. He
thinks better results can be obtained from a short appli¬
cation with a temperature of 106 degs. Cent, to 110 degs.
Cent, than a longer period with a 100 degs. to 105 degs.
Cent.
The reapplication should not he undertaken before
regeneration of the mucous membrane takes place, which
will probably be four weeks later.
The proper christening of this instrument has been a
source of considerable difficulty to the patentee. At
first the modest designation of vaporisers and vaporisa¬
tion of the uterus sufficed to convey the author’s meaning,
but discovering that the effects were locally concentrated,
and at a very high temperature, vapocautor and vapo-
cauterisation was subsequently adopted as the more
suitable expression. Later, the aut hor turns it over again
to atmocauter and atmocausis, and finally he discovers
in his Greek lexicon that it should be Zestocauter and
Zestocausis, from y e*6r6rnt, seething or scalding. It
may possibly be recognised by some of these names in
future, but at present it is not decided.
The indications for this form of treatment are tabu¬
lated as endometritis, hsemorrhagic and gonorrhoeic j
endometritis pueiperalis incipiens; atonia; climacteric
haemorrhage; senile catarrh; interstitial myoma; sub-
involutio; infarct sterilising cavity in putrid abortions;
dysmenorrhoea, Ac., Ac.
Contra-indications are malignancy, tubal affections,
I abscess in adnexa, rigid portio vaginalis.
Digitized by Google
HOLLAND.
Sept. 6, 1899.
242 The Medical Press.
In "the discussion Arndt thought the apparatus was
especially suitable for climacteric haemorrhage. He also
added that the vapour flowing from the exhaust tube in
the uterus was not 115 degs. Cent., as Pincus would have
us believe, but only 65 degs. Cent.
Schlutius said that he had the apparatus modified
to avert.the danger of over pressure, and had obtained
excellent results from its application in haemorrhages.
Menstruatio Pbecox.
Hofacker showed the meeting a singular case of a girl,
set. 9, who began to learn her letters when twenty
months old. About the end of the first year she began
to menstruate regularly every four weeks, each period
lasting three to five days, before each of which she
became languid and dull. She was as tall in her second
year as a girl of seven years, but since that time this
rapidity (of growth has ceased, so that at the present
time she is only at the normal height for her age.
The] breasts are well developed; a rich crop of hair in
the armpits and mons veneris. The labia minora and
majora larger than normal; while the mental condition
of]the child seems to be retrograding.
In such precocities there is usually to be found some
pathological change, and this is no exception to the rule,
as rachitis has been diagnosed.
Treatment of Puerperal Fever by Injections of a
Common Salt Solution.
Eberhardt recorded great success with an injection of
sodium chloride in cases of puerperal fever, and more par¬
ticularly in those septic cases where vomiting is persistent
and no fluids can be retained on the stomach, whereby
the fluids of the body are reduced and poison more con¬
centrated.
From the report of many experiments he showed that
one litre of this 09 per cent, solution effectively
produced diuresis, which promptly eliminated the bac¬
teria with effete nitrogenous products. After this start
the circulation of the kidneys became more vigorous, and
averted all future danger of concentration in the kidneys.
He was supported in this favourable report by Sahli,
who could vouch for the beneficial effects of the
solution.
He strongly recommended the treatment to practi¬
tioners, by whom it could be easily applied without any
danger to the patient, which was also a serious consider¬
ation in these days of highly forced aesthetics.
.Ijollanb.
THE INTERNATIONAL GYNAECOLOGICAL
CONGRESS AT AMSTERDAM.
[from our special correspondent.]
(Continued from page 190.)
A Congress may be said to serve two chief purposes,
namely, the advancement of the science or the cause in
which the Congressists are interested, and, secondly, a
social purpose. It iB conceivable that in earlier days,
when a Congress was known as a Diet, the first object
outweighed the other; the delegates met, discussed the
questions of the day. and then returned to their own
places without causing much stir. But this is not the
way of doing things at the present time ; the Congress
js now raised into a kind of
Feast of Learning.
The delegates meet and discuss, it is true, but that is
not the whole of the matter, indeed it is sometimes only
the minor part. The gathering of men of name and
fame from every part of the world into a town is the
signal for entertainments, feastings, excursions, and
hospitality of all kinds on the part of the authorities
and of private individuals, who delight to do honour to
those by whose presence they themselves feel honoured.
This dual aspect must have impressed those who at¬
tended the Gynaecological Congress at Amsterdam.
The Scientific IYork Done
cannot be regarded as insignificant; at a rough estimate
I should say that about sixty papers were read, many of
them being of considerable value; whilst, in addition,
four important discussions were held, the total time
occupied in solid work amounting to 24 hours. It is
probable that as the result of these deliberations
suffering humanity, and especially its female portion, will
reap a material advantage in life prolonged and in health
restored. It is impossible for me to criticise the papers
and reports individually, but two papers call for a pass¬
ing mention. With the aid of some excellent prepara¬
tions, Mdlle. Catherine van Tussckenbrock demon¬
strated beyond dispute the possibility of the
occurrence of ovarian pregnancy. I believe that such
a complete presentation of the case in favour of this
condition has not hitherto been made. The second
paper I wish to refer to is important from its probable
results. It was one by Dr. La Torre, of Rome, on
nomenclature of contracted pelves, and it led to the
nomination of an international commission of experts,
who hope to report the conclusions at which they arrive
to the Paris Congress next year. Yet the medical work
done is probably not the aspect of the Congress which
will leave the strongest personal impression on those who
were present, because all that was read and spoken, is it
not written in the book of the chronicles of the Congress,
the Comptes Rendus, to wit ? To this extent, the man who
stayed at home will profit equally with the man who
journeyed to Amsterdam.
Official and Private Courtesies.
That which will remain more especially in the
minds of those present is the memory of acquaintances
formed and friendships matured with medical brethren
who live far removed from our daily life, but whose
names were deservedly familiar through their work. And
perhaps more than all will be remembered the kind¬
ness and the hospitality shown, in public and in
private, by State, municipality, and residents in
and around Amsterdam. These things are not
much dwelt upon in reports, and for this reason I wish
to place them on record here. Moreover, I take it that
the matter should be regarded, not simply as courtesy
shown to a handful of our countrymen and their wives
and daughters; but as an expression of goodwill toward 9
members of the medical profession in Great Britain, in
the person of their representatives. Professor Treub,
president of the organising committee, and Dr. Mendes
de Leon, general secretary, were quite indefatigable
in their efforts to further the convenience and
enjoyment of the visitors to the Congress; and
I think many will recall their ubiquitous presence
during the excursions to Scheveningen and to the Isle
of Marken, where they Beemed to feel a personal respon¬
sibility for every individual excursionist. In these
efforts they were ably seconded by Dr. Stratz, Dr
Digitized by v^. ooQie
Sept. 6, 1899.
Nijhoff, Dr. Van der Welde, Dr. Miinlieff, Dr. Barnouw >
and others. It would be as ungrateful as it would be
ungallant to forget the part played in the festivities of
the week by our two admirable hostesses, Madame Treub
and'Madame Mendes de Leon, who well exemplified the
Dutch Ladies’ Standard of Hospitality.
As is well known, this standard is high. Commencing
with a charming reception at the Maison Couturier, these
two ladies continued their gracious dispensations of hos¬
pitality throughout the week, in luncheon and dinner
parties. Several of us also were from time to time the
guests of Dr. and Madame Mendes de Leon at their
delightful seaside villa at Landvoort.
I’might write at some length on the various attrac¬
tions which Holland offers to the visitor to its shores
but that would be beyond my present purpose. I will
only add that whether they go mainly for work or mainly
for pleasure, visitors to this unique and fascinating
country will not be disappointed.
^hc ©perating theatres.
8T. THOMAS’S HOSPITAL.
Operation for Strangulated Ventral Hernia
Gangrenous Gut.—Excision of Four Feet of Intes¬
tine. —Mr. Battle operated on a woman, let. about 85
who had been admitted shortly before with a large ven¬
tral hernia and symptoms of acute strangulation. The
stated that she had undergone some abdominal
operation two years before, and that a scar had
resulted below the umbilicus and in the middle
line, and that it was not long before this Bear began to
bulge, and the present hernia was the result. The
woman was vomiting frequently, the vomit consisting of
a brown coloured fluid, not feculent. She was in a con¬
dition of serious shock, being pale-faced, restless, and
with a small, rapid pulse. Her pain was extreme, and
the hernia was very tender. There had been no action
of the bowels, and Bhe had passed no flatus. She
stated that her severe symptoms had commenced
during the previous night. Examination revealed
a ventral hernia as large as the patient’s head, which
came through an opening in the middle line below the
umbilicus. It was tympanitic on percussion, and very
hard to the touch, whilst the surface, which had come in
■ contact with the clothes, was superficially ulcerated. It
was evident there was a condition of acute strangula¬
tion. An operation was performed as soon as
possible. The surface of the hernia and the sur¬
rounding skin were thoroughly cleansed, and the pubes
- shaved; the sac was then opened to the left of the
middle line and a coil of gangrenous intestine found,
there was also a very offensive purulent fluid in the sac;
- the first coil of intestine occupied a kind of diverticulum
of the main sac, and it was hoped that this was the limit
of the gangrenous process, but as the incision was
extended it was found that there were several of these
loculi, and that the whole of the intestine which
oooupied the large sac was in a condition of
gangrene. There was no omentum in the sac. The
patient’s general condition was now very bad, and the
question as to duration of operation was very important
it was evident that she could not stand excision of the
. gangrenous part which was estimated as more than
Tee Medical Pkem. 243
three feet in extent, and included the ctecum part of the
ascending colon, the appendix, and some ileum, and it
was not thought prudent to attempt resection alone on
account of the increased shock which would have un¬
doubtedly followed. It was decided therefore, to
close the abdominal opening, leaving the intestine
affected outside. A tube was placed in the ileum where
it appeared healthy, and then the gangrenous gut
was emptied of its contents, thoroughly washed with
perchloride of mercury, dusted with iodoform, and then
closed aith a layer of cyanide gauze. The patient rallied
satisfactorily from this operation, and two days after wards
the gangrenous intestine was excised. The number
of vessels requiring ligature showed how unwise it would
have been to have attempted this at the first operation.
A Paul’s tube was fastened into the end of the ileum,
and another into the end of the ascending colon, and
the whole wound thoroughly disinfected. The portion
of intestine removed measured more than four feet.
Mr. Battle remarked that he hoped to re-establish
the intestinal canal on some future occasion when
the patient had sufficiently recovered. The case,
he said, was a very unusual one, because the
opening through which the hernia had come was
large enough to admit four fingers, and it is not common
to get such acute strangulation when the opening is of
such large size. This was certainly a most acute
process, and perhaps the absence of omentum in the
sac was partly accountable for it. The gangrene
of the large intestine ceased abruptly at the point
where the edge of the opening had compressed it.
ST. MARK'S HOSPITAL FOR FISTULA.
Carcinoma of the Rectum complicated with a
Perirectal Tumour. — Mr. Swinford Edwards
operated on a man, let. about 55, for malignant disease,
which extended up the bowel for about three inches.
The patient had only complained of symptoms for six
months; he was singularly free from pain, but suffered
at times from a sanious discharge from the rectum,
accompanied by frequent desire to stool. Ether having
been administered, the patient was placed in the left
lateral decubitus, and Mr. Edwards inserted his finger
into the rectum in order to make a more thorough
examination than he had previously been able to do;
immediately above the growth the finger touched a
rounded elastic swelling over which the mucous membrane
was freely movable; this tumour lay towards the
front of the rectum, apparently between it and the
bladder. In order to make a more thorough examina¬
tion a posterior proctotomy was performed; the swelling
now appeared to be the size of a tangerine orange.
Although Bomewbat movable, it seemed to have deep
attachments to the pelvis. Under these circumstances
it became a question whether it was worth while attempt¬
ing to remove the carcinoma, as the tumour first referred
to might possibly be either glanular enlargement or
extension of the disease upwards, not involving th e
mucous membrane. However, having exposed the diseased
area, Mr. Edwards thoughtit best to proceed to remove the
portion of the rectum which was evidently carcinoma¬
tous before proceeding to deal with the other tumour.
The patient having been placed in the kneeling posture,
a modification of Godlee’a position recommended by
Littlewood (the patient being placed as for dissection of
the buttocks, the chest and abdomen being on the ope-
THE OPERATING THEATRES.
Digitized by Google
LEADING ARTICLES.
Sept. 6, 1899.
244 The Medical Pbess.
rating table with the pelvis raised (and the knees flexed
and resting on a chair to which they are attached), the
lower portion of the rectum, including the anus, was
removed from below upwards, the part of the gut just
below the tumour being clamped with large pressure for¬
ceps. About three inches of bowel were removed in
all, and the peritoneal cavity escaped injury. As the
patient was now in a somewhat collapsed condition, it
was not thought advisable to proceed with the removal
of the extra-rectal tumour, but to leave this for
observation and possible further operation. It was found
difficult to apply ligatures to some of the deeper vessels,
so pressure forceps were left on and the wound packed
with gauze. Mr. Edwards said that this was an unique
case in his experience, for it was rare to have a case of
carcinoma of the rectum complicated with what appeared
to be a perfectly distinct tumour, the features of which
pointed rather to an innocent than to a malignant
growth. From its feel he thought it might not unlikely
prove to be a dermoid, as it was quite smooth, somewhat
movable, and elastic. As he had before remarked,
the mucous membrane was freely movable over
it, as also probably the muscular coat. It
was a matter for regret, he thought, that the
patient’s condition did not warrant further operative
interference such as would be necessary for its removal.
With regard to the patient’s position he had employed
this posture because at first he considered he might have
to perform a Kraske’s or similar operation. Mr. Edwards
thought this modification of Godlee’s position recom¬
mended by Littlewood, to be the best when Kraske’s
operation was undertaken, but for a case such as the
present one in which a more limited operation had
sufficed, no bone having been removed, and the
peritoneal cavity being left intact, he considered a better
view would have been obtained in the lithotomy position;
he pointed out, however, that even with the many
advantages of Littlewood’s position it had one great
drawback, that it was very difficult to keep blankets on
the thighs and to protect them from getting soiled, as
mackintosh sheeting was very apt to slip down.
It is satisfactory to say that the patient a fortnight
after operation is doing well. The haemostatic forceps
were removed after forty-eight hours, the large wound
is granulating nicely, and the peri-rectal tumour shows
no sign of increase.
Acquired Syphilis in an Infant.
Acquired syphilis in an infant of seven months
is a recognised rarity. An interesting case of the
kind is recorded in the current number of the New
York Medical News, by Dr. L. D. Bulkley. The
primary lesion was a chancre on the lower lip, which
was apparently traced to the infected nipple of a
feeding bottle. Upon the trunk was a fully developed
macular syphilide, which had been noticed for four
days. The child was well nourished and of splendid
development. The mother was healthy. The chancre
wus half an inch in diameter, there was enlargement
of the glands under the jaw. The infant having been
fed by the bottle, the supposition was that the infec¬
tion was conveyed by some one who had tasted the con-
tents of the bottle to ascertain if the food was of
the proper temperature.
Bkoistbsbd roK Trabskibseox Abroad.
<2The JEebical Jwbb aitb Circular.
Published every Wednesday morning, Price 5d. Pest free, lid.
ADVERTISEMENTS.
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z Jttebiral fr cbs attb Circular.
“ 8ALU8 POPULI 8UPREMA LEX.”
WEDNESDAY, SEPTEMBER 6, 1899.
PROVISION FOR THE MENTALLY
DEFICIENT.
No excuse is needed for referring once again to the
Poor-law provision for the mentally deficient class,
for although there has been muoh talk very little has
been really done. The question is a very large one,
and to reduce the whole matter to practice instead of
theory would imply a considerable unanimity of
opinion on the part of Public Boards in England.
When we consider the various classes of the feeble¬
minded, the different accommodation required for
them, and the need of specialised treatment for those
who are capable of some educational or industrial
training, it will be seen that a very important
revolution of affairs is involved in reducing
suggestions to a practical form. No one will
question the axiom that lunatic asylums are
not the most suitable places for juvenile imbeciles
even for those requiring custodial care, but when we
consider the immense charge that lunacy has been to
this country, and the extravagant ideas which now
prevail regarding the building and equipment of
modern asylums, we are not surprised that there
should be hesitation and delay in differen¬
tiating, in the manner proposed by Dr. Shuttleworth
in his address before the recent Poor-law Conference.
That his requirements are good goes without saying,
but there are practical difficulties in the way which
cannot readily be got over. Thus, for example, we
find that the statistics of this class are insufficient to
form a basis for structural erections or changes
because of the large number of imbeciles who are not,
treated in institutions of any kind, but are allowed to
roam about at their own sweet will, and are whollj
Digitized by
Google
Sept. 6, 1899.
LEADING ARTICLES.
The Medical Pbess. 245
or partly provided for by doles from Boards of
Guardians. As a very good example of what is being
done and wbat ought to be done, Dr. Shuttleworth
quotes the combination of the great Unions of Man¬
chester and Chorlton, which on the instigation of
Dr. J. M. Rhodes, who has devoted much intelligent
attention to the treatment of imbeciles, combined to
establish a colony for 1,500 epileptics and imbeciles
now accommodated in their workhouses. A site has
been secured, and if this be approved by the
Local Government Board, cottages will be erected
on the Alt - Scherbity plan to accommodate
groups of fifty patients, with central admini¬
strative offices, infirmary, &c. A similar com¬
bination of Unions to establish a school for
pauper imbecile children has been suggested by the
Birmingham Guardians, but so far without success.
Of course there are voluntary institutions, such as
those at Earlswood, Lancaster, Colchester, Starcross,
and Knowle, affording in the aggregate accommodation
to 1,700 patients, but those do not meet all require¬
ments and do not profess to admit paupers. It is
pointed out by Dr. Shuttleworth that where there is
no such charitable provision, or a totally inadequate
ODe, as in the Midland Counties, the urgency for the
provision of imbeciles is greatest. Voluntary homes
have been established in various parts of the country
by charitable effort, the weekly rates of payment
varying from 5s. to 7s. A confederation of existing
homes, which are usually for twenty inmates, has
been formed, and full particulars may be had from
the National Society for Promoting the Welfare of
the Feeble-Minded, 53 Victoria Street, S.W. We
have taken special notice of Dr. Shuttleworth’s
paper because he is an acknowledged authority on
the subject, and because we feel strongly with him.
Those interested and anxious to see an improvement
in the present system, should (as he describes it)
“ keep pegging away.” It is earnestly to be desired
that something may be done, for it is sad to think of
the neglected opportunities that have been at our
door for years, and of the young lives that might be
brightened and improved, morally and socially, as
well as intellectually by well-directed efforts on their
behalf. __
THE PHYSICS OF AUSCULTATION.
One of the most important improvements in the
diagnosis of diseases was that which was effected by
the work of Laennec, when he turned attention to the
methods by which the sense of hearing could be
utilised in a manner not previously observed or
appreciated. The eye and the hand, the sense of
sight and the sense of touch, were the two senses
we chiefly relied upon in medical and surgical practice.
How to use the ear did not seem to have occurred
to others as it did to Laennec. What could be
learnt from the use of the ear in the diseases
of the most important organs of the human
body, the heart .and the lungs, was first pointed
out by him; and there is no subject which
attracted so much attention in the profession
about half a century ago as the use of the stethoscope.
As far as this instrument is of use it is quite
clear that its value depends on the assistance
it affords in the conduction of various sounds from the
patient’s body to the ear of the physician. The ques¬
tion of how and why various changes in the heart and
lungs can cause various sounds is quite different from
the question how we can best hear them. The only
way to obtain answers to the first question was clearly
dependent more on pathology or morbid anatomy
than upon anything else, though experiments on
living animals were to some extent resorted to. On
what principle the stethoscope should be constructed,
and how the instrument could be best applied to
the detection of variations of sound in the heart
and lungs, is a subject that can only properly be
dealt with by those who have studied the science
of Bound, by such men as the late Prof. Tyndall,
who gave special attention to it. When we see
that it was Tyndall who presented to the Royal
Society the paper which Dr. Alison wrote on
the stethoscope, we have evidence that he saw the
importance of using the science of sound in medical
practice-! [.There seems, however, to have been a want
of scientific knowledge on the part of Laennec and
his followers in his own and other countries. Various
names were invented to describe the various sounds
which could be heard in the heart and lungs when
certain pathological changes occurred in them.
Souffles, bronchophony, segophonv, pectoriloquy,
murmurs, frictions, and various others were used to
describe certain well-known affections of the tissues
of the heart, pericardium, lungs, and pleural cavities.
An d then the method of percussion became of im¬
portance, and how best to use it was attractive to
many physicians. To go back, however, to the
physics of auscultation, we have to consider on what
scientific principles we depend when we try to use
the ear in diagnosis. In the case of the lungs we are
dealing with vibrations of air; in the case of the
heart and blood vessels with vibi'ations of a
fluid—and Jhow best to carry these through an
instrument to the ear requires some considera¬
tion. Would the same conducting medium answer
equally well for both is a question we need not
discuss. A point, however, that we consider
still requires study is the qualities of the vibra¬
tions of air and fluid, or, rather, the differences
between them; and then we shall arrive at some
conclusions how best to convey them to the ear.
The curious way in which a thin layer of fluid in the
pleural cavity alters the voice sounds, and the differ¬
ence between a solid stethoscope and a tubular one in
heart and lung diagnosis, we know depends on the
variation in the conduction powers of solids, liquids,
and air. There seems to have been more ignoranoe
than we should have expected in a great deal that has
been done in this line of medical research. The
reason, we suppose, is because the science of the
physics of Bound was not sufficiently well known in the
profession to prevent the imagination from mislead¬
ing, and much time and trouble being wasted to no
purpose.
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ii46 The Medical Pbe&s.
NOTES ON CURRENT TOPICS.
Skit. 6, 18tf8.
INTERNATIONAL MEDICAL CONGRESSES.
Now that the novelty of the huge gatherings
which pass muster for international scientific con¬
gresses is passing off, the intelligent public are
beginning to ask themselves whether these modern
Babels really do much for the advancement of
science, and of medical science in particular. Ex¬
perience shows clearly enough that the contributions*
which are bewildering in their abundance, rarely
convey original information, or, indeed, any informa¬
tion that has not already been, or would not subse¬
quently be, published to the world at large through
the medium of the press, under conditions far more
favourable to judicious elimination and emendation
than the editors of the portly volumes of proceedings
can possibly secure. As a matter of fact, the reading
of papers at these congresses is more or less a farce, I
seeing that in such a Babel of tongues anything in the
nature of a thorough discussion is impossible, partly
for want of time, partly by reason of the multiplicity :
of languages. Judging from the prominence in¬
variably accorded to a particular series of names, the ]
principal object of these meetings appears to be that |
of affording certain energetic persons the longed-for
opportunity of blowing their respective trumpets to
the best advantage. It may be urged, on the other
hand, that the gathering together of scientific men
from all parts of the world must tend to obliterate
insularity and to pave the way to personal acquaint¬
anceship between investigators who are following the
same lines of research. So far, so good, and we are
not concerned to deny that advantages of this kind
may, and do, result from the opportunities which
international congresses afford. The recent Obstetrical
Congress at Amsterdam shows, however, that, instead
of obliterating international jealousies, these meetings
afford an unrivalled opportunity for placing them
en evidence. For many years past the German¬
speaking countries of the continent have been the
happy hunting ground of German professors, an in¬
vasion which, naturally enough, has awakened native
susceptibilities. This feeling has reached a crisis in
Holland where a stand has been made against the
encroachments of German professors with the result
that at the recent Obstetrical Congress the German
delegates ostentatiously abstained from assisting
thereat, although they had accepted the posts
assigned to them and their papers had been
printed. A similar movement is pretty oertain
to take form in Switzerland where German
professors have, in many instances, succeeded in
ousting the Swiss candidates for professorships. The
movement is likely to spread, and may ultimately
prove fatal to the future of the international congress
as at present organised. The vice of the present
method is in particular the utter absence of selection,
and this vice attains its maximum in congresses not
devoted to a specialty. There is an abominable
plethora of papers emanating from men who for the
most part are unknown to fame, even to that
restricted fame whieh is limited to their own frontiers,
and there is in reality no attempt to edit the pro¬
ceedings. The consequence is that the occasional
grains of wheat are submerged in an incredible
quantity of stuff which is neither original nor
interesting. In fine, there is no scientific object
which cannot be attained by the publication of con¬
tributions in the columns of the medical and scientific
press which, after all, is the path by which the care-
fully sifted proceedings ultimately reach the pro¬
fession. The criticisms which we have passed on
international congresses apply mutatie mutandis to
national congresses except when these meet for the
discussion of a specific subject, such, for example, as
tuberculosis.
$olz& ott (Eurrnti topics.
The Plague in Europe.
Dr. Mendoza, one of the two Spanish physicians
sent from Madrid to report to the Government on
the outbreak of the plague in Oporto, writes to our
Spanish contemporary El Siglo Medico, on the sub¬
ject, that the first cases of plague in the city occurred
among quay labourers who were employed discharg¬
ing the steamship City of Cork, of a cargo which she
shipped in Bombay. The cargo was reported to con¬
sist of hides, the importation of which is prohibited
in Portugal, but this is denied, and the cargo is
declared by the agent of the shipping company to
have been bags of rice and chests of tea. An d
it is urged that the customs authorities would
not allow of the discharge of a cargo of
hides. Dr. Mendoza, nevertheless, thinks that
it is quite possible that the cargo was of hides
although he quotes the case of the introduction of
the plague germs into Madagascar in a cargo of rice
as showing that the germs may have been brought
with the rice. The outbreak took place on June 22nd,
the day the steamer was unladen; it assumed the
fulminant type in the case of the labourers who were
engaged on the City of Cork and a less virulent
type among those to whom they transmitted the
disease. In their report to the Government Drs.
Vicente and Mendoza, state that the cases examined
had all the well-known characteristic symptoms of the
Eastern plague. They carefully examined diseases,
three of men and of women, which were under
the care of Dr. Noguerias, in Misericordia Hospital.
Four of the cases, one man and three women, had
enlargement of the glands of the inguinal, axillary,
submaxillary, and cervical regions. The three women
were suffering from pneumonia. In one ful m i na nt
case the inguinal glands suppurated and bled, and a
rash resembling chicken pox appealed, petechias
appeared on the chest, the skin became cyanotic,
and death resulted in twenty hours. Writing on
August 16th, the physicians conclude that the
epidemic is arrested, and that its virulence is greatly
diminished. No antitoxins were used in the treat¬
ment, for the very good reason that none were to
hand, there was not sufficient time for their prepara¬
tion. The Spanish Government has placed a sanitary
cordon round the Portuguese territory, bordering
Digitized by
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Sept. 6, 1899.
NOTES ON CURRENT TOPICS.
The Medical Pre6s. 247
Spain, under the charge of General Mariano
Capdepon, and at Valencia de Alcantara. Fuentes
de Onoro, and Fregenada, Juy, and Padajoza. a
doctor with a military guard is stationed to prevent
infected persons or goods crossing the border. Any
person coming from any suspected centre of infection
is to be detained for such time as the medical officer
in charge thinks necessary up to ten days, which is
considered by the authorities as the maximum period
of incubation. Arrangements are made for the dis¬
infection of the person, clothing, and luggage or
wares of the traveller, and none are to be allowed to
pass without being submitted to the process. A
royal order further charges all medical men to notify
to the central authorities any case occurring in their
practice resembling plague, and to inculcate on
the people the necessity for keeping their dwell¬
ings clean. Dr.' Ovilo has been entrusted with
the carrying out of the sanitary arrangements.
Twenty tent hospitals, in groups of five, are pro¬
vided. Of these ten are set apart aB observation
tents, and of the remaining ten five are reserved for
men and five for women. With these are installed
apparatus for cooking, lighting, sanitation, disinfec¬
tion, and an abundant water supply. Senor Dato, the
member of the Government charged with the direc¬
tion of sanitation, has expressed his gratification at
the completeness of the arrangements made in this
epidemic hospital for fighting the plague.
What Constitutes Pecuniary Ineligibility
for Hospital Relief.
A great miBconoeption undeniably prevails in the
minds of most laymen relative to consultants' fees,
and this fact is made very prominent by a letter
published in the Times last week on “ Hospitals and
Out-Patients,” by Sir Trevor Lawrence. He raises
the question of what should constitute pecuniary
ineligibility for hospital relief, and adduces the case
of a clerk, whose income may be £200 per annum.
Such a person he maintains would be quite
unable to pay fifty or one hundred guineas
for an operation, with all its attendant ex¬
penses, and, therefore, those who belong to the
class of clerks, he considers are not ineligible for
hospital relief. We are sorry to see that Sir Trevor
should have fallen into the error of supposing that
a hard and fast line exists by which it is impossible
for consultants to accept reduced fees. As a matter
of fact it is the rule rather than the exception for
modified fees to be offered and taken. Indeed, if this
were not so, the surgical beds of our hospitals would
soon be crowded by persons able and willing to accept
those modified terms. Moreover, it is quite a
mistake to suppose that there are no nursing homes
whose proprietors do not cater for the class of per¬
sons in question. Most operating surgeons are
acquainted with surgical homeB where the weekly
charge is only two guineas. We are, therefore, bound
to disagree seriously with Sir Treror Lawrence when
he contends that a clerk earning £200 a year is not
in a position to pay the fees of a consultant for a
grave operation. There are many young hospital
surgeons who cannot expect to obtain full fees for
their operations, and it is to them that clerks and
others similarly placed in a pecuniary sense should
apply. Perhaps some of the junior members of the
staff at-St. Bartholomew’s Hospital, of which insti¬
tution Sir Trevor Lawrence is the treasurer, will take
steps to point out that they are quite prepared to
operate upon any number of £200 per annum clerks
at reduced fees. The truth is that it is only
a very select few of operating surgeons whose inde¬
pendence is such as to enable them to claim the
maximum fees for their operations.
Opium Eating.
An inquest held last week in London upon the
wife of a dock labourer, called attention to a form of
drug craving of which one rarely hears nowadays.
From the evidence it appeared that for no less than
thirteen years,accordingtoherownstatement, deceased
had been in the habit of taking opium. The hus¬
band stated that his wife met with an accident
eighteen years ago, and ever since had been in the
habit of taking opium pills. 8he bought about three
pennyworth of the pills every day, and procured
them from a chemist in the East India Road. The
medical testimony pointed to the drug mentioned
having been the indirect cause of death. The
coroner drew attention to the fact that the box
in which the pills were sold was not labelled,
although the opium was a scheduled poiBon, and
there was no actual proof as to where it was pur¬
chased. The infraction of the law, as laid down by
the Poisons Act, appears to be clear enough, and if
that salutary law is not to become a dead letter, the
present is evidently a case in which the police should
prosecute. So far as we can judge from the evidence
of coroners’ courts, there is no law more systemati¬
cally evaded than that which is framed to regulate
the sale of poisons. Why should this be P Even the
national interest in the affairs of South Africa can
hardly excuse a social omission of this kind. So far
as the opium habit is concerned, there is reason to
believe that the practice is widely prevalent in
various parts of the United Kingdom, more espe¬
cially in rural districts. From the facts of the case,
however, this form of indulgence seldom come9 to
light.
The Weighing of Packet Wrappers.
For some time past the community has been
witnessing a series of duels between various local
authorities and dealers in tea, upon the vexed point
as to whether the vendor should be permitted to
weigh the wrapper along with the amount sold to the
customer. Clearly, if the practice be allowed, the
grocer is selling cheap paper at the price of tea, and
in large transactions must come out considerably the
gainer. Indeed, this point has always been evidently
one in which the poorer classes have to pay a higher
proportionate price for their commodities than the
rich. Four quarter pounds of tea mean the purchase
of four paper wrappers, whereas the rich man gets
his full value by buying in bulk, say. a seven pounds'
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248 The Medical Press.
NOTES ON CURRENT TOPICS.
Sept. 6, 1899.
parcel of tea weighed independently of the tin canister
in which it is delivered. A similar 6harp practice
applies to many articles other than groceries. The
chemist, for example, vends many drugs in which
the gross weight includes the wrapper. Nor are the
tobacconist and the butterinan above suspicion in
the matter. Many worthy folk want to know why the
*ocal authorities should attack the jam-makers upon
a disputed point as to the use of absolutely fresh
fruit in their trade, while the vast army of offenders
in the shape of milkmen, grocers, chemists, butter-
men, and other purveyors of food are allowed to go
practically scot free The key probably lies in the
constitution of the vestries. How many adulteration
prosecutions take place annually in each London
parish on an average ? Yet gross adulteration is
rampant. It is easy to attack the large merchants
and factory owners, who are regarded as fair game
by the small tradesmen who virtually rule the
vestries.
Lockjaw in Kent.
Four deaths from tetanus have been reported
within the last ten days from Kent. In two at least
of these cases there was presumptive evidence of soil
contamination, namely, those of a cyclist and of a
quoit player who met with accidents. Traumatism
was present in each instance. The infectivity of soil
in these cases iB now well established, and the only
wonder is that tetanus is not a much commoner
affection, when we take into consideration the vast
number of wounds, both serious and trifling, that are
exposed to soil contamination. The progress of our
knowledge with regard to this most terrible of human
maladies reads like a fairy tale of science. It
is only a few years ago that medical men were abso¬
lutely in the dark as to the origin of tetanus, although
the share of soil in causation had long been recog¬
nised. In 1889 Kitasato succeeded in isolating the
specific organism, which, with itB “ drumstick ” shape
and its numerous flagella, forms an attractive object
under the microscope. The next great step in advance
was the work of Faber, who showed that the
symptoms of the disease could be produced by the
injection into susceptible animals, as mice and
guinea-pigs, of culture fluids freed from the specific
bacillus. The history of the tetanus experiments and
researches is well worthy of careful perusal by the
medical practitioner who has not the opportunity of
working at practical bacteriology.
The Registrar-General and Death
Certificates.
A week ago the subject of death certificates was
dealt with in a leading article in the Medical Press
and Circular. In the course of our remarks we felt
it a duty to reflect strongly upon the way in which
the Registrar-General played into the hands of un¬
licensed practice by allowing his local representatives
to receive lax and informal notices of death from
various quarters. This week the truth of some of our
claims has been virtually admitted by the issuing of
an order from the Registrar-General to District Regis¬
trars not to accept certificates of death unless deceased
had been attended by a doctor within a period of three
days prior to death. This is a Btep in the right direc¬
tion, and it is to be hoped that the Registrar-General
will follow up his new policy of attempting to render
death certification something less of a farce than it is
at piesent. The right thing would be to allow no
corpse to be buried unless properly certified by a
qualified medical man or by a coroner after due
inquiry. Otherwise the due protection of life, so far
as it can be checked by official machinery, is at an end.
Medical men have done foolishly in not refusing a
certificate when they have not attended within a few
days of death, but the registrars will now discharge
the unpleasant duty of negation for them. By the
way, this new order will knock on the head the laxity
of the hospital physicians and surgeons who have so
cheerily granted certificates of death in cases they
have seen perhaps once some time before death.
The Dangers of Prolonged Sea Bathing.
Several instances of illness due to excessive
bathing in the sea have come under our notice. In
each case the patient suffered from pains in the limbs,
depressed circulation and prostration, with general
symptoms of malaise and “ chill." The duration of
the illness was in some instances three weeks or
more, showing that the nerve centres had received a
severe shock. Enquiry proved that on several suc¬
cessive days the sufferers had remained in the sea for
at least an hour under a scorching sun. The un¬
wisdom of such a proceeding in persons who are not
accustomed to prolonged baths and to violent mus¬
cular exercise is all too apparent. A young man
fresh from college training can swim for an
hour with ease and afterwards be none the worse
for it. But how wide the difference between
experience and that of a woman who perhaps takes a
morning sponge bath and little or no active exercise !
Can she be expected to face the extremes of tempera¬
ture involved in an hour's sea-bathing, to say nothing
of the sheer hard muscular exertion of paddling,
floating, swimming, and moving about in a tidal
water? The proper length of a sea bath for a novice
should not be more than five or ten minutes, gradually
lengthened as tolerance is acquired. Even a man who
has been a strong swimmer needs to begin sea¬
bathing cautiously after a long abstention. Many a
whilom athlete has met his death by trusting to his
former prowess. Yet sea-bathing, properly used, is
undoubtedly a most valuable means of restoring health
and tone to the debilitated.
Lead in Condensed Water.
In a recent issue of the Australasian Medical
Gazette Mr. R. R. Harvey, M.B., Medical Officer of
Health for a West Australian distinct, points out a
danger connected with the use of condensed water.
In the gold districts of the region in question there
is great scarcity of water, and the drinking supply
has to be obtained by condensation of the salt water
obtained from shallow wells. Under certain condi¬
tions the heat is apt to release muriatic and aul-
Digitized by v^ooQle
Sift. 6, 1890.
NOTES 0& CURRENT TOPICS. The Medical Press. 249
phuric acids from the salt caked on the sides of the
boiler, and the acids then eat away the lead of the
solder and form various poisonous metallic salts-
A peculiar form of amemia is prevalent on the
gold fields, and it is believed by the people
to be due to the want of fresh vegetables and to
the use of tinned foods. Mr. Harvey has met
with several cases of chronic lead poisoning,
and not unreasonably concludes that much of the
ansemia may be attributable to the same cause.
His practical conclusion is that the condensing of
water should be conducted under skilled supervision.
In Great Britain the risk of plumbiBm from that
source is not likely to occur. Still the medical man
will do well to bear in mind the possibility of such
an event. Now that many ocean Bteamers are in the
habit of using condensed water it would be interest¬
ing to learn whether any cases of lead poisoning have
ever been traced to that quarter. It might be sug¬
gested to the Western Australian authorities that
they should prohibit the use of lead in all condensing
apparatus, a condition that would not be very diffi¬
cult to satisfy.
Sewer Ventilators.
Anyone who has taken the trouble to notice the
sewer ventilators in the London streets must have
been astonished to find that the majority of them
are merely ventilators in name. It iB quite the ex¬
ception to come across a ventilator which is not firmly
blocked up with road refuse. So far as the City is
concerned we glean the explanation of this from a
letter which appeared in the Times last week from the
City Medical Officer of Health. This official asserts
that his sanitary committee take every opportunity of
closing openings in roadways from subsidiary sewers,
and ventilate the same by- shafts of six inches in
diameter affixed to the nearest building. He also
adds that two hundred and eleven of these shafts
have already been erected in the various districts.
We are disposed to take exception to this arrange¬
ment. The principle is undoubtedly sound, but
its application is faulty. There should be just
as many ventilating shafts as there are road
ventilators; unless this be the case, there is bound
to be a high pressure of sewer gas at the higher levels
Should it then so happen that a road ventilator be
open at this part, it is not difficult to understand that
the opening would give exit to volumes of gas, and
thus cause a nuisance. Failing, however, a multi¬
plication of ventilating shafts, such as appear to be in
use in the City, we think that plenty of road ventila¬
tors carefully kept in a patent condition is the next
best plan of sewerveDtilation. By this means the gas by
having many channels by which to escape has no
opportunity of reaching the outside air in a state of
high pressure. The nuisance under these circum¬
stances is not directly the sewer opening in the road¬
way, but the faulty ventilation of the sewer by which
the gas contained therein has been allowed to accu¬
mulate and escape in bulk. If the sanitary authorities
throughout the metropolis were to see that every
road ventilator was kept free and open we
have no hesitation in saying that the complaint
against special openings of the kind would soon cease*
Meanwhile the attention of the London County
Council might well be directed to this matter.
Boracic Milk.
The Board of Agriculture have been appealed to
in order to prohibit the sale of “ milk extract,”
which consists of condensed milk, without sugar,
preserved by boracic acid. Apparently during the
summer considerable quantities of this preparation
have been sold at seaside resorts and other places
where the demand for milk has surpassed the
natural supply. It is said to be prepared in
Lombardy, and an analyst attached to the In¬
land Revenue has reported that the amount
of boracic acid in the milk was not of sufficient quan¬
tity to substantiate a charge of adulteration against
the vendors. Under the circumstances, then, the
Board of Agriculture have intimated that they can
do nothing in the matter. This is rather a serious
state of affairs. Is it to be hencefoi-th understood
that milk can be mixed with a certain proportion of
boracic acid and still, from a legal point of view, be
an unadulterated product ? What constitutes
adulteration in such a case ? The answer to this
question is one which the authorities concerned
should lose no time in considering. The position seems
to have been assumed that adulteration cannot be
proved unless the boracic acid in the milk is in
sufficient quantity to cause harm to the consumer.
That is to say, the acid is placed upon the same foot¬
ing as the sugar, the latter being the ordinary pre¬
servative used in condensed milk. Clearly in the
interests of the community generally some authorita¬
tive conclusion should be arrived at in regard to the
use of boracic acid as a preservative of food.
Boards of Guardians and the Appointment
of Vaccination Officers.
. The law officers of the Crown have just burst a
bombshell in the anti-vaccination camp. The Lutter¬
worth Board of Guardians recently appointed a
vaccination officer with a condition attached that he
would only institute proceedings againt defaulters
under the Vaccination Acts when specially authorised
by the guardians under their common seal. This
arrangement naturally did not meet with the concur¬
rence of the Local Government Board, and the
latter authority felt it their duty to remonstrate.
Subsequently the matter was referred to the
law officers of the Crown, who reported that the duties
of the vaccination officer were defined by the Acts
relating thereto, and could not be curtailed, restricted,
or superseded by any resolution of Boards of
Guardians. Consequently, the appointment made by
the Lutterworth Board was declared to be void, and
thus the guardians have been called upon to make
another which shall be in accordance with the Acts.
We are glad to see that the Local Government Board
are showing their determination not to be trifled with
in regard to the administration of the Vaccination
Acte. If the Board were to display any laxity in
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250 The Medical Press NOTES ON CURRENT TOPICS. Sept. 6, 1899.
their dealings with the guardians in this matter
vaccination would soon degenerate into a farce, and
no one could predict what the ending theieof would be.
Successful Removal of Sarcoma of Brain.
There is no branch of regional surgery that has
made greater strides within the experience of the pre¬
sent generation than that which deals with the brain.
Like all other organs situated in cavities the brain
has been brought within the range of practical sur¬
gical therapeutics simply and solely by the introduc¬
tion of Lister’s system of aseptic surgery. In view
of what has already been accomplished it may safely
be asserted that the limit of brain surgery ‘still
lies hidden away on a remote horizon. The
recent introduction of the practice of trephin¬
ing and injecting curative serums into the
substance of the brain opens up a new and
suggestive field of direct therapy of organs. Clearly
it would be quicker to inject such a serum into
an affected gland than to allow it to reach the
desired Bpot indirectly and in a diluted form by
means of the general circulation. Of all brain con¬
ditions, however, that of sarcoma would appear to be
least amenable to the surgeon. A successful case of
the kind, nevertheless, has been reported by Carle in
the Revue de Chirurgie. He removed a sarcoma
from the left frontal lobe of a patient who showed
localising signs. Two years later the patient remained
well, and was intellectually clear, the only remaining
trouble being a slowness of speech. This case is
worth careful consideration by all who are interested
in brain surgery.
Chemists Beware!
The relations between the dispensing chemist and
the medical profession are not altogether of the moet
harmonious nature, and it is to be hoped that one
day the legislature will put a stop to the pernicious
custom of counter-prescribing. The most heated
opponent of this form of unqualified practice, however,-
will hardly approve of the latest rigours of supervision
to which the tradesmen in question have been sub¬
jected. At Fulham, several chemists were last week
prosecuted by the Vestry for “ selling a compounded
drug not composed of ingredients in accordance with
the demand of their purchaser.’’ At first blush the
reader will conclude that the object of the prosecution
was a fit and proper one, but he will most likely alter
his opinion on hearing further details. It appears
that a prescription was made up by the defendant,
and according to the vestry’s analyst the bottle con¬
tained 258 grains of iodide of potassium, instead of
240, as ordered. The magistrate dismissed the sum¬
mons as he thought the Act was meant to deal with
frauds, and had no relation to a trifling excess of an
ingredient in a bottle of medicine. The futility of
such a prosecution lies on the surface. If this hair¬
splitting Vestry, instead of attacking a chemist on
such shadowy and debateable ground, had taken a
dozen samples of simple everyday drugs and had
tested their purity, then a solid service would have
l>een rendered to the public. The laxity, or rather
the absence, of anything like a systematic control
over the purity of drugs vended to the community is
nothing short of a scandal. Yet all the needful
machinery lies at the elbows of the vestries.
Gainsborough as a Plague Spot.
In 1894 the Local Government Board made jan
official inquiry into the sanitary condition of Gains¬
borough, with results that furnished a most unfavour¬
able commentary upon local administration. Hence,
in the absence of detailed and definite information as
to certain deaths registered as due to “ fever ’
another inquiry has been conducted by Dr. Muir,
Medical Inspector of the Board. His report discloses
a scandalous condition of affairs, so much so as
to be hardly credible. A large number of the houses
have middens, which are badly made and neglected.
The sewers are unventilated and for a great portion
of the day tide-locked, the drains often untrapped, and
the general disposition of the sewage disposal appa¬
rently such as to secure the greatest possible amount
of soil contamination. The sanitary inspector is a
retired cabinet-maker, sixty years of age, who seems
to content himself with an intermittent supervision
of the scavengers. Nuisances abound throughout
the district, and typhoid • infected middens are
left untouched in spite of frequent applications for
cleansing on the part of owners. The inhabitants
of the place are for the most part drawn from the
working class, and numbers of their dwellings are
“ so damp and dilapidated from age or neglect as to
be unfit for human habitation.” Gainsborough, in
short, is in a state that may well make the sanitarian
pause when he is inclined to boast of the progress
made by Great Britain in practical preventive
administration. If this backward urban district will
not do its duty, then Government muse interfere.
Would it not be possible to prosecute the Council
for polluting the Trent, into which they discharge
large quantities of raw sewage ? Surely the Pollu¬
tion of Rivers' Act may be made a lever for exerting
indirect pressure upon the rulers of unwholesome
Gainsborough.
The Assuan Hospital.
Messrs. John Aird & Co. have sent us a
copy of the First Annual Report of the Assuan
Hospital established in connection with the
Nile Reservoir Works. It is of interest to note
that the staff consists of Dr. E. Sohmitt, as chief
medical officer, Dr. Fahri, an assistant medical
officer, Dr. Montessoii, an Italian, especially
engaged to attend to the large contingent of Italian
labourers; three trained male nurses and a female
housekeeper, apparently the only woman upon the
premises. There were a total of 198 cases treated
during the course of the year, 28 of which were fatal.
The accident caseB numbered 53, 10 of which were
fatal. The total number of beds is 48, and these
include separate quarters foi the Europeans and
natives. The remarks in the report upon the cases
of sunstroke and heat affections, numbering 33,
are especially noteworthy. It is stated that in
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Sept. 6, 1899.
SANITARY INSTITUTE.
The Medical Press. 251
almost every serious case the patieut was found to
have drunk to excess, whisky and beer being the
source of harm with Englishmen, and mastic with other
workmen, and it is further added that, provided
that a man is temperate and takes proper precau¬
tions, there is very little risk of Bunstroke. Perhaps
the firm might take up the question of encouraging
temperance among their workpeople by providing
non-alcoholic beverages at a cheap rate.
Yellow Fever in Virginia.
The following account of the present epidemic of
yellow fever in the State of Virginia ( Vir. Med. Semi-
Monthly) will do much to allay the fear of a serious
outbreak of the disease among our American cousins :
“It seemB probable that the thirty odd cases of
yellow fever announced July 30th in the Soldieis’
Home at Hampton, Va., formed a part of an endemic
that had existed for a week or more. As best can
be learned, the disease was introduced by an ‘ Old
Soldier’ who spent some days of his furlough in June
and early July in or about Santiago. The usual
error of diagnosis of dengue was first made of cases
in the hospital prior to July 30th, when the Virginia
State Board of Health, the military authorities at
Fortress Monroe, and the health officers of the towns
and counties near by were advised of the true
nature of the disease. At once quarantine
was declared against infected sections of the
peninsula of Virginia, and the disease has
shown no tendency to spread—up to this date
(August 7th). Beside the prompt, rigid measures of
-quarantine adopted at once by Newport News, Nor¬
folk, Portsmouth, &c., the Virginia State Board of
Health, as far as its limited means will allow, aided
by a donation from the contingent fund under the
direction of the Governor of Virginia, has commis¬
sioned medical inspectors along all the lines of travel
coming from the infected section on York River,
.James River, Chesapeake and Ohio Railroad, Nor¬
folk and Western Railroad, &c. It seems to be the
dpinion of experts and those in authority that the
apprehension of an epidemic is at an end. This is
the first time yellow fever has originated or caused
any alarm in Virginia since the terribly severe epi-
-demic of 1855—forty-four years ago.”
Messrs. Burroughs and Wellcome were
awarded a silver medal for the solid disinfectant at
the Health Exhibition recently held in Southampton.
THE CONGRESS OF THE SANITARY
INSTITUTE.
The past week has been marked in the medical
calendar by the assembly of the Sanitary Institute in
Southampton—brought to a termination on Saturday,
the 2nd inst. The gathering was larger than had been
expected, so much so that, even for many of those who
had sought to reserve hotel accommodation several days
beforehand, much difficulty was experienced in getting
even good lodgings. Nearly 600 names appeared on the
official list of members present, while, probably, as many
more camp followers (if we may use the phrase) accom¬
panied them. The Mayor, in one of his addresses,
estimated the total number of those who took part in
the proceedings in one or other form at 1,760. The
municipality offered its hospitality through the
medium of the worshipful the Mayor (Councillor
Hussey), the Senior Bailiff, the local hon. secs..
Dr. Wellesley Harris, Medical Officer of Health;
Mr. Matthews, C.E.; Mr. Bennett, C.E., and Dr. Russell.
The Institute itself was represented by Sir William
Preece, K.C.B., the newly elected president; Mr. Law,
chairman of the Council; Sir Heory Littlejohn, by
several other leading members of the Council, and by
Mr. White Wallis. P.S.S., its very efficient secretary.
After the initiatory ceremonial of the opening of the
Congress by the Mayor, and the installation of the
President, an adjournment was made to the publio
luncheon held at the Pavilion under the chairmanship
of the Mayor, the large hall being quite full. The
collation was abundant and good, but the caterer’s
charge for it (4e. 6d. rin non comprit) was decidedly in
excess of value given.
Sir William Preece’s presidential address (which we
print in abstract in this issue) was well designed and
eloquently expressed. Not being a Medical Officer
of Health or otherwise officially connected with
sanitation, he did not attempt a scientific exposi¬
tion of it, but devoted himself to an enunciation
of its general principles and to the six requirements for
the ment tana in corpora r tano. In this he was very suc¬
cessful, his observations being systematic and lucid, and
his foundation of these principles on the law of Moses,
whom he described as “ the greatest sanitary engineer
the world has ever known," being particularly happy.
We refrain from particularising his points as our readers
can peruse them for themselves.
The evening of the first day (Tuesday) was assigned
to the opening of the Health Exhibition, which function
was officially performed by the Mayor. We shall notice
the. exhibition later on.
The scientific work of the Congress was conducted in
a series of conferences and meetings of sections. The
conferences included eight classes of sanitary officials:
(1) Municipal representatives j (2) Port sanitary authori¬
ties ; (3) Medical Officers of Health; (4) Medical
Officers of Schools; (6) Sanitary Engineers and
Surveyors; (0) Veterinary Inspectors; (7) Sanitary
Inspectors; (8) Domestic Hygiene. It was understood
that no one but the officials named should take part in
the Conference with which they are in relation. The
sections were three in number—(1) Sanitary Science
and Preventive Medicine; (2) Engineering; (3) Physics,
Chemistry, and Biology; and in the proceedings of these
sections any member might take part. In the conferences
many questions of great interest to sanitarians were
discussed, e.g., housing of the working classes, sanita¬
tion of passenger ships, child labour and infant mortality,
recrudescence of the plague in Europe, the repression of
venereal disease, and the prevention of malaria
disseminated by mosquitoes. The lion’s share of
the work of the Institution was, however, taken
by the subject of tuberculosis viewed from one or other
aspect. Precautions against its dissemination by (a)
the human subject; (6) tuberculous meat; (c) tuber¬
culous milk. ( d) Sanatoria for phthisical patients, their
maintenance and administration. On Thursday evening
a public lecture on the subject was delivered by Mr.
Malcolm Morris. F.R.C.S. He asked himself, “Is a
crusade for the suppression of tuberculosis expedient ? "
and proceeded to establish, rather unnecessarily, the
affirmative by adducing the statistics of the disease and
the media for its dissemination, which are now argu¬
ments rather of historic than present interest. As to
practicable means of “suppression,” the lecturer had
no suggestion worthy of special notice to offer. His
panacea is the usual one of coercion—the enaction
of laws to make spitting by consumptives an offence
punishable by gaol, unless the unhappy victim expector¬
ated into a leaf of antiseptic paper (carried home in his
pocket for destruction) or in a spit cup carried in his
hand. Some of the speakers at the sections elaborated
this suggestion by adding the compulsory removal of all
phthisical patients from their homes and their work, and
their incarceration, at State expense, in sanitoria for an
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OBITUARY.
252 Thk Medical Pbbs-.
unlimited period. All such suggestions are useful as an
illustration of “ how not to do it,” of how to disgust the
public, the Government, and the ratepayer with the
consumption crusade. There are many alternative means
which may, and must be adopted, eg., education of the
public on the subject through the Board Schools, inter¬
ception of tuberculous meat and milk before it reaches
the consumer, and provision of economical State-aided
sanatoria for those who can afford to isolate themselves
voluntarily. But these expedients are altogether too
simple for the sanatorium extremists, whose motto is
“ the whole thing or none.”
Our space does not permit us to do more than
enumerate some of the most noteworthy papers read.
The subject of the bacteriological treatment of sewage
was the subject of a valuable discussion, on the initiative
of Professor Frankland, which, we doubt rot. will give
a stimulus to the further investigation of the subject.
Professor Simpson read an admirably practical paper on
the recrudescence of the plague in Europe, and got a
resolution passed in favour of a Government Commission
to visit Portugal and investigate. The scientific
work of the Congress wound up by a lecture
by Bailie Dick, of Glasgow, on the Belvedere In¬
fectious Disease Hospital of that city, which he illus¬
trated by views on the screen of that institution in all
its departments. The lecture was that of an enthusiast
of his subject, admirably delivered, practically put, and
enlivened by much dry humour. It was received by the
somewhat limited audience with great approval, and, we
doubt not, has left behind a desire to imitate Glasgow
in the minds of those hearers who, unfortunately, have
not the means of doing so.
Thk Health Exhibition
is established apart from the meeting hall of the Con¬
gress, and presents an exhaustive collection of apparatus
required by the sanitary engineer. The greater part
of it is occupied with competing exhibits of sanitary
earthenware, but there is much else deserving of explana¬
tion and notice. The nursing division is especially
worthy of examination.
There is, of course, the usual leaven of incongruous
advertising stalls where sewing machines, knife cleaners,
carpenters’ tools, and cheap spectacles are puffed off. It
seems to us that the admission of such catch-penny
booths, which have nothing whatever to say to sanitation,
are a blot upon such exhibitions, and that the cheap jack
advocacy of wares across the counter should not at all be
permitted. At one stall in this exhibition a vendor of
cheap spectacles, who calls himself an “ oculist-optician,”
was busy going through the usual farce of a twenty
seconds test-type examination preparatory to the
putting off of spectacles of which he might know
nothing for the accommodation of eyes of which he
probably knows less. We put it to future exhibition
committees that the invasion of such stalls as this
should be prohibited.
The Entertainments.
As far as we could see the provision made by the
local committee for the instruction of the members by
inspection of works in action, and for their enjoyment
out of business hours, were as nearly perfect as possible.
The instructional part included visits to waterworks,
sewage works, isolation hospitals, electric works, and
Dr. Poore’s sanitary garden ; and the social relaxations
comprised garden parties given by Lady Crichton at
Netley Abbey, by Surgeon-General Nash and the medical
officers at Netley Hospital; an At Home on board the
splendid Cape Liner Scot, sea trips to the Isle of Wight,
archseological excursions to view the antiquities of the
town, a visit to Osborne House, and an all-day drive
through the New Forest, besides organised cycle excur¬
sions every day and everywhere. Unfortunately these
entertainments were held in April weather ; frequent
sunshine interspersed with violent showers, but none of
them were spoiled altogether by the elements.
The Local Administration.
It only remains for us to express, as we believe we do,
the feeling of thanks and admiration felt by almost all
Sept. 6, 1899.
present for the efforts put forth by the local com mittee
to make the Congress a success. ] "J
It is, we hope, not invidious for us to say that Dt.
Wellesley Harris, Medical Officer of Health, took, natu¬
rally, the lead in organisation, and he and his colleagues
may well be congratulated on a result which does them
infinite credit.
(tarwpmtflence
We do not bold ourselves responsible for tbe opinions of oar
correspond ente.
NURSES OF THE LATEST FASHION.
To the Editor of The Medical Pbess awd Cibculab.
Sir,—I n justice to any literary ability I may possess,
will you allow me to state, that the abridgment which
my stories relating to “Nurses of the Latest Fashion,”
have undergone—a curtailment, not by my hand- in The
Medical Press has, in my opinion, seriously impaired
their vitality and interest.
The portiaiturea drawn from life have thus been re¬
duced to almost lifeless puppets by the loes of nearly all
characterisation.
For instance, the husband huntress and trapper, in
the pursuit of her game, as a private nurse, is shorn of
the moral tone of her character by .your having entirely
omitted the portraitures of the “ son ” and the “ father,”
on whom she successively tried her hand to get a hus¬
band in spite of their depravities. Nurse Lovibond,
and how many more of her species seems to have entered
the nursing vocation solely as a means for her intimate
association with family life, thus to entrap the most
eligible man into a legal union—with a good settlement.
I might notice your abridgement of each of the other
stories as published. These important omissions will
be more apparent if the whole were published in book
form ; but I trust you will, in fairness to me, publish this
letter, with any comments you may be pleased to offer.
I am, Sir, yours truly,
Frederick J. Gant.
September 1st, 1899.
[After careful perusal of Mr. Gant’s MS. we were
compelled to curtail, first, on account of its extreme
length ; secondly, because much of the material was
unsuitable for a medical journal, and many details were
introduced which, however desirab’e in book form, were
unnecessary in our columns for the purpose he had in
view - i.e., that of calling attention to the necessity exist¬
ing for the systematic registration of properly qualified
nurses, in order that base characters may be eliminated
from their ranks. Many of these nurse portraits were
‘•'untouched” by us, and we do not consider that the
detailed descriptions of their victims were- neoessary
in our columns, or that such omission detracted from the
indictment which he penned.— Ed.]
©bituari).
PROFESSOR CUMING, OF BELFAST.
The Budden death, on last Sunday week, of this most
estimable member of our profession, has been sad news,
not only for his family, but for all who knew h im, pro¬
fessionally or socially. He had been in rather delicate-
health for a year past, but, on the day of his death, had
been at his business in Belfast. On his return home he
was seized with a violent fit of coughing, and died in a
few minutes.
Professor Cuming held the Chair of Medicine in
Queen’s College, Belfast, until last winter, when he
relinquished it and was succeeded by Dr. Lindsay. He
was an Armagh man, bom in 1831, and received his
primary education in the Royal School there, and his
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Sept. 6, 1899.
LITERATURE
The Medical Press. 253
graduation education in both Arts and Medicine in the
Belfast College. He also served as a pupil under Char¬
cot. In 1865, he succeeded Professor Ferguson in the
Professionate of Medicine—and in addition to all the
honours which the North of Ireland had at its disposal
he received the special distinction of Honorary Fellow
of the Royal College of Physicians in Ireland, and, after¬
wards, held the Presidency of the British Medical Asso¬
ciation at the Belfast meeting in 1884 He was put
forward at the last election of a Direct Representative
for Ireland on the General Medical Council, and he ran
a very good second to Sir Wil'iam Thomson. Ho was a
Catholic in religion.
Very few men depart from the ranks of any profession
amid more universal sorrow on the part of his brethren
than Professor Cuming. He was essentially a gentle¬
man and had all the attributes of such, besides that he
was kind to all and an astute and thoughtful physician.
He was quite incapable of making his professional posi¬
tion subservient to selfish or sordid ends, and was always
ready to help his congeners with his best advice.
DR. HUGH CHARLES, J.P., COOKSTOWN. .
This well-known North of Ireland practitioner met a
shocking death at Oxford, whither he had come from his
residence at Cookstown, co. Tyrone, in order to reside
with his son. He arrived at Oxford on Saturday week
and was found burned to a cinder in his bed on the
succeeding Monday morning. He was 81 years of age,
and had upset the lamp upon his bed.
DR. WILLIAM PARKER.
We regret to announce the death of Dr. William W.
Parker, who died at Richmond, Va., August 4th, 1899.
He'was born at Port Royal, in 1824, graduated in 1848, and
was connected with the well-known Bellevue Hospital,
of that city, until about 1861. When the Confederate
War broke.out he organised the famous “ Parker Battery,”
which made a gallant record. The war ended, he re¬
sinned the practice of medicine in Richmond. He has
filled every position of honour in the gift of the pro-
feesnn of his city and State. In the Medical Society of
Virginia, of which he was a founder, he was its President
for a term, and filled the position of Chairman of the
Executive Committee for many years.
Sabomtorg Jtotcs.
WHEATLEY’S NON-INTOXICANT DRINK8.
We must acknowledge that we have been hitherto
rather prejudiced against temperance beverages, of
which our experience has been that they are usually
not agreeable to taste or sight, and are, moreover, almost
as expensive as the ale, porter, and light wine, which
they are intended to supersede. We are, however, to
some extent converted from this faith by an examina¬
tion of Wheatley’s well-known Hop Bitters and Stone
Ginger Beer for which an opportunity wa9 recently
afforded us.
The Hop Bitters if not labelled or if called by another
name, would hardly be distinguishable from any of the
better class light pale ales. When decanted it is of the
orthodox amber colour—perfectly clear and without
sediment, and brisk in flavour, which is slightly of the
Lager type. It is a very pleasant thirst-allayer, with
none of the undesirable intoxicant quality, and its esta¬
blished popularity as a beverage ought to increase.
The Stone Ginger Beer may be said to be the stronger
of the two drinks, for it is more pungent. It is opalescent
when decanted, and we have noticed, in some of the
samples a slight sediment arising—as we suppose —from
precipitation of the ginger which it contains. It is
much more pleasingly redolent of the real ginger than
the ordinary syphon ginger-bee/, and—we should expect
—would be much preferred by the public.
These beverages bear their own testimony to quality,
of which anyone oan judge by giving them a fair trial.
They appear to be both suitable as stomachic tonics,
and entirely innocent of after dangers.
literature.
GOWERS’ NERVOUS SYSTEM, (a)
We are glad to see a third edition of this well-known
work, and in the assistance rendered by Dr. Taylor we
have a guarantee of thorough revision with the assur¬
ance also that the ripe experience of Sir W. R. Gowers
is made the most of. The first volume, dealing with
Diseases of the Nerves and Spinal Cord, which is now
before us, is well done. A short chapter is interpolated
dealing with the modern conception of the elementary
arrangement of the nervous system as the result of the
labours of Golgi, Ramon y Cajal, Kolliker, and others,
and though thiB chapter rather disturbs the arrange¬
ment of the others by its appearance in the wrong plaoe,
it is none the less welcome and not too long. The final
twigs of the primitive fibrils are termed “ anitee,” but
this designation is not needed, and, indeed, a simplifica¬
tion of the terminology of neuropathology is very much
to be desired. With regard to the author’s views re¬
garding the uncertainty of tee nature of many of the
Bmall brain cells—whether nervous or neuroglial—we
quite agree. The whole method of the book is very
good, and while much of it may be passed over by the
practitioner as beyond his interest, for many nervous
diseases are rare, ir he refers to it at all he is sure to be
interested, not only because of the lucidity of style,
but the really instructive and authoritative character of
the page. If we take, for example, neuro-myosotis, of
which, by the way, some further speculation and detail
might be forthcoming, and the various forms of neuritis
which are here fully referred to, we have a fair concep¬
tion of the thoroughly practical and scientific value of
the work. For a third edition the book requires scarcely
an introduction; but considering the amount of new
matter which appears in it, we must draw attention to
the fact that it is a third edition in the best sense of the
term.
Bt. Thomas’s Hospital.—House Appointments.
The following gentlemen have been selected as house
officers, their duties commencing yesterday :—
House Physicians: E. H. Ross, L.R.C.P., M.R.C.S,
(extension); J. Gaff, L.R.C.P., M.R.C.S.; A. Bevan,
L. R.C.P., M.R.C.S., and H. C. Thorpe, M.A., M.B., B.C.,
Cantab, (extension).
Assistant House Physicians: F. H. Ellis, B;A., M.B.
B.C., Cantab., L.R.C.P., M.R.C.S., and B. F. Howlett
L T? C P M RC8
House Surgeons: H. J. Phillips, L.R.C.P., M.R.C.S.j
P. W. G. Sargent, M.A., M.B., B.C.Cantab., L.R.C.P.,
M. R.C.S.; S. A. Lucas L.R.C.P., M.R.C.S.; H. T. D.
Acland, L.R.C.P., M.R.C.S.
Assistant House Surgeons: A. Webb Jones, L.R.C.P.,
M.R.C.S.; E. A. Gates, L.R.C.P., M.R.C.S.; E. C.
Bourdas, L.R.C.P., M.R.C.S.; N. Unsworth, L.R.C.P.,
M.R.C.S.
Obstetric House Physicians: (Senior) H. M. Scaping,
B.A.Cantab., L.R.C.P., M.R.CS.; (Junior) A. E. Stevens,
M.B.Durham, L.R.C.P., M.R.C.S.
Ophthalmic House Surgeons: (Senior) T. Hoban,
L.R.C.P., M.R.C.S.; (Junior) J. A. Barnes, L.R.C.P.,
MRC.S
Clinical Assistants in the 8pecial Department for
Diseases of the Throat: L. H. Lindley, B.A., M.B., B.Ch.
Oxon. (Extension); C. L. Hawkins, B.A., Cantab.,
L. R.C.P., M.R.C.S. Skin.- H. R. Beale, L R.C.P.,
M. R.C.S. (Extension); T. Perrin, L.R.C.P., M.R.C.S.
Ear: A E. Martin, B.A., Cantab., L.R.C.P., M.R.C.S.
Students' Guide of the Boyal College of Burgeon's, Ireland.
The “ Medical 8tudent’ Guide,” published by the
Royal College of Surgeons, Ireland, has just been issued.
The preliminary examination will be held on Wednes¬
day and Thursday, September 27th and 28th, the winter
session commencing in October. The “ Medical Students’
Guide ” can be had free on written application to the
Registrar, Royal College of Surgeons, Dublin.
(a) “A Manual of Diseases of the Nervous System.” Vol. I.
Edited by 8ir W. B. Gowers, M.D., and James A. Taylor, M.A.,
M.D. Third Edition. London: J. and A. Churchill.
Digitized by G00gle
254 Th* Medical Press- NOTICES TO CORRESPONDENTS.
Sept. 6, 1899.
Notices to
(EoroeponbttttB, Short %zttztz, &c.
Correspondents requiring a reply in thia column are par¬
ticularly requested to make uh of a distinctive tignatwr* or
initial*, and avoid the practice of signing themselves “ Reader,'
••Subscriber," "Old Subscriber,” Ac Much confusion will be
spared by attention to this rule. |
Local Reports and News.— Correspondents desirous of drawing
attention to these are requested kindly to mark the newspapers 1
when sending them to the Editor. |
THE SCOTTISH MEDICAL AND SURGICAL JOURNAL,
LIMITED.
The Financial Sew* publishes the following announcement: —
W itered with a capital of £2,000 in 800 £5 preference shares and
£1 ordinary shares. Object, to acquire and carry on the
journal now known as the Scottish Medical and Surgical Journal.
Registered office : 43, Castle 8treet, Edinburgh.
Dr. Y. J- Smith.— The diagnosis of cesopbageal ulcer, which you
suspect, is as a rule difficult to arrive at. There is no absolutely
patnognomonic symptom, and, indeed, in many instances the
symptoms are so slight as to be altogether overlooked. Pain and
vomiting after food are among the earliest symptoms, and later
there is difficulty in swallowing, regurgitation of food and heemor- j
rhage. Stricture cannot be detected at this stage. Death may I
occur from exhaustion or perforation, or the ulcer may cure |
spontaneously. Treatment is practically the same as for gastric .
ulcer. I
R. T. Williamson.— Before giving evidence in the case you had
better consult Murrell's “ What to do in cases of poisoning.” and
Husband's Forensic Medicine. Chronic coal-gas poisoning is a recog¬
nised condition. In acute cases the toxicity is probably due in
great part to the carbonic acid contained (Murrell). Every
practitioner should refresh his memory from time to time in the I
matter of poisons and their antidotes. I
CHEMICO-MEDICAL MADRIGAL.
I know a maiden, charming and true,
With beautiful eyes, like tne cobalt blue
Of the borax bead, and I guess she'll do
If she hasn't another reaction.
Her form is no bundle of toilet shams,
Her beauty no boon of arsenical balms,
And she weighB just sixtv-twc kilograms
To a deci-decimal fraction.
Her hair is a crown, I can truthfully state
'Tie a meter long, nor curly, nor straight,
And it is as yellow as plumbic chromate
In a slightly acid solution.
One day I said, “ I will leave you for years,”
To try her love by rousing her fears ;
She shed a deciliter of tears,
Turning brown the tumeric yellow.
To dry her tears, I gave her, you know,
A hectogram of candy; also,
To bathe her red eyes, some H s O.
She said : " i ou’re a naughty fellow.”
I have bought me a lot, about a hectare.
And have built me a house ten meters square.
And soon I think I shall take her there,
My tart little acid radicle.
Perhaps little sailors in life’s deep sea
Will be the salts of this chemistry,
And the lisp of the infantile A, B, C,
Be the refrain of this Madrigal.
Indian* Med. Journal.
Epexeuesis.— Comment of the kind you suggest would be most
valuable to all concerned. We doubt, however, whether a book on
therapeutics—even of an elementary kind—could be written on the
lines indicated. The difficulty lies in the evidence. When so much
illness is fleeting and symptomatic, who is to say what is the exact
process of cure, or whether this or that drug has been the active
curative agent ?
Oca 8pecial Correspondent.— We were reluctantly compelled to
hold over your article on Brides-Balins on account of great pressure
on our spaoe.
Paterfamilias.— The point is an important one. and we propose
referring to it fully in our “ Educational Number ’ next week.
A correspondent signing himself " A Barrister” has omitted to
enclose his card.
fteemteus.
Durham County Asylum, Winterton. Ferry Hill.—Assistant Medical
Officer, unmarried. Salary £120 per annum, with apartments,
board, and attendance. Applications to the Chief Medical
Officer by 8ept. 8th.
Folkestone, Victoria Hospital.—House-Surgeon. Salary, £80 per
annum, rising to £100, with board, residence, and washing.
Applications to the Secretaryby Oct. 1st.
Great Yarmouth Hosj ital. — House-Surgeon. Salary £90 per
annum, with board, lodging, and washing. Applications to
F. E. Ferrier, Honorary Secretary, 33, Hall Plain, Great Yar¬
mouth, by Sept. 28rd. __
Hemel Hempstead : West Herts Infirmary.—House-Surgeon and
Dispenser, unmarried, Appointment for two yean. Salary.
£100 per annum, with board, fire, light, attendance, and washing.
Application to the Assistant Secretary by Sept. 13th.
Lancaster: Royal Albert Asylum. — Resident Medical Officer.
Between 30 and 40 years of age. Salary, £400 per annum,
advancing to £450, with furnished bouse, coals, gas, Ac. Appli¬
cations to the Principal and Secretiry by Sept. 14th.
Portsmouth Borough Asylum.—Junior Assistant Medical Officer.
Salary, £120 per annum, inoreasingto £150, with board, lodging,
and washing. Application to the Medical Superintendent.
Preston Royal Infirmary.—Assistant Honse-8urgeon. Salary, £50
per annum, with board, lodging, washing, Ac. Applications to
the Secretary. 5, Winkley Street, Preston, by Sept. 13th.
Prestwich : Manchester County Asylum.—Assistant Medical Offioer.
unmarried, and under 35 years of age. Salary £125, increasing
to £250, with board, apportments, and washing. Applications
to the Superintendent.
Stoke-on-Trent: North Staffordsliire Infirmary and Eye Hospital.
Hartshill.—House-8urgeon. Salary commencing ai £120 per
annum, with furnished apartments, board, and washing. Appli¬
cations to the Secretary by Oct. 9th.
Tralee Union.—Analyst to the Board of Guardians. Application to
Clerk of Union. (See Advt.)
Westminster Hospital—Pathologist. Salary, £250 per annum, and
a sum of £80 per annum allowed for expenses. Applications to
the Secretaryby Oct. 1st.
^pyohttnunts.
Caddick, C.J., M.B., C.M. House Surgeon to the Walsall and Dis
trict Hospital.
Ceowtheb, E.E., L.R.C.P.Edin., L.R.C.S.Edin., L.F.P.S.Gksg.,
Medical Officer for the Luddenden District of the Halifax
Union.
Dc Bdisbon, E. W., L.R.C.P.Lond., M.R.C.S.Eng., Medical Officer
to the Dewchnrch District of the Hereford Union.
Harrison, H.F. E., L.R.C.P.Lond., M.R.C S.Lond., MedicalOffioer
for the Third District of the Parish of Hammersmith.
Jones, W. E. f M.B.C.S., L.R.C.P.Lond., Senior House 8urgeon to
the Halifax Infirmary.
Lonoford, J. M., L.B.C.P.I A L.M., L.B.C.S.I.A L.M., Assistant
Medical Officer of the Workhouse of the Halifax Union
Maynard, G. D., M.R.C.S.Bng., L.R.C.P.Lond., Junior Out-patient
Surgical Officer to the Royal London Ophthalmic Hospital,
City Road.
Nutt all, T. E.. M.B., C.M.Edin., Medical Officer for the Fint
Accrington District oi the Haslingden Union.
Reid, J., M.D.Glasg., M.B., C.M., Medical Officer of the First Dis¬
trict of the Parish of Hammersmith.
Stewart, J. B., M.A.Olaag., M.B., C.M., Medical Officer of the
Workhouse of the Haslingden Union.
Stdrois-White, R., M.B., C.M.Edin., Medical Officer for the Crad-
ley District of the Stourbridge Union.
#irth0.
Elkinoton.— On September 2nd, at Newport, Salop, the wife of
G. A. Elkington, M.B., of a daughter.
^ttarriages.
Barrt—Leppington.— On August 30th, at St. Mary Abbott’s
Church, Kensington, Jas. Wm. Barry, L.R.C.P., M.B.C.S., son
of the late Dr. J. J. Barry, of Ramsgate, to Ann Elizabeth,
daughter of the late Dr. H. M. Leppington, J. P„ of Great
Grimsby.
Dent - Mitchell.— On August 31st, at St. John’s Church, Clifton,
Bristol, Ernest Albert Dent, M.B., C.M. Edin., of Cheltenham,
to Mary Stewart Mitchell, third daughter of the late Captain
J. M. Mitchell, of Georgefield, Uddingston, N.B.
Moore—Price-Dbnt.— On August 31st, at Hallaton Parish Church,
James Lennox Irwin Moore, M.B., C.M., of Market Har
borough, son of the late George Moore, M.D., of London, to
Georgina Roberta, daughter of the late Maj or-General B. H.
Price-Dent, B.S C., J.P., of Hallaton, Leicestershire
Milton—De la Condamine.— On August 29th, at St. John's the
Evangelist Church, Kingston-on-Thaines, J. Pern Milton,
L.R.C.P., M.R.C.S.. son of J. P. Milton, of Lanowetb, to Alice
Ellen, daughter of the late John de la Condamine, of Penzance,
Cornwall.
Smith-J ot.—On August 31at, at the Parish Church, Hampetiad,
Geo. Z. Smith, LJR.C.P., M.R.C.8., of Watford, to Edith Dors,
daughter of David Joy, Esq., of 118, Broadhurst Gardens,
Hampstead.
Stevens—Reeves. —On August 31st, at St. Peter's Church, Eltham,
Thomas George Stevens,M.D.Lond., F.R.C.R.Eng., M.B.C.P-
Lond.,of 8, St. Thomas’s Street, London, S.E., eldest eon of
G. J. B. Stevens, M.R.C.P.Eug., L.R.C.P.Lond., of Newington
Green, N., to Lizzie, eldest daughter of John Reeves, Esq., of
Ecclesbourne, Lee, S.E.
MacWharrie.— On August 28th, at Toftcombs, Biggar, N.B.,
Robt. MacWharrie, M.D., Deputy Inspector-General of army
hospitals.
Erskine. -On August 29th, at his residence, Bournemouth, John
Low Erakine, M.D., Deputy 8urgeon-General Army Med. Dept
Retired.
Stuart.— On August 29th, at his residence, Wigan, John Stuart,
M D. P J.P. for the County and Borough of Wigan, aged *8
years.
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“SALUS POPULI SUPREMA LEX.”
Vol. CXIX. WEDNESDAY, SEPTEMBER 13, 1899. No. 11.
S T UDE N T S’ NUM BER.
INTRODUCTORY REMARKS.
It is customary to devote one number in each year of
a medical journal to the subject of medical education,
and tradition has assigned ;he month preceding the open- j
ing of the medical schools as the date best suited for the
purpose. Why this should be so it is not altogether easy
to explain. The information brought together in this
number is unquestionably of the greatest utility to those
who contemplate taking up medicine as a study or who
may be interested in the subject indirectly in the capa¬
city of parents or guardians, but it may l^e assumed that
the necessary arrangements will have been made ore this.
Be that as it may, there is a sufficient element of incon
stancy in the details of the curriculum for an annual
synopsis to be necessary, and this we have prepared with
the greatest care with a view to bringing it up to date-
In most instances the corrections have been made by the
secretaries of the various institutions, and in the others
the requirements have been collated with the official
schedules of studies.
We have not been enabled to embody the modifications
which the new scheme for a teaching university for
London must enrail in the regulations because the
scheme is still being elaborated, and some time must still
elapse before it can be promulgated, but we have the
satisfactory assurance that by this time next year the
reconstituted university will be in working order, a
dream long caressed by those who are interested in the
medical schools of the metropolis. It will then remain
to be seen whether the result of so many years’ agita¬
tion will confer upon London students advantages at all
commensurate with the expenditure of time and energy
involved.
We are evidently, though slowly, approaching a one-
portal system, in that each year shows a more marked
preference on the part of students for a degree in medi¬
cine rather than a mere diploma; not, indeed, that there
is any essential difference between the professional
knowledge which they respectively imply, but in defer¬
ence to the opinion generally rece.ved among the
public that a doctor of medicine stands higher to an a
diplomate. There used, indeed, to be a difference—at
any rate, in regard to general culture - but we doubt if
that obtains at present. Nevertheless, the fact remains
that a diplomate on entering practice finds himself in
a somewhat invidious position. He has no right to the
prefix “ Dr.,” and though many nowadays do not hesitate
to make use of the titular designation, the diplomate
who does so exposes himself to the charge of pretend¬
ing to be that which he is not. By-and-bye, as the
teaching and degree-conferring bodies become merged and
I affiliated, it will be open to every student to enter for
the course of study and examination which, without any
greater strain than is at present put upon the candidate
by the conjoined examining boards, will ultimately
invest them with the uncontested right to the distinction.
I The fellowships of the colleges will still enable those who
propose to tread the higher walks of the profession to
distinguish themselves from their fellows, and the exten¬
sion of the system of more or less unauthorised diplomas
in special subjects will furnish evidence of special study.
In mo3t other countries the doctorate of medicine is the
only recognised qualification for practice, and not
until a similar evolution has taken place in this country
will existing chaos give place to orderly simplicity.
The main lines of medical education are determined
by the General Medical Council, and are uniform for the
United Kingdom. Itis, therefore, to the regulations issued
by that body that the student must turn for detailed
information The first step, the indispensable condition
for admission to the Students' Register is the Preliminary
Examination in General Education. Until this has been
passed in accordance with the requirements of the
Council, no time spent in study or in attending lectures
will be allowed to reckon as part of the prescribed five
years of medical study. The minimum standard of
general education accepted by the Council is still
shockingly low, and there is an inexplicable reluctance
onthe part of the Council to bring about any substa n-
tial improvement in the standard. When this examina¬
tion has been passed and registered, there remains the
choice of a medical school. In many instances
this choice will doubtless be determined by purely
geographical considerations, but apart therefrom there
remain to be considered the advantages attaching to a
large, as compared with those peculiar to a comparatively
small,school. To a student of sound physique, energy, and
talent the large school unquestionably offers advantages
which are denied to the smaller institutions. The prizes
are more numerous and substantial, there is greater
scope for competitive work, and the successful student
has the inestimable advantage of coming into contact
with the most eminent representatives of the professional
men in whose power it is, later on in his career, to afford
him material assistance. The small schools on the other
hand allow of a more intimate relationship between
teacher and pupil, the conduct of each individual student
is under close surveillance—a point of some importance
to parents - and a much larger proportion of the students
are afforded an opportunity of acquiring the invaluable
experience which is alone to be acquired by holding
resident appointments.
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It is important to remember that the student must
make up his mind before entering on his medical
studies as to the goal to be striven for, that is to say ,
whether he will content himself with a simple licence
to practise or whether he will make the additional
sacrifice of time and money which the possession of an
university degree usually implies. To swerve from an
original plan almost always entails unavoidable loss of
time, inasmuch as the university examinations have to ,
be passed at stated intervals.
At most schools there are entrance scholarships, many
of considerable value, awarded on the strength of i
competitive examinations in the subjects of general
education, but the selection is usually made some weeks
before the date for opening the schools. Prizes are also
awarded at the end of each session for proficiency in
each branch of study, together with scholarships which
are periodically thrown open to competition. It is well J
for the energetic student to acquaint himself with the
conditions under which these may be competed for early
in his course, for they constitute a valuable incentive to
exertion. At the end of his student’s career, should
circumstances allow of his doing so, the newly qualified
man will aim at obtaining a nomination to one or other
of the resident appointments. These, of course, are
reserved to the few, but the practical experience which
they confer and the confidence which such experience
begets, are to be obtained in no other way, and we
would strongly advise all who are not otherwise pre¬
vented therefrom to do their best to crown their student
career by serving their hospital in this capacity.
The Course of Study.
Students who enter for the winter session will devote
most of their attention to anatomy and physiology, and
it will^be found greatly to their interest to have got rid
of the preliminary scientific work—chemistry, physics,
and biology—before entering upon the study of these
two engrossing branches of medical study proper.
Anatomy and physiology constitute the bases of medicine
and surgery, and their importance as subjects of study
cannot be overrated. On the way in which this part of
his work is done will depend to a large extent the suc¬
cess of the student’s subsequent career. It is in the
dissecting room that he learns the i nportance of direct !
personal observation, and no amount of mere book .
work will adequately replace the methodical inves¬
tigation of human anatomy. Text-books and atlases |
ought to be regarded only as guides to dissection and >
never as a substitute therefor. The late Mr. Thomas
they become finally incorporated in his mind. Here, as
elsewhere, method is everything. The burden of study
sits lightly upon those who work systematically, and
attempts to assimilate the myriad details in a short
space of time is sure to prove a disastrous failure.
By the time the student has passed the examination in
anatomy and physiology at the end of the second
academical year his transfer to the wards will come as a
pleasant change. He passes from theory to practice,
from the dissecting room, with its unenticing associa¬
tions and total lack of animation, to the wards, replete
with living, suffering, but always interesting, specimens
of humanity, each with his tale of woe. It will be his
privilege to unreeve the tangled threads of each story,
and to record all that may assist in elucidating the
problem before him, for every patient is a problem. And
let the student never for one moment allow himself to
forget that in the patient whose “ case ” he is taking he
i" dealing with a man and a brother. Suffering is demo¬
cratic in its incidence, and should always be treated with
respect in the person of its victim. It is rare that one has
to reproach the medical student with downright heart-
lessnessa; his sins, such as they are, are usually due to
thoughtlessness and want of tact. He who has once taken
to heart the terrified look of the unhappy sufferer, the
gloom and hopelessness of whose destiny has been
suddenly revealed to him by a careless word at the bed¬
side, will be careful never again to inflict this cruel pang.
Clinical Work.
Nowhere is thoroughness more necessary than in
clinical work. The student has before him in each patient
the means of acquiring practical knowledge, but the
value of the opportunity depends absolutely on his
ability and his willingness to observe. The object and
aim of his clinical training is to learn how to observe.
The difference between a trustworthy practitioner and
the other lies mainly, if not entirely, in the fact that
one observes and the others do not. This faculty is one
which can be acquired and vastly improved by systematic
training, and the training consists in observing faithfully
and carefully every case.
The Post-Mortem Boom.
We would strongly advise every student to spend aa
much time as possible during the last three years of his
studies in the post-mortem room. The post-mortem
room is the natural complement of the clinical wards, it
is often only in the room that the clinical problem
is unravelled, it is there that the student can see for
Cooke rightly raised his protest against the modern himself the physical result of the processes of disease
tendency to scamp actual dissection in favour of mere which he has been watching at the bedside. He learns
book work, and we have always endorsed his contention ; too, as he can never learn in the dissecting room, to
that the tendency was one to be deplored. The first j recognise the post-mortem appearances of the various
thing, therefore, that the student should do on joining a viscera, and to distinguish between changes due to
school is to arrange for a “ part,” because the supp'y of decomposition and those caused by the ravages of
subjects is rarely equal to the demand, and the last disease. The lack of this familiarity has over and over
comers are left out in the cold, and may have to wait for again led to errors of the gravest kind, errors which have
weeks, or even months, before they are able to begin had for effect to jeopardise the administration of justice
practical work. The study of the dry bones will first and perchance to place innocent persons in the most
engage the student’s attention. If somewhat arid, the serious predicaments.
subject is an indispensable preliminary to that of the Lastly, the conscientious student should avail him-
structures which normally envelop them, and the facte self of every possible opportunity to acquire experience
which the student is required to consign to memory are in the administration of anaesthetics. He can do this
peculiarly elusive, and require many sturdy efforts before 1 with a minimum of risk to the patients in hospital
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ENGLAND—-©DUC ATI ON.
The Medical Prejs. 257
Sept. 13, 1*99.
where his earlier steps will be taken under the super- LONDON SCHOOLS.
vision of skilled and experienced persons. Let him
never forget that the various anaesthetics are lethal drugs
if improperly or incautiously used. Let him remember
that he has no more right to administer chloroform
recklessly than to dispense with the use of the measure
when about to administer strychnine solution or other
violent poison. Many of the mishaps which are daily
occurring are, it is to be feared, the result of ignorance
or carelessness. Every practitioner is sure to be called
upon to administer an anaesthetic at some time or
another, and it behoves him, therefore, to ensure that his
doing so does not expose his patient to any unnecessary
risk.
The Services.
For a certain proportion of young medical men the
Services will be certain to offer invincible attractions.
The remuneration is fair, and the duties, for the most
part, not of too exacting a nature; and last, but not least,
there is a security of tenure which does not obtain in
private practice. The pa it year has brought to pass a
reform which had long been agitated for in the Army
Medical Service, which had deservedly become so
unpopular that the greatest difficulty was experienced
in filling up the vacancies; indeed, even at the present
time, a large number remain unfilled. We need not go
into ancient history as to the reasons for this unpopu¬
larity, suffice it to say, that the Service has been trans¬
formed into a Royal Corps, the officers of which are
described by corresponding military titles. It is hoped
that under the ne™ rigime the old spirit of discontent
will give place to a happier state ol things, and that the
Service will once more regain its popularity.
In addition to the Army and Navy, there is the
Indian Medical Service, which annually attracts the
ilite of our young surgeons, and there are medical
appointments in the colonies details whereof will be
found elsewhere.
Post-Graduate Tuition.
One of the most remarkable features in medical educa¬
tion during the past few years is the growth in popularity
of the Bystem of post-graduate teaching. It would seem
that the medical authorities in the metropolis have at
length awakened to the fact that a demand exists for
such teaching, and that the time has arrived to deal with
it on a scale commensurate with its importance. That
no facilities of the kind were available a few years ago
for alien practitioners who visited this country for the
purpose of improving their knowledge was a con¬
dition of things which compared very unfavourably
with the Continental homes of medical learning
—and thus it has come to pass that foreign medical
men have never been attracted to London for the pur¬
pose of study, nor even of following the hospital practice
of those British practitioners whose names happen to
be well known for distinguished work. This reproach
has now to some extent been done away with, at any
rate in London. Post-graduate lectures have been
organised in connection with many of the large general
hospitals, and a focus of post graduate work has been
constituted at the Polyclinic, in Chenies Street, which
promises to develop into an important centre of study
within the near future.
The Schools of Medicine in the Metropolis are
the following, the scholarships, prizes, students’
appointments, fees, &c., being set forth in connec¬
tion with each place named. The names of the
hospital staff, lectures, residential, and other
detailed information, will be generally found in
our advertisement columns.
St. Bartholomew's Hospital. —This hospital ha« 750
j beds, and for many years past the school attached has
occupied the enviable position of being the most popular
with students, and of having a larger number of entries
than any other medical school in London. Collegiate
residence is here permissible, subject to the ordinary
rules. A recreation ground for the use of students has
recently been purchased at Winch more Hill.
Appointments. —Ten house physicians and ten house
surgeons are appointed annually. During the first six
months of office they act as “junior” house physicians
and house surgeons, and receive a salary of £25 a year.
During their second six months they become “ senior ”
house physicians and house surgeons, and are provided
with rooms by the hospital authorities, and recei re a
salary of .£80 a year. A resident midwifery assistant
and an ophthalmic house surgeon are appointed every
six months, and are provided with rooms and receive a
salary of £80 a year. Two assistant anaesthetists are
appointed annually, and receive salaries of .£120 and
.£100 a year respectively. An extern midwifery assistant
is appointed every three months, and receives a salary of
£80 a year. Two assistant electricians are appointed
every six months, and in-patient dressers, in-patient
clinical clerks, clerks and dressers to the assistant
physicians and to the physicans and surgeons in charge
of special departments are appointed every three months
without fee.
Scholarships, 4‘c.—There are four open scholarships in
science, £75, £75, £150, £50, in biology, chemistry,
physics, and physiology, tenable for one year, an<l a
Jeaffreson exhibition, value £20; four junior scholarships,
of £30, £25, £20 and £10, respectively ; Treasurer's prize
for practical anatomy ; Foster prize in practical Anatomy;
I senior scholarships, value £50, for anatomy, physiology,
: and chemistry; Wix prize; Hichens prize; Lawrence
! scholarship and gold medal, value40guineas,for medicine,
I surgery, and midwifery; two "lakenbury scholarships,
of £39 in medicine and surgery ; Bentley prize, for reports
of surgical cases ; the Kirkes gold medal for clinical
medicine, with scholarship of £30. Shuter scholarship of
£50 ; Skynner prize of £16 ; Sir G. Burrows’ prize of £10
and Matthews Duncan medal and prize, value about £20;
the Treasurer’s Research Studentship, of the value of £100
is given annually, the elected student being required to
engage in original research in pathology.
Fees. —Fees for perpetual attendance on lectures and
hospital practice, 160 guineas, payable in the following
instalments:—First year, 40 guineas; second year, 40
guineas; third year, 40 guineas; fourth year, 40 guineas;
or a single payment of 150 guineas. Fee for general
subjects for students of dental surgery: First winter, 31J
guineas; first summer, 31 i guineas ; or a single payment
of 63 guineas. Fee to University students, 80 guineas ;
Fee for laboratory instruction for D.P.H., 20 guineas;
Composition Fee to University of London students for one
year’s instruction for the Preliminary Scientific Examina¬
tion, 20 guineas. Composition fee to University of London
students who have passed the preliminary scientific
examination, 150 guineas.
The Warden, Dr. James Calvert, will furnish further
details on application.
Charing Cross Hospital. —The school attached to
this hospital is situated in central London, and contains
new physiological, pathological, and bacteriological
laboratories, materia medica museum, an anatomical
theatre, enlarged dissecting-room, ard chemical theatre.
The hospital, which is now being enlarged, contains 180
beds, making, with the 30 beds at th6 adjoining Royal
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258 The Medical Press.
ENGLAND—EDUCATION.
Sept. 13. 1899.
Westminster Ophthalmic Hospital (to the practice of
which general students are.admitted free) a total of 210
beds available for clinical study.
Clinical instruction is given in medicine, surgery, and
obstetrics, and in the special department, diseases of the
skin, diseases of children, the throat, the nose and ear,
and in the orthopaedic, Rontgen, and electrical depart¬
ments.
Scholarship*, Medals , 4*c.—Five entrance scholarships,
the Livingstone scholarship, 60 guineas, and 56 guineas ;
Huxley scholarship, 40 guineas and 30 guineas. Three
(100 guineas, 60 guineas, and 40 guineas) are open to all
general students, one (55 guineas) is reserved for the
sons of medical men, and one (30 guineas) is open to
dental students only. All are awarded annually. Twe
Universities Scholarships, value 60 guineas each, are open
to students from the University of Oxford who have
passed the 1st M B., to students of the University of
Cambridge who have passed the 2nd M B., and to students
of the University of London w o have passed the inter¬
mediate examination in medicine. Candidates most
give notice to the librarian of their intention to
compete on or before September 23rd, 1899. The
Golding Prize of .£10 is open to students at the end of
th -ir first winter session. The Huxley Medal, with prizs
of .£10, is open to students at the end of their second
winter session. The Pereira Prize of £5 is open to all
general students. The Llewellyn Prize of £25 is awarded
annually. The Governors’ Clinical Gold Medal is op-n
to students at the end of their fifth winter session. And
a silver medal, or its equivalent in books, is awarded to
the most distinguished student in each class.
Appointments. —The curator and pathologist is ap¬
pointed annually, and receives £100 a year ; medical and
Burgical registrars to the hospital receive £40 a year
each, with luncheon in the hospital; six house physi¬
cians. six house surgeons, and two resident obstetrical
officers are appointed each year; clinical clerks, dressers,
and surgical ward clerks are appointed in all the general
and special departments of the hospital.
Fees. —For the curriculum of study required by the
various examining bodies and hospital practice, 110
guineas in one sum, or 121 guineas in five instalments.
The composition fee for sons of registered medical
practitioners is 100 guineas, and the fee by instalments
110 guineas.
St. George’s Hospital. —This hospital is situated in
a favoured position in the West End, facing Hyde Park.
It contains 350 beds, and special wards for ophthalmic
cases and diseases of women.
Appointments —Four house physicians and four house
surgeons, entitled to reside and board in the hospital
free of expense; two assistant house physicians, two
assistant house surgeons, four assistants in the special
departments. Candidates for the above offices are
selected quarterly by competition from among the per¬
petual pupils, and hold all the offices in succession
during a period of two years, sixteen pupils being
in office at any one time. Obstetric assistant with a
yearly salary at the rate of £100 and board and resi¬
dence in the hospital; pathological curator with a salary
of £50; assistant curator with a salary of £30; two
medical registrars, with salaries of £50 and £30 per
annum : a surgical registrar with a salary of £50 per
annum ; an administrator of anesthetics with a salary
of £50 and two with salaries of £30 per annum ; a
surgery officer with a salary of £100 a year; three de¬
monstrators of anatomy with a salary of £50 each ;
and assistant demonstrators. All offices are open to
candidates without additional fee.
Exhibitions, ,\v—The Brown exhibitions, one of £10<>
per annum, tenable for two years, and open to perpetual
pupils possessing a registrable diploma; aud one of £40
per annum, tenable for three years and open to students
in their third year. The Brackenbury prizes of the value
of £40 each, one each ia medicine and surgery. The
Webb prize in bacteriology, value £30. The Clarke good
conduct and clinical work prize in surgery, the Thompson
medal, the Brodie clinical prize in surgery, the Acland
clinical prize, the Johnson prize in Anatomy, the Pollock
prize in physiology, the Treasurer’s prize for clinical
reports, and four general proficiency prizes of ten guineas
each.
Scholarships. —One in arts of £150 for sons of medical
men who have entered the school during the current year.
Two in arts of £50, open to commencing students.
Examination, September 26th. Two of £85 in anatomy
and physiology, open to students who have signed up for
or passed the first M.B. Oxford or second M.B. Cam¬
bridge. Two of similar value for students of Provincial
University colleges of similar standing. Examination.
October 3rd.
Fees. —Composition fee for perpetual pupils, £150, or
£160 in the following instalments: First year £50, second
year £50, third year £40, fourth year £20. The fee for
general subjects in dental surgery is£55, payable in two
instalments: first year £30, second year £25. Only per¬
petual pupils can hold house office or compete for the
Brown exhibitions
Guy’s Hospital. —This hospital is situated on the
Surrey side of London Bridge, and contains 546 beds
with special wards for ophthalmic and obstetric cases.
Attached to the hospital is a large residential college
with rooniB for about sixty men, whilst for students who
prefer to li ve in the suburbs, no other hospital is so con¬
veniently placed, the railway accommodation being good
and close at band. There i3 now a complete School of
Dental Surgery at this Institution, which is recognised
by the Ro\al College of Surgeons of England, the facili¬
ties thus afforded of completing the whole course of
dental study within the walls of one hospital, and the
professional and social advantages to the dental student
of a close connection with a large school of general
medicine and surgery have already led to a considerable
entry of students in this department.
Re-opened Ward. - One of the wards which have for
many years been closed for want of funds was re-opened
in October last as a special ward for diseases of women,
eight beds being set apart for difficult cases of labour
An obstetric registrar and tutor and an ophthalmic
registrar and tutor have recently been appointed to aug¬
ment the teaching in the snecial departments.
Appointments —Eight house surgeons, eight house
physicians, eight assistant house physicians, twenty-four
assistant house surgeons, eight obstetric residents,
twenty-four clinical assistants, and ninety six dressers
are selected annually from the students according to
merit, and without payment. There are also a large
number of junior appointments, every part of the
hospital practice being systematically employed for
instruction.
Scholarships.— Open scholarships of £100 or £50 in
classics, mathematics, and modern languages. Open
scholarships of £150 and £60 in chemistry, physics, and
biology, and an open scholarship of £50 for University
students in two of the following subjects :—Anatomy,
physiology, organic chemistry, zoology, physics. Six
scholarships, varying in value from £10 to £25 each, for
general proficiency in medical study, open to students of
different years The Treasurer’s gold medal in medicine;
the Treasurer’s gold medal in surgery ; the Sands Cox
scholarship of £15 per annum for three years for physi¬
ology ; the Michael Harris prize of £10 for anatomy ;
Beaney prize in pathology, 30 guineas; the Beaney
scholarship in materia meoica, 30 guineas ; the Bred in
prize for clinical study, £25, theGolding-Bird gold medal
and scholarship (£20) for sanitary science ; and the Gull
Research scholarship of £150 per annum. The Physical
Society awards two prizes, each of £5 to the authors of
the best assays on selected subjects, prizes of £10 and £5
for the best papers read before the Society, and a prize
of £5 to the member who has most distinguished him¬
self in the debates of the session.
New School Buildings .—A considerable addition to the
school buildings wa3 opened in 1897, comprising a seri-s
of class-rooms, laboratories, and a lecture theatre for -.he
teaching of physiology.
Fees .—For the entire course of lectures aud hospitV
practice, 150 guineas, if paid in one sum on entrance ; or
payment may be made by four instalments of 40 guineas
Digitized by GoOgle
Sept. 13, 1899. EXGUAND — EDUCATION. The Medical Press 2i>9
each, payable at the beginning of the first, second, third, rations and additions, arrangements have been made in
and fourth years respectivaly. the hospital for additional clinical teaching.
Kino’s College Hospital. —This hospital is centrally Pees.—Perpetual fee for lectures, demonstrations, and
situated, being contiguous to the Royal College of Sur- Hospital Practice, payable in three instalments of 45,
geons, Lincoln'8 Inn Fields, and the New Law Courts, 45, and 40 guineas at the commencement of the 1st,
Strand. The College adjoins Somerset House, and is 2nd, and 3rd years respectively, 130 guineas ; or if in one
close to the hospital. There are 220 beds; ophthalmic, payment, 120 guineas. A reduction of 8 guineas for
ear, throat, skin, and dental departments, are attached chemistry and physics, and 5 guineas for elementary
to the hospital. Some wards are specially devoted to biology, is made from the above fees, in the case of
children's diseases, and ophthalmic diseases. students who have passed in these subjects at the First
Scholarship*. —.£800 are awarded annually in scholar- Conjoint Examination before entering the College. Fee
Bhips and prizes. At entrance two science exhibitions for students entering in their third year (their first and
of .£60 and .£40 value are open to all candidates under second years having been spent at a recognised medical
the age of nineteen ; two scholarships of the value of school elsewhere), 60 guineas. (This fee is payable by
£75 each (subjects literary) and two exhibitions of the students entering who have passed the first M.B.Oxford;
value of .£60 and £40 each (subjects scientific) are open the second M B.Cambridge ; or the Intermediate M.B.
to students commencing their curriculum. Two scholar- London.) Fee for University students for hospital
ships, value seventy and sixty guineas, are open to practice and appointments, 50 guineas. Dental students
students of a British University who come up to London (general hospital practice and lectures), 40 guineas,
to complete their curriculum ; two junior scholarships General fee for dental practice, 10 guineas,
of £20 each for first year students, one of £30 for second Note. —A reduction of 50 guineas will be allowed to
year students, one of £50 for third year students in the sons of medical men from the perpetual fee if paid in
residence, and one of £40 for fourth year students. In full, or 5 guineas from each instalment,
addition students may compete for the Daniell scholar- Special entries can be made either for single courses
ship, value £40; the Warneford prizes, value £40; the of lectures or for hospital practice.
Rabbeth scholarship, value £20; the Carter, Todd, Accommodation is obtainable at a very reasonable rate
Jelf, Tanner, Leathes prizes, and all clasB and clinical close by, cr in the suburbs a few minutes’distant by train,
prizes. Dinners and luncheons are provided in the Student’s Club,
Appointments. —Medical and surgical Sambrooke re- which, with the reading and smoking-rooms, now form
gistrarships, tenable for two years, each £50 per annum, part of the college buildings. Students wishing to reside
Resident hospital appointments, viz., senior and junior with a member of the profession can obtain information
house physicians, assistant house physician, physician as to vacancies and terms from the Warden. A list of
accoucheur’s assistant and assistant house accoucheur, approved lodgings is kept All inquiries should be
and three house surgeons with free board and residence addressed with reference to these and other matters to
at the hospital; and senior and junior clinical assistants the Warden. The “ London Hospitals’ Club Union”
in special departments. haB a field for cricket football, Ac., with an excellent
Residence of Students. —There are chambers allowing | pavilion, at Lower Edmonton The clubs and societies
some students the opportunity of residing at the | are open to all the students, and are warmly encouraged
College. by the staff. Full particulars of the Warden, Dr. Munro
University of London. —Special courses of lectures and Scott,
practical instruction in the chemical, physical, and St. Mary’s Hospital. —This hospital is situated at
physiological laboratories have been arranged for j Paddington, near the terminus of the Great Western
students preparing for preliminary scientific and inter- I Railway, and contains 281 beds, of which 128 are devoted
mediate science examinations of the University of to medical and 158 to surgical cases. A fresh Labora-
London. ! tory, fitted with electric light and all modern improve-
London Hospital. —This hospitalfis the largest in the ments, for the study of biology, pathology, and bacterio-
United Ringdom, containing as it does 800 beds. It has, logy, has recently been added, and also a new physio’o-
moreover. wards and a teaching staff for almost every gical theatre. The whole of the building hitherto used
special department in the domain of medicine; the for the Out-Patients’ Department of the Hospital has
scholarship and prizes are many and valuable, and been apportioned to the Medical School for the purposes
school and staff are alike deservedly popular with the of new laboratories, class-rooms, and a new museum,
students. There are also special wards for the diseases of women
Scholarships and Prizes. —At Entrance.—Price scholar- and children, and a new and very extentive out-patient
ship in science, £120 ; Price scholarship in anatomy and 1 department.
physiology, £60; entrance scholarships in science, £60 Appointments. —There are, in addition to clinical clerks
and £85; Epsom scholarship, £126 ; Buxton scholarships and dressers, appointnunts in the hospital each year
in arts, £30 and £20. After entrance —Anatomy and open to students as house physicians, house Burgeons,
biology scholarship, £20; anatomy and physiology and obstetric officers, free of all expense for board and
scholarship, £25 ; Letheby prize, senior, £20; Letheby residence. Two paid prosectors or more as occasion
prize, junior, £10 ; scholarship in clinical medicine, £20; arises are appointed annually; two demonstrators of
scholarship in clinical surgery, £20; scholarship in anatomy, receiving £70, and one junior, £50; also two
clinical obstetrics, £20 ; Duckworth Nelson prize, £10 ; or more assistant demonstrators of anatomy ; a demon-
Hutchinson prize, £35 ; Sutton prize, £20 ; Sir Andrew strator of physiology is appointed with an annual salary
dark, prize. £26; Anderson prizes, £9 , Out-patient of £100, and two or more assistant demonstrators,
dressers’ prizes, £60 ; practical anatomy prizes, £10. Scholarships, ffc. —One scholarship in natural science,
Appointments .— The “ House ” appointments, which of the value of £144, open to any gentleman who has
are more numerous than at any other hospital in the not completed a winter session of study at a medical
Kingdom, are made withuut fee of any kind, and all school. Two scholarships in natural science, each of the
resident officers are provided with free board and rooms, value of £78 15s, and one of £52 10s., under the same
and in a few instances with a small salary also. conditions One scholarship of the value of £144 open
Additional buildings for the department of publio to students from Epsom College, being sons of medical
health, for the biological, chemical, and physical men, and who have not completed a winter session of
laboratories, materia medica museum, Ac., and a new study at a medical school. Two scholarships, each of
bacteriological department with general laboratory, 55 guineas, open to students from the Universities of
research laboratories, class rooms for D.P.H. work, Oxford and Cambridge, who have not entered at any
sterilising room, animal room, Ac., have just been London medical school. All these scholarships are
erected and are now open. For all these departments, awarded by examination on September 20th and 21st.
special teachers have already been appointed who are Fees .—Fee for attendance on the full five years’ cur-
devoting their entire time to the particular subjects riculum of hospital practice and all lectures, demonstra-
that they have undertaken. In addition to these alte- tions, and all classes of the medical, surgical, and
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260 Ihb Medical Press.
ENGLAND—EDUCATION.
Sept. 13, 1899.
obstetric tutors given in the school and hospital, includ¬
ing membership of the Library, Medical Society, Students
Club, and all the athletic clubs, and the receipt of the
hospital Gazette, for five years, .£139 paid on entering the
schoool; or in instalments. .£144. The only additional fee
is one of £3 3s. for those desirous of taking up a course
of dispensing in the dispensary of the hospital.
Students who have completed the examination in
anatomy and physiology at the Universities of Oxford,
Cambridge, or other University, are admitted as per¬
petual pupils of this hospital and Medical School on
payment of a fee of 55 guineas in one sum, or pay an
annual fee of 28 guineas. University students, prior to
completing the anatomy and physiology examinations,
pay an annual fee of 28 guineas. After completing the
anatomy and physiology examinations the inclusive fee
or the annual fees detailed above may be paid.
Residential College. Gentlemen desirous of entering
the residential college pay £75 for the academic year.
Middlesex Hospital. —This hospital, which is con¬
veniently situated in the centre both of business and
residential London, contains 320 beds. There are special
departments for cancer, and for ophthalmic, throat,
aural, skin, dental, and children's cases. Wards are also
devoted to cases of uterine disease and of syphilis. The
medical school buildings have been considerably enlarged
and improved during the last twelve months. The new
dissecting-room and pathological, bacteriological, phy¬
siological, and chemical laboratories are now in regular
use. Residence for students is here obtainable in the
college buildings attached to t’ne school, additions to
which have also been decided on.
Appointments. — Casualty surgical officer, casualty
medical officer, six house surgeons, six house physicians,
and two resident obstetric physicians. The above officers
have residence and board in the college free of expense.
Clinical clerks and dressers in all the departments are
also appointed in addition to the foregoing.
Scholarship)*, ^'c.—Two entrance scholarships of the
value of £100 and £60 respectively. One entrance
scholarship of the value of £60, open to Oxford and Cam¬
bridge students only. (Subjects—Anatomy and physio¬
logy, including histology.) Two Broderip scholarships
of £60 and £40 respectively, for medicine and surgery ;
John Murray medal and scholarship, awarded every j
third year; the Governors’ prize of £21 for students in
their final year. Hetley clinical prize, value £25. awarded J
annually for proficiency in practical clinical medicine, '
surgery, and obstetrics; the Lyell Gold Medal in surgery
and surgical anatomy ; the Leopold Hudson prize, value
11 guineas, in surgical pathology, including bacteriology ; i
Freeman scholarship, £30, in obstetrics and gynaecology; 1
exhibitions of 10 guineas and 5 guineas for anatomy and 1
physiology to second and first year’s students respec¬
tively, as well as class prizes in all subjects.
Fees .—General fee for the entire course of hospital
practice and lectures, 135 guineas if paid in one sum on
entrance, or by instalments of 60, 50, and 35 guineas,
payable at the commencement of the first, second and
third years respectively. General fee for members of a
University who have completed one year of medical
study, 90 guineas if paid in one sum, or by instalments of
60 and 40 guineas. For those who have completed their
anatomical and physiological studies the fee is 70 guineas
on entrance, or in two instalments of 40 and 35 guineas.
The composition fee for London Uniuersity students who
have passed the preliminary science examination is 116
guineas. The fee for the curriculum for dental students
is 64 guineas on entranoe, or two instalments of 40
guineas and 20 guineas.
St. Thomas’s Hospital. —This hospital with its medical
school attached is situated on the southern embankment
of the Thames, facing the Houses of Parliament, and
contains 572 beds.
The school buildings, which are separated from the
hospital by a quadrangle containing a lawn tennis court
for the use of the residents, comprises numerous theatres,
laboratories and class rooms, and are well adapted for the
modern teaching of large bodies of students in all the
subjects of the medical curriculum. A large library and
reading room and a very oomplete museum are open to
all students. The new club premises, opened in 1894,
contain a dining room, a smoking and reading room
supplied with daily and illustrated weekly papers, and a
gymnasium.
A clinical laboratory has been recently built, in which,
all the more difficult methods of diagnosis, bacteriological,
chemical and microscopical, are carried on under the
direction of a superintendent. The department for out¬
patients has been re-arranged, so that large numbers of
students are enabled to follow closely the practice and
teaching of the assistant staff.
Appointments are open to all students. A resident
assistant physician ana a resident assistant surgeon are
appointed annually at a salary of £100 with board
and lodging. Two hospital registrars, at an annual salary
of £100 each are appointed yearly. An obstetric tutor and
registrar is appointed each year at an annual salary of
£50. The tenure of these offices may be renewed for a
term not exceeding three years. Four house physicians,
two assistant house physicians, four house surgeons,
four a-sistant house surgeons, two obstetric house physi¬
cians, two ophthalmic house surgeons and eight clinical
assistants in the special departments are appointed every
three months. Clinical clerkships and dresserships to
in and out-patient departments are available to the
number of more than 40 each year.
Scholarships, Prices, <fa.—Three Entrance Scholar¬
ships are offered for competition in September, viz.: one
of £150 and one of £60, in chemistry, and physics, with
either physiology, botany, or zoology at the option of
candidates for first year’s students. (The Medical
8chool Committee is empowered to grant an exhibition
of £20 to any unsuccessful competitor who obtains suffi¬
cient marks to qualify for a scholarship) : one of £50
open to University students who have passed in anatomy,
physiology, materia medica and pharmacy for a medical
degree in any of the Universities of the United King¬
dom and have not entered as students in any London,
medical school. Copies of the examination papers of last
year may be obtained on application to the medical
secretary. Applications must be sent in not later than
September 19th, with certificate of birth and of pre¬
liminary examination, and in the case of candidates for
vhe Science scholarships with a notification of their
choice of optional subject. Numerous scholarships,
prizes, and medals are open to competition throughout
the whole oareer of a student, including a Fellowship of
£100 given by the Salters’ Company for research in
pharmaoology.
Fees .—The fees may be paid in one sum or by instal¬
ments. Entries may be made separately to lectures or to
hospital practice. Special arrangements are made for
students from the Univesities and elsewhere entering
in their second or subsequent years, also for dental
students and for qualified practitioners.
Special classes for the preliminary Scientific and
Intermed., M.B.Lond. for the Oxford and Cambridge
examinations, and for the Primary, F.RC.S., are head
throughout the year.
A register of approved lodgings is kept by the medical
secretary, who has a list of local medical practitioners,
and others who deceive students into their houses.
The prospectus of the school containing full particulars
as to fees, course of study advised, &c., and all neoea-
sary information will be given on application to Mr.
Rendle, the medical secretary.
Univkrbitt Collkoe Hospital.— This hospital is
situated in Gower Street, not far from Euston Railway
terminus. The college where the classes are held faoes
the hospital, on the opposite side of the street. The
number of beds available for teaching purposes is 210.
Appointments.— Eight house physicians, six house sur¬
geons, four senior and four junior obstetric assistants,
and two ophthalmic assistants, are selected annually by
examination from among the senior students, without
fee. The house physicians and house surgeons reside
in the hospital for a period of six months, and the senior
obstetric assistants for three months, and receive their
board and lodging free.
Digitized
Sept. 13. 1899.
ENGLAND—EDUCATION.
The Medical Press. 261
The offices of oat-patient physicians’ and surgeons’
assistants, clinical clerks, surgeons’ dressers, and oph¬
thalmic surgeons’ assistants are filled by pupils who are
also students of the college, without additional fee.
Scholarships, S'c. —Entranoe Scholarships: One of the
ralue of .£120, and two of 55 guineas for proficiency
in science, the subjects being those of the Preliminary
Scientific Examination of the University of London,
and two of 76 guineas each, the subjects being Anatomy
and Physiology; the Atkinson-Morley surgical scholar¬
ship of .£45 a year, tenable for three years; Atchison's
scholarship, value £55, tenable for two years; Sharpey
physiological scholarship, value about £110 a year,
tenable for three years; Filliter exhibition for profi¬
ciency in pathological anntomy. value £30; Erichsen
prize, operating case, value £10 10s., awarded for
practical surgery. Dr. Fellow’s clinical medals, the
Liston gold medal, Alexander Bruce gold medal, Cluff
memorial prize, Tuke medals for pathology class medals,
Ac.; gold and silver medals, or other prizes as
well as certificates of honour, are awarded after com¬
petitive examinations in particular branches of study.
The Tuffnell scholarship of £100 for chemistry, two
years; and the Clothworkers’ exhibitions in chemistry
and physics of £30 each, can also be held in the medical
faculty.
Fees. —The following have been grouped to meet the
requirements of the various examining boards :—1. For the
medical examination required by the Examining Board
in England and the Scciety of Apothecaries (exclusive of
instruction in vaccination and attendance at a fever hos¬
pital) : 135 gs., if paid in one sum at the commencement
of the course ; 140 gs. if paid by instalments, as follows :
First year, 65 gs., second year 50 gs., third year 25 gs.
2. For those students who do not require to attend chemis¬
try, pharmacy, and elementary biology at a medical
school (under the regulations of the examining board in
England) the fee is: 117 gs. if paid in one sum ; 122 gs.
if paid by instalments, as follows: First year 55 gB.,
Becond year 40 gs., third years 27 gs. 3. For the courses
necessary for the preliminary scientific examinations of the
University of London, 35 gs. 4. For the course of in¬
struction for the intermediate examination in Medicine of
the University of London, 55 gs. paid in one sum. 5. For
the course of instruction for the final M.B. examination of
the University of London, 76 gs. if paid in one sum ;
78 gs. if paid by instalments, as follows : First year 45 gs.;
second year 33 gs. This course of instruction is also suit¬
able for the corresponding examinations at the Universi¬
ties of Oxford, Cambridge, and Durham. 6. Composition
fee for dental students, for the courses required for the
L.D.8., 65 gs., or exclusive of chemistry, practical chem¬
istry, physics, and materia medica, 50 gs. The composi¬
tion fees, 1,2,4, and 5, admit to attendance on systematic
lectures and to hospital practice, where this is included
in the fee, during five years.
Westminster Hospital. - This hospital is conveni¬
ently situated, facing the Abbey, and is readily accessible
from all parts of the metropolis. It contains 205 beds
for general cases, and all the special departments. New
school buildings have been erected close by which afFord
accommodation for 150 students. The class rooms, dis¬
secting rooms, and lecture theatre are excellent samples
of modern erections, affording ample scope for study.
Appointments.— Curator and pathologist, receiving
respectively £40 and £50 per annum; medical and
surgical registrars, each £40 ; two house physicians, two
house surgeons, two assistant house surgeons, and resi¬
dent obstetric assistant. These officers, except the four
first named, are all boarded free of expense. Fourth
year’s students are appointed to be clinical assistants in
the various departments.
Scholarships, Sfc —(a) Winter Session—The Guthrie
Scholarship £60, entrance scholarship £40, entrance
scholarship £30, colonial scholarship £60, colonial
scholarship £40, dental scholarship £20 ; subjects, Latin,
mathematics, experimental physics, chemistry, and either
Greek, French, or German. Oxford and Cambridge
Scholarships, £40, subject—anatomy and physiology,
Natural science scholarship, £60, same as for Prel Sci.
of University of London. Natural science scholarship,
£40, chemistry and physics. Free presentation, open to
pupils of Epsom Medical College. (6) Summer Session.
—Natural science scholarship, £60, same as winter.
Natural science scholarship, £40, same as above. Arts
scholarship £50, arts scholarship £50, colonial scholar¬
ship £60, colonial scholarship £40, Oxford and Cambridge
scholarship £40, subjects same as in winter session, (c)
Prizes.—Treasurer's, 10 guineas, for first year’s men;
President’s, 20 guinaas, for second year’s men; Chad¬
wick, 20 guineas, for students of any year not exceeding
fifth; Fish, £20, for proficiency in pathology. To be
competed for by unqualified men. Bird medal and
prize, £14, for students who have completed fourth winter
session. Sturges prize in clinical medicine £8, clinical
surgery prize £5, to be competed for by unqualified men.
And olass prizes in the various subjects.
Fees .—In one payment of 110 guineas, or two payments
of 60 guineas each, payable on entrance, and at the
commencement of second year respectively, or by six
payments distributed over six sessions of 26 guineas and
20 guineas alternately. Fees for shorter periods or for
single courses may be learned on application to the
Dean. Fees for deutal students, payable in one sum on
entrance, 50 guineas, or in two instalments of £27 10s.
London (Royal Free Hospital) School of Medi¬
cine for Women. —This school, which is situated in
Hunter Street, Brunswick Square, opens at the same
time, and the periods of study, lectures, Ac., are similar
to those at the ordinary medical schools. A commodious
dissecting-room, physiological and chemical laboratories,
and library are provided at the School, and clinical lec¬
tures are regularly delivered at the Royal Free Hospital,
Gray’s Inn Road, which institution is appropriated to
the students at this School as a field of practical study
and experience; clerkships, dresserships, being tenable
there without fee by the women.
Scholarships, S'c .—Entrance Scholarship of £30. Bos-
tock Scholarship, £ 60 , for two or four years, given on the
result of the Preliminary Scientific Examination of the
University of London. The John Bryon scholarship of
£20 a year for four years, the Stuart Mill scholarship of
£30 a year for four years, the Fanny Butler scholarship
of £14 10s. a year for four years are offered from time
to time. The Mabel Webb Research Scholarship, value
£30 for two years, for research work in chemistry, phy¬
siology, or pathology. The Helen Prideaux prize of
£50 iB offered every other year to graduates of the
School. Three Evans prizes of £3 3s., £2 2s., and
£1 Is. respectively, are given in the midwifery
class, and two Durham prizes of £5 and £3 are-
given in the gynaecology class. Two Mackay prizes
of £20 each are offered annually. There are other
scholarships for ladies willing to qualify themselves
as practitioners io India. There is also a small fundi
from which assistance can occasionally be given to-
students who specially require pecuniary help.
Fees .—The fee for the ordinary curriculum of non-
clinical lectures is £90 if paid in one sum, or £96 if paid
in instalments. The fee for clinical teaching is £35, or
£40 if paid in instalments.
Classes for the Preliminary Scientific Examination of
the University of London will commence in October,
1899. Fee for the whole course, 16 guineas.
Women are eligible for the diplomas of the University
of London, the Royal University of Ireland, the Univer¬
sity of Durham, the Universities of Edinburgh. Glasgow,
Aberdeen, and St. Andrews, the Conjoint Examinations-
of the Royal Colleges of Physicians and Surgeons, Edin¬
burgh, and Faculty of Physicians and Surgeons, Glasgow,
the Royal Colleges of Physicians and Surgeons, Ireland,
and the Society of Apothecaries, London, each of which
gives a qualification in medicine, surgery, and mid¬
wifery.
EXTRA-ACADEMICAL INSTITUTIONS
IN LONDON.
Cooke’s Medical School. —The school is prepared
to admit to its supplementary work all who may wish to
join the same, but in regard to its curriculum work it
does not receive more than half-a-dozen students in the
course of the year, these have special advantages both
as regards anatomy and physiology. Charges but slightly
in excess of current charges. The Bland Sutton Presenta-
Digitized
262 The Medical Press.
ENGLAND—EDUCATION.
Sept. 13, 1899.
tion—named after Mr. Bland Sutton, F.R.C.S., surgeon
to Middlesex Hospital (a former pupil of the school)—
confers the privilege of free education during the first
two years of medical studies. Particulars forwarded on
application. By decision of various examining bodies
gentlemen rejected at their anatomical and physiological
examinations (second conjoint, &c.) can get signed up
for the supplementary work they are required to put in
before re-examination. The school is also recognised
for the special dissections for the Fellowship of the
Royal College of Surgeons. The surgical operations are
performed on the dead body, and these courses are recog¬
nised for army examinations and the College of Surgeons,
&c. The school possesses a good collection of physiologi¬
cal and chemical apparatus, and gentlemen preparing
for the higher examinations receive special instruction
in the more difficult subjects by separate classes.
London School of Dental Surgery. —This in*titu-
tion is the oldest of the Dental Colleges in the United
Kingdom, and its teaching is recognised by the Royal
College of Surgeons for the dental diploma. It is cen¬
trally situated in Leicester Square, is open daily, »nd
under the supervision of a special staff and house sur¬
geon. The mechanical laboratory is the most perfect of
its kind, and ita usefulness can hardly be over-estimated.
At the present time its accommodation is hardly equal
to increasing requirements, and an enlarged building is
in contemplation. Four demonstrators have been
appointed to instruct the new students in the elements
of operative dental surgery, and at the beginning of the
session each demonstrator gives a course of lectures on
this subject. There is the Saunders Scholarship and
Walker Scholarship (entrance) value .£20 each, awarded
yearly, and the eight house surgeoncies are filled by
students of the hospital holding the L.D S. Fee for two
years’ hospital practice required by the curriculum
including lectures, £50.
National Dental Hospital. —This institution is
situated in North-West London (Great Portland Street)
and the same teaching facilities and hospital practice
are obtainable here as at the foregoing institution,
special demonstrations being given by members of the
staff daily. There are also a mechanical laboratory,
students’ common room, a metallurgical laboratory, ex¬
traction and stopping rooms, students’ hall, &c., all
lighted by electricity, and warmed and ventilated after
the most approved requirements ; in fact, this institu¬
tion may be pronounced a model dental hospital and
school. The winter session commences at the same time
as at the medical schools, on October 3rd. The medical
tutors hold special classes before each College examina¬
tion. The prizes include one entrance exhibition, value
.£15; and the Rymer prize of .£5 5s The fee for two
years’ hospital practice required by the curriculum,
including lectures, is <£40.
University Examination Postal Institution.—
There is an institution conducted by Mr. E. S.Weymouth,
M.A. (27,Southampton Street, Strand, which offers special
courses of lessons through the post for the medical
examinations of the London University (including the
M.D.), and of the Royal Colleges. Also for the Diploma
in Public Health of Cambridge or the Royal Colleges.
Three of the medical tutors are Gold medallists.
Medical students are admitted to the practice
at the following metropolitan hospitals, to which
no medical school is attached. Detailed par¬
ticulars will be supplied on application to the
various secretaries.
Royal Free Hospital, Grays’ Inn Road.—This hos¬
pital contains 170 beds. It is here that the students at
the London 8chool of Medicine for Women do their
medical, surgical, and clinical work. The clinical clerk¬
ships and surgical dresserships arc held exclusively by
these students. The fees payable are £28 the first, and
.£16 each succeeding year. The composition fee for all
classes and lectures, except clinical, is £80 in one sum,
or three payments of .£40, .£30, and .£15.
Wbst London Hospital, Hammersmith.—This con¬
tains OTer 100 beds, and has an extensive out-patient
department. Dresserships and clinical clerkships may
j be obtained. Two house-surgeans and two house-
physicians are elected every six months. Special de¬
partments have recently been opened for diseases of the
throat, ear, skin, and deformities. An electrical depart¬
ment has also been added.
Great Northern Central Hospital, Holloway
Road, N.—This institution has been recently enlarged,
and dow contains 155 beds. The practice of the hos¬
pital is open to practitioners and senior students, and
clinical assistants are appointed in the wards and out¬
patient departments, as in the larger general hospitals.
Bktelem Hospital. —This hospital is open for the
admission of two recently qualified resident medical
assistants who are desirous of acquiring special know¬
ledge regarding the insane. The next election takes
place in October at Bridewell Hospital, and the elected
candidates will be expected to take up their residence
on November 1st.
National Hospital eor Epilepsy and other
Diseases of the Nervous System.— Contains 200 beds.
It has on its staff men of European reputation, and the
Institution is recognised by the Conjoint Board where
part of the fifth year of study may be devoted to
clinical work. Clinical clerks are appointed to the
physicians for out patients, and courses of lectures and
clinical demonstrations are given each year.
Hospital for Consumption and Diseases of the
Chest, Brompton.—The largest institution for the treat¬
ment of affections of the chest in the United Kingdom,
there being 321 beds in the two buildings. There are
four house-physicians, who reside in the hospital, each,
for a period of six months. Lectures and demonstrations
are given by members of the medical staff on Wednes¬
days and Fridays at 4 o’clock, save during the vacations.
Pupils are admitted to the practice of the hospital.
Terms, .£3 8s. for three months; six months, £5 5s. ;
perpetual, £10 10s.
City of London Hospital for Diseases of the
Chest, Victoria Park.—This is a large and well-equipped
hospital at the East End, containing 164 beds. Clinical
lectures and demonstrations are given by the members
of an exceptionally experienced staff. Fee for three
months’ attendance on hospital practice, 2 guineas ; six
months, 3 guineas.
Central London Throat, No 6 e, and Ear Hospital,
Gray’s Inn Road, contains seventeen beds, with an ex¬
tensive out-patient department recently enlarged.
Clinical demonstrations and instruction to qualified
practitioners and senior students daily during the hours
of the surgeon’s visits. Twelve clinical assistants who
must be duly qualified are elected to assist the surgeons.
Operation days—in-patients, Tuesdays, 2.15 p.m.; out¬
patients, Fridays, 2 p.m. Fees for the three months’
attendance, £3 3s.; six months, £5 5s. Full details of
this institution will be found on reference to our
advertisement columns.
H08PITAL FOR DI8EASB8 OF THE THROAT AND CHE 8 T,
Golden Square, W., with branches at Newington, Wal¬
worth and Notting Hill, contains 50 beds. Students are
admitted to hospital practice on payment of fee of three
months’ oourse, £3 3s.; for six months, £5 5s ; perpetual,
£7 7s.
The Hospital fob Women, Soho Square.—The hos¬
pital contains 61 beds. In connection with this institution
there is now an organised school of gynaecology, open to
qualified medical men and to students after their third
year. Clinical assistants to the physicians and surgeons
in the in-patient and out-patient d‘ partments are
appointed every three months. Fee for the three months'
course, £5 5s.
The Samaritan Free Hospital for Women and
Children, Lower Seymour Street, W., offers excellent
opportunities for clinical study and training in the
details of operative gynaecology. The success of the
staff in this department have gained for them an European
reputation. There are 47 beds.
Hospital fob Sick Children, Great Ormond Street,
Queen’s Square, and Cromwell House, Highgate. Fee f«'r
three months’ attendance, £3 3s.; perpetual, £5 5s.
There are now 244 beds, and it is probably the largest
institution of its kind in the world. The practice of the
hospital has been thrown open gratuitously to pupils of
y Goi gle
Digitiz
ENGLAND -EDUCATION.
The Medical Press. 263
Sept. 13, 1899.
the different hospitals and medical schools of London,
on conditions to be ascertained from the secretary.
Royal London Ophthalmic Hospital (formerly in
Moorflelds, rebuilt daring the present year in the City
Road), is the largest hospital devoted to this specialty
in Great Britain. Students and practitioners are
admitted to the practice daily at 9 o’clock. Operations,
10 o’clock and after. Fee for six months, £3 3s.; per-
r tual, £5 5s. Further particulars of the secretary, Mr.
J. Bland.
Royal Westminster Ophthalmic Hospital, King
William Street, Charing Cross, has about 30 beds, and a
very large out-patient clinique. The lectures and demon¬
strations are arranged with special reference to the
requirements of practitioners and senior students. Fee,
six months, £3 3b. ; perpetual, .£5 5s.
Royal Eye Hospital, St. George’s Circus, Southwark.
—There are 40 beds and 2 cote. Fees £2 2b. for 3
months, £3 3s. for 6 months, and £5 5s. perpetual.
Courses are held on ophthalmoscopy, refraction and
diseases of the eye; fee £1 Is. for each course, but per¬
petual students may attend each course once without extra
fee. Pathology class, £11 s. extra to oover cost of materials.
St. Peter’s Hospital for Stone. —This is the only
special hospital for the treatment of stone and genito¬
urinary diseases in the United Kingdom. It contains
28 beds and one private ward, and has an excellent
reoord. Students are admitted on the usual terms
Seamen’s Hospital. —This is situated on the Thames
at Greenwich, having bed accommodation for 225 patients,
with a branch at the Victoria and Albert Docks con¬
taining 23 beds. In connection with this institution
there has recently been established a school for the study
of tropical diseases, at which opportunities are afforded to
students and others who may be desirous of studying
diseases incidental to tropical climates, and also practice
surgery, before entering the Services or going abroad.
Resident chambers are available for students who
must be post-graduates or in the fifth year of their
medical studies.
Metropolitan Hospital, Kingsland. — This was
until recently known as the Metropolitan Free Hospital,
is situated in the north-eastern district of the metropolis,
and contains 160 beds. It is a general hospital, with
various special departments for the treatment of diseases
of the eye, throat, ear, Ac.
8 kin Hospitals. —“ 8t. John’s Hospital for Diseases
of the 8kin.” Out-patient Department, 49 Leicester
Square; In-patient Department, 238 Uxbridge Road.
This hospital has now a splendidly-equipped in-patient
department, with 50 beds, some of which are entirely
isolated from the main part of the building for the
reception of contagious cases. One of the oldest
institutions of the kind is the Western Skin Hospital,
which was started as long ago as 1851. In recent
years the number of patients has greatly increased.
The practice of the hospital is open to students and
practitionen. Students of this speciality have also the
“ London Skin Hospital,” in Fitzroj Square, with seven
beds and an out-patient department of over 1,400. There
is also the Stamford Street Skin Hospital, in the southern
part of the metropolis, with 10 beds and an out-patient
department of 5,600, so that students’ needs in this
direction are well catered for.
PROVINCIAL MEDICAL SCHOOLS.
Birmingham.—The Mason University College.—
The School of Medicine, formerly in existence at the
Queen's College, is now united with the Mason Univer¬
sity College under the title of “ The Queen’s Faculty of
Medicine.” New buildings have been specially erected
for the purpose, and contain large dissecting-rooms,
museums, theatres, and all the necessary accessory
rooms of a large and well-equipped school. A new
bacteriological laboratory has recently been built, capable
of accommodating about 75 students, and a Professor
appointed to devote the whole of his time to the sub¬
ject. At the Queen’s and General Hospitals, to whioh
students at this, college have access, there are 400 beds
available for clinical instruction. Students also have
admission to the City Lunatic Asylum, the City Fever
Hospital, the Eye, Orthopedic, and Ear and Throat ]
Hospitals. Students are admitted—(1) as matriculated
students who enter for their entire medical education ;
(2) as occasional students for one or more courses of
lectures. There are thirty-five resident appointments-
in the hospitals of the City, open to students of the School.
Scholarships, Prise*, Ac.-Two Ingleby Scholarships
for obstetric medicine and surgery and diseases of
women. Sydenham, Queen’s, and Sands Cox scholarships
of £31 10s. Clinical prizes:—Senior medical prize for
third and fourth year’s students, £5 5s.; Junior medical
for first or second year’s students, £3 3s. Senior surgical
prize for third and fourth year’s students, £6 5s.; J unior
surgical prize for first and second year’s students, £3 3s.
Midwifery prize, £4 4s. Examinations are held in the
various subjects at the end of each session, and medals
and certificates are awarded.
Feet. —College fees for all lectures amount to £70,
payable by two equal instalments. There is an entranoe
fee of £3 8s. Students entering for single oouroes have
to pay entrance fee, £1 Is. for each winter, and 10s. 6d
for each summer session. Ail students will be required
to attend at the Queen’s and the General Hospitals as
direced by the Clinical Board, excepting students who-
enter the hospital for six months only. Fees for attend¬
ance for four years on the medical and surgical practioe,
and on the clinical lectures at both hospitals, £42.
8pecial facilities are offered at Mason University Col¬
lege to medical students for the work of the Preliminary
Scientific Examination of the University of London.
The Dental Department, in conjunction with the
General, Queen’s and Dental Hospitals, affords a com¬
plete curriculum for all Dental Diplomas. There is an
entrance scholarship value 15 guineas, and medals and
honour certificates are awarded in the classes.
Bristol University College.- Faculty of Medi¬
cine —This is the only medical school in the West of
England. The lectures and instruction given in the-
Faculty of Arts and Soienoe of University College,
Bristol, are adapted to the various preliminary examina¬
tions, and students can complete in Bristol the entire
course of study required for the medical and surgical
degrees of the University of London and the Royal
College of 8urgeons of England, and of the Apothecaries’
Society of London, and for the examination of the Army
and Navy Boards. It is now arranged that students of
the college shall be admitted to the clinical practice of
the Bristol Royal Infirmary and the Bristol General
Hospital oonjointly, and consequently both these insti¬
tutions are open to all students. The infirmary and the
hospital comprise between them a total of 470 beds, and
both have very extensive out-patient departments.
Special departments for the diseases of women and
children, and of the eye, ear, and throat, besides large-
outdoor maternity departments and dental departments.
Very exceptional facilities are thus offered to students
for obtaining a wide and thorough acquaintance with all
branches of medical and surgical work.
Appointments. —At the Royal Infirmary, and also at
the General Hospital, clinical clerks and dressers reside
in the house in weekly rotation. A pathological clerk
is appointed every three months.
Clinical lectures are given regularly at both institutions -
Scholarships, Prises, S(c. —Prizes and certificates of
honour are given in University College in all the subjects
of the curriculum, open only to perpetual students.
There are two entrance scholarships, value £50 and £30
respectively, two Martyrs’ memorial scholarships
(pathology and morbid anatomy) of £10 each, the
TibbiFs memorial prize, value £9, for proficiency in
practical surgery, one gold and silver medal awarded by
the oommittee, and various prizes for clinical work in
surgery and medicine.
Fees. —School fees for attendance on all courses of
lectures except comparative anatomy, 65 guineas, or 55-
guineas. Clinical fees—Surgical practice, one year, 12
guineas; perpetual, 20 guineas. Medical practice pupil,
20 guineas; perpetual medical and surgery, 36 guineas j
clerk or dresser, 5 guineas; obstetric clerk, 3 guineas.
Prospectus and further information on application to
the Dean, Professor E. Markham Skerritt.
Yorkshire College 8chool of Medicine, Leeds.—
This school, which was founded sixty-nine years since aa
the Leeds Medical School, forms the medical department
of the Yorkshire College, one of the colleges constituting
Digitized by G00^Ie
y y (j)
264 t "k Medical 1* kicks. ENGLAND—EDUCATION. Sbpt. 13. 1899.
the Victoria University. Students of the Yorkshire and two clerks to the Thornton Ward fjr diseases of
College are therefore eligible for the degrees of the Women are appointed every three months. Post-mortem
Victoria University as well as for those of the London, olerks are appointed for six weeks.
Durham, and Edinburgh Universities, and for the Scholarships. —(o) Four Gee Entrance Scholarships are
ordinary diplomas. The building erected on a site con- awarded annually of the value of £25. On the results of
tiguous to the infirmary, and opened five years ago a special scholarship examination, and numerous class
contains one of the finest dissecting rooms in the kingdom, prizes are awarded annually, (b) Two Lyon Jones scholar
extensive laboratories for physiology and pathology with shipB, of the value of £21 each, a j unior scholarsh ip, open at
the most recent improvements in fittings and apparatus, the end of the first year of study to Victoria University
ample lecture room accommodation, a large library, and students, in the subjects of the first M.B. examinations;
separate museums for pathology and anatomy. Pro- and a senior scholarship open to all students in the
feasors and lecturers are attached, and the clinical teach- school at the end of the third year of study, on the sub-
ing is given by the physicians and surgeons attached to jects of anatomy, physiology, and materia medica. (c)
the infirmary. Ophthalmic demonstrations and demon- The Derby exhibition of £15 is awarded in clinical medi-
strations of skin diseases are given in the infirmary by cine and surgery in alternate years; in 1900 the subject
surgeons in each department, where also are obtainable will be clinical surgery, (d) Two Holt fellowships, each
various clinical clerkships, dresserships, and other of the value of £100, to senior students, for study and
appointments; and an extern maternity charity is research in physiology and pathology, (e) A Robert
attached, at which the necessary attendance at labours Gee fellowship in anatomy of the value of £100, for
can be taken; besides the infirmary, there are a large study and research in anatomy, (f) An Alexander
dispensary, a large hospital for infectious diseases, and a fellowship of £100 a year is offered for research in
hospital for women and children, all of whioh are open pathology, (g) The Torr gold medal in anatomy and
to students of the schools. the Holt medal in physiology.
Students here have also excellent opportunities of School of Dental Surgery .—There is a School of Dental
acquiring a thorough insight into psychological medi- Surgery in connection with the medical faculty. The
cine, as the renowned West Riding Lunatio Asylum is curriculum includes lectures and demonstrations on all
in connection, whereat lectures on mental diseases are the subjects required for diplomas in dental surgery. In
delivered during the summer. addition, laboratory courses are conducted in dental
Scholarships Prises, Sfc. —(1) A Gilchrist scholarship histology and dental pathology. Practical instruction
of £50 a year for three years is awarded annually, and a in dentistry is given at the Dental Hospital in Mount
feoond biennially, to the candidate who stands highest Pleasant, where an admirable operating room and a new
at the June Preliminary Examination at the Victoria mechanical laboratory have recently been constructed.
University, provided he passes in the first division. (2) Fees. —A payment of £50 on entrance, or in two equal
A university scholarship of £50 is awarded anually on instalments, entitles the student to attendance on all
the results of the second examination for the degree of lectures and demonstrations (medical and special) re-
M.B. and Ch.B , held in March. (3) An entrance scholar- quired for the dental licence of the College of 8urgeons.
ship of 64 guineas (covering composition fee for a full The fee for two winters’ surgical practice is £1010s., and
curriculum of lectures) is offered every September to for two years’ dental hospital praJ^ioe, £21.
university students. There are also a Hardwick prize in A limited number of apprentices are taken at the
clinical medicine, a M’Gill prize in clinical surgery, each hospital, fee, £105.
of the value of £10, and Thorpe prizes of £10 and £5 in Scholarships. —(a) A Fletcher scholarship of the value
forensic medicine and hygiene, oesides silver and gold of £20 is awarded for exoellenoe in Dental Mechanics
medals and other class prizes. The composition fee for to students beginning their course, (b) A scholarship
attendance upon all the required courses of school lee- in Dental Surgery (value £10 10s.) is awarded as the
tures is 64 guineas for university students who have results of examinations in general and dental surgery,
attended the preliminary scientific courses, and the same (c) Quinby prizes (of the value of £20 altogether)
for non-university students, exclusive of ohemistry and lor operative denistry. (d) A prize (value £5 5s.) for
biology. Dental Mechanics. («) A^sh’s prizes (value £2 2s.) for an
At the General Infirmary, containing 447 beds, the essay on some subject in Dental Surgery, (f) Medical
perpetual fee for medical and surgical practice and faculty prizes, medals, and certificates,
clinical lectures is £42 in one sum, or two instalments School of Pharmacy. —A department of Pharmacy haa
of £22 each. These fees are not included in the been instituted, comprising the necessary courses for the
composition fees for lectures, and are payable separately, minor and major examinations of the Pharmaceutical
A scholarship of £42 to cover the cost of medical and Society, in ohemistry, physics, botany, materia medica,
iurgical practice is also offered annually. and pharmacy. The composition fee is £17, and the
Liverpool University College (Victoria Univer- classes may be attended in one or two years.
SiTY).—New physiological and pathological laboratories Manchester.—Victoria University. Owens College
were opened by Lord Lister last October. The oollege School of Medicine. —The medical school buildings,
contains ample class-room and laboratory aocommoda- which include large laboratories, dissecting-rooms, library
tion for study and research in pathology and bacteri- and reading rooms, are on the most modern principles,
ology, and provision in the way of laboratories and and students wishing to engage in anatomical, physiolo-
m use urns for the study of public health. The museums gical, or pathological research will find excellent oppor-
of anatomy, pathology, materia medica, and public tunity for study in the complete and well furnished
health are furnished with complete provision for the laboratories. The buildings were extended only a few
needs of students, and have recently been reorganised years ago, but owing to the rapid growth of the school
and revised. further large additions have been made, including
Royal Infirmary. —The Royal Infirmary which adjoins lecture theatres and laboratories. Hospital practice is
the school, contains 300 beds, with 40 special beds for taken out at the Royal Infirmary, which contains 300
the treatment of diseases of women. The Lock, Lying- beds. The Cheadle Lunatic Asylum, 8t. Mary’s Hospital,
in, Eye and Ear, Children’s, and Dental Hospitals are in the Southern Hospital, and other special hospital also
the immediate vicinity, and their practice is open to the afford teaching facilities of great importance,
students of the medical faculty. Appointments— The following appointments are made
Fees. —The composition fee for lectures and classes is in connection with the Manchester Royal Infirmary ;
£24 16s. for preliminary scientific classes; £60 for the Surgical Registrar, at £80 per annum; a Pathological
medical classes required for the Victoria University Registrar, at £100 per annum; a Medical Registrar, at
Degree ; £70 for classes required for the Diplomas of £70 per annum ; two Assistant Medical Officers, each at
the Conjoint Boards. Royal Infirmary, £42, All fees, £80 per annum ; a Resident Medical Officer at the Con-
exoept the first named, are payable in two instalments. valeecent Hospital, Cheadle, one year, £150 per annum ;
Appointments at the Royal Infirmary. —Three house sur- Resident Medical Officer, one year, £150; Resident Sur¬
geons, 3 house physicians, and one extern house surgeon gical Officer, one year, £150 per annum; two Chloro-
are appointed for six months. Three clinical clerks for formists, annually, at £50; two House Surgeons and one
iach physician; three or more dressers tor each surgeon. House Physioian are appointed every three months for
byCaOOg
Sept. 13, 1899.
ENGLAND—EDUCATION.
The Medical Press. 265
a term of six months; a Resident Assistant at the
Convalesoent Hospital, Cheadle, appointed every six
months.
Scholarships. —Dalton Entranoe Scholarship, £40 per
annum for two years : Cartwright Entranoe Scholarship,
£35 per annum for three years; Holme Entrance
Scholarship, .£35 per annum for three years; Rogers
Entranoe Scholarship, .£40 per annum for two years ;
Seaton Entrance Scholarship, £40 per annum for two
years; James Gaskill Entrance Scholarship, £40 per
annum for two years; Kay Shuttleworth (8ir Jas.
Philips) Scholarship, £30 per annum for three years;
Theodores Modern Languages Exhibition, .£15 ;
Honorary Research Fellowships; Manchester Grammar
School Scholarship, .£18 per annum for three years;
Turner Scholarship of £20 to students who have com¬
pleted four years of study in the College ; Platt Physio¬
logical Scholarship, value £50, tenable for two years,
open to students between the ages of 18 and 25 ; two Platt
exhibitions, .£15 each, for first and second year's students
in physiology; Sidney Renshaw Physiological Exhibition,
.£15; Dumville Surgical Prize, £15, at the end of the
winter session ; two Dauntsey Medical Entrance Scholar¬
ships, value £36, tenable for one year; John Henry
Agnew Scholarship in Diseases of Children, value
about £30 awarded annually ; Gilchrist Scholarships of
£50 per annum, tenable for three years in any of the
Colleges of the Victoria University, awarded annually
to the candidate gaining the highest number of marks
in the first division of the Preliminary Examination of
the Victoria Universary ; the Bradley Memorial Scholar¬
ship, £20, in Clinical Surgery is offered annually in the
summer session to candidates who must be fourth year
students; one Medical and one 8urgical Clinical Prize
are also offered annually.
Fees. —Composition fee, £70, in two sums of £35 each.
Hospital practice: composition fee, £40, or two instal¬
ments of £25 each.
Dental Feet. — Composition fee, £50, payable in two
snms of £25 each. Hospital practice, £21.
Sheffield University College, Medical Depart¬
ment. —The Sheffield school of Medicine has been incor¬
porated by Royal Charter with Firth College and the
Technical School to form the “ University College, Shef¬
field.” The new medical school was opened in 1888. It
contains a medical library, good class-rooms, an excellent
anatomical department, and every provision for medical
education under the most modern principles. Last year
the physiological department was entirely reconstructed ■
and equipped, in memory of the late president of the
school, Mr. Wm. F. Favell, through the generosity of
anonymous donors. The department consists of a lec¬
ture and demonstration theatre, students’ laboratory,
reparing room and galvanometer room. Each student
as his own laboratory bench, with gas, water, electric
light, and all the requisite apparatus. New premises
have been acquired near the College for the pathological
museum and laboratory, and also for a bacteriological
laboratory, which has been completely eqipped through
the generosity of “ A Sheffield Citizen.” The course of
lectures and instruction is adapted to meet the
requirements of the various examining bodies.
Students at this college obtain medical and sur¬
gical practice at the Royal Infirmary, a well-appointed
institution, containing 240 beds, and also at the
Sheffield Royal Hospital, containing 125 beds. The fees
for attendance, £6 6s. each for medical and surgical
practice during the winter session, and for three months
£3 3s. each. Perpetual fee for medical and surgical
hospital practioe in a single payment of £45, or in two
payments, viz., £26 on entranoe, and £22 within twelve
months afterwards. Students are also admitted to the
practice of the Jessop Hospital for Diseases of Women, to
the City Fever Hospitals, and to the South Yorkshire
Lunatic Asylum at Wadsley. Some of the lecturers and
other local members of the profession receive house
pupils, assisting them in their studies where such
arrangements are desirable. The winter session will
commence on October 2nd. Dean, Dr. W. T. Cocking, to
whom applications may be addressed. .
Scholarthipt, $c. —An entrance scholarship of the value
of £110 is annually awarded to the best candidate (if of
sufficient merit) in mathematics, elementary physics,
inorganic chemistry, Latin. English.
Composition fee, 60 guineas, or in two instalments of
35 guineas and 30 guineas for lectures and practical
classes required by the Examining Board in England.
Prizes for clinical medicine and clinical surgery of 10
guineas; prizes in books and certificates awarded
annually.
University of Durham College of Medicine, New¬
castle-upon-Tyne.—A very commodious and ornate new
building has been erected here at a cost of about
£31,000. The electric light has been installed through¬
out the whole of the working part of the college. The
Royal Infirmary, at which clinical instruction is obtained,
contains 280 beds. Pathological demonstrations are
given as opportunity offers. Practical midwifery can be
studied at the Newcastle Lying-in Hospital. Oppor¬
tunities for practical study are also afforded by the
Dispensary, City Infectious Diseases Hospital, Eye
Infirmary, Children’s Hospital and Northumberland
County Lunatic Asylum. Lectures are given on psycho¬
logical medicine and public health.
Appointments. —Assistant demonstrators of anatomy
receiving each an honorarium; prosectors for the pro¬
fessor of anatomy, assistant demonstrators of physiology
and pathology, assistants to the dental surgeons, clinical
clerks, and dressers are appointed at regular intervals.
One year attendance at the College is required on the
part of candidates for the degrees in medicine of the
University of Durham.
Scholarships, <fyc. —University scholarships, value £1U0,
for proficiency in arts, awarded annually at the beginning
of winter session to full students in their first year only
The Dickinson memorial scholarship (value .- the interest
of £400 with a gold medal) for medicine, surgery,
midwifery, and pathology, open to full students, who
have passed the primary examination of a licensing body.
The Tulloch scholarship, interest of £400 annually, for
anatomy, physiology, and chemistry. The Charlton
memorial scholarship, interest of £700 annually, open t>*
full students entered for the class of medicine at end of
the fourth or fifth winter. The Gibb scholarship, interest
of £500 annually, for pathology, at end of summer
session. Goyder memorial scholarship in clinical medi¬
cine and clinical surgery, proceeds of £325 annually. The
Luke Armstrong memorial scholarship, interest on £880.
The Stephen Scott scholarship in surgery, interest on
£1,000. The Heath scholarship in surgery, the next
award will be in 1900: the interest on £4,000 is awarded
every second year. The Gibson prize in midwifery and
diseases of women and children ; the interest on £226 is
awarded yearly. At the end of each session a prize of
books and honours certificates are awarded in each of
the regular classes.
Fees. — o) A composition ticket for lectures at the col¬
lege may be obtained—1. By payment of 70 guineas on
entrance. 2. By payment of 45 guineas at the commence¬
ment of the first sessional year and 36 guineas at the
commencement of the second sessional year. 3. By
three annual instalments of 35, 80, and 20 guineas re¬
spectively at the commencement of the sessional year.
(6) Fees for attendance on hospital practice : For three
months’ medical and hospital practice, 5 guineas; for six
months, 8 guineas; for one year, 12 guineas; perpetual,
25 guineas; or by three instalments at the commence¬
ment of the sessional year, viz., first year, 12 guineas;
second year, 10 guineas ; third year, 6 guineas ; or by two
instalments, viz, first year, 14 guineas ; second year, 12
guinaas.
University College, Cardiff, School of Medi¬
cine. — The winter session commences on Monday,
October 2nd. The annual address to students will be
given on the evening of October 6th by Professor A. W.
Hughes, of King’s College, London.
The courses of study are recognised as qualifying for
the preliminary scientific examination and the interme¬
diate examination in medicine in the University of
London, and for the corresponding examinations in the
Universities of Edinburgh, Glasgow, St. Andrews, Aber¬
deen, and Durham, in Victoria University, and in the
Royal University of Ireland. Students who are prepar¬
ing for these examinations may compound for tneir
Digitized by GoOgle
266 The Medical Press.
ENGLAND—EDUCATION.
S*pt. 13, 1899.
courses by paying a fee of £57 10s., while a composition
fee of £40 includes all the courses necessary for the
first and second examinations of the conjoint board or
for those of the Society of Apothecaries, London.
In all cases these composition fees may be paid by instal¬
ments.
Particulars regarding the staff of the school and the
various courses will be found in our advertisement
columns.
Scholarships, ftc .—The attention of students about to
matriculate is drawn to the numerous entrance scholar¬
ships and exhibitions which are offered at this college
for competition during the present month, most of which
may be held by medical students. Full particulars of
the examination for these may be obtained from the
Registrar.
The college is furnished with all modern requirements
for teaching and for laboratory work, whilst hospital
instruction is given at the Cardiff Infirmary which is
within five minutes’ walk of the college. The institution
contains 200 beds and has a large out-patient department
as well as special departmental for the eye, ear and
throat.
During the last year it has been found necessary to
considerably extend the Chemical Laboratory and a new
lecture theatre for the physical department has also been
built.
Liverpool Royal Southern Hospital. —The clinical
school of this hospital is situated within convenient
distance of the 8chool of Medicine, and affords every
facility for clinical and pathological study. The hospital
contains 200 beds, and, in addition, to the general medical
and surgical cases, attention is devoted to the diseases of
women and children. The medical and surgical staff
visit the wards daily, and the ward instruction is supple¬
mented by weekly clinical lectures. Additions have been
made to the teaching staff, so that students may now
obtain instruction in diseases of the eye, ear, and throat.
The medical and surgical tutors attend every day to
instruct the junior students in the methods of diagnosis,
and to prepare the senior men for their final examinations.
There is an excellent pathological department, with labor- .
atory attached, where demonstrations are arranged for, and
regular instruction is given in practical pathology. The
practice of St. Oeorge's Hospital for Diseases of the Skin
i3 free to students. Ample opportunity is afforded for
acquiring a knowledge of dermatology. Recently a
bacteriological laboratory has been added where students
can obtain a practical knowledge in bacteriology. In
connection with the hospital a oourse of instruction for
gentlemen desirous of obtaining a diploma in public
health is given, and with this object a chemical and
bacteriological laboratory under Mr. Herbert Davies, :
M.A.Camb., B.Sc., and Dr. Hugh R. Jones, M.A., M.D., i
B.Sc. (Lond.) has been opened. In addition to the
clinical clerkships which are allotted to the students the j
resident post of ambulance officer is given to the student
whom the board may think most suited to hold it every i
three months. A prize of £20 iB annually competed for
which affords special advantages for clinical and patho¬
logical researches to the holder, and three prizes of £5
each are also awarded to the gentlemen who present the
best taken series of medical and surgical cases. Fees.— :
Perpetual, £20 5s.; one year, £10 10s. ; six months,
£7 7s.; three months, £4 4s. There are rooms for
a limited number of resident students ; terms exclusive
of foe for hospital practice), £116 15s. per quarter. The
practice of the hospital is recognised by all examin¬
ing bodies.
Bristol Royal Infirmary. —This is one of the largest
provincial hospitals in Great Britain, and oontains 270
beds. It is provided with all the necessary appliances
for a complete clinical education. The resident appoint¬
ments are five in number, the two juniors of which are
each tenable for six months, and are intended for quali- [
fied studients of the infirmary who have previously
acted as medical and surgical registrars. Several
scholarships and prizes are obtainable. Fees for admis¬
sion to the medical practice, six months, 7 guineas ;
twelve months, 12 guineas ; perpetual, 20 guineas. The
same fees are payable for surgical practice. Perpetual
fee for medical and surgical practice, 35 guineas.
Dental practice, one year, £7 7s.; perpetual, £12 12 a.
The following are the principal provincial hospi¬
tals to which students are admitted where clinical
instruction can be obtained, but to which there ia
no medical sohool attached
Bath Royal United Hospital. —This is a well-
appointed hospital in the West of England, with 120
beds, at which students can obtain clinical instruction.
The hospital is recognised by the Colleges, and is lioenssd
for dissection. It contains also an excellent museum and
library. Fee for six months' attendance, five guineas;
twelve months’, ten guineas.
Bradford Infirmary. —The hospital contains 210
beds. Non-resident pupils are received—and abundance
of clinical material is obtainable. One year’s attendance
is recognised by the Examining Boards. Fee, perpetual,
£10 10s.
Brighton Sussex County Hospital contains 173
beds. It is reoognised by the College of Surgeons and
by the Conjoint Board. Out-pupils are admitted to the
clinical teaching and the classes at a fee of £21 for two
years.
Norfolk and Norwich Hospital.— This hospital is
recognised by the Colleges, and oontains 220 beds. Fees,
£10 10s. for six months', £16 15s. for twelve months’
medical and surgical practice. Pupils, resident and non¬
resident, are admitted.
Wolverhampton General Hospital.— The hospital
contains 230 beds, attendance at this hospital being
recognised by all the Examining Boards. Pupils are
trained in clinical work by the medical and surgical
staff. Fees.—8ix months, £6 6e.; twelve months, £1212s.;
perpetual. £21.
THE ENGLISH UNIVERSITIES.
The English Universities are five in number—viz.,
Oxford, Cambridge, London, the Victoria, and Durham.
Each of these “turns out" a due proportion of medical
graduates every year. Those students who have means
at command will probably elect to enter at either Oxford
or Cambridge, where, perhaps, the social advantages
arising from residence at the ancient seats of learning
form the chief attraction. Of the University of London
we have already spoken, and the Victoria University
comprises Owens College, Manchester; University Col¬
lege, Liverpool; and the Yorkshire College, Leeds. W ith
regard to Durham University, great facilities have within
the past few years been provided in the matter of medical
degrees.
OXFORD.
There are two degrees in medicine, M.B. and M.D..
and two degrees in surgery, B.Ch. and M.Ch. The M. B.
and B.Ch. degrees are granted to those members of the
University who have passed the second examination.
Graduates in Arts, B.A. or M.A., are alone eligible for
these two degrees. In order to obtain the degrees of
M.B. and B.Ch., the following examinations must be
passed:—1. Preliminary subjects: Mechanics and physics,
chemistry, animal morphology and botany. 2. Profes¬
sional (a) First Examination: Subjects — Organic che¬
mistry, unless the candidate has obtained a first or
second class in chemistry in the Natural Science School;
Human physiology, unless he has obtained a first or
second class in animal physiology in the Natural
Science School; Human anatomy, and Materia medica
with Pharmacy. (6) Second Examination: Subjects—
Medicine, Surgery, Midwifery, Pathology, Forensic
medicine with Hygiene. The approximate dates of the
examinations are as follows:—Preliminaries—Mechanics,
physics, and chemistry, December and June; Animal
morphology and botany, December and March; Pro¬
fessional (First and Second M B.). June and December.
The degree of M.D. is granted to Bachelors of Medi¬
cine of the University—(1) who took the degree of M.B.
previously to the end of Trinity Term, 1886, provided
they have spent three years in the practice of medicine
after taking that degree, and have oomposed a disaerta-
ed by Google
Sept. 13, 1899.
ENGLAND—EDUCATION.
The Medical Press.
tion <n some medical subject approved by the Begins
Professor of Medicine, before whom it must be read in
public; (2) who took the degree of M.B. subsequently
to the end of Trinity Term, 1880, provided they have
entered their thirty-ninth term and have composed on
some medical subject a dissertation which is approved
by the professors in the Faculty of Medicine and
examiners for the degree of M.B. whose subject is dealt
with. A book published within two years of the candi¬
date’s application for the degree may be substituted
for a dissertation. The degree of M.Ch. ie granted to
Bachelors of Surgery of the University who have entered
their twenty-seventh term, who are members of the sur¬
gical staff of a recognised hospital, or have acted as
areeser or house surgeon in such a hospital for six
months, and who have passed an examination in surgery,
surgical anatomy, and surgical operations. This examina¬
tion is held annually, in June, at the end of the Second
M.B. Examination.
The First Examination for the degrees of M.B. and
B.Ch. may be passed as soon as the Preliminary Scien¬
tific Examinations have been completed. The subjects
of this examination may be presented separately or in
any combination or in any order, provided anatomy and
physiology be passed together.
The Second Examination may be passed after the com¬
pletion of the first. The subjects of medicine, surgery,
and midwifery must be passed at the same examination,
but candidates are allowed to offer pathology at a pre- :
vious examination. Before admission to the second
examination candidates must present certificates of
instruction in infeotions and mental diseases, and of
attendance on labours, and of proficiency in the practice
of vaccination.
Diploma is Public Health. —An examination is held
yearly in Michaelmas Term, open to all registered medi¬
cal practitioners. No one is admitted as a candidate
unless his name has been on the Medical Segiiter for
twelve months, and unless he has spent after registra¬
tion a period of at least six months studying in a public
health laboratory, and not less than six months studying
under the medical officer of health of a county or town
containing at least 50,000 inhabitants, or has himself
held the position of medical offioer of health of a county
or urban district of more than 20,000 inhabitants.
Scholarshipi, S(c. —Scholarships in some branch of
Natural Science (chemistry, physics, biology) of the
average value of .£80 per annum, tenable for four years
and renewable under certain conditions for a fifth year,
as well as exhibitions of a less annual value, are awarded
after competitive examination every year by some of the
Colleges. Notices of vacancy, Ac., are published in the
University Oatette. In February theie is competed for
annually, by those who, having obtained a first-class in
any school (moderations or final), or a scholarship or
prise open to general competition in the University,
nave passed all the examinations for the degree of B.A.,
one Badcliffe Travelling Fellowship. It is tenable for
three years, and is of the annual value of .£200. The
examination is partly scientific, partly medical. The
holder must travel abroad for the purpose of medical
study. A Rolleston Memorial prize is awarded once in
two years to members of the Universities of Oxford and
Cambridge of not more than ten years’ standing for an
original research in some biological subject including
physiology or pathology.
More detailed information may be obtained from the
University Calendar; from the Examination Statutes,
1894, which contain the official schedules of the several
subjects of examination in both Arts and Medicine;
from the Student’s Handbook to the University; from
the Begins Professor of Medicine; and from the Pro¬
fessors in the several departments of science.
CAMBRIDGE.
At the University of Cambridge five years of medical
study are required for the M.B. and B.C. degrees. The
candidate must have resided nine terms (three years)
in the university, and have passed the “previous”
examination in classics and mathematics. There are
three examinations for these degrees. The first is in
chemistry, physics, and biology ; the second in human 1
anatomy, physiology, and pharmaceutical chemistry;
and the third, in the usual practical subjects with
hygiene and pathology, each examination is divided into
two parts, which can be taken separately. Subsequently
to the third examination an Act has to be kept, which
consists in reading an original thesis, followed by an oral
examination on the subject of the thesis. As the sub¬
jects for the examination for the degree in 8urgery are
included in the third examination for the M.B. degree,
candidates are admitted to the degree of Bachelor of
Surgery on passing the third examination for Bachelor
of Medicine.
The M.D. degree may be taken three years after the
M.B. An Act has to be kept, with oral examinations,
and an essay has to be written extempore. There is
also the degree of Master of Surgery, for which the
candidate, having already passed for B.C., or being M.A.
has otherwise qualified in surgery, has to pursue extra
study in Surgery, and pass a special examination or
submit original contributions of merit to the scienoe or
art of surgery. The yearly expenditure of a student who
keeps his term by residence in a college is from .£150 to
.£200 a year. This, however, may include all payments to
the University and the College—all fees, as well as
clothes, pocket money, travelling expenses, Ac. Non-
collegiate students have only to pay the University fees,
which are not large. They lodge and board as they
like; their expenses, therefore, are entirely in their own
hands.
The University degree grants a diploma in Publio
Health without the necessity of residence, the examina¬
tion being in so much of State Medicine as is comprised
in the functions of officer* of health, and subject to the
latest requirements of the General Medical Council in
this respect. These examinations are held in Cambridge
the first week in April and October. Candidates, whose
names must be on the Medical Register of the United
Kingdom, and need not be members of the University,
should send in their applications to the Secretary of the
State Medicine Syndicate a fortnight in advance. Every
candidate who has passed both parts of the examination
to the satisfaction of the examiners will receive a testi¬
monial, testifying to his competent knowledge of the sub¬
jects comprised in the duties of a medical officer of
health. Candidates who desire to present themselves for
examination in October next must send in.their applica¬
tions, and transmit the fees (JiG 6s. for each part) to the
Begistrary, University of Cambridge, on or before
September 25th.
An abstract of the Regulations and Schedules of the
range of the examinations in chemistry, physics, biology,
and pharmaceutical chemistry, may be obtained upon
sending a stamped directed envelope to the Assistant
Begistrary, Cambridge. Full information is contained
in the Cambridge University Calendar.
UNIVERSITY OF LONDON.
The Matriculation Examination. —Candidates for any
degree in this university must have passed the matricu¬
lation examination. It is held twice in each year—on
the second Monday in January, and the second Monday
in June ; and may be held not only at the University of
London, but also, under special arrangement, in other
parts of the United Kingdom or in the colonies.
The Preliminary Scientific M.B. Examination. — Pro¬
fessional studies pursued before the whole of this
examination has been passed will not count towards the
course required for the M.B. degree. The examination
takes place twice in each year, once for Pass and Honours,
commencing on the third Monday in July, and once for
Pass candidates only, commencing on the third Monday
in January.
Intermediate Examination. —The Intermediate Exami¬
nation in Medicine takes place twice in each year—onoe
for Pass and Honours, commencing on the second Mon¬
day in July, and once for Pass candidates only, com¬
mencing on the third Monday in January. The subjects
of the examination are anatomy, physiology and his-
tology, organic chemistry, materia medica, and pharma¬
ceutical chemistry. No candidate shall be admitted to
this examination unless he is nineteen years of age and
has passed the Preliminary Scientific Examination at
,oog
268 The Medical Prehb.
ENGLAND—EDUCATION.
Sept. 13, 1899.
least two years previously. Fee for this examination, jB5.
4. M.B. Examination. —This examination is held for
Pass and Honours in October, and for Pass only in May.
The candidate must have passed the Intermediate
Examination at least twenty-one months earlier, must
have attended lectures and hospital practice in a recog¬
nised medical school for two years, including at least
two months’ attendance, each on lunacy and infectious
diseases, one of which must be subsequent to the Inter¬
mediate E lamination, must have conducted at least twenty
labours, and have I acquired 'proficiency in vaccination.
After having attended Medical and Surgical Hospital
practice for at least twelve months subsequent to
passing the Intermediate Examination in Medicine, the
student is required to attend to Practical Medicine,
Surgery, or Obstetric Medicine, with special charge of
patients in a Hospital, Infirmary, Dispensary, or
Parochial Union during six months, such attendance
not to count as part of the Surgical or Medical Hos¬
pital Practice already referred to. The examination,
which is conducted by written papers, viva voce, and
by practical examinations, comprises the following sub¬
jects Pathology, Therapeutics. Hygiene, Surgery,
Medicine, Obstetric Medicine, and Forensic Medicine.
The candidate must pass in all the subjects. Honours
may be taken in Medicine, Obstetric Medicine, and
Forensic Medicine.
Bachelor of Surgery. —The examination for the degree
of Bachelor of Surgery takes place once in each year, in
December. Candidates must produce certificates to the
following effect:—1. Of having passed the examination
for the degree of Bachelor of Medicine in this Univer¬
sity. 2. Of having attended a course of instruction,
in operative surgery, and of having operated on the dead
subject. The subjects of the examination are surgery
(including operatiohs on the dead body), pathology and
surgical anatomy. Fee, £5.
Master in Surgery. —The examination for the degree
of Master in Surgery takes place once in each year, in
December. Candidates must be Bachelors of Surgery
of at least two years’ standing; one year is, however,
remitted in the case of candidates who parsed the B.S.
examination in the first division. The examination com¬
prises Mentai Physiology, Surgery, and Surgical Ana¬
tomy.
Degree of Doctor of M.D.—Doctor of Medicine. —The
degree of Doctor of Medicine is granted after examina-
nation to Bachelors of Medicine of at least two years'
standing The examination comprises mental physiology
and medicine, and is conducted by written papers,
clinical examination, and viva voce. A candidate who
presents a thesis approved by the examiners is excused
the written examination.
Doctor of Medicine in State Medicine. —This degree is
granted to Bachelors of Medicine after examination on
producing evidence of having been engaged in the study
of State Medicine for at least two years. The examina¬
tion is the same as for the ordinary M.D., with the
exception that State Medicine takes the place of medicine.
Prizes: 1.—The Sherbrooke Prize is awarded triennially
for the best essay, embodying original research in some
branch of science.
2.—The Granville Prize is awarded in each of the
two years intervening between the several awards of the
Sherbrooke Prize.
UNIVERSITY OF DURHAM.
One diploma and six degrees in Medicine and Hygiene
are conferred :—viz., the degrees of Bachelor in Medicine,
Bachelor in Surgery. Master in Surgery, Doctor in Medi¬
cine, Bachelor in Hygiene, and Doctor in Hygi9ne, and
Diploma in Public Health. These degrees are open to
both men and women.
For the degree of Bachelor in Medicine (M.B.) there
are four professional examinations. The subjects for the
first are — Elementary Anatomy and Elementary Biology,
Chemistry, and Physics. For the second—Anatomy,
Physiology, Materia Medica, Therapeutics, and Pharma¬
cology. For the third — Pathology, Medical Juris¬
prudence, Public Health, and Elementary Bacteriology;
and for the fourth—Medicine, Clinical Medicine, and
Physiological Medicine, Surgery and Clinical Surgery,
Midwifery and Diseases of Women and Children.
It is required that one of the five years of professional
education shall be spent in attendance at the University
College of Medicine, Newcastle-upon-Tyne. Candidates
for the First Examination who have passed the First
Examination of the Conjoint Board in England, and
candidates who hold a qualification from a recognised
Licensing Body in the United Kingdom, will be exempt
from the First Examination of the University, except
in the subject of Chemistry with Physics. [N.B.—
This regulation will not apply to candidates who com¬
menced their medical studies on or after October 1st,
1896.] Candidates who have passed the First and
Second Examinations of the University will be exempt
from the First and Second Examinations of the Conjoint
Board.
For the degree of Bachelor in Surgery (B.S.) every
candidate must have passed the examination for the
degree of Bachelor or Medioine of the University of
Durham, and must have attended one course of lectures
on Operative Surgery, and one course on Regional
Anatomy. Candidates will be required to perform
operations on the dead body, and to give proof of
practical knowledge of the use of surgical installments
and appliances.
For the degree of Master in Surgery (M.S.) candi¬
dates must not be Iobs than twenty-four years of age,
and must satisfy the University as to their knowledge of
Greek. In case they shall not have passed in this sub¬
ject at the Preliminary Examination in Arts for the M.B.
degree, they must present themselves at Durham for
examination in it at one of the ordinary examinations
held for this purpose before they can proceed to the
higher degree of M.S. They must also have obtained
the degree of Bachelor in Surgery of the University
of Durham, and must have been engaged for at least
two years, subsequently to the date of acquirement
of the degree of Bachelor in Surgery, in attendance
on the practice of a recognised hospital, or in the
naval or military service, or in medical or surgical
practice.
For the degree of Doctor in Medicine (M.D.) candi¬
dates must be of not less than twenty-four years of age,
and must satisfy the University as to their knowledge
of Greek. In case they shall not have passed in this
subject at the Preliminary Examination in Arts for the
M.B. degree, they must present themselves at Durham
for examination in it at one of the ordinary examina¬
tions held for this purpose before they proceed to the
higher degree of M.D. They must also nave obtained
the degree of Bachelor in Medicine of the University of
Durham, and must have been engaged for at least two
years, subsequently to the date of acquirement of the
degree of Bachelor of Medicine, in attendance on the
practice of a recognised hospital or in the military or
naval services, or in medical and surgical practice.
Each candidate must write an essay, based on original
research or observation, on some medical subject
selected by himself, and approved of by the Professor of
Medicine, and must pass an examination thereon, and
must be prepared to answer questions on the other sub¬
jects of his curriculum so far as they are related to the
subjects of the essay.
For regulations for degrees in Hygiene and for the
diploma in Public Health see Calendar for 1899-1900.
Candidates for any of the above degrees must give at
least twenty-eight days’ notice to the Secretary of the
College of Medicine, Newcastle-on-Tyne.
Residence can be had in separate hostels for male and
female students at moderate inclusive fees for board,
Ac., particulars of which and any other college informa¬
tion will be given on application to Prof. Howden,
Secretary, University of Durham College of Medicine,
Newcastle-on-Tyne.
VICTORIA UNIVERSITY.
Colleges of the University: Owens College, Man¬
chester; University College. Liverpool; and Yorkshire
College, Leeds. Candidates for degrees in medicine and
surgery must attend, dining at least two years, classes
in one of the colleges of the University, and one of these
zed by GoOgle
Sept. 13, 1899.
ENGLAND—EDUCATION.
years must be subsequent to the date of passing the
First Examination.
The degrees in the Faculty of Medicine are Bachelor
of Medicine (M.B.), Bachelor of Surgery (Ch.B.), Doctor
of Medicine (M.D.), and Master of Surgery (Ch.M.). All
candidates for degrees in medicine and surgery are
required to pass the Entrance Examination in Arts, or
to have passed such other examination as may from
time to time be recognised for this purpose by the
University.
The subjects of the Entranoe Examination in Arts are
—1, Latin; 2, Elementary Mathematics; 3, Elementary
Mechanics; 4, English; 5, one of the following
(a) French; (b) German; (c) Greek; (d) Italian;
(e( Spanish ; (/) any other modern language, permission
to present which has been obtained from the Board of
Studies. Notice of intention to present either Italian or
Spanish must bo given before March 31st in each year.
Before admission to the degrees of Bachelor of Medi¬
cine and Surgery candidates are required to send in the
usual certificates of age and study as at the other
Universities.
All candidates for these degrees must pass three ex¬
aminations, namely—the First Examination; the Second
Examination ; and the Final Examination.
First Examination.—The subjects of the examination
are—1, Chemistry ; 2, Elemontary Biology ; 3, Physics.
Candidates must have attended, during at least one
year, courses of both lectures and laboratory work in each
of the above-named subjects.
Second.—1, Anatomy ; 2, Physiology (including Phy¬
siological Chemistry and Histology); Materia Medica
and Pharmacy.
Candidates must have passed the First Examination,
and have attended courses of instruction in anatomy
(systematic and practical) during two winter sessions and
one summer session, in physiology for two winter ses¬
sions, in materia medica and pharmacy for one summer
session Candidates may present themselves separately
in (a) Anatomy and Physiology ; (6) Ma‘eria Medica
and Pharmacy. Candidates may present themselves in
(a) and (6) separately.
Final .—The examination is divided into two parte,
which may be passed separately or on the same occasion,
but the first part cannot be taken before the end of the
third year, and the second part cannot be taken before
the end of the fifth year of medical study in accordance
with the University regulations. The subjects of exa¬
mination are as follows : -1, Pharmacology and Thera¬
peutics ; 2, General Pathology and Morbid Anatomy ; 3,
Forensic Medicine and Toxicology and Publio Health; 4,
Obstetrics and Diseases of Women ; 5, Surgery, Syste¬
matic, Clinical, and Practical; 6, Medicine, Systematic
and Clinical, including Mental Diseases and Diseases of
Children. Candidates may select as a first part of the
examination two or three of the subjects 1, 2, and 3.
The certificates required from candidates at the Final
Examination are practically the same as for the corre¬
sponding examination at the London University, and
only those who have previously passed the Second
Examination are admitted to it. The regulations relating
to the M.D. and Ch.M. degrees can be obtained on appli¬
cation to the Registrar.
Fees. —Entrance Examination in Arts £2. First
Examination £o ; for any subsequent examination £2.
The fees for the Second Examination, for the Final
Examination, and for the Examination for the degree of
Ch.M. are the same as for the First Examination. A fee
of £10 is payable on the conferring of the degree of M.D.,
a fee of £4 on the conferring of the degree of Ch.M.
The Entranoe Examination in Arte is held in Jnne,
and about the end of September. The first M.B. and
Ch.B. is held in June ; also about the end of September.
The Seoond and Final Examinations held in March and
July, the Examination for Ch.M. in July only.
THE ENGLISH COLLEGES.
The medical corporations in England are the Royal
College of Physicians of London, the Royal College of
Surgeons of England and the Society of Apothecaries
of London. The two Royal Colleges now co-operate to
hold a series of examinations, on passing which the
Thx Medical Press. 2 69
candidate receives the diploma of Lioentiate of the Royal
College of Physicians (L.R.C.P.). and member of the
Royal College of 8urgeons (M.R.C S.). The Society of
Apothecaries grants a complete diploma in medicine,
surgery, and midwifery.
Conjoined Examining Board in England (Rotal
College of Physicians of London and the Rotal
College of Sorgeons of England).
Regulations relating to the several Examinations
applicable to candidates who commenced their pro¬
fessional education on or after January 1st, 1892.
Any candidate who desires to obtain both the licence
of the Royal College of Physicians of London, and the
diploma of Member of the Royal College of Surgeons of
England, is required to complete five years of profes¬
sional study at recognised medical schools and hospitals,
aod to oomply with the following regulations and to
pass the examinations hereinafter set forth.
Professional Examinations .—There are three examina¬
tions, called herein the first examination, the second
examination, and the third or final examination, each
being partly written, partly oral, and partly practical.
These examinations will be held in the months of
January, April, July, and October, unless otherwioe
appointed. Every candidate intending to present himself
for examination is required to give notioe in writing to
Mr. F. G. Hallett, Secretary of the Examining Board,
Examination Hall, Victoria Embankment, W.C., four¬
teen clear days before the day on which the examination
commences, transmitting at the same time the required
certificates.
The subjects of the first professional examination are
—Chemistry and physics, practical pharmacy, and ele¬
mentary biology. A candidate may take this examina¬
tion in three parte at different times. A candidate will
be admitted to examination in chemistry and physics and
elementary bio’ogy before registration as a' medical
student by the General Medical Council, and he may
take pharmacy at any time during the curriculum.
Rejection entails a delay of not less than three
months from the date of rejection, and the
candidates will be re-examined in the subject or
subjects in which he has been rejected. If referred in
chemistry or biology, he must produce evidenoe of
further instruction at a reoognised institution. Any can¬
didate who shall produce satisfactory evidence of having
passed an examination for a degree in medicine on any"
of the subjects of this examination conducted at a uni¬
versity in the United Kingdom, India, or in a British
oolony, will be exempt from examination in those sub¬
jects in which he has passed.
The fees for admission to the first examination are as
follows: For the whole examination, £10 10 b. ; for re¬
examination after rejection in Part I., £3 3s.; and for
re-examination in each of the other parts, £2 2s.
The subjeots of the second examination are anatomy
and physiology. Candidates will be required to pass in
both subjects at one and the same time. Candidates will
be admissible to the seoond examination at the expira¬
tion of two winter sessions and one summer session (or
fifteen months during the ordinary sessions) from the date
of registration as medical students and after the lapse of
not leB8 than twelve months from the date of passing
Parts I. and III. of the first examination.
A candidate referred at the second examination will be
required, before being admitted to re-examination, to
produce a certificate that he had pursued, to the satis¬
faction of his teachers, iD a recognised place of study, his
anatomical and physiological studies during a period of
not less than three months subsequently to the date of
his reference.
The fees for admission to the second examinations
are .- £10 10s. for the whole examination, and £6 6s. for
re-examination after rejection.
The subjects of the third and final examinations are
Part I. Medicine, including medical anatomy, pathology,
practical pharmacy, therapeutics, forensic medicine, and
public health. Candidates who have passed in practical
The diploma of Member of the Boyal College of Surgeons of
England and the licence of the Boyal College of Physicians of
London are no longer granted separately except to students who
commenced their professional study prior to October 1st, 1884.
Digitized by G00gk
270 The Medical Press.
ENGLAND—EDUCATION.
Sept. 13, 1899.
pharmacy at the first examination will not be re-examined
in that subject at the third examination. Part II.
Surgery, including pathology, surgical anatomy, and the
use of surgical appliances Part III. Midwifery and
diseases peculiar to women. Candidates may present
themselves for examination in midwifery and diseases of
women at any time after the completion of the fourth
year of professional study, not lees than one year after
pasting the second examination, on production of the
required certificates. Candidates may take this exami¬
nation in three parts at different times, or they may
present themselves for the whole examination at one
time. They will be required to produce the following
evidence before being admitted to any pait of the third,
or final examination—viz.: In medicine, of having
attended lectures on medicine, pathology including
bacteriology, pharmacology and therapeutics, forensic
medicine, and public health; practical instruction in
medicine; medical hospital practice during two winter
and two summer sessions; demonstrations in the post¬
mortem room during twelve months; clinical lectures on
medicine during nine months; of having discharged the
duties of medical clinical clerk; of having attended
practice of a fever hospital and clinical demonstrations
at a recognised lunatic asylum: In surgery, of having
attended lectures on surgery and pathology including
bacteriology; practical instruction in surgery ; of having
performed operations upon the dead subject; of having
attended surgical hospital practice duriug two winter
and two summer sessions; demonstrations in the post¬
mortem room during twelve months; clinical lectures on
eurger y during nine months; of having discharged the
duties c of surgical dresser and having received clinical
instru tion in ophthalmology: In midwifery, of having
attended lectures on midwifery; practical instruction in
midwifery; clinical or other lectures, with practical
instruction in diseases peculiar to women ; and of attend¬
ance on 20 labours.
Fees for admission to the third or final examination
are as follows:—For the whole examination, .£15 15s.
Part I. For re-examination in medicine, including
medical anatomy, pathology, therapeutics, forensic
medicine, and public health, £5 5s.; for re-examination
in practical pharmacy (if taken at this examination),
£2 2b. Part II. For re-examination in surgery, including
pathology, surgical anatomy, and the use of surgical
appliances, £6 5a. Part III. For re-examination in mid¬
wifery and dieases peculiar to women, £3 3s.
A candidate referred on the third or final examination
will not be admitted to re-examination until after the
lapse of a period of not less than three months from the
date of rejection, and will be required, before being
admitted to re-examination, to produce a certificate, in
regard to medicine and surgery, of having attended the
medical and surgical practioe, or the medical or surgical
practioe, as the case may be, during the period of his
reference; and in regard to midwifery and diseases
peculiar to women, a certificate of having received subse¬
quently to the date of his reference, not less than three
months' instruction in that subject by a recognised
teacher.
Royal College of Physicians of London.
Licentiate*. —Candidates are now subject to the regu¬
lations of the Conjoint Examining Board in England.
Members. —The membership of the college is granted
after examination to persons above the age of 25 years
who do not engage in trade, do not dispense medicine,
and do not practise in partnership.
Medical graduates of a recognised university are ad¬
mitted to a pass examination, but others must have passed
the examinations required for the licence of the college.
The examination, which is held in January, April, July,
and Ootober, is partly written and partly oral. It is directed
to medicine, and is conducted by the president and
censers. Candidates under 40, unless they have obtained
a degree in arts in a British univessity, are examined in
Latin, and either Greek, French or German. Candidates
over 40 are not so examined, and the examination in
medicine may in their case be modified under conditions
to be ascertained by application to the Registrar. The
f ee for the membership is £42, but if the candidate is a •
licentiate -£15 15s. is deducted. In either case £6 6s. is
paid for examination.
Royal College of Surgeons of England.
Membership. —The candidates are now subject to the
regulations of the Conjoint Board.
Fellowship. —The Fellowship of the College of Snrgeons
is granted after examination to persons at least 25 years
of age, who have been engaged in professional studies for
six years. There are two examinations—the first in
Anatomy aad Physiology, which may be passed after the
third winter session; the second chiefly directed to
Surgery, which may be passed after six years of profes¬
sional study. The Second Examination may be passed
before attaining the age of 25, but the diploma is not
granted until the age is reached. Candidates for this
part of the examination must have passed the final
examination of the Conjoint Board in England, and
have been admitted members of the college before they
can be admitted thereto.
Fees. —At First Examination: Members, £5 5s.; non-
Members, .£ 10 10s.; £5 5s. returned if rejected. At Second
Examination ; Members, £10 10s.; if not a Member, £21.
In the latter case £10 10s. is returned in case of rejection.
Further information can be obtained on application to
the Secretary of the Royal College of Surgeons, Lincoln’s
Inn Fields, London, W.C.
Society of Apothecaries of London.
Primary Examination. —This examination consists of
two parts: Part I.—Elementary Biology, Chemistry,
Chemical Physics, including the Elementary Mechanics
of 8olids and Fluids; Heat, • Light, and Electricity;
Practical Chemistry and Pharmacy. A synopsis indi¬
cating the range of the subjects may be obtained on
application. Part II.—Anatomy and Physiology and
Histology. A candidate rejected in one or more subjects
is not re-examined in the subjeots in which he passes.
The examination is held in January, April, July, and
October.
The Final Examination is held monthy, and is divided
into Sections 1 and 2.
Section 1 oonsists of three parts.
Part I. includes:—Principles and Practice of Surgery
Surgical Pathology, and Surgical Anatomy, Operative
Manipulations, Instruments and Appliances.
Part II. includes :—(a) The Principles and Practioe of
Medicine, including Therapeutics, Pharmacology, Patho¬
logy and Morbid Histology. ( b ) Forensic Medioine,
Hygiene, Theory and Practioe of Vaccination; and Men¬
tal Diseases.
Candidates passing either (a) or (6) will not be re¬
examined therein.
Part III. includes: Midwifery, Gynaecology, and
Diseases of New-born Cnildren. Obstetric Instruments
and Appliaaces. Candidates may enter for Parts I., II.,
and III. together or separately.
Section 1 of the Final Examination, or any part
thereof cannot be passed before the expiration of 45
months from the date of registration as a medical student.
During the above period of 45 months not less than 3
winter sessions and 2 summer sessions must have been
passed at one or more of the Medical Sohools connected
with a general hospital reoognised by the Society.
Section 2.—This section consists of two parts.
Part I.—Clinical Surgery.
Part II.—Clinital Medicine and Medical Anatomy.
Section 2 cannot be passed before the expiration of the
fifth year.
Fees. —The fee for examination is £5 5s., total for
the licence, £15 15s.; Re-examination—Primary for each
Part, £3 3s.; Final, Sec. I., for each Part, £3 3s. ; Final,
Sec. II, for each Part £3 3s.
Further information, with particulars as to the course
of study, and of the certificates required, can be obtained
from the Secretary to the Court of Examiners, Apothe¬
caries’ Hall, E.C.
The licence is a registrable diploma in Medicine, Sur¬
gery, and Midwifery, and qualifies the holder to compete
for medical appointments in the Army, Navy, and Inai&n
Services, also for Poor-law, Civil, and Colonial appoint¬
ments.
S*pt. 13, 1899.
IRELAND.—EDUCATION.
Th* MkDICAL PBB88. 271
irclanb.
QUALIFICATION IN IRELAND.
The Medical Licensing Bodies of Ireland are five in
number, and, aa a rule, students gravitate into one or
other of five classes:—a. Those who enter Trinity
College, and take a full graduation in arts in addition
to their professional degrees, b. Those who take the
lioenoe of the College of Surgeons with that of the Col*
lege of Physicians, c. Those who take the lioence of the
Apothecaries' Hall. d. Those who take their qualifica¬
tions at the Boyal Irish University, because graduation
in arts is not necessary to that institution, e. Those who
pursue their studies in Ireland, but who migrate to Edin¬
burgh or Glasgow for their licences. Almost all these
emigrants come from the Queen’s Colleges, and the
greater number of them from Belfast, while the Dublin
students qualify, as a rule, in Dublin.
We do not attempt to give details as to the requisite
courses of instruction for degrees or diplomas, as our
epitome must necessarily be insufficient for the informa¬
tion of the student, and we can occupy our available
spaoe with information more useful to him.
The Irish Licensing Bodies are as follows:—
THE UNIVERSITY OF DUBLIN,
which grants the degrees of M.B., B.Ch, and B.AO.
to students who have obtained their Arts degree, and
the higher degrees of M.D. and M.Ch. to those who have
held for at least three years the grade of M.B and M.Ch.
It does not grant degrees to any but full graduates in
arts, consequently its degrees hold the highest rank of
social and educational qualifications, and are sought for
by those who look forward to occupying the beet positions
in the profession.
The expense of obtaining the degrees of M.B., B.Ch.
and B.A.O. is approximately as follows:—Lectures,
£89 6s.; Hospitals, .£55 13s.; Degree Fees, £27.—
£161 19s.
The expense of the B.A. amounting altogether to
£83 4s., should be added, making the total cost £235 3s.
Doctor in Medicine. —In addition to its ordinary quali¬
fications, the University giants the following higher
degree of M.D.Must be M.B., or qualified to take
that degree for three years. Total fee for this degree,
£13.
Master in Surgery. —Must be a Bachelor in Surgery
of three years’ standing, and he must then pass an ex¬
amination in clinical surgery, operative surgery, surgi¬
cal pathology, surgery, and surgical anatomy (on the
dead subject). Fee for the degree of Master in 8urgery,
£ 11 .
Matter in Obstetric Science. —Must have passed the
M.B. and B.Ch. examinations, and have completed in
addition to the courses for M.B., B Ch, a course in
obstetric medicine and surgery. Fee for the degree of
M.A.O., £5.
Diplomats in Medicine, Surgery, and Midwifery. —The
oourse and examination is the same as for the degrees,
exoept that the lectures and examinations in botany and
zoology need not have been taken out or passed. Fee
for the diplomas in medicine, surgery, and midwifery,
£ 21 .
Qualification in State Medicine. —The candidate muBt
be a M.D. of Dublin, Oxford, or Cambridge.
The candidate must have completed, subsequent to
registration, six months’ practical instruction in a
laboratory, and also have studied practically outdoor
sanitary work for six months, under an approved officer
of health. This condition does not apply to medical
practitioners, registered, or entitled to be registered on
or before January, 1890. 1
THE ROYAL UNIVERSITY OF IRELAND.
The degrees of the university are granted on one year’s
acts, i.e., the matriculation examination of this univer¬
sity (none other will suffice) and a '* first university
examination ” at the termination of the first year. The
cost of the M.B. and M.Ch. of the university, with all
the necessary curriculum, is about £125. Some of the
arts examinations are conducted, not only in Dublin but
at certain local centres.
The university confers the following medical
degrees :—
M.B., M.D., B.Ch., M.Ch., B.A.O., M.A.O.; in sanitary
Bcienoe, a special diploma; in mental diseases, a special
diploma.
All degrees are open to persons of either sex.
The university examinations are held in the spring,
beginning about May 1st, and in the autumn, beginning
about September 24th.
All candidates for any degree must pass the
matriculation examination and the first university
examination.
The course for the degree of M.B., B.Ch., B.A.O., ex¬
tends over five years.
8tudents will be admitted to the first university
xamination after one year from matriculation.
Fee, £1.
The course consists in three previous examinations and
one degree examination; one at the end of each year.
Fee for each primary, £1; for the degree, £2; for the
diploma, £10.
In addition the following degrees are granted :—
Diplon a in Sanitary 8cience.—Conferred only on gradu¬
ates in medicine of the university of one year’s standing.
Fee, £2. Subjects.—Climatology, chemistry, geology,
physis, vital statistics/ hygiene, sanitary law.
The M.B. Degree.— Conferred only on graduates in
medicine of the university of three years’ standing. Fee.
£5. The examination will comprise medical diseases,
and the theory and practice of medicine, including
pathology.
The M.Ch Degree. —Conferred only on graduates in
medicine of the university of three years’ standing.
Fee £5.
The examinat on comprises surgery, both theoretical
and operative; surgical anatomy; ophthalmology and
otology.
The Mastership of Obstetrics. —Conferred only on
graduates in medicine of the university of three years’
standing. Fee £5.
Examination comprises midwifery and diseases of
women and children.
Honours, tVc.—First Examination in Medicine. Two
first exhibitions of £23 each, and two second of £10 each.
Second Examination in Medicine.—Two first exhibi¬
tions of £25 each and two second of £15 erch.
Third Examination in Medicine.—Two first of £30
each, and two second of £20 each.
Medical Degrees Examination.—Two first of £49 each,
and two seconds of £25 each. One travelling medical
scholarship of £100. One medical studentship of £200
per annum, tenable for two years.
ROYAL COLLEGE OF PHYSICIANS (L.R.C.P.I.)
AND SURGEONS (L.R.C.S.I.).
The examinations held oonjointly by the two colleges
are the inlet of most Irish students to the profession,
especially of those educated in Dublin The course, as in
other bodies, extends over five years, with examinations
at the end of the first, second, third, and final years,
these examinations being oonducted by examiners chosen
by each of the colleges for the subjects appropriate to
them. The five years may be described as—first, pre¬
paratory ; second, theoretical; third and fourth, appli¬
cation of the theory to practical work; and,final, strictly
practical in hospitals, general and special. The regula¬
tions are so voluminous that an epitome of them would
Digitized by CjOCK^Ic
IRELAND—EDUCATION.
Sbpt. 18, 189ft-
272 The Medical Pbess.
ROYAL COLLEGE OF SCIENCE.
be unsatisfactory, and we recommend students to apply
for the official programme to the Secretary of the Com*
mittee of Management, College of Physicians.
The total of the examination fees, spread over the four
examinations, is £42, while the school and hospital fees>
if taken in Dublin, amount to £124 19s., making alto¬
gether £167, exclusive of “grinding” or of re-examina¬
tion fees which have to be paid in case the candidate
fails to pass in all the subjects oi his examination at the
one time. The cost of education is much less if taken
out in Belfast, Cork, or Galway, at a Queen’s College.
All information may be obtained from the Secretary
of the Committee of Management, College of Physicians.
Professional Examination.
Every candidate must pass four examinations—one at
the end of each session.
APOTHECARIES HALL OF IRELAND (L.A.H.).
This body is now authorised to grant a complete quali¬
fication in medicine, surgery, and midwifery, recognised
and registrable under the Medical Act of 1886, and en¬
titling the holder to occupy medical appointments in all
the public services. It also confers the legal right to
dispense medicines in Ireland. The examinations will
be held on the third Monday in January, April, July,
and October, and the requirements in respect of studies
will be approximately the same as those of the conjoint
examinations of the Royal Colleges of Physicians and
Surgeons in Ireland. The examination feeB payable for
the qualification of L.A.H. will be as follows .-—First pro¬
fessional, £5 5b. ; second, £5 5s.; third, £5 5s.; final
examination, £6 6s.
A candidate is allowed for each professional examina¬
tion which he has completed at any other licensing body,
except the final. If he has passed only in part of his
subject in a given division, he has to pay the whole of
the fee for that division.
The fees for re-examination are for each subject, £1 Is.,
excepting in the subjects of chemistry, pharmacy, sur¬
gery, ana medicine, the fees for which are £2 2s.
The fee for final alone, £15 16s. Candidates may be
admitted to a special examination under special circum¬
stances, at an extra fee of ten guineas.
Candidates already on the Register will receive the
diploma of the Hall on passing an examination in medi¬
cine, surgery, midwifery, and pharmacy, and paying a fee
of ten guineas. If medicine or surgery are required, two
guineas extra will be charged. The candidate will be
exempt from each of the above subjects, which are
oovered by his previous qualification or qualifications
THE PHARMACEUTICAL SOCIETY OF IRELAND.
The above Society grants the diplomas of Pharmaceu¬
tical ChemiBt and Assistant to Pharmaceutical Chemists,
and of Registered Druggiot. The pharmaceutical chemist
is not entitled by the Society’s licence to prescribe. In
this respect he differo from the apothecary. All persons
who keep open shops for compounding prescriptions
must hold the licence of the Pharmaceutical Society or
Apothecaries’ Hall. Pharmaceutical chemists under the
Act are entitled to hold the office of apothecary to dis¬
trict lunatic asylums, county gaols, and, by a recent
order of the L^cal Government Board, may also hold
similar office in workhouses and dispensaries, and are
also eligible to compete for dispenserships in naval hos¬
pitals. The registered druggist is entitled to sell poisons,
but not to compound prescriptions. The Society, accord¬
ing to the Calendar, which was corrected to December,
1896, had the names of 528 pharmaceutical chemists, 305
chemists and druggists, 406 registered druggists, and
14 assistants to pharmaceutical chemists—in all 1,253
persons—on its registers.
Lectures are delivered on materia medica, and botany
and chemistry, in the Society’s schools, which will be
reopened in October.
The Introductory Lectures in botany and materia
medica will be delivered on October 5th, by Professor
Falkiner, and that on chemistry by Professor Tich-
bome on October 1st.
Department of Science and Abt.
This College, situate in Stephen’s Green, Dublin*
supplies a complete course of instruction in science
applicable to the industrial arts, especially those
which may be cast broadly under the heads of
chemical manufactures, mining engineering, physics, and
natural scienoe. A diploma of Associate of the College
is granted at the end of the three years’ course.
There are four Royal scholarships of the value of £50
each yearly, with free education, including laboratory
instruction and drawing, tenable for two years. Two
become vaoant every year. They are competed for by
the associate students with certain restrictions at the
end of the first year. The chemical, physical, zoological,
and botanical, geological, and mineralogies! laboratories
and drawing schools are open daily for practical instruc¬
tion. The session commences on Tuesday, October 3rd.
The course of chemistry, physics, botany, geology, and
mineralogy, and zoology are recognised by the Royal
University of Ireland, and certificates of attendance are
granted to medical and other students, attending these
courses, as also the courses of ohemical, physical, zoolo¬
gical, and botanical and geological laboratories.
THE EDUCATIONAL PROSPECT.
The Irish teaching centres, speaking generally, were
fairly busy last year, and there seems to be no sufficient
reason to fear that there will be a falling off in the
coming Medical Session. There was a retrogression in
the Dublin Schools, but it was more than compensated
for by an increase in Belfast and Cork. The total out¬
put of students qualifying from Ireland showed a
material advance, but the profession was most manifest
in the number of candidates for the Scotch Colleges,
although the Dublin Colleges and Universities partici¬
pated to some extent.
THE IRISH MEDICAL SYSTEM.
The system of medical teaching in Ireland differs
from that in England in important particulars. In
London each clinical hospital has its attached medical
school, which is fully equipped, and which educates the
students of that hospital, and very seldom those of any
other. In Dublin, on the oontrary, the hospitals and
schools are entiiely separate (except that Sir Patrick
Dun’s Hospital is officially connected with Trinity
College), and a student of any hospital is free to enter
the whole or any part of his course at any school or
hospital he pleases. As might be expected, religion,
social rank, and locality of residence have their influ¬
ence in causing certain classes of students to resort to
schools and hospitals suitable to their condition. But
scholastic or collegiate regulations impose no restric¬
tions as to the place of study, and as the school and
hospital fees are paid in detail in Dublin, and not in a
lump sum, as in London, the pupil is absolutely free ^o
do as he pleases.
In London the student bargains with his hospital and
sohools, in the first instance, for a complete course of
instruction, for which he pays, in whole or part, in
advance, and his entire study is conducted within the
one institution. In Dublin, on the contrary, the student
enters for hospital and for courses of stuay separately,
and takes the courses at any school or hospital he pleaseB
which “ gives best value,” migrating from one school or
hospital to another as he thinks fit.
LODGING AND LIVING OF IRISH MEDICAL STUDENTS.
There is, unfortunately, in Dublin no proper organisa¬
tion for domestic accommodation of medical students.
For those who are passing through Trinity College rooms
and “ commons,” or meals, are provided at fixed rates.
Those who can afford to pay £6 6s. or £7 7s. per month
for their lodging and maintenance may find accommoda¬
tion in the family of some medical man who receives
boarders, in which case they become members of the
family for the time being, and subject to its discipline.
The majority of Dublin students, however, take a lodging
y Google
Sept. 13, 1899.
IRELAND—EDUCATION,
in some economical locality, or they “ chum ” with some
other student for the purpose. It is usual to contract
with the lodging-house keeper for board or partial board,
but some students cater for themselves. On the whole,
the domestic arrangements of the Dublin student are
unsatisfactory, cheerless, and not calculated to encourage
home comforts or home discipline.
COST OF EDUCATION IN IRELAND.
The total expense of the course of study requisite for
the Conjoint Diplomas of the Colleges of Surgeons and
Physicians, or the College of Surgeons and Apothecaries’
Hall, including “ grinding ” and all the necessary pro¬
fessional expenses, totals up to about .£124 19s., spread
over five years, and the cost of them is the same in all
the Dublin Schools, but if they be taken out in the
Queen’s Colleges the amount is very much less.
This, with the examination fee of £42 for the Conjoint
Diplomas of the College of Surgeons and College of
Physicians, represent the epsentials. Thus, the absolute
payment will amount to somewhere about £166 19s.,
taking the minimum mode of payment. So that, assum¬
ing the extras or voluntary costs are incurred, the total
will vary, say from £170 to £200. “ Grinding ” usually
costs £5 5s. for each of the four examinations, but if a
student needs “private grind” in special subjects he
must pay extra for them.
This sum, or something like it, may be expended by
the student or his parent paying for lectures, Ac., and
examination fees as they accrue, and there is not the
least difficulty about obtaining the information needful
for their guidance if thev like to act independently, but
if they prefer to pay a lump sum down, such payment
will secure to a pupil the advantage (?) of being “ ap¬
prenticed ” to a teacher who will undertake all monetary
responsibility for his education, and may be able to
give him some special advantages as his own pupil at
hospital, but the so-called apprenticeship is veiy gene¬
rally a simple contract for the payment of fees, and
involves but little of that special teaching which is due
by a master to a true apprentice, and as it deprives the
student of his independence in selecting the schools and
hospitals which suit him best, we advise him not to be
an apprentice unless he knows very well indeed the
master to whom he entrusts himself. All the Dublin
schools now require fees to be paid in advance, and the
remainder on the issue of the certificate, while some will
give credit for the whole amount. Most of the apprentice-
holders will accept payments by instalments.
IRISH PRELIMINARY EXAMINATIONS.
The fin>t work of the student is to pass a preliminary
examination, without which he cannot get credit for any
medical studies pursued. The next is to commence
medical study. This he does by entering for lectures at
a medical school. From the school registrar he gets a
form of certificate, and his third act is to take it or send
it to the Branch Medical Council, 35 Dawson Street,
Dublin. He is thereupon placed upon the Register of
Medical Students (without fee) and his period of study
counts from that date. Be must register at the earliest
possible moment, or he will lose credit for his work.
The only preliminary examination held specially for
medical students is now held conjointly by the Royal
Colleges of Physicians and Surgeons, but other examina¬
tions, e.g., the public entrance at Trinity College, the
matriculation of the Royal University, the Intermediate
Education passes in the required subjects, and all other
examinations recognised by the General Medical Council
are accepted as equivalent.
The Preliminary is held in March and September, in
the subjects specified by the General Medical Council.
DAT* OF ENTRY IN IRELAND.
The entry of names and commencement of study in
Ireland is supposed to date from the 1st of October in
each year, but the session really does date from the 1st of
November, and the entry of names may be delayed by
the dilatory to the 25th of the same month, but it should
be recollected that no credit is given for studies or
attendance until the entry is regularly made. The
student must attend three-fourths of the lectures
The Medical Press. 273
delivered, and if he loses a fortnight at the beginning he
must “ pull up ” afterwards by constant attendance.
The student begins work attending a recognised
medical school each morning at ten o’clock, and occupy¬
ing his day, to five p.m., between lectures and dissections.
His vacations are a fortnight at Christmas and a week
at Easter, and he finally returns home at the end of
June.
MEDICAL SCHOOLS AND HOSPITALS
IN DUBLIN.
The clinical hospitals in Dublin are ten in numberi
exclusive of the Cork Street Fever Hospital, three
lying-in hospitals, two ophthalmio hospitals, a dental
hospital, the National Children’s Hospital in Harcourt
Street, the Orthopscdic Hospital, and the other special
institutions. Some of the olinical hospitals, though they
have no actual or official connection with any school, are
in close affinity with certain teaching bodies, while
others, again, are without any special connection with any
school. "While, however, such affiliation of a school or
hospital may exist, it should be remembered that the
Dublin schools and hospitals are open to all comers, and
the student is competent to attend any hospital or any
school he wishes, and to change his place of instruction
from year to year as he may Bee fit.
The Irish Licensing Bodies require attendance on hos¬
pital for 27 months (i.e., three winter sessions of 6 months
and three summers of 3 months) within the five years of
study. The fee at all general hospitals is £8 in winter,
and for the summer £6, or £12 for the entire session of
9 months if taken together.
The names of the Professors, Lecturers , and Hospital
Staffs of the following Schools and Hospitals, are not
included in this place, being found in the advertise -
ment of each Institution, as indicated on next column,
in our advertising columns.
Page
Richmond Whitworth and
Hardwicke •
Meath.
Mercers ....
Mater Mlsericordia-
Adelaide ....
Jervis 8treet ■
Special Hospitals:
Rotunda Lying-in ■
Royal v ictorla Eye and Ear 58
National Children's- * 54
Red Cross Nursing Home 63
Page
Royal College of Physicians 63
Schools .
University of Dublin - 59
Royal College of .Surgeons 55
Queen's College. Cork ■ 63
Catholic University- - 62
General Hospitals :
City of Dublin ... 61
Sir Patrick bun's • - 59
St. Vincent’s 57
The 8chool of Physic is a medical school formed by
an amalgamation of the School of Trinity College and of
the College of Physicians. Some of the professors in the
schools are ex ejficio medical officers of Sir Patrick Dun’s
Hospital. The school is freely accessible to all students,
and the instruction provided oocupies a high rank.
The arts students of the University have certain ad¬
vantages in attending. In their *• sophister ” years
medical students may drop certain languages out of their
arts course. Every student of the school must be matri¬
culated by the senior lecturer, for which a fee of 5s. is
payable, but he need not attend any of the arts course
unless he desires to obtain a university licence or degree,
in medicine, surgery, and midwifery. No student is
permitted to matriculate unless he has passed the
entrance examination in Arts in Trinity College, the pre¬
liminary examinations of the Royal University, of the
College of Surgeons, or some other examination recog¬
nised by the General Medical Council.
Two Medical Scholarships are given annually at the
School of Physio, valued £20 per annum, tenable for
two years, the examinations for which are held each
year in June, in the following subjectsAnatomy and
Institutes of Medicine, zoology, chemistry, botany, and
experimental physics. Three*fourths of the lectures must
be attended, and a daily roll is marked by each pro¬
fessor.
Die
boogie
274 The Medical Press.
IRELAND—EDUCATION.
Sept. 13, 1899.
The Royal College op Surgeons in Ireland
Schools of Surgery. —By the amalgamation of the
Carmichael College and the Ledwich School with the
School of the Royal College of Surgeons the combined
schools form the largest medical teaching body in Ire¬
land. These schools are attached by Charter to the
Royal College of Surgeons. They are carried on within
the College Building, and are specially subject to the
supervision and control of the Council, who are em¬
powered to appoint and remove the Professors, and to
regulate the methods of teaching pursued. The Build¬
ings have been reconstructed, the capacity of the dis¬
secting room nearly trebled, and special histological,
pathological, bacteriological, public health, and phar¬
maceutical laboratories fitted with the most approved
appliances in order that students may have the advan¬
tage df the most modern methods of instruction.
Lady Students. —Ladies are eligible for all the
Diplomas granted by the College, separate rooms have
been provided, and careful provision is made for their
instruction and comfort.
Prizes. —The Carmichael Scholarship, .£15 ; the Mayne
Scholarship, £16. The Gold and Silver Medals in sur¬
gery, and the Stoney Memorial Medal in anatomy will
be awarded at the end of the session. The “ Barker ”
Prize, £21 is also open to students of the school.
Class Prizes of £3 and £1, accompanied by medal if
sufficient merit be shown, will also be given in each
subject. Prospectus can be obtained on application to
the Registrar.
The Catholic University School is situated in
Cecilia 8treet, Dame Street. It prepares students for
all medical examinations, particularly those of the Irish
College of Physicians and Surgeons, and the Royal Uni¬
versity of Ireland. The Bchool has recently been rebuilt
and refitted, its working space having thereby been
nearly doubled, and several new laboratories including
those for the study of Bacteriology and Public Health
have been added. The institution has also been recently
chartered, and it is now controlled by a Board of
Governors.
There has been formed in connection with the school a
“ Medical and Scientific Society ” for the discussion of
medical and scientific subjects.
The following exhibitions are awarded annually.-—
Two first year’s, value, £12 10s. each ; two second year’s,
value, £10 each; two third year’s, value, £12 12s. each;
one third year’s Royal Exhibition of £12 10s.; one final
of £12 10a.; and two large gold medals, besides several
other class.
A guide to students commencing medicine may be
obtained free on application to the Registrar.
THE QUEEN’S COLLEGES—BELFAST, CORK AND
GALWAY.
Thebe three important academic institutions were the
special schools of the Queen’s University. They have
ceased to have any direct relation to a central examining
body, but educate students for all colleges and degrees,
and are maintained, as hitherto, by a handsome Govern¬
ment grant. The same curriculum as that heretofore
adopted will be continued. The various exhibitions and
scholarships will still be available. Each college has
the disposal of about £1,500 per annum in scholarships
and prizes. The curriculum is generally well adapted for
preparation for the Royal University examination. The
colleges are well adapted for high-class technical educa¬
tion, having lecture rooms provided with every appliance
necessary in the modern training of a medical student.
The great want in the colleges of Cork and Galway is a
summer session. This necessitates the loss to the student
each year of three available working months. The col¬
leges are completely equipped with students' reading
rooms and lending libraries and refreshment rooms, ana
with all adjuncts to collegiate life, such as literary
societies ana athletic organisations. The students do
not, however, reside within the college, but halls of
residence and licensed boarding houses are provided for
those who do not live with friends. The expense of
living in the collegiate towns is quite moderate. The
course of lectures in the winter session must be dili¬
gently attended, no student obtaining a certificate who
has not put in three-fourths of a course. The winter
medical session commences on October 29th and ends
about Easter. The scholarships examinations are held
in October. A detail of the prizes and exhibitions in
medicine, the names of the professors, and other infor¬
mation may be found in the advertisements of this issue,
and full details may be had on application to—
Belfast, John Purser, LL.D., Registrar.
Cork, Alexander Jack, M.A.
Galway, Edward Townsend, M.A.
CLINICAL HOSPITAL8.
Richmond, Whitworth, and Hardwicks Hospitals.
—The accommodation of these hospitals is as follows:—
Hardwicke Hospital, 120 beds ; Whitworth Hospital, 82
beds; Richmond Hospital, 110 beds—total, 312 beds.
These hospitals are visited each morning at 9 o’clock
by the Physicians and Surgeons, and in addition to the
usual bedside instruction clinical lectures are delivered
on the most important cases. Special instruction is also
given on various branohes of medicine and surgery. The
Truss Establishment for the distribution of trusses to
the ruptured poor of Ireland is connected with these
hospitals. There are very large ophthalmic, aural,
throat, and gynaecological dispensaries, and instruction
in these important subjects is given. Eight resident
clinical clerks are appointed each half-year, and pro¬
vided with furnished apartments, fuel, &c. The appoint¬
ments are open not only to advanced students, as for¬
merly, but also to those who are qualified in medicine
or surgery. A house surgeon for the Richmond Hos¬
pital and a house physician for the Whitworth and
Hardwicke Hospitals are elected an n ual l y, and receive a
salary. The Richmond Lunatio Asylums, containing
1,600 beds, adjoin these hospitals.
Meath Hospital and Co. Dublin Infirmary.—
This hospital was founded in 1753, and now contains 160
beds available for clinical teaching. A new building
for the isolated treatment of fevers has recently been
added. The certificates of this hospital are recognised
by all the universities and licensing bodies of the United
Kingdom. Medical and surgical resident pupils and
clinical clerks and dressers are appointed every six
months, and a house surgeon is elected annually. A
prospectus giving the complete arrangements for medical
and surgical classes for the coming session may be
obtained from the secretary of the Medical Board,
R. Glasgow Pattoson, F.R.C.S., 20, Lower Baggot 8treet,
Dublin.
The Adelaide Medical and Surgical Hospitals
are in Peter Street, and occupy a central position within
a few minutes’ walk of the College of Surgeons and
Trinity College. From October 1st the physicians and
surgeons visit the wards, and give instruction at the
bedside at the advertised hours. There is a large de¬
tached fever hospital, and also wards for infants and
ohildren. Operations are performed, except in cases of
urgency, at 10 a.m. on Tuesday, Thursday, and Saturday.
Special hours are devoted to clinical instruction in the
diseases peculiar to women, and students are individually
instructed in the use of the stethosoope, ophthalmoscope,
laryngoscope, and microscope; also special instruction is
given on practical pathology and X-ray photography.
Three resident pupils are selected half-yearly and a house
surgeon annually. Prize examinations, including ex¬
aminations for the Hudson Scholarship, £30 and a gold
medal, and a senior prize of £10 and a silver medal, in
addition to surgical and medical prizes, are held at the
termination of the session. The large dispensaries Afford
facilities for the study of eye, ear, throat, and cutaneous
diseases, as well as of minor surgery and dentistry.
Further particulars from Dr. Heuston, 15, Stephen's
Green North.
Sir Patrick Dun’s Hospital is Bituated on the south¬
eastern side of the city, and about half a mile from the
University School of Physic. It is officered exclusively
by the professors and examiners in that school. For¬
merly all University students were compelled to attend
this hospital, which was purely a medical institution, but
some years ago the obligation was removed, and the
hospital was opened for surgical cases. It is now per¬
fectly free to all students.
Digitized by GoOgle
IRELAND—EDUCATION.
Sept. 13, 1899.
This Medical Press. 275
The City of Dublin Hospital. —This hospital is sit¬
uated in Upper Baggot Street, about ten minutes’ walk
from the Royal College of Surgeons and Trinity College.
It has just been enlarged and improved to a very con¬
siderable ertent. A special course of instruction is given
on ophthalmic and aural disease. There are special
wards for the treatment of diseases of the eye, of chil¬
dren, and of women, and practical instruction is given
on diseases peculiar to women, also a separate building
for infectious diseases. Clinical clerks to the physicians
and dressers to the surgeons are appointed from the most
deserving of the class. An entirely new operation
theatre, sterilising room, and anaesthetic room, are being
constructed in accordance with the most modern surgioal
requirements, and are now almost completed. A house
surgeon is elected annually, and resident medical and
surgical pupils are appointed from among the past and
present students of tne hospital. Operations are per¬
formed on Tuesdays, Thursdays, and Saturdays, at 10.30
a.m. Full particulars can be had on application to Mr.
G. Jameson Johnson, Hon. Sec. Med. Board.
Mates Misericordie Hospital. —This hospital, the
largest in Dublin, containing 335 beds, is open at all
hours for the reception of accidents and urgent cases.
Fifty beds are specially reserved for the reception of
patients suffering from fever and other contagious
diseases. A course of lectures and instruction on fever
will be given during the winter and summer sessions.
A certificate of attendance upon this course to meet the
requirements of the various licensing bodies, may be
obtained. Opportunities are afforded for the study of the
diseases of women in the wards under the care of the
obstetric physician, and at the dispensary held on Tues¬
days and Saturdays. Lectures on clinical gynaecology
will be delivered on Saturdays at 11 a.m. Ophthalmic
surgery will be taught in the special wards and dispen¬
sary. A special course of instruction in pathology and
bacteriology, as applied to medicine, will be given. Con¬
nected with the hospital are extensive dispensaries,
which afford valuable opportunities for the study of
general, medical, and surgical diseases, accidents, Ac.
Four house physicians and eight house surgeons will be
appointed annually. Ten resident pupils will be eleoted,
each to hold office for six months, from the most atten¬
tive of the class. For the current session the elec¬
tions will take place in November and in May.
Dressers and clinical clerks will be appointed, and
certificates will be given to students who exhibit pro¬
ficiency and punctuality in performing their duties.
Leonard prizes: one gold and one Bilver medal will
be offered for competition annually in the subject
of medicine, and one gold and silver medal in the
subject of surgery. Junior Leonard prizes: two
prizes of the value of £3 and two prizes of the value
of £2 will be offered for competition in medicine and
surgery, respectively. They will be awarded on the
aggregate of marks gained by reports of cases, and at a
clinical examination to be held at the close of the
summer session.
Mebcib’8 Hospital, William Street, founded a.d.
1707.—This hospital educates students of all schools.
It is situated in the centre of the metropolis, in the
midst of a densely-crowded population, and its doors
are open at all hours for the reception of accidents and
acute cases. Dispensaries are held daily, and are
largely attended. Special instruction is given in
cutaneous, infantile, gynaecological, and ophthalmic
diseases. From the large number of accidents which,
from its position, come to the hospital, students are
offered ample opportunities of rendering themselves
familiar with the nature and treatment of disease in its
various forms and of obtaining dexterity in the dressing
and manual operations of minor surgery. In addition to
the new wing built some years ago, another wing, facing
Stephen’s Green, has been completed, which contains a
new operating theatre, students’ room, lavatory, dis¬
pensary department, pay wards, aud nurses’ homes.
St. Vincent’s Hospital. Stephen’s Green, Dublin, was
established in 1834. The hospital has 1(30 beds constantly
full, and in connection with it there is a largely attended
dispensary, a convalescent home, and a nurses’ institute.
In addition to the ordinary clinical instruction, systematic
courses of lectures are given in each department of medi->
cine and surgery, and are illustrated by cases in the hos¬
pitals. The resident officers consist of a house surgeon,
a house physician, and four resident pupils. Three olinical
lectures are delivered daily in the wards, illustrated by
selected oases, and beginning at 9 a m. A special feature
of this hospital is the division of the students into senior
and junior classes, thus providing for their systematic
and appropriate instruction from the beginning to the
end of the course.
Two gold medals and other valuable prizes and certifi¬
cates of merit are awarded at the end of each session.
A prospectus can be had from Dr. McHugh, 25, Har*
court Street, Stephen’s Green.
The Introductory Address will be delivered by Dr.
Tobin, on Tuesday, October 3rd, at 4.30 p.m.
SPECIAL HOSPITALS.
The special hospitals of Dublin are the Rotunda*
Coombe and National Lying-in Hospitals, Cork Street
Fever Hospital, the Royal Victoria Eye snd Ear Hospital
(amalgamation of St. Mark's Ophthalmic Hospital, and
the National Eye and Ear Hospital), the Dental Hospital,
the Throat Hospital, the Orthopedic Hospital, and the
Children’s Hospitals in Haroourt Street and in Temple
Street.
The Rotunda Hospital. —This, the largest and best*
known lying in hospital of the United Kingdom is every
year becoming more appreciated as a school of midwifery,
and of late; more especially, as affording peculiar advan*
tages both to the student and the practitioner for
acquiring a thorough knowledge of gynaecology. It con¬
tains two distinct departments—viz., the lying-in hos¬
pitals, into which about 1,600 cases of labour are admitted
annually ; and the hospital for the treatment of diseases
peculiar to women, into which some 500 patients are now
admitted during the course of the year. The present
master, Dr. Purefoy, was previously well known as
Gynaecologist to the Adelaide Hospital. There is a
large extern maternity in connection with the hospital,
more than 2,000 women being attended during the past
year at their own homes, and also a large daily dispensary
for the treatment of the diseases peculiar to women.
Every facility is afforded for the study of the special
departments of medicine to which the hospital is devoted,
and both students and midwives are granted a diploma
on passing an examination. Two clinical clerks, at a salary
of iJ50 per annum each, are appointed every six months
from among the students who have attended the full
course of instruction in the hospital. A considerable
number of female pupils are also yearly trained as nurse
tenders and midwives.
National Maternity Hospital. —This institution,
under the mastership of Dr. Barry and Dr. H. Horne, is
situated in Holies Street, close to 8ir Patrick Dun’s.
Pork Street Fever Hospital is the only special fever
hospital in Dublin. It is supported mainly by an annual
Government grant. All particulars may be obtained on
application to the Registrar and Resident Medical
Officer.
National Children’s Hospital for the treatment of
all non-infectious diseases peculiar to children, 87 and 88,
Haroourt Street, Dublin. The hospital, with which
the Pitt Street Children’s Hospital, founded in 1821,
was amalgamated, is capable of containing 50 beds for
the reception of cases of deformity and all other forms
of surgioal disease. There is a large general dispensary
for extern patients held daily from 10 to 11. Operations
are performed on Saturday at 12 o’clock. Practitioners
and students can attend on application to Mr. Ormsby.
Dublin Orthopedic Hospital, Great Brunswick
Street, containing 40 beds for the treatment of every
class of deformities ai.d for the practioe of orthopaedic
surgery. This institution is under the management of
Mr. Swan.
The Royal Victoria Eye and Ear Hospital consists
—until the new combined hospital is erected—of the
two institutions which have, heretofore, given special
instruction in ophthalmology separately. They are :—
276 The Medical Press.
IRELAND—EDL CATION.
Sept. 13. 1899.
St. Mark’s Ophthalmic Hospital and Dispensary.
—This hospital was founded by the late Sir William
Wilde, and contains 50 beds. Clinical lectures are de¬
livered on the mornings of Mondays, Tuesdays, Thurs¬
days, and Fridays at 11 o’clock, and operations are per¬
formed on Wednesdays and Saturdays at the same
hour.
National Eyb and Ear Infirmary, Molesworth St.—
This hospital contains thirty beds. Clinical instruction
in diseases of the eye, including the use of the ophthal¬
moscope, is given daily. Operations at 12 o’clock. In¬
struction in aural surgery is also given. Students may
enter their names for a three months’ course any day.
Afternoon classes for practical instruction in the
use of the ophthalmoscope, Ac., and for the demon¬
stration of cases, are formed from time to time by the
assistant surgeons.
IRISH PUBLIC 8ERVICES.
Since the issue of our last Students’ Number a vital
change has taken place in the Irish Poor-law Medical
Service—the service which has, heretofore, absorbed
most of the Irish rising medical generation. By the Irish
Local Government Act the administration of the
system, the appointment and payment and slloca-
tion of duties of 'medical officers was transferred
from the old Boards of Guardians composed, in
due proportion, of members elected by the local
voters and members who acted ex-officio in virtue of
property qualifications to new boards composed wholly
of the elected representatives. This change has had the
most disastrous effect upon the Service. The ex-officio
guardians frequently perpetrated politico-religious jobs
when they had the upper hand but, in a general sense,
they inclined towards justice and decency of administra¬
tion, and, even when they were in a minority, they
maintained a drag upon the unscrupulousness of the
village agitator, and the doctor managed generally to
live in charity with his employers. All this is changed
by the Act. The ex-officio guardians—i.e., the local gentry
were, thereby, eliminated, and the sole control of the
service has been transferred to the elected Guardians,
who have unhesitatingly seized the opportunity to
sweat and worry the dispensary and workhouse medical
officers. More work has, in every position, been imposed
upon them, and their former miserable pittance has
been, in every item, whittled down. If the Medical
Officer does not happen to be of the predominant religion
or politics a campaign is quietly organised to worry him
into resigning his office, and a popular candidate is held
in readiness to take the office when he does. We need
go no further than to say, which we do in perfect
honesty, that the Irish Poor-law Medical Service is one
to get out of as speedily as possible, and one quite unfit
for a self-respecting gentleman. Leaving this latter
class out of consideration, there are, no doubt, a number
of fifth-class practitioners whose professional or social
attainments do not entitle them to any better position
than that of running footmen to the elected guax’dians
to whom their candidature will, no doubt, be acceptable.
To all others who contemplate entering the Irish Poor-
law service we emphatically say, Don’t!
The Poor-Law.
The newly-qualified medical practitioner who may elect
to try his luck in the Irish provinces sete his hopes in the
great majority of instances upon obtaining one or more
Poor-law medical appointments in some district where
there is hope of private practioe. There are 159 workhouses
and about 813 dispensary medical officers, besides apothe- 1
caries. The number of vacancies that occur annually
averages 100. The salary in this service averages about
.£114, and when it iB taken into consideration that in
the vast majority of rural districts it is usual to keep one
or more horses, the average area being from forty to sixty
square miles, it is plain that there will not be a large
margin left from the public emoluments. The medical
officer is also ipso facto the registrar of births, marriages,
and deaths, and medical officer of health for the district,
under the Public Health Act passed in '73 and amended
in '78.
The former office, in country districts, yields between
£5 and £10 a year, and the emoluments of the latter ap¬
pointment in very few cases reach £20, averaging about
£12. The medical officer is also vaccinator for the locality,
and is required to vaccinate everyone who wishes to come.
For each patient his fee of 2s. is paid, along with his
salary, by the guardians, and the sum total of those fees
varies, according to the populousness of the district, from
£4 to £100, an average for the provinces being about £10.
Despite the miserable salary, and the very many discom¬
forts of dispensary life, these appointments are generally
eagerly sought for— first, because they afford the new
corner a certain, though hardly-earned salary, to supple¬
ment his private earnings; and secondly, because, if not
secured by the new comer, they would of necessity bring
a competit ir for office into the field, and inasmuch as
private income is of far greater import than public earn¬
ings, country medical practitioners are obliged to under¬
take the public duty in order to save themselves the
monopoly of their private emoluments.
Appointments .—The qualifications required by the
Poor-law Commissioners are a licence in surgery, in
medicine, and in midwifery ; the candidate must also be
twenty-three years of age.
The appointment lies with the guardians, who elect by
vote. As politics and religious feeling run high in
Ii eland, these elements enter largely into the election of
Poor-law medical officers. Family interest also possesses
great weight.
The candidate will do well to bear these facts in mind, as
his personal attendance on the day of election will be re¬
quired, and whatever other qualification he may have, he
will then find that his compatibility in these respects with
the majority of the committee is essential; and accord¬
ingly, he had better first make himself acquainted with
the local peculiarity, whatever it may be. before he
enters on his canditme, otherwise, in all probability, any
expenditure that he may make in the matter will be
simply thrown away.
Duties .—The duty of the dispensary doctor is twofold.
He is to attend his dispensary on a given day or days in
the week. Frequently there are two dispensaries in the
district, separated from each other by several miles, and
he will have perhaps to attend two days a week. He has
also to visit at any hour of the day or night a sick person
for whose relief a visiting ticket has been issued by a
member of the committee or the relieving officer, and to
continue his attendance as often as may be necessary to
the termination of the same. Moreover, he has a great
many registry books to keep and a multitude of returns
to make, and in the majority of districts he has to make
up all the medicines for the poor.
The pressure of these duties is in the greatest degree
dependent on the goodwill of the guardians. If the
medical man be a favourite with his masters they will
give him very little trouble with “ scarlet runners,” as
the visiting tickets are, from the colour of the paper on
which they are printed, humorously called, and will be
unwilling to trouble him even with cases deserving of
personal attendance.
If, on the other hand, it is his misfortune to come in
contact with some of the half-bred guardians, who know
nothing of the treatment fit for an educated gentleman or
cherish a personal spite, the discharge of his duties may
become simply unbearable. He may be peremptorily
summoned in any weather, at any hour, ana to any dis¬
tance, to a case which he may probably find to be alto¬
gether trivial, or to a person whom he may know to be
perfectly well able to pay—aye, even to the committee¬
man’s own brother or daughter.
Workhouse Hospitals.—The number of unions in Ireland
Digitized by GoOglC
b*PT. 18, 1899.
SCOTLAND—EDUCATION.
The Medical Press. 277
is 159, to each of which is attached a medical offioer, who is
appointed and controlled by the board of guardians in the
same manner as the dispensary surgeon is by his com¬
mittee. The salary is usually better than that of the
dispensary doctor, and the duties of a more easy and satis-
•factory description inasmuch as they are confined to
daily attendance at the workhouse hospitals, and no night
visits out of doors or any long journeys across the country
are involved.
The Irish Lcnact 8ervice.
This Bervioe, at present, affords a comfortable liveli¬
hood for -22 Resident Medical Superintendents and 32
Assistants. The Superintendent receives a handsome
salary and allowances ranging, according to the number
of inmates of the asylum, from .£500 to .£1,000 a year, and
the Assistants receive salary and emoluments averaging
about .£200 a year. There are also Visiting Physicians
receiving about .£120 a year, but this class of officers is
being allowed to die out, and no new appointments will
be made.
The Superintendents and Assistants are supposed to
devote their whole time to their duties and not to take
any private practice, and if thev attend to their business
it will give them plenty to do, but complaints have been
made to us of their trying to poach on the professional
preserves of their neighbours occasionally.
Heretofore the appointments of Medical Superin¬
tendents have been in the patronage of the Lord
Lieutenant, but, under the new Local Government Act,
they will be in the hands of the County Councils, with
the proviso that no one shall be appointed who is not a
fully registered practitioner with five years’ service as
Assistant. The Assistant has been, heretofore, appointed
by the Board of Governors, and will, in future, be
appointed by the Committee of the County Council to
wbich the management of the asylum is entrusted. In
addition to these officers, there are, in certain larger
asylums. Clinical Residents, who receive about £50 a
year and full allowances. Those appointments afford
excellent introduction to the higher places in the
-service.
It will be seen that the Irish Lunacy servioe is well,
but not too well paid, not only for the valuable and respon¬
sible services rendered, but for the disagrtmens of living
in a lunatic asylum, but it is available for only a very
few who have political or personal influence to obtain
appointments.
Other Appointments.
There are, in addition to those which we have men¬
tioned, certain emoluments open to medical practitioners
in special localities. They are:—
1. Attendance on the Royal Irish Constabulary.
2. Attendance on the Coast Guards.
8. Factory Surgeoncies.
4. Attendance upon the depot soldiers when not other¬
wise provided for.
The Constabulary are paid for at the rate of 2s. per
month for each member of the force on duty in the
district, including the wives and children of the men but
not of the officers. This includes the supply of medi¬
cines. The appointment to this position rests with the
Inspector-General of Royal Irish Constabulary, who
usually acts upon the advice of the local District
Inspectors as to the convenience of the men.
The Coastguard appointments are, of course, only on
-the coast line. The duty of the Medical Officer is to
attend the men when sick and to examine candidates
either for admission or for superannuation. The fees
vary from 6s. to 2s. 6d. per visit. The appointments rest
with the Admiralty, but are usually secure for the local
Poor-law Medical Offioer.
Factory surgeoncies are in the gift of the Chief
Inspector of Factories in Whitehall, and are, of course,
Available only in the few districts in which there are
factories to inspect. There is a set scale of payment by
-the factory owner to the inspector for this work, but we
believe it is not adhered to and, in some districts at all
•events, the emolument is a matter of arrangement. The
Amount depends, of course, upon the size of the factory,
the position being, in Dublin or Belfast or in other large
manufacturing centre, a lucrative one but in other plaoes
scarcely worth taking. The attendance on the military
depots is not worth mentioning.
§cxrtlatti).
The Northern part of Great Britain has made a name
for herself for many things. Scotland is the land o’ cakes,
of porridge, of the kilt, of thrift, the mother of golf ; but
she has also earned a well-merited reputation for the
excellence and thoroughness of her system of education,
and for the undoubted success of her alumni
dating, not only from yesterday, but from some centuries
back. 8he still maintains her educational system at the
high level to which it long ago attained, and, with a lees
numerous population inhabiting her whole area than that
of London alone, keeps up four venerable and historic
Universities, all with a honoured past and a
magnificent record. The Universities of Edinburgh
Glasgow, Aberdeen, and 8t. Andrews have sent
forth many illustrious graduates in all the different
branches of higher learning ; few schools can show so
illustrious a series of medical giant6. In Edinburgh and
Glasgow those who do not aspire to the honour of the
University degree can obtain college diplomas and excel¬
lent medical teaching from the extra-mural schools.
The inhabitants of Scotland have always evinced a
deeply rooted dislike to constraint; the regulations of
their Universities are examples of this. The student
in Scotland is his own master; he lives where he likes,
dines where he pleases, and can clothe himself in any
kind of garment he chooses. In but one of the Univer¬
sities have students to don gowns. No doubt the great
freedom allowed students occasionally leads to unsatis¬
factory results, but the advantages which accrue from
the system may be held to more than counterbalance
the drawbacks. The student is no longer a schoolboy,
amenable to a common discipline, and impelled towards,
rather than restrained from, enjoying forbidden
pleasures; so alluring when against rules, so common¬
place when free. He is only required by the autho¬
rities to attend with due regularity various compulsory
classes, to give evidence of his diligence, and to conduct
himself with proper decorum while within the Univer
sity precincts. Several halls of residence for students
have lately been established, but even here the students
are their own masters. Absence of residential colleges
implies the absence of oollege fees, and the invariable
large extras incurred by college life.
Until recently the sole method of teaching
medicine at these institutions consisted in the
delivery of a stated number of didactic lectures
and attendance on hospital practice-, the students
listened, took notes, and were supposed to
be trained physicians and surgeons. Lately, however,
although the lectures persist they are of a less theoreti¬
cal nature, and are supplemented by numerous practical
classes in whioh smaller numbers can receive greater
individual attention. The large classes attendant at
some of the universities render personal intercourse
between the Professor and students impossible; but
large classes (implying proportionate fees) compensate
for this by permitting of a more extensive choice of
teachers, and the probable appointment of the ablest
men, and, what is more, their retention afterwards.
Digitized by Google
278 The Medical Phess.
SCOTLAND-EDUCATION.
Sept. 13, 1899.
The co-existence of teaching and degree-granting
universities and extra-mural medical schools in Scot¬
land forms one of the most important factors in the
system of medical education in the country. The extra¬
mural teacher, struggling for his own bread, naturally
does his beet; the professor cannot afford to fall behind,
or his students will attend elsewhere. The medical
education at the universities is the best of its kind, com¬
prising courses on all branches of special medicine and
surgery; at the extra-mural schools the special subjects
are perhaps even better treated, as they are taught by
specialists themselves. In the way of expense, there is
little between the University course and the curriculum
obligatory for the Licence of the Colleges. The mini¬
mum oost for five years’ attendance for the Licence may
be put down at .£120, which includes class and examina¬
tion fees; and at the universities at £146; a difference
of about £5 a year. As the five years’ course has been
imperative in Scotland for five years, no note need be
given as to the old four-year regulations. Anyone who
commenced study before that date may be considered
to be conversant with their main facts.
Perhaps the one blot upon the Scottish system of
medical education at Universities arises from the plan
adopted at their professional examinations of delegating
the examiners’ duties to the professors themselves, along
with only one coadjutor for each subject. As University
students are now allowed to attend one-half of the total
number of courses required for graduation outside the
University walls, it happens now and again that those
who have done so in a subject, upon which they are
examined by the professor teaching it, are placed at a
disadvantage in not being thoroughly oonversant with
subjeots specially lectured on by the examiner during the
preceding session. The examining board for the diploma
of the Scottish colleges, indeed, is largely made up of
the extra-mural lecturers, but the number assigned to
each subject is large enough to avoid the examination
of a candidate by his own teacher in the majority of
instances.
Apart from the educational attractions offered to
students of medicine by the Scottish schools, a very
important fact aids to explain the reason why so many
students from all parts of the Empire enrol their names
in their books: the cost of maintenance is less than in
England. As a general rule the higher the latitude the
cheaper is the living in Great Britain. Edinburgh and
Glasgow are more economical than London; Aberdeen
less expensive than they are.
UNIVERSITY OF EDINBURGH.
Four degrees in Medicine are granted: Bachelor of
Medicine (M.B.), Bachelor of Surgery (Ch.B.), Doctor of
Medicine (M.D.), and Master of Surgery (Ch.M.). The
first two mu»t be taken together, the last two may be
taken separately.
No one is admitted to the degrees of Bachelor of
Medicine and Bachelor of Surgery who has not been
engaged in medical and surgical study for five years,
after passing a preliminary examination in general
knowledge in accordance with the medical ordinances.
The degree of M.A. of a British University is held to
supersede such preliminary examination. The subjects
included in this general examination are English
gr ammar and composition, English history and geo¬
graphy, Latin, arithmetic, and the elements of mathe¬
matics, and, in addition, as optional subjects, Greek,
Fr?nch, or German.
ihe annus medicus of each year is held to be consti¬
tuted by at least two courses of not less than one hun¬
dred lectures each, or by one of such course, and two
courses of not lees than fifty lectures each, exclusive of
the clinical courses, in which lectures are given twice a
week during prescribed periods. Two years of the five
must be spent at the University, the remaining three
years at any University of the United Kingdom, or other
Universities or Medical Schools recognised by the Univer¬
sity Court.
During the first four years the student must attend
elementary botany, elementary zoology, physics, prac¬
tical chemistry, practical physiology, practical patho¬
logy, and medical jurisprudence and public health during
courses of not less than 2i months each; practical
anatomy during two courses of not less than five months
each; chemistry, anatomy, physiology, pathology, sur¬
gery ; materia' medica and therapeutics, medicine, and
midwifery and the diseases of women and children,
during courses of not less than five months each. Eight
of these subjects must be taken at a University. He
must attend a course of 25 meetings on practical phar¬
macy in a University or recognised school of medicine,
or have dispensed drugs for a period of three months in
a hospital or dispensary, or in an establishment recog¬
nised by the Pharmaceutical Society. He must attend
a nine months’ course in clinical medicine and in clinical
surgery. During the fifth or final year he must be
engaged in clinical study for at least nine months. In
all, before graduation he must have attended for at least
three years a hospital which accommodates no fewer
than 80 patients, and possesses a distinct staff of
physicians and surgeons, and he must have acted as
clerk in the medical and dresser in the surgical wards of
such a hospital, or the practice of a dispensary, or of a
physician or surgeon. He must have had approved
opportunities of studying at a hospital, post-mortem
examinations, fevers, diseases of children, ophthalmology,
vaccination, and mental diseases.
He must personally attend at least twelve cases of
labour under the superintendence of a registered medical
practitioner, or six such cases, and, for at least three
months, the practice of a midwifery hospital in which
practical instruction is regularly given.
Every candidate must deliver before the 81st day of
March of the year in which he proposes to graduate to
the Dean of the Faculty of Medicine—
1. A declaration in his own handwriting that he has
completed his twenty-first year, or that he will have
done so on or before the day of graduation, under
articles of apprenticeship to any surgeon or other master.
(This declaration, along with a statement of studies, is
appended to the schedule for the final examination, and
must be signed before the schedule is giv«-n in.)
2. A statement of his studies, as well in literature and
philosophy as in medicine, accompanied with proper
certificates.
Each candidate is examined both in writing and vivo
vore :—
1. Zoology, botany, physics, and chemistry.
2. On anatomy, physiology, and materia medica, and
therapeutics.
3. On pathology, medical jurisprudence, and publio
health.
4. On medicine, surgery, and midwifery.
The examinations in anatomy, chemistry, physiology,
botany, and zoology, materia medica, and pathology, are
conducted, as far as possible, by demonstration of objects
placed before the candidates.
Candidates who are ready to submit to an examination
in tho subjects comprised in the first division, viz., botany,
zoology, physics, and chemistry, may be admitted to
examination in all or any two of these subjects at any
examination held after they ha ve attended a full course
in each of the subjects professed.
Candidates who have passed their examination in the
subjects in the first division may go up for examination
in those of the second division at the end of their third
winter session, but may postpone their examination in
materia medica and therapeutics until the close of the
summer session following.
They may, in a similar way, go up for the subjects of
the third division at the end of their fourth winter
session, and may postpone their examination in medical
Die
boogie
S spt. 13, 1899. _ SCOTLAND—EDUCATIO N._ The Mebicaii Press. 279
jurisprudence and public health until the close of the degrees, Batchelor of Science(B.Sc/ 1 and Doctor of Science
following summer session. [D.Sc.] These degrees are given in pure science and in
Candidates who have passed their examinations in applied science. Candidates for the degree of B.Sc. in
the subjects comprised in the first, second, and third pure science rnuet attend at least seven courses of instruc-
divisions may be admitted to examination in the fourth tion in the subjects selected by them during the course
or final division, when they have completed the fifth of not less than three academical years. Three of these
year of 6tudy. courses must be on subjects prescribed for the first science
The degree of Doctor of Medicine may be conferred on examination, and four on those for the final examination,
any candidate who has obtained the degrees of Bachelor Four of these courses must be taken in the University of
of Medicine and Bachelor of Surgery, and who is of the Edinburgh. Among the subjects recognised are
age of twenty-four years, and who produces a certificate chemistry, human anatomy, physiology, zoology, and
of having been engaged, subsequently to his having re- botany. Graduates as B.Sc. may, after five years, pro-
ceived the degrees of M.B. and Ch.B., for at least two ceed to the degree of D.Sc., undergoing an examination
years in attendance on a hospital, or in scientific work in the subjects chosen, and presenting a thesis founded
bearing directly on his profession, or in the Military or on original work.
Naval Medical Services, or in medical or surgical prac- Graduation in Public Health. —Similar degrees are con*
tice. The candidate shall submit to the Faculty of ferred in Public Health. Candidates must be graduates
Medicine a thesis certified by him to have been com- in medicine of a university recognised by the University
posed by himself, and which shall be approved by the Court, and must matriculate for the year in which they
Faculty, on any branch of knowledge comprised in the appear for examination. Before proceeding to the first
professional examinations for the degrees ot Bachelor of examination they must produce evidence that (1) they
Medicine and Bachelor in Surgery, which he may have have worked for at least twenty hours a week during a
made a Bubject of study after having received those period of not less than eight months, after taking their
degrees. The candidate will also be examined in clinical medical degree, in a recognised Public Health Laboratory,
medicine and in some of its special departments. Five of these months must be spent consecutively in the
The regulations for the degree of Ch.M. are very Public Health Laboratory of the University of Edinburgh
similar, the candidate being examined in surgical and (2) have attended a course of lectures on physics,
anatomy, operations on the dead body, clinical surgery, and one, of at least three months’ duration, on geology,
and some of the special branches. such as the Senators may approve of.
Candidates settled abroad, who cannot appear per Candidates for the second examination for B.Sc. in
sonally to receive the degree, may, after satisfying the Public Health are not admitted until at least eighteen
Senatus to that effect, have the degree conferred on them months have elapsed after having passed Vt .B., Ch.B., or
»» absentia. sooner than six months after the first examination.
Fees. —The fee to be paid for the degrees of Bachelor They must have attended two separate courses of Publio
of Medicine and Bachelor of Surgery is twenty-two Health, or at least forty lectures in each, one dealing
guineas and the proportion of this sum 1o be paid by a with medicine, the other with engineering, each in its
candidate at each division of the examination is regis- relation to public health, in such manner as the Senatus
tered from time to time in the University Court. The shall determine. They must also have studied practical
fee for the degree of Doctor of Medicine or of Master of sanitary work under a Medical Officer of Health for six
Surgery is ten guineas. months, have had three months’ clinical instruction in a
The total expenses of the curriculum, including ex- recognised fever hospital and three months’ instruction
animation and matriculation fee, is about £146. in mensuration and drawing.
Bursaries and Scholarships open for Session 1899-1900. Full details of the subjects included in the different
—Among the bursaries and scholarships open during the courses are given in the official programme of the
ensuing year are .-—Two Sibbald Bursaries of £30 a year Faculty of Science, which may be obtained from the
for three years, particulars from Messrs. Mackenzie, University (price 2d.).
Innes and Logan, W.8., 23, Queen St., Edinburgh, before In a similar manner to that described under degre< s
September 15th. Two Thomson Bursaries of £25 for in pure science, a B.^c. may after five years proceed to
four years, one conferred at each preliminary examina- take the degree of D.Sc. in Public Health
tion in October and March. Five Grierson Bursaries, Fees for Science Degrees. —B.Sc., first examination,
natives of Crawford and Leadhills, have a preference. £3 3s.; B.Sc. s econd examination, £3 3s.; D>Sc.,
Names must be sent in before September 17th. Two £10 10s.; total, £16 16s.
John Aitken Carlyle Bursaries of £28 one year for pro- University Hall, Edinbnrgh. —In an educational number
fioiency in class examinations in anatomy and chemistry it is worth while to call attention to the advantages
or physiology. Two Mackenzie Bursaries of £20 in prac- now offered to students coming to Edinbugh to study,
tical anatomy. Renton Bursary of £20, for one year, in the shape of social residences akin to though very
for students attending classes of natural physiology, much less pretentiou* than, the English University Col-
mathematics. chemistry, or political economy, who also leges. During the past Bix years several buildings have
can show they are in need of pecuniary aid. Names been acquired in Edinburgh for this purpose, in which
to be sent to secretary before the middle of September, students can live in a self- governing community. In
Two Crichton Bursaries of £50, for four years, one each house there are private studies with or without
competed for at each preliminary examination. Stark bedrooms, and common sitting and dining rooms. The
Scholarship in Clinical Medic'ne, of about £100, awarded charges vary from 7s. 6d. to 22s. 6d. per week. The resi-
in July, 1900; Murchison Memorial Scholarship, of the dents elect a treasurer from among their number, who
interest from £1,000, to take place in London in the acts as intermediary between them and the housekeeper
summer of 1900, Buchanan Scholarship, of £40 10s., or servants. It is a satisfactory indication of the
for profloiency in midwifery and gynaecology, as shown comfort of the Hall that several graduates now live in it
“by class work and in the final examination. Other and are willing to help or coach the undergraduates for
scholarships are:—The James Scott, £42 10s., annually, moderate fees. To gain admission two references must
in midwifery; the Thomson, £40 for four years, in be produced from past or present residents. These are
botany, zoology, and elementary mechanics in October ; considered and voted on at a house meeting. In all dis-
the Ettles, £31 6s. annually, to the most distinguished puted points Professor Geddes is the referee, while Dr.
graduate; two Hope Prizes, £30 annually, in chemistry ; Ricardo Stephens is the rent treasurer, who will supply
two Crichton, £100 annually, in anatomy and physio- any further information required. The Hall is an admir-
logy. able place for parents to send their sons to. Any unruly
Full particulars of these and of the other prizes may member may be expelled by a meeting of the residents
be found in the "University Calendar" (published by similar to that held for elective purposes.
Mr. Thin, South Bridge, Edinburgh, price 3 b., post free, Medical School for Women in Edinburgh —The Medical
3 b. 6d.), or the “ Medical Programme ” (price 2d.) from Teaching of Women in Edinburgh is carried on by the
the same publisher. Scottish Association for the Medical Education of
Graduation in Science. —The University of Edinburgh Women (the Secretary, Minto House, Chambers Street),
also possesses a Faculty of Science which may oonfer two The classes are conducted by the lecturers of the Medical
odbyU.OOg
280 The Medical Press.
SCOTLAND—EDUCATION.
Sept. 18, 1899.
School of the Royal Colleges, and qualify both for the
Edinburgh University degree and for the Licence of the
Triple Board. The classes are for women alone. The
University of Edinburgh does not recognise certificates
presented by female candidates for mixed classes without
special cause shown.
Royal Medical Society, Edinburgh.— 8tudents
commencing their medical studies in Edinburgh should
not neglect to join this fine old Society. It still fulfils
the purpose for which it was founded as far back as 173/ ;
namely, to facilitate intercourse between medical
students of different years of study, to afford them the
use of a large medical and scientific library, and to pro¬
mote the discussion of medical matters apart from the
supervision of the professors or teachers, lhe post of
Senior President of this Society is one of the highest
honours to which an Edinburgh student may attain.
The list of eminent men in the profession who have filled
the presidential chair from time to time would be hard
to parallel. Intending members should apply to the sub¬
librarian at the .-ociety’s Hall, 7 Melbourne Place,
Edinburgh. The annual subscription is two guineas.
Payment of eight guineas at once renders the student a
life member.
UNIVERSITY OF GLASGOW.
The University of Glasgow is both a teaching and an
examining body, but admits to examination only those
candidates whose course conforms to its own regulations.
Within certain limits provision is made for accepting
instruction given by recognised medical schools and
teachers; but eight of the subjects other than clinical
must be taken in this or some other recognised Univer¬
sity entitled to confer the degree of M.D., and at least
two years of the course must be taken in Glasgow Uni¬
versity. Under the new regulations, laid down in Ordi¬
nance No. 14, Glasgow No. 1, of the Commissioners under
the Universities (Scotland) Act, 1889, four degrees,
open both to men and to women, are conferred—M.B. ana
Ch.B. (always conjointly), M.D., and Ch.M. A preli¬
minary examination must be passed in (1) English,
(2) Latin, (3) Elementaly Mathematics, and (4) Greek, |
French, or German, with possible options to students
whose native tongue is not English in the case of the
fourth subject, and on passing students must register in
the books of the General Medical Council. By a regula¬
tion recently enacted, it is no longer compulsory to pass
in all the four preliminary subjects at once, and they
may now be passed at two stages. For M.B. and Ch.B.
a curriculum of five years is required.
The fees for M.B. and Ch.B. are .£23 2s., and the pre¬
sent fee for hospital attendance is £21. The fee for M.D.
is £10 10s., and for Ch.M. iB £10 10s.
Bursaries and prizes to tte annual amount of about
£900 are appropriated to medical students, including
an Arthur bursary for women, £26 for three years.
Several bursaries open to students in any faculty are
not infrequently held by medical students, and scholar¬
ships and fellowships to the annual amount of £1,600
may be held by medical students who have gone through
the Arts course.
Queen Margaret College for Women. —Founded
in 1883 (by the Glasgow Association for the Higher
Education of Women, which was formed in 1877 with
the object of bringing university instruction, or its
equivalent, within the reach of women). Queen Mar¬
garet College in 185*0 added to its Faculty of Arts a
School of Medicine for Women This was organised
entirely on university lines, and with the view of pre¬
paring for university degrees : and when, in 1892, in
consequence of the Ordinance of the University Com¬
missioners authorising the Scottish Universities to
admit women to instruction and graduation. Queen
Margaret College became the Women’s Department of
the University of Glasgow, its classes in medicine taken
previously to its incorporation with the University were
recognised as preparing for the degree. A full course
of study for M.B.Ch.B. is given, with excellent facilities
for hospital and dispensary work. A Hall of Residence
for the students was founded four years ago.
UNIVERSITY OF ABERDEEN.
The University of Aberdeen possesses under its charters
the amplest privileges claimed or enjoyed bv any
academical institution. It confers degrees in the fire
faculties of Arts, Science, Divinity, Law, and Medicine.
It also grants diplomas in Public Health, Agriculture,
and in Education. It is, moreover, a teaching body,
equipped with twelve distinct chairs in the various
branches of medicine and surgery, besides a Lectureship
in Tropical Medicine. The majority of the professors
devote their whole time to the work of the chairs.
There are fully-equipped laboratories, the accommoda¬
tion for which has recently undergone considerable
extension. The degrees of M.B. and Ch. B. are conferred
together; they cannot be obtained separately. The
curriculum of study is nearly the same as in the
University of Edinburgh; the regulations in the pre¬
ceding columns will therefore apply here. Two years
must be passed at Aberdeen. With regard to fees, each
candidate for the degrees of M.B. and Ch.B. must pay
a fee of £5 6s. in respect of each of the first three
professional examinations, and £7 7s. for the final
examination. Class fees, £3 3s. each. Toial coat,
exclusive of the fees for degrees is about £100. Besidee-
the Royal Infirmary, students have the opportunity of
attending several ether local institutions where special
courses of instruction are given. Perpetual fee for
hospital practice is only £6. The professional examina¬
tions are held twice in each year, namely, in March and
July, directly after the close of the winter and summer
sessions. Through the liberality of the late Dr. Charles
Mitchell, students will be privileged to commence work
in the coming session in the magnificently equipped
extension buildings of the University.
Bursaries. - Bursaries, Scholarships, and Fellowships,,
to the number of forty-two, and of the annual value of
over £1,600, may be held by students of medicine. See
University Calendar.
The Degree of M.D.—The degree of Doctor of Medi¬
cine may be conferred on any candidate who has ob¬
tained the degrees of M.B. and C M. (Old Regulations),
is of the age of twenty-four years, and has been engaged
subsequently to his having received the degree of M.B.
for two years in attendance in a hospital, or in military or
naval medical service, or in medical or surgical practice,
and has presented a thesis which has been approved of
by the Medical Faculty. Candidates for the degree of
M.D. (New Regulations) are required to pass an examina¬
tion in clinical medicine in addition to presenting a
thesis. Similar regulations apply to a degree of Ch.M.
(Master of Surgery).
A Diploma in Public Health is conferred after
examination on graduates in medicine of any university
in the Unit'd Kingdom.—Regulations may be seen in
the Calendar, or obtained on application to the Sec retary
of the Medical Faculty.
Aberdeen Royal Infirmary.- This is a well equipped
institution, containing 240 beds, and affords excellent
opportunities for clinical study to students at the Aber¬
deen University. The city, moreover, offers inducements
in the way of cheaper living and comparative quiet to
that obtained in Edinburgh and Glasgow, and will doubt¬
less be preferred by some on thiB account.
ST. ANDREW’S UNIVERSITY.
United College St. Andrews and Univerbitt
College, Dundee.
This University (session opens October 11th) grants
the degrees of M.B., Ch B., M.D., and Ch.M., and also a
diploma in Public Health. The degrees of the Univer¬
sity are open to either sex. For the degree of M.B., Ch.B.
two of the five years of medical study must be spent in
the University of St. Andrews; the remaining three may
be spent in any University of the United Kingdom, or
l in any foreign, Indian, or Colonial University recognised
I for the purpose by the University Court, or in sach
medical schools or under such teachers as may be recog-
I nised for the purpose by the University Court. The
I preliminary examination and the professicnal examina¬
tions are of the same character as in the other Scottish
Universities.
University College, Dundee, was affiliated and made to
form part of the University of St. Andrew’s on January
16th, 1897, and the whole medical curriculum may be
zed by GoOgle
Sept. 13, 1899 SCOTLAND—EDUCATION ._ The Medical Press. 281
taken in the college. The United College, St. Andrews,
offers classes for the first two years of professional study
Bursaries and Scholarships.
United College, 8t. Andrews. —Two Berry bursaries
of .£40 tenable for three years, open to men for arts,
science, or medicine. Twelve Berry bursaries of £20
tenable for two years open to men only proceeding to
graduate in medicine. Candidates must reach the
standard necessary to entitle them to pass the medical
preliminary examination of ’he university. Fourteen
Taylor-Thompson bursaries £20 to £30 tenable for one
year, partly for two, open to women only proceeding to
graduate in medicine.
University College, Dundee. — Eleven entrance
bursaries of £15 open to men or women for arts,
science, or medicine, tenable for one year. Four
£20 and three £15 second year bursaries for men
or women in art, science, or medicine, tenable for one
year. Four £20 and two £15 third year bursaries for
men or women in arts, science, or medicine, tenable for
one year. Two Educational Trust Bursaries of £25,
tenable for three years. Applicants must have attended
a public or state aided school in Dundee for at least one
year before examination. Bute Bursary annual income
from £ 1,000 (men ody).
Preliminary Examinations. —The dates of the next
two examinations are September 3oth, 1899, and March
24th, 1900. Schedules (obtainable from the Secretary
of the University) to be returned filled up, and fees paid
by September 15th, 1899, on March 10th, 19n0.
Fees for Degrees .—Total fees for M.B., Ch.B., are the
same as at other Scottish Universities, i.e , 22 guineas
(payable in instalments). Fee for the degree of M.D.,
and also for that of Ch M., is ten guineas in each case.
For the Diploma of Public Health examinations the fee
is £5 5s. for each of the two examinations. The diploma
is granted on special examination to graduates in medi¬
cine of any University of the United Kingdom.
United College, St. Andrews. —Class Fees —The
fee payable in each of the following separate classes is
three guineas, viz., in Chemistry, Practical Chemistry.
Physics, Zoology, Botany, Physiology, Practical Physio¬
logy, Anatomy, Practical Anatomy, Materia Medica. and
Practical Pharmacy.
University College, Dundee. —Class Fees .—The fee
payable in each of the following separate classes is
3 guineas, viz., in Chemistry, Practical Chemistry,
Physics, Zoology, Botany, Physiology, Anatomy, Practical
Anatomy, Materia Medica, Practical Pharmacy, Path-
ology, Practical Pathology, Bacteriology, Medical Juris¬
prudence and Public Health, Medicine, Surgery, Opera¬
tive Surgery, and Midwifery.
In Clinical Medicine, Clinical 8urgery, Ophthalmology
and Mental Diseases, the class fees are 2 guineas each,
and in Fevers 1 guinea. For the Chemistry required for
the D.P.H. the fee is 7 guineas. A special class is also
held for the D.P.H., for which the fee is 3 guineas.
Dundee Royal Asylum. —The appointments include
a qualified resident assistant and two resident clinical
clerks. Clinical instruction is given.
Further information will be found in the Calendar
of the University, published by Messrs Blackwood and
Sons, Edinburgh, or.can be had of the Dean of the Medi¬
cal Faculty, Professor Waymouth Reid, F.R.S.
Dundee Royal Infirmary. —The Infirmary contains
286 beds, with a special ward for the treatment of child¬
ren. Three resident qualified assistants are appointed
annually. Clinical clerks and dressers are attached to
the physicians and surgeons, and students are appointed
to assist in the post mortem room. Out patients are seen
daily at 9 a.m. The instruction given at the Infirmary
is recognised for purposes of graduation by the 8cotch
Universities, the University of London, the Royal Uni¬
versity of Ireland, and by the Royal Colleges of England
and Scotland. Hospital ticket for the Infirmary £2 2s.
each session, or £3 3s. Od. a year. Further information
on application to the Medical Superintendent.
THE COLLEGES.
The Royal College of Physicians of Edinburgh, the
Royal College of Surgeons of Edinburgh, and the Faculty
of Physicians and Surgeons of Glasgow have made
arrangements by which, after a series of examinations,
the student may obtain the diplomas of the co-operating
bodies.
The holders thereof are enabled to register three
diplomas under the Medical Acts, viz., Licentiate of the
Royal College of Physicians of Edinburgh, Licentiate of
the Royal College of Surgeons of Edinburgh, and Licen¬
tiate of the Faculty of Physicians and Surgeons of
Glasgow. The diplomas are also recognised by the
Army, Navy, and other public bodies.
The three co-operating bodies grant their single
qualifications only to candidates who are already
registered as possessing another and opposite qualifica¬
tion in medicine or surgery, as the case may be.
Regulations of the Conjoint Board of the
Royal College of Physicians of Edinburgh and
the Royal College of Surgeons of Edinburgh
and the Faculty of Physicians and Surgeons,
Glasgow. —The candidate must produce certificates of
having attended the following separate and distinct
course of lectures, the certificate distinguishing the
sessions and the schools in which the courses were sever¬
ally attended. Anatomy, one course, six months. Prac¬
tical anatomy, twelve months. Chemistry, one course,
six months. Practical or analytical chemistry, one
course, three months. Materia medica, one course, three
months. Physiology, one course, six months. Practice
of medicine, one course, six months. Clinical medicine,
nin<> months. Principles and practice of surgery, one
course, six months. Clinical surgery, nine months.
Midwifery and diseases of women and children, one
course, three months. Medical jurisprudence, one course,
three months. Pathological anatomy, one course, three
months. The candidates must also produce the following
certificates :— (a) Of haviing attended not less than six
cases of labour under the superintendence of the practi¬
tioner who signs the certificates, who must be a regis¬
tered medical practitioner, (b) Of having attended, for
three months, instruction in practical pharmacy. The
certificate to be signed by the teacher, who must be a
member of the Pharmaceutical Society of Great Britain,
or the superintendent of the laboratory of a public
hospital or dispensary, or a registered practitioner who
dispenses medicine to his patients, or a teacher to a class
of practical pharmacy (c) Of having attended for
twenty-four months the medical and surgical practice
of a public general hospital, containing on an average
at least eighty patients, and possessing distinct staffs of
physicians and of surgeons, (d) Of having attended,
for six months, the practice of a public dispensary speci¬
ally recognised by any of the co-operating bodies; of
having been engaged for six months as visiting assistant
to a registered medical practitioner, (e) Of having been
instructed in vaccination.
First Examination, Fee £6.—The first examination
shall embrace chemistry, embracing the following par¬
ticulars :—Chemical physics, heat, light, and electricity,
the principal non-metallic and metallic elements, and
their more common combinations, also the leading
alcohols, organic acids, ethers, carbohydrates, and
alkaloids; the candidate will also be examined practi¬
cally in testing; physics and elementary biology. The
first examination shall take place not sooner than the
end of the first year, including a winter and summer
session. Candidates who desire to enter for the first
professional examination must apply to the Inspector of
Certificates on or before the Friday preceding the day of
examination, and must produce certificates of attend¬
ance on one course of chemistry, one course of practical
chemistry, one course of anatomy, and six months’ prac¬
tical anatomy.
Second Examination, Fee £5.—The'second examination
shall embrace anatomy and physiology, and shall not
take place before the termination of the summer session
of thesecond year of study. Candidates must produce
to the inspector certificates of attendance on the pre¬
scribed courses of anatomy, practical anatomy, and
physiology.
Third Examination, Fee £5.—Comprises the subjects
of pathology, materia medica, and pharmacoligy and
advanced anatomy.
Dii
Google
SCOTLAND—EDUCATION.
Sept. 13, 1899.
2S2 The Medical Pbbss.
Fmal Examination, Fee £15.—The final examination
shall embrace the principles and practice of medicine
(including therapeutics and medical anatomy, clinical
medicine) ; the principles and practice of surgery, (in¬
cluding surgical anatomy and surgical pathology);
clinical surgery ; midwifery and gynaecology, medical
jurisprudence and hygiene; and shall not take place
before the termination of the full period of study.
Subject of Preliminary Education. —(l) English lan¬
guage, including grammar and composition ; (2) Latin,
including grammar, translation from specific authors,
and translation of easy passage not taken from such
authors; (3) elements of mathematics, comprising (a)
arithmetic, including vulgar and decimal fractions; (b)
algebra, including simple equations; (c) geometry,
including the first two bookB of Euclid; (4) elementary
mechanics of solids and fluids, comprising the elements
of Btatics, dynamics, and hydrostatics; (5) one of the
following optional subjects :— (a) Greek; (b) French;
(c) German; (d) Italian; (e) any other modern lan¬
guage; (/) logic; (g) botany; (A) zoology; (») ele¬
mentary chemistry.
Qualification in Public Health. —The College of Physi¬
cians, in association with the Royal College of Surgeons
of Edinburgh and the Faculty of Physicians and Sur¬
geons of Glasgow, confers a certificate of competency in
public health. The examinations are held in April and
October. Fee, £10 10s.
For the special regulations of the Royal College of
Surgeons of Edinburgh, intending candidates should
apply to Mr. James Robertson 48, Gporge Square, Edin¬
burgh, and for those of the Royal College of Physiciaus,
to Dr. R. W. Philip, 45, Charlotte Square.
The Fellowship of the Royal College of Physicians of
Edinburgh is conferred only by election, and the candi¬
date must have been a member of the college for at least
one year previously, and have attained the age of twenty-
five years.
The membership is conferred only on licentiates of the
college or graduates of a Brirish or Irish university after
an examination in medicine and therapeutics, and in any
other branch of medical science to be selected by the
candidate. Under certain conditions as to age and pro¬
fessional standing, candidates may, however, be admitted
without examination to the licence of R.C.P.Ed.
The licence, or single qualification in medicine, is con¬
ferred on candidates who already possess a recognised
qualification in surgery. The examinations of this licence
are held on the first Wednesday of each month, save
those of September and October, on medicine, materia
medica, midwifery, and medical jurisprudence. The fee
is £15 158., and intending candidates should communicate
with the Secretary of the College at least eight days
before the date of examination.
The Fellowship of tie Royal College qf Surgeons of
Edinburgh is conferred (except under certain conditions
as to age and professional standing), only on candidates
who have passed a special examination, and have pre¬
viously obtained a diploma from the college, or from
either of the Colleges of Surgeons of England or Ireland,
or the Faculty of Physicians and Surgeons of Glasgow,
or the surgical degrees of the Universities of Great
Britain, and who are twenty-five years of age The
subjects for examination for those who are already
Licentiates of tbe College are on the principles and
practice of surgery, clinical and operative surgery, and
one optional subject.
Those who are not Licentiates of this College: on
principles and practice of surgery, clinical and operative
surgery, surgical anatomy, and one optional subject;
and in such supplementary subjects as have not, in an
adequate maimer, been included in the examination for
the registrable surgical qualification possessed by such
candidates and which are required in the examination
for Licentiates of this College.
The optional subjects shall embrace: (a) Surgery,
special branches; (6) advanoed anatomy and physiology ;
(c) surgical pathology and morbid anatomy; (d) midwifery
and gynaecological medicine and surgery; («) medical
jurisprudence and hygiene; (/) practice of medicine and
therapeutics. The examinations are written, oral, and
practical. Three weeks' notice must be given to Mr.
James Robertson, from whom full particulars as to certi¬
ficates required may be obtained. The fee is £30 for
those who hold the diploma of Licentiate of the College,
and £45 to others (no stamp duty is payable on the dip¬
loma). Registered practitioners, aged not less than 40,
who have been in practice for not less than ten years,
and who have highly distinguished themselves by original
investigations,may under special circumstances be elected
without examination. Women are not admitted to the
Fellowship.
Licence. —The examination embraces the principles
and practice of surgery (including operative surgery and
surgical pathology), clinical surgery, and surgical
anatomy, and shall not take place before the termination
of the full period of study. Fee £15 15s.
Dental Diploma. —Every candidate for the dental
diploma must have attended the general lectures and
courses of instruction required at a university or an estab¬
lished medical or dental school recognised by the College
as qualifying for the diploma in surgery. The fee is
£10 108 .
Edinburgh Royal Infirmary. —Clinical instruction is
afforded at this institution, which contains 780 beds in
the building, and 10 beds in a convalescent home, under
the supervision of professors of the university and the
ordinary physicians and surgeons of the infirmary. Special
instruction is given on diseases of women, physical dia¬
gnosis, and diseases of the eye, ear, throat, and teeth.
Separate wards are devoted to venereal diseases, diseases
of women, diseases of eye. also to cases of incidental
delirium or insanity, and three wards are specially set
apart for clinical instruction to women students. Post¬
mortem examinations are conducted in the anatomical
theatre by the pathologists, who also give practical in¬
struction in pathological anatomy and histology. The
perpetual fee, on one payment, £12; the annual fee,
£6 6s.; half-yearly, £4 4s.; quarterly, £2 2a.; monthly,
£1 Is Separate payments amounting to £12 12s. entitle
the student to perpetual ticket. No fees are payable for
any surgical or medical appointment.
The appointments are as follows -.—
1. Resident physicians and surgeons are appointed,
and live in the house free of charge. There is no salary.
The appointment is for six months, but may be renewed
at the end of that period by special recommendation.
2. Special non-resident clerks (in the special subjects,
and for out-patient work) are appointed for six months.
These also may be similarly renewed.
3. Clerks and dressers are appointed by the surgeons
and physicians. Those are open to all students and
junior practitioners holding hospital tickets.
4. Assistants in the pathological department are
appointed by the pathologists to conduct post-mortem
examinations in the anatomical theatre.
School of Medicine of the Royal Colleges, Edin¬
burgh. —This school, established in 1505, is constituted
by over fifty lecturers especially licensed by the colleges.
The lectures qualify for the University of Edinburgh,
and other Universities, the Royal Colleges of Physicians
and Surgeons of Edinburgh, London, and Dublin, and
the other medical and surgical boards.
The minimum cost of the education in the School of
Medicine for the triple qualifications of physician and
surgeon from the Royal Colleges of Physicians and Sur¬
geons of Edinburgh and the faculty of Physicians and
Surgeons of Glasgow, including the fees for the joint
examinations, is about £116, which is payable by yearly
instalments during the period of study.
The Winter Session opens October 2nd. iThe secretary,
Mr. R. N. Ramsay, 24, Forrest Road, Edinburgh, will
forward the School Calendar gratis to inquirers.
St. Mungo’s College and Glasgow Royal Infir¬
mary. —This college was incorporated in 1889 under its
new title, being formerly known as the Glasgow toy si
Infirmary School of Medicine. The Medical Faculty
occupies buildings erected for the purposes of the medical
school in the grounds of the hospital, and the labora¬
tories, museums, and lecture rooms are of the most
approved description. Attendance on the olasses in St.
Mungo’B College qualifies for the medical degrees of the
Universities and the medical and surgical colleges in
accordance with their regulations.
Digitized by vjOOQ
y y
SkPT. 13. 1899.
OPENING OF MEDICAL SCHOOLS.
The Medical Press. 283
The Royal Infirmary, which is at the service of the
College for teaching purposes, is one of the largest
general hospitals in the kingdom. It has 612 bod*
available for clinical instruction, including an ophthalmic
department, and it has special wards for diseases peculiar
to women, for venereal diseases, erysipelas, burns, and
diseases of the throat. At the dispensary ppecial
advice and treatment are given in diseases of the eye,
ear, teeth, and skin, in addition to the large and varied
number of ordinary medical and surgical cases—
about 44.000 per annum—which in a great industrial
centre daily require attention. Students at the college
and hospital get the benefit of dispensary experience
free of charge, and no better or wider field for seeing
hospital practice and receiving clinical experience can
be found than in the Glasgow Royal Infirmary.
Appointments .—All appointments are open. There are
five physicians’ and seven surgeons’ assistants who ob¬
tain free b arc! and residence in the hospital and act in
the capacity of house physicians and house surgeons,
and there is an assistant to the gynecologist who boards
but does not reside in the hospital. There is also a
house surgeon for the ophthalmic department. These
appointments are made for six months, and are open to
gentlemen who have a legal qualification in medicine
and surgery. Clerks and dressers are appointed l*y the
visiting physicians and surgeons. From the large
number of cases of acute diseases and accidents of varied
character received, these appointments are valuable to
students. In the pathological department assistants
are also appointed by the pathologist
Fee*. —The fees for Lectures, including Hospital
attendance necessary for candidates for the Diplomas
of the English, Scotch, and Irish Colleges of Physicians
and Surgeons, amount to £72
Andeksos’s College Medical School, Glasgow.—
New and excellently equipped buildings were opened in
October, 1877, in Dumbarton Road, immediately to the
west of the entrance to the Western Infirmary and
within four minutes’ walk of the university. Extensive
laboratory accommodation is provided for practical
anatomy, practical chemistry, practical botany, prac¬
tical zoology, practical physiology, practical pharmacy,
operative surgery, and hygiene and public health.
There are also provided a library and reading
room, and a students’ recreation room. The build¬
ings are constructed upon the most approved modern
principles. Tho dissecting room it open in winter from
9 a.m. to 6 p.m., and in summer from 6 a.m. to 6 p.m.
These students are assisted in their dissection by the
professor and demonstrators, by whom daily examina¬
tions and demonstrations on the parts dissected are con¬
ducted. The supply of subjects is ample, and students
are conseque ntly provided with parts as soon as they may
be ready for them. The dissecting room is provided
with a complete series of dissected specimens mounted 1
in plaster of Paris illustrating the anatomy of the 1
human body. There is also a large Bone Room fur¬
nished with complete sets of painted and unpainted bones.
Dental Curriculum. —Students studying with a view
to the dental diploma can obtain instruction in the fol¬
lowing subjects :—Physics, chemistry, anatomy, physio¬
logy, surgery, practice of medicine, and materia mediea.
The special dental courses may be obtained in the
Dental School, 5, St. Vincent Street, Glasgow.
Fees. —Fees for hospital practice and clinical lectures,
first year, £10 10s : second year, £10 10s.; afterwards
free. For six months. £6 6s. ; three months, £4 4e.
Students who have paid 20 guineas at another hospital
for its perpetual ticket are admitted six months for
£2 2s.; or one year for £3 33. Vaccnation certificate,
recognised by Privy Council, £1 Is.
POST-GRADUATE COURSES IN SCOTLAND.
In Edinburgh a number of permanent post-graduate
corses continue more or less continuously throughout
the year. Among those open to or especially for post¬
graduates are:—
1. Ophthalmology : daily at the Royal Infirmary. 2. Oph¬
thalmoscopy : Dr. George Mackay, Eye Dispensary,
Chambers Street, fee £2 2s.; Dr W. G. Sym, Eye, Ear,
and Throat Infirmary. Cambridge Street, fee £2 2s. 3.
Aural Surgery, Ac.: Dr. MacBride and assistants. Royal
Infirmary ; Dr. Hunter Mackenzie, Eye, Ear and Throat
Infirmary, fee £2 2s. 4 Pathological Bacteriology: Dr-
T. Shennan, Surgeon’s Hall, fee £2 2s. 5. Dermatology :
Drs. Allan Jamieson and Norman Walker, fee £3 3s.; Dr-
Stewart Stirling, 8kin Dispensary, Lauriston Place, fee
£1 Is. 6. Diseases of Children : Sick Children’s Hospital,
Dr. John Thomson; minor surgical diseases of children,
Mr. H. J. Stiles, fee £2 2s. 7. Chest diseases : Dr. R.W.
Philip, Victoria Hospital and Dispensary, fee £2 2s. 8,
Gynaecology: Dr. Brewis, fee £2 2s. 9. The Demonstra¬
tions on Modern Gastric Methods, by I)r. A. Lockhart
• Gillespie, fee £2 2s , available at any time during the
year on the ropiest of a sufficient number of post-
! graduates. All these courses are of short duration,
I varying in length from three to six weeks. In addition
j to these, arrangements have been made whereby a
I special series of short courses, including many of those
. above, are given simultaneously at a time to be after-
i wards fixed upon and advertised. The additional
j subjects dealt with include— Medical and Surgical
| Anatomy, Electricity in medicine, by Dr. Dawson
I Turner; Infectious Diseases, by Dr. C. Ker; Practical
i Sanitation, Dr. H. Littlejohn ; Operative Surgery, Ac
i The usual fee for each class is £2 2s. The Honorary
Secretary, Post-Graduate courses, Surgeons’ Hall, will
supply a full syllabus on application.
In Glasgow, special courses in ear diseases are held in
Noveml>er and May at Ander.-ou's College, and post¬
graduate courses in pathology and bacteriology at the
University from September 13th to October 12th, 1898.
Fee for either, £3 3s.; for both, £5 os., with 5s. matricu¬
lation fee.
THE OPENIN'*i OK THE MEDICAL SCHOOLS, LONDON.
Charing Cross Hospital Medical School—Mon lay, Oct. 2n<l. Intro¬
ductory Address by Dr. Mitchell Bruce.
Dental Hospital of London—Mon 1 iv. Oct. 2m!.
Guy's Hospital Medical School - Monday, Oct. 2nd.
King's College Lon Ion, Medical Faculty— Mon lay, Oct. 2nd.
London Hospital Medical College - Monday. Oct. 2nd.
Middlesex Hospital Medical School—Monday, Oct. 2nd. Introduc¬
tory Address by Mr. .1 Murray, F R.C'.S.
Royal Free Hospital School of Modi- ine for Women Monday Oct.
2nd. Introductory Address by the Dean, Mrs. Garrett Ander¬
son, M.D.
St. Bartholomew's Hospital and College Monday, Oct. 2nd.
St. George's Hospital Medical School—Monday, i>et. 2nd, at 4 p.ui.
Introductory Address by Dr. Howship Dickinson.
St. Mary's Hospital Medical School— Monday. Oct. 2nd, at 3 p.ui.
Introductory Address by H. <1. Plimmer. Esq.
St. Thomas's Hospital Medical College- Tuesday, Oct. 3rd, at
3 p.m. Prizes distributed bv Prof. T. C. Allbutt. M.D., F-R.S.
University College Medical School - Monday, Oct. 2nd, at 4 p.ui.
Introductory Address by Dr. G. F. Blacker.
Westminster Hospital Medical School—Monday, Oct. 2nd, at 4 p.m.
PROVINCES.
Birmingham, Mason Collette—Monday, Oct. 2nd.
Bristol, University College—October.
Cardiff, University School of Medicine—Monday, Ocf. 2nd. Intro
duetory Address on the evening of Oct. 6th, by Professor A. W.
Hughes.
Durham University School of Medicine—Monday, Oct. 2nd.
Liverpool, University College—Tuesday. Oct 3rd.
Manchester. Owens College - Monday, Oct. 2nd.
Sheffield. University College—Monday, Oct. 2nd. Introductory
Address by Sir Crichton Browne, LL.I)., M.D., F.R.S.
The Yorkshire College -Monday, Oct. 2nd. Introductory Address,
followed by the Distribution of Prizes, at 5 p.ui., bj Dr. Byrom
Br.imwell.
IRELAND.
Adelaide Medical and Surgical Hospitals, Dublin.
Catholic University Medical School, Dublin—Nov. 2nd.
City of Dublin Hospital—Oct. 2nd - Monday, Oct. 2nd.
Dublin University. Oct. 2nd.
Meith Hospital—Moinlav, Oct. 2nd, at 4.30 p.m. Introductory
Address by Dr. .Toliu William Moore.
Mercer'* Hospital, Monday—Oct. 2nd.
St. Vincent's Hospital—Tuesday, Oct. 3rd. Dr. Tobin, 4.3 'p.m.
Queen's College, Cork- Monday. Oct. 23rd.
Royal l ol. of Surgeons. Dublin Schools of Surgery—Monday < let. 2nd.
Trinity College School of Physic, Dublin, Dissecting Rooms, &c.
First week in October: lectures begin first week November.
SCOTLAND.
Aberdeen University—Monday. Oct. Idth.
Dundee University College—Wednesday, Oct. 12th.
Edinburgh University Tuesday. Oct. 17th.
Edinburgh School of Medicine, Rooms, and Laboratories, Mon¬
day, Oct. 2nd.
Edinburgh School of Medicine for Women- Tuesday, Oct. 17th.
Glasgow, Anderson's College Medical School—Thursday, Oct. lath.
Glasgow. Queen Margaret College School of Medicine’tor Women
—Oct. P>th.
Glasgow University—Thursday. Oct. 3th.
Glasgow, St. Mungo’s College Thursday, Oct. littli.
Glasgow Royal Iuiirumr.v—Thursday, Oct. P'th.
Royal Colleges. Edinburgh -Tuesday, Oct. 17th.
St. Andrew’s University —Wedues-lay, Oct. 11th.
Digitized by G00gle
284 The Medical Press. NOTES ON CURRENT TOPICS. Sept. 13 . 1899 .
.JilotM on Current topics.
The Question of Education.
There are many interested at this time of the
year in the question how they can best prepare their
eons for that business in life for which they are, in
their opinion, best qualified, or are most likely to
eucceed in. School is over, and now certain lines of
study must be selected which will gradually lead to
qualifying for a profession or a business, by which
an independence will be secured. The question we
are considering is whether a boy, before he leaves
school, can prepare himself for the line of study
required by the Medical Council after he has regis¬
tered, and before he can enter at a medical school.
There are oertain subjects which are not specially
medical, such as chemistry, botany, and physic*,
and which are now taught at most of our public
schools. Whether a boy shall acquire any knowledge
of them or not while at school requires consideration.
There is no doubt but that it gives a boy a great advan¬
tage, if he intends to register, to have acquired some
knowledge of chemistry, biology, and physics before
he leaves school, and there is no doubt but that every
encouragement is being given to our public schools
to provide tuition in science subjects. If our medical
schools are relieved of these subjects, and those who
enter them can at once begin to attend lectures on ana¬
tomy and physiology, it must greatly simplify matters.
But we think it would be well if more care were taken
at our medical schools to avoid a great deal of the
useless detail which is taught in anatomy and
physiology. It ought to be clearly recognised that
these subjects should always be studied with a prac¬
tical end in view. They are certainly sciences, but
in the teaching of a science it is a mere waste of time
to enter into minute details which are of no practical
use to students. How much of the anatomy of the
bones and other parts in our text books is really of
use in the practice of medicine and surgery ? For
examination purposes they have to be learnt, but it
would be well if examiners were prevented from
requiring a student to cram for examination, and
those who teach anatomy and physiology ought to be,
not professors, but surgeons and physicians. The
education of our medical students as at present carried
out is far more a question of preparing them for
examinations than of teaching them what they
ought to know ; and there is no doubt but that
the teaching at our hospitals has sadly degene¬
rated, and that a system of cramming has
grown up which urgently calls for reform. The
operating room ought to be the chief source of
knowledge of surgery for students, but veiy little, if
any, use is made of it for this purpose. The real
reason of this is that there is no inducement for the
surgeons at hospitals to give any time to teaching,
for the good reason that they are not paid well enough
to make it worth their while to do so. All that the
student has to do is to get his lectures signed up,
and as to learning anything from lectures which
will help him in examinations he generally feels that
the time would be far better spent in reading than in
listening to a lecturer. We will not say more on this
subject except that we think it would be well for
the managers of our medical schools to set about the
reform of the present state of things.
Secret Commissions and the Medical
Profession.
Considerable discussion has taken place in the
daily press on the indictment framed by Sir Edward
Fry concerning the alleged participation of members
of the medical profession in the practice of receiving
secret commissions. As might be expected, no fnr-
ther light has been thrown on the allegation which
rests upon the unsupported assertions of two or
three irresponsible witnesses. The ventilation of this
unsavoury topic will, however, have rendered one
signal service, for it will, we trust, have made it per¬
fectly clear that even if a few individual members of
the profession have really stooped to the practice it
is heartily condemned and religiously shunned by the
profession as a whole. The publicity given to the
matter, moreover, may give rise to searchings of con¬
science and thus reinforce the abhorrence which is
unquestionably felt by the vast majority of medical
men towards such a degrading means of making
money. It is within the experience of most
medical practitioners that opportunities of the
kind are very frequently offered but, as far
as our experience goes, such offers are inva¬
riably regarded in the light of personal insults
and recoil upon those who have had the temerity to
make them. The matter is not one of which the
General Medical Council has so far taken recognizance,
but it has never been asked to do so. and in any
event delinquencies of this kind are obviously very
difficult to bring home to the offender. It would not
be amiss, by way of reassuring public opinion, if the
Council took an early opportunity of publicly stigma¬
tising the taking of secret commissions as “ infamous
conduct in a professional respect.” In so doing it
would only voice the unanimous feeling in the ranks
of the medical profession, and the pronouncement
would go far to correct the impression which the
mere mention of the contingency cannot fail to have
left in the minds of a certain section of the public.
The Malarial Mosquito.
The achievements of the little band of observers
sent to Africa by the Liverpool School of Tropical
Diseases are being well advertised in the lay Press, a
course which is sufficiently at variance with custom
to excite some diffidence in expressing approval
thereof. We have had too much experience of these
interim reports in the past for them to carry con¬
viction, and we prefer to postpone judgment in
respect of the results until the subject has been duly
brought forward by the observers in medical cir¬
cles and subjected to the disintegrating force of hos¬
tile criticism. Even if, as announced, the parasite
of malaria has been discovered in the body of the
anopheles, that fact does not clear up the mystery
surrounding the etiology of the disease because, as
Digitized by CjOO^Ic
Sept. 13, 1890.
NOTES ON CURRENT TOPICS.
The Medical Press. 285
lias been pointed out, malaria exists in places where
the mosquito is unknown. Then, again, though the
discovery, if authenticated, possesses considerable
scientific interest, we are but on the thresh hold of the
preventive treatment of malaria. If, for instance, it
were shown that measles was communicated by the
bite of the flea, the extinction of the genus flea
would not be easy of accomplishment, and the problem
of the extinction of the mosquito is a problem of even
greater magnitude. The attentive study of the natural
history of the mosquito will doubtless enable us to
follow it through the various phases of its evolution,
but the uncontrollable facilities which nature provides
for its multiplication in tropical climes are likely to
defy our puny attempts at extermination. Our
object in making these remarks is assuredly not to
decry the invaluable work which is being done all
over the world in the investigation of the causes and
prevention of malarial disease, but rather to present
these recent discoveries in their true light. It is
greatly to be hoped that the Government will do its
duty in providing the means of carrying on this line
of research. At present it may truthfully be said
that the field is vast, but the labourers are few.
Lord Rosebery and the Hospital.
In our recent article on the hospital question we
pointed out in what respect the character of the
hospital of to-day was changing from what it was
some years ago. No longer is a hospital regarded
as an institution limited in its purpose to the relief
of the sick poor. Lord Rosebery seems to be in
favour of organizing some hospitals on the same
principles fas those on which clubs, insurance com¬
panies, and other co-operative societies depend for
their support. The hospital at Bishop Auckland,
will not depend on charity in any form, but on the
contributions of those for whose benefit it is intended
namely for the miners themselves. The question of
chief interest to the profession is how it can best
serve the good of society by assisting in the satis¬
factory arrangement of hospitals of this character.
There seems to be rather a tendency on the part of
the public to leave the profession very much out of
the calculations in this matter. It is assumed that
the medical and surgical work can be obtained much
in the same way as any of the common necessities
of a club or institution, and that contracts can
be made much in the same way as for any
articles of trade. To some extent this may
be true, but how far it is so requires to
be distinctly understood both by the profession
and those who are disposed to follow the example set
at Bishop Auckland. There may be no difficulty in
organising a co-operative hospital on the same lines
as an insurance company, but if the chief article
required for the satisfactory working of such an
association is not taken into much account, the
association will fail in its chief purpose. If the pro¬
fession should be seriously injured by such a system
the public would suffer. If one of the objects of 3uch
co-operation is to cheapen as much as possible the
service of the profession, tr tubles will attend it. It
would be well for Lord Rosebery and others well
capable to deal with this question to be careful how
they give support to a movement which is not as
simple in its practical working as they might at first
suppose. One of the chief difficulties which the pro¬
vident dispensaries have to deal with is the securing
of efficient medical and surgical treatment for mem¬
bers. It is unreasonable to expect the profession to
give its labour for inadequate payment, for the
majority of the profession cannot work unless it is
properly paid. If charity is to be called upon t >
support this system it at once loses its character, and
the results will be disappointing. This is a subject
deserving the serious attention of the whole profes¬
sion, and we trust that it will be considered as such
in a sensible and proper manner.
Labori’s Bullet Wound.
An illustrated contemporary, Black and White,
has with a good deal of enterprise presented English
readers with a reproduction of the radiogram show¬
ing the bullet wound in Maitre Labori’s back. So far
as one can judge the missile has been arrested to the
right of the spinal column somewhere between the
fifth and sixth vertebrae. Less than an inch to the
right, or two or three inches to the left, and the
wound would have infallibly killed the illustrious
advocate. On this side of the Channel it is hard to
comprehend the fatuous psychology of attempting to
settle a criminal trial by shooting the prisoner's
counsel. It is not a little remarkable how quickly
Labori recovered from the shock and was able to
walk daily down to his labours in Court “with
the anti-semitic argument in his back.” Fortu¬
nately, this successful result of the new method
of Rontgen photography has furnished a crushing
reply to the report circulated by a few of the least
scrupulous journals that the attempted assassination
was merely a little theatrical spectacle arranged by
Labori himself to further h is own ends. The bullet
displays a curious little “ tail” of lead—a long, thin
scrap, the thickness of fine twine, apparently shaved
off by contact with an outstanding process of bone.
The congratulations of the British public have
been already showered upon this brave man and
great lawyer, and will be echoed with peculiar force
by members of the medical profession, who naturally
recognise with more exact appreciation the hair's-
breadth escape of Labori from the point-blank shot
of the dastardly miscreant, apparently destined to
escape the toils of justice.
The Hospital Reform Association.
A conference will be held next month under
the auspices of the above Association to discuss
various topics of vital importance to the medical
profession. Its work will be distributed over two
days, October 10th and 11th at the St. Martin's
Town Hall, London. The three subjects chosen for
discussion are (1) The enquiry system ; (2) Payments
by patients; (3) Provident dispensaries. It is to be
Digitized by Google
286 The Medical Press.
NOTES ON CURRENT TOPICS.
hoped that these meetings will be attended by many
general practitioners, who here have an opportunity
afforded them of laying their views and experiences
before those influential laymen in whose hands,
af ter all is said and done, the coming reform of the
hospitals must lie. Unless medical men will attend
meetings of the kind initiated by this energetic body,
the world will never be persuaded that abuses exist
in our great medical charities. At last year's con¬
ference in St. Martin's Hall a flood of lightwas thrown
into the inner workings of the mind of some who
pose as world-wide philanthropists. Further parti¬
culars cf the forthcoming meetings may be obtained
from the honorary secretary. Dr. Garrett Horder, of
Cardiff, whose unceasing efforts in the direction of
hospital reform deserve to be rewarded by crowded
and enthusiastic meetings next October. It is par¬
ticularly desired that medical men desirous of taking
part in the discussions will send in their names to the
secretary at the earliest possible date.
Salivary Superstitions.
Apropos of our paragraph of a fortnight ago as to
the unsavoury habits among many peoples based
upon traditional tales of salivary virtues transmitted
to them from the past, it might be worth our while
to add another example to our former list. This
example of the widespread belief in the wonder-
iul powers possessed by saliva, is, however, less
allied to imaginative superstition, but rather seems
to Bavour of empiricism. In parts of Scotland, it
may be throughout Scotland and perhaps in Eng¬
land, warts on the hands are supposed to vanish with
great celerity should they be anointed each morning
with the first spittle formed by their owner’s salivary
glands after awaking. The most extraordinary part
of the story is that there seems to be some truth in the
results following this procedure. On more than one
occasion endeavours to eradicate the growth of
warts on the hands of children, successful enough in
so far as the destruction of the actual warts present at
the time of treatment was concerned, but unsuccessful
in the prevention of new crops, were desisted from,
and, mostly owing to a feeling of curiosity as to the
effect produced by a popular method of treatment,
superseded by permission as sought for to soak the
warty area in the spittle first secreted on awaking
each morning. The idea appeared more than
ludicrous ; to be on a par with medieval
“ Eye of newt, and toe of frog
Wool of bat, and tongue of dog.”
But the result was no less surprising. Whatever the
explanation may be in truth, due to coincidence,
or to some real property, in several instances
we have watched the death of the warts and
the non-appearance of a fni’ther crop. Canine
wounds are almost invariably said to heal best if
treated solely with the injured’s tongue, and there is
no doubt that solutions of continuity in the integu¬
ment of dogs present healthy signs and escape septic
invasions in apparently much larger proportion than
such wounds would show in man were he to confine
his treatment to oral and li gua applications. We
Sept. IS, J899.
are unaware of any observations as to the properties
of the saliva secreted by the dog and his allies, but
know that human saliva is markedly pro-septic. If
its action upon the skin's tendency towards gene¬
rating of warts be true, as smoke argues fire, so
belief must have base, and tradition may be possibly
right. Unless the small proportion of alkali of the
saliva be the beneficial agent, the actual underlying
cause is far to seek. Can the salivary glands be the
producers of Rome dermatic tonic, like unto the pro¬
ducts of other glandular tissues ? Or is the “ first
spittle in the morning ” a salivary superstition ?
The Metric System.
The Associated Chambers of Commerce, at their
meeting on the 6th inst„ adopted, almost unani¬
mously, the following resolution :—
“ That the Association, reaffirming its frequently
expressed opinion that the metric system of weights
and measures should be made compulsory in the
United Kingdom, strongly urges her Majesty’s
Government to use it in all Government departments,
and to strictly enforce the existing provisions in the
Education Code with regard to the teaching of, and
examinations in, the subject in elementary schools,
and that representations to this effect l>e made to
the Government.”
Four resolutions to the same effect were on the
notice paper, emanating from such commercial centres
as Birmingham, London, Bristol, and Leicester, but
they were all withdrawn in favour of the above.
The advocates of the resolution urged, of course,
the great stimulus given to foreign commer¬
cial competition by the continuance of the out-
of-date British system of weights, measures, and
currency, and we are able to endorse their argu¬
ments by pointing out that chemistry, pharmacy,
and other cognate subjects lag behind the time in
England, because none but the cognoscenti are able to
translate our ounces, drachms, pints, quarts, inches,
yards, and acres into their metric equivalents. It is
to be hoped that our Government will respond to the
above resolution by at least making a start towards
reform.
The Congress of the Institute of Public
Health
Will open in Blackpool on September 21st under
the presidency of the Marquis of Lome, who will
deliver an inaugural address. The usual division of
the work of a Congiess among sections— each dealing
with its own speciality—will be made. A feature of
the Health Exhibition, in connection with this Con¬
gress, will be special exhibition and discussion on
smoke abatement. The Congress is expected to
attract a large number of memliers of the Institute
and visitors.
A requisition has been presented to the Lord
Mayor of Belfast to convene a public meeting to
consider the propriety of inviting the British Asso¬
ciation for the Advancement of Science to visit that
city. The requisition has been very influentially
signed.
Digitized by LjOOQle
The Medical Puu, 287
Skit. 13, 1899._ AU STRIA.
The Medical Administration of Gaols in
Scotland.
The Secretary for Scotland has appointed a
Departmental Commission to investigate the housing,
nursing, and dietary of prisoners, and certain other
subjects bearing thereon. The Earl of Elgin as
chairman, and Sir Thomas Carmichael, Sir Batty
Tuke, and Sir Colin Moncrieff are members of the
Commission.
Jranct.
[FROM OUR OWN CORRESPONDENT.]
Paris, September lOtli, 1880.
Treatment of Gunshot Wounds in this Back.
The gravity of gunshot wounds in the dorsal region
varies essentially with the diameter, the weight, and
the speed of the projectile.
The bullets, says Dr. Auscaler, of ordinary revolvers
do not possess a great power of penetration. These
S ' setiles, which do not weigh more than sixty or
ty grains, are frequently fired with an initial of
speed of only 160 yards. Consequently they cannot
pierce tissues of any resistance, glide upon bones of
small dimensions, or are arrested by their contact
without breaking them. Th6 gravest cases are those
where the projectile meets only with soft tissues. The
bullet in Buch cases can penetrate even to the medias¬
tinum and lodge in the immediate neighbourhood of the
heart and the large vessels without wounding them or
producing the slightest immediate accident. Death
ensues later on from internal haemorrhage, or the for¬
mation of an abscess at a time when the patient was
considered cured. Projectiles, on the other hand, of
great speed act differently. The Lebel ball, for
ins tan oe, which has an initial speed of 700 yards
per seoond, and capable of piercing through six
men walking in Indian file produces quite different
lesions. The projectile causes a wound much the more
grave when ic touches the osseous By stem. As example of
the chanoes afforded by the modern rifle, Dr. Auscaler
cites the case of a prisoner who in attempting to escape
was shot at a distance of six yards, ana pierced right
through in the region of the liver. The man fell from
the shook, but in eight days he was perfectly well. The
ball of an ordinary revolver would have probably lodged
in the liver and produced by subsequent inflammation
fatal results. On the other hand, if the ball of arifle struck
the back in the median line, shaving as it were one of
the transverse processes, it would smash to pieces the
vertebra and cause immediate death from wound of the
medulla, while the projectile of a cheap revolver would
not produce any important lesion, it would be simply
arrested by lamina of the vertebra as in the case of M.
Labori, recently wounded at Rennes.
The approximative diagnosis of the seat of the projec¬
tile can be determined almost at the outset according to
the symptoms observed.
If no haemoptysis occurs, and if no symptoms of
internal haemorrhage be present, the wound is most pro¬
bably localised in the soft parts of the posterior wall
of the thorax. The wounded man rarely loses conscious¬
ness. The first symptom which should be sought for is
paraplegia. If no sign of p aralysis exists the wound is
almost always benign. Where paraplegia is present a
cure is rarely obtained, for almost always the medulla is
cut across, and sutures never were successful. Some¬
times, however, the medulla is simply compressed by the
projectile or by a bony fragment. In any case where
paraplegia is present surgical interference is imperative
as soon as the patient has recovered from the shock and
the foreign body removed. The paraplegia, however,
will persist.
In cases where no paraplegia exists surgeons were not
agreed as to the conduct to be observed. Some say that,
as no important organ has been touched, matters should
be left alone, while others pretend that a projectile lodged
in the neighbourhood of the mediastinum, the patient is
in permanent danger of prevertebral suppuration. The
opinion of Dr. Auscaler is that intervention is here as
neoessary as in the first case, with the advantage that a
perfect cure can be expected.
- ♦
<5mrnmp.
[FROM OUR OWN CORRESPONDENT.]
Berlin, September 8th, 1888.
How Par Can we Disinfect our Hands?
Once again this question has come up for discussion
This time the inquirers are Drs. Gottstein and Blum-
berg, who publish the result of their research in the
Bert. Klin. Woehmuck. 34/09. Doderlein at the Surgical
Congress, 1898, declared that the hands could be
rendered perfectly sterile, that therefore Miku¬
licz’s gloves for operation were at least super¬
fluous if not positively harmful, and it was for the
purpose of testing the accuracy of the declaration
that the author undertook new and independent inquiry.
Up to three years ago the method of disinfection in use
in Mikulicz’s Klinik was that of Fiirbringer—viz., three
minutes scrubbing in hot water and soap, one to two
minutes soaking in a 6 per cent, solution of alcohol, and
finally scrubbing with a 1 per 1,000 solution of perchloride
of mercury. As the results of such disinfection were
glaringly unsatisfactory, the periods were lengthened
to eight to ten minutes hot water and soap, three
minutes aloohol, at first 36 per oent. then 60
per cent., and at last 70 per oent. in strength, and
then 2 to 3 minutes with sublimate solution as before.
The results were now so muoh improved that the hands
were infested with germ in 63 per cent, of oases instead
61 - 3 per oent. as before. For scientific purposes]the different
procedures in stages of the disinfecting process were now
prolonged further than would be possible in practice, with
the result that the germs were reduced in number;
although they were still present. In 29 per oent. germs were
still there. The germ almost always formed after com¬
pleted disinfection was the staphyloooocus albus. This
showed that the germs on the skin were indeed removable,
but that the normal epiphytes of the skin oould not be
removed. Biaohoff has shown that in a oertain number
of cases the staphylococcus albus possesses pathogenic
properties, and this being so, it is evident that in malting
or treating wounds there is always danger of infection
from the surgeon’s own hands. It was this evident danger
of infection that led to the introduction of the glove by
Mikulicz. Knitted gloves have always used worn by
Mikulioz with satisfactory results. The authors, speak¬
ing of the good results obtained by Doderlein with
Friedrich’s indiarubber gloves in obstetric operations,
maintain that this shows the enormous value of a cover¬
ing for the hand. The Mikulicz glove has the advan¬
tage over the Friedrioh that it can be changed oftener.
It is of course understood that the hands must be as
carefully disinfected as if no gloves were worn, so long
as an impermeable covering for the hand is not pro¬
curable.
The authors sum up to the effect that absolute removal
of all pathogenic germs is not possible by any method
of disinfection, that, however, their numbers can be
materially reduced.
JUtfrtrra.
[from our own correspondent.
Vienna, September 18th, 1888.
Premature Labour.
At the “ Naturforscher Versammlung ” Hucklenbroich
raised a discussion on the utility of inducing premature
labour in severe and dangerous cases. During the six¬
teen years he had devoted his attention to the subject he
Dii
oogle
288 The Medical Pbi*b. CONTINENTAL HEALTH RESORTS. 8eft. 13, 1899.
had performed 60 operations on 29 females. In 26 of these
cases the operation was on account of a narrowing of the
pal vis; the other three were due to uncontrollable
vomiting and carcinoma of the pylorus. In the “flat”
pelvis the conjugate vera was never less than 8 centi¬
metres (8177 in.).
Of the 29 females who had the operation performed, 16
had it peiformed once, six had it performed twice, one
had it three times, two had it four times, three had it
five times, and one had it six times. One died after the
fifth operation from septic peritonitis. A rise of tempe¬
rature occurred in other three from septic poisoning,
one had pneumonia, and another had an elevated tem¬
perature for twenty-four hours from catarrh of the
stomach.
Forty-eight of the children were bom alive, but
twenty-one of these died in hospital before leaving,
thus proving their weakness to resist the force of living
ex-utero. Twins were bora once, making in all sixty-
one children. In respect of the position ten were cross
births, seven feet, four buttocks, one brow, and one face.
Three times the umbilieal (cord prolapsed, three times
the instruments were applied, once perforation was
resorted to, and in eight of the cases cramps were so
violent as to retard labour, and were alleviated by means
of opium, warm baths, and rubefacient paints.
Tho weight of the children ranged between 2,250 to
3,000 grammes—4’96 to 6 6 lbs. The method of perform¬
ing the operation was that i©commended by Krause, by
inserting a bougie and occasionally turning it to induce
contractions; the bougie is held in position by tampons
of iodoform gauze tightly packed into the vagina and,
if no pains within twenty-four hours, the dressing is
renewed. No anesthetics should be given. It is worthy
of note that a good thick bougie should be used as
small ones are disappointing. As a rule pains commence
in .a few hours, or within six or twelve hours, although
it | is not unusual to run into two days. The birth
usually terminates in eighteen hours to seven days.
In the mother that died from sepsis the pains had
gone on for five and a half days, when sovere bleeding
commenced, necessitating the opening of the cervix and
extraction of the foetus. Four hours after delivery the
mother developed tetanus, dying on the fifth day from
peritonitis. The child died on tho third day from
erysipelas.
Fehling was the first to open the discussion, and said
that these facts all tended to prove what he has long
taught that premature labour should be more frequently
practised than it usually is at the present time by the
general practitioner, when the pelvis has an exit of not
less than eight centimetres in the conjugate. He objects to
Krauese’s method of performing the operation as danger¬
ous. He prefers using a modification of Barnes’ “ Col-
peurynter ” to the bougie which never should be used,
as it goes too high up in the uterus for any practical use
beside the danger of transmitting infection which is
nlways to be avoided. The “ vagino-cervix colpeurynter ”
is the quicker and safer instrument.
Hofmeir considered both of the foregoing instruments
far too dangerous for every day use and recommended
Kehrer’s method of iodoform gauze tampons as safe and
effectual. He admitted that this method does not bring
on the pains as quickly as either of the above. When
the cervix is open the “Colpeurynter” may be used
to hasten the operation.
Mertens said he bad obtained far better results with
the bougie than he ever had with Fehling’s modified
Barnes’ “Colpeurynter.”
(Eontincntnl gcalth JUsorts.
[From Oub Special Cobbespokdbnt.]
BRIDES-SALINS (Savoy).
Brides- lkh- Bains, -until recently, has been rather
difficult of access, even from the chief Savoy Spa ot
Aix-lus-Bains; for going even the short distance from
Aix, travellers had to change railway carriages, or wait
an hour or so at Chambery, change again at St. Pierre,
wait another hour at Albertville, and drive from tho
railroad terminus at Moutiers up to Brides. The Paris,
Lyon, and Mediterranean Railway Company have this
season given some direct trains from Paris (via Aix-lea-
Bains) to Moutiers (promising more direct connections
for next year), and an electric tramway is now con¬
structed from Moutiers to Brides. These improvements
will make Brides-Salins easily accessible from England.
Brides and Moutiers-Salins are two distinct health
stations, belonging to one company and under one
management. These twin stations are only two miles
apart; their waters are frequently used together, and
the communications between them are so easy that they
really form one and the same watering-place. They are
situated in the heart of the Tarentaiae Alpine region,
the most picturesque part of Savoy, rivalling, with its
great glaciers and superb mountain scenery, anything of
the kind to be seen elsewhere in Europe.
Moutiers, the P.L.M. railway terminus, is a town of
prehistoric antiquity, and its immediate neighbourhood
affords much of archaeological and geologioaTintereet.
Many venerable traditions cluster around it. Even in
Hannibal’s time it was an ancient city, and bis passage
through these Tarentaise defiles and gorges C06t him
much time, labour, and the sacrifice of many veteran
soldiers, and the irremediable loss of most of his most
potent military force, .the elephants, in the first years
of his Italian campaigns a novel terror to the Roman
armies.
The Salins-Springa and Bath Establishment are about
a mile from the town of Moutiers, on the road to Brides.
Salins was itself an important town until submerged
by the avalanche of almost an entire mountain in the
fifteenth century. Now it is a hamlet, containing only
the bath*, with their adjoining hotel and park, some
comfortable pensions, villas, and houses let out in
furnished apartments.
The more desirable place of residence is at Brides, a
pleasant village with excellent hotels, good Casino and
reading-rooms, English and French churches, boarding
houses, and furnished flats and cottages ; affording both
to invalids and to pleasure-seekers an agreeable summer
home from May to October; the preferable months for
British visitors to Brides are from the middle of May
until July, and from early September to the middle of
October. “ The season ” at Brides-Salins opens officially
on May 15th and closes October 15th.
The leading hotels are the “ Grand H6tel des
Thermos,” “ Hotel de France,” “ Nouvel Hotel," and the
*• Grand ChAlet,” all ably conducted by the same pro¬
prietors, Mr. and Mrs. Robin, There are various other
good hotels, as the “Grand Hotel” of Mr. Lafont,
opposite the Catholic church.
Tho “ Grand Hotel des Thermes ” has interior com¬
munications with the bath establishment at Brides, and
is in the same park as “ The Casino ” and the “ Grand
Chalet.”
Brides is also well supplied with thoroughly competent
physicians; amongst them Dr. P. Delastre, so favourably
known to many of the profession in London, Edinburgh,
and Dublin, who has written much both in French and
in English on the BrideB and Salins Springs.
The Doctors Laissus (father and son). Dr. Desprez,
and Dr. Emile Philbert, have also ably advocated the
claims of these twin-stations. Likewise Dr. D. W.
Samways, who practices (at Brides in the summers, and
at Mentone, Riviera, during the winters. An analytical
laboratory, well equipped and directed by Mr. Boumat,
is attached to the Moutiers-Salins establishment.
The Saline Baths form the basis of the treatment at
Moutiers ; the water is also much drunk for its thermal
properties and its large proportion of carbonic acid gas.
It is tonic and stimulating, especially upon the circula¬
tion, strengthening and increasing the pulsation, and its
beneficial action is very remarkable upon the glandular
system. Glandular swellings, diseased joints, emaciated
limbs, anaemia, diseases of women, and fibrous growths
are sjiecial indications for these Salins.
The springs at Brides itself are highly efficacious for
diabetes, dyspepsia, gout, corpulence, constipation,
kidney and liver troubles, and moBt maladies of the
intestines.
Sift. 13, 1899.
MEDICAL NEWS.
We do not hold o or ee l vee responsible for the opinions of oor
eorrespondenu.
THE TREATMENT OF CHRONIC PHARYNGITIS.
To the Editor of The Medical Press and Circular.
Sir, — I have no desire to express any difference from the
views of Dr. Woods on the importance of nasal obstruction
as an etiological factor of chronic pharyngitis ; on the
contrary I cordially agree with them. But I venture
to suggest that it was recognised long before
“a considerable number of these cases” could have
“ passed through his hands.” Nor can it be admitted by
any one who can lay fair claim to be considered a
throat specialist that “ the necessity for rhinoscopy in
throat disease was only pointed out a few years ago.”
The art of rhinoscopy dates from a paper published by
Czermak {Wien, Medicin Wochenschrift, August 6, 1859),
which was only fifteen months after the first publication
in the same journal on the art of laryngoscopy as
practised by him, the form, indeed, which it has ever
sinoo remained to ns. I am indebted for these facts to
the third edition of “ The Laryngoscope ” published in
1871, by iMorell Mackenzie who, in an appendix, gave
every detail necessary for rhinoscopy, and illustrative
cases demonstrating its utility.
Without in the least desiring to detract from the merits
of other teachers, I may be allowed to state my own
position. In the first edition of my systematic work
published in 1878—ten years before Dr. Woods took
his degree—I wrote:—“ Nasal respiration is often ob¬
structed in certain pharyngeal diseases. ... No
examination of the throat is complete without careful
inspection of the nasal passages through both anterior
and posterior nostrils, and also where symptoms point
to disease of the naao-pharnyx, by means of the index
finger introduced upwards behinds the velum,
though these are points much neglectod both in
precept and practice." (P. 43.) In later editions,
especially in the third published in 1890, these
points are still more strongly enforced as evidenced
by the remark that “the first indication (against
recurrence of chronic pharyngitis) is to establish
actually free nasal respiration.” (P. 198.)
While making this reclamation in favour of the posi¬
tion of the specialist on this subject, I fully agree with
Dr. Woods that the importance of free nasal respira¬
tion, not only in chronic pharyngitis, but in affections
of the whole of the respiratory and auditory passages, is
not yet sufficiently recognised either by the leaders of
general surgery or by the general practitioner, but this
is no fault of the specialist. The artiole of Dr. Woods
may reasonably be expected to result in a more extended
appreciation.
I am, Sir, yours truly,
Lennox Browne.
Mansfield Street, W.,
September 8th, 1899.
NURSES OF THE LATEST FASHION.
To the Editor of The Medical Press and Circular.
8ih, —The “ interest and vitality ” of Mr. Gant’s
literary achievement may have suffered, as he complains,
from your curtailing pen, but the only fault I personally
find with the process of which he complains is that it
did not extend to complete excision. Briefly, I regard
his sketches as a prurient and indefensible attack upon
a sisterhood which deserves tender treatment from all
mankind, and most of all at the hands of the medical pro¬
fession. He may qualify his statements as he likes, but
they will go out to the world as aimed at trained nurses
in general.
Take the men or women of any class of the community
from the Royal court to the East-end court, and you
will find a certain percentage worthless and criminal.
In the modern nursing profession, I venture to assert
that the average moral tone is far higher than that of
any other class of the community drawn from similar
stations of life. That statement applies to skilled nurses
The Medical Press, 289
and not to social failures who have drifted into nursing
as a mere means of livelihood. Supposing some writer
of ability was to dip his pen in gall, and deck out in
literary form the histories of the medical men at present
lying in gaol, could that be taken as fair commentary
upon the character of the main mass of their profession ?
Yet that is the principle Mr. Gant adopts in dealing with
nurses. He would find no difficulty in writing a series
of sensational articles on the moral delinquencies of men
in holy orders, founded on the criminal history, say, of
the past ten years. Why fix on a defenceless, class of
women? Why pen Philippics against womankind to
the exclusion of the sex that plays no inactive part in
the drama of life’s treachery ? Yet, Mr. Gant thinks
that such men as the father and son ho describes should
be protected “ from marriage in spite of their depravities.”
Christian charity and kindly tolerance one looks
for in a gentleman who has passed many years in the
exercise of a liberal and humane profession like that of
medicine, those qualities are not conspicuous in Mr*
Gant’s articles.
I am, Sir, yours truly,
Bentinck St., W. David Walsh.
Munificences to the London Hospital.
The race of large-hearted, wealthy patrons to hos¬
pitals is not exhausted by any means, witness the recent
gift of .£10,000 by Mr. E. Raphael towards the establish¬
ment of a new Jewish ward at the London Hospital.
Along with this announcement is that of a gift of
-200,000 made by the executors of the late Baroness do
Stern towards the establishment of a convalescent
home.
Venereal Disease and Marriage.
A law has just been passed by the Michigan legisla¬
ture forbidding the marriage of persons suffering from
gonorrhoea or syphilis, offenders being punishable by a
fine of from 600 to 1,000 dols. or a term of imprison¬
ment not exceeding five years. No limit of time appears
to have been imposed, so that the fear of proceedings
may remain as a sword of Damocles held over the head
of the erring party to the contract for an indefinite
period; moreover, professional secrecy is to be abolished
in respect of such actions. It is one thing to make such
a law and another to enforce it. Were it otherwise it
is probable that Bimilar legislation would long since have
graced our own statute book.
A Gallant Bescue.
Dr. Martin, of Gilford, near Wigan, narrowly escaped
drowning last week when bathing at Douglas, Isle of
Man. The sea was rough and the tide high, and he was
in sore plight, when a lad of 13 went to his assistance,
and after several attempts was successful in bringing
him to land. That, at least, is the version given by a
local newspaper, and if correct, every praise is due to the
plucky youngster who thus prevented the depletion of
the ranks of the profession.
A Surgical Catastrophe.
We regret to have to record the death of Dr. William
McLaurin, of Barnsbury, from pytemia, consequent upon
a trifling injury received during an operation for removal
of the tonsils, which took place a few days since. He at
first made light of the matter, and when Mr. George
Brown was called in the disease had already made such
strides that treatment was powerless to avert a fatal
result.
Death from Anthrax.
Another death from anthrax is reported to have
occurred at Worcester, where a lad, jet. 13, employed at a
horsehair factory, died of the disease, induced, it is
believed, by his scratching a pimple while engaged in
manipulating horsehair imported from abroad. This is
the third death which has occurred in Worcester from
this cause within the last few months.
The Peculiar People Again.
An adjourned inquest was held at Canning Town on
the 5th inst. on a child, rot. 17 months, who had died of
bronchitis in the absence of medical attendance. The
jury on the former occasion failed to agree on a verdict,
and they were not more successful at this, the re¬
sumed, inquest, so the coroner adjourned the inquiry to
the Old Bailey.
Digitized by vj ooQle
290 Th* Medical Pbsm. NOTICES TO CORRESPONDENTS.
Sept. 13, 189».
fiotittB t0
CflmBpmtbfltte, glurrt 'jtettero, &t.
(V* Cobbmfotoewts 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.
NOTICE TO HOSPITAL AND COLLEGE DEANS.
The Editor desires to thank those gentlemen attached to the
various Medical Schools and Hospitals for supplying him with the
information ffom which the foregoing pages have been composed.
NOTICE TO OUB BEADEBS.
As this number is mainly devoted to information necessary for
students intending to join one or other of the various Medical
Colleges, and for those who, having passed their cnrriculum, are
about to enter the ranks of the profession, much of the ordinary
matter which usually fills our columns is necessarily deferred till
next week. Should any of our readers desire to present this
number to a patient or friend who contemplates sending his son t°
a medical oollege, our Publisher will be happy to supply him with a
duplicate free of cost on reoeipt of address.
A PICTURESQUELY WOBDED MEMOBIAL.
The Indian Lancet publishes a memorial received by an adminis¬
trative medical offioer in India, praying for the removal of a native
subordinate in favour of a rival, couched in terms not usually em¬
bodied in documents of the kind. The officer whose translation is
desired is described as “ a superannuated, lethargic, diabetic, worn-
out dry stick of humanity,” and the unhealthiness of the place is
ascribed to the “ foul-mouthed vituperations, peevish revilings,
and short temper of the old diabetic ASsculapius ” in question.
The memorial winds up with the expression of a hope that the
authorities would shortly see fit to rid them of “ this old man of the
woods.” Even the most intemperate guardian, in his desire to
obtain the dismissal of a medical officer, stops short of eloquence of
this kind, though the difference is sometimes more of form than of
substance.
Da. Hokdxk (Cardiff).—Next week.
Ma. W. J. Corbxt, M.P.— Your letter is unavoidably held over in
consequenoe of pressure on our space by educational material.
Dr. J. Conor (Buenos Ayres).—Communication to hand is marked
for early insertion.
Da. Dues (Cheltenham).— Wo are a little surprised that our eon-
temporary inserted the letter, which is an advertisement of a pro¬
prietary article, but more so that the author, who is admittedly
one of the foremost men in the profession, should allow it to be
printed and circulated broadcast as an advertisement. There would
be a sudden outburst of indignant remonstrance if such a thing
emanated from among the rank and file.
Dr. Coboravk.— See reply to Dr. J. Conor.
C. S. G.—The Army Medical Service Corps does not confer any
privilege in respect of the regular study of medicine, and it would
do idle to base any plans on such an assumption. Ton must be
under a misapprehension as to the nature of tne duties devolving
on members of that corps.
Dr. N.— Technically, no doubt, the consultant was in the wrong,
but as he duly communicated with you and declined to further
attend the patient, we cannot hold that you have any tangible
ground for complaint
Uacattcioe.
Barn wood House Hospital for the Insane, Gloucester.—Junior
Assistant Medical Officer. Salary, £120 per annum, with board,
Ac., rising to £140 per annum.
Borough Asylum, Portsmouth.- Junior Assistant Medical Officer.
Salary commencing at £120 per annum, with board, lodging,
and washing.
County Asylum, Prestwich, Manchester.—Assistant Medical Officer,
unmarried. Salary commencing nt £125, with board, apart¬
ments, washing, Ac.
Cambridgeshire, Ac., Lunatic Asylum, Fulbourn, near Cambridge.—
Assistant Medical Officer. Salary, £140 per aunmn, with l>oard,
lodgings, and attendance.—Applications to the Clerk to the
Visitors, Cambridge.
Manchester Clinical Hospital for Women and Children, Clieetham
Hill.—House Surgeon. Salary, £80 per annum, with apart¬
ments and board.—Apply to the Secretary, Barton Arcade,
Manchester.
Metropolitan Asylums Board.—Two Assistant Medical Officers at
Daren th Asylum, near Dartford, Kent, and one at the Leavea-
den Asylum, near Watford, Herts. Salary, £120 per annum,
rising, conditionally, to £150, with board, lodging, attendance,
and washing, subject to statutory deductiona—Apply at the
office of the Board, Norfolk Street, 8trand, London. (See
advert.)
North Staffordshire Infirmary and Eye Hospital, Hartshill, Stoke -
upon-Trent.—House-Surgeon. Salary commencing ai £120 per
annum, with furnished apartments, hoard, and washing.
Queen’s Colleges, Ireland.—Professor of Medicine in the Queen’s
College, Belfast.—Apply to the Undersecretary, Dublin Castle.
Royal Albert Asylum, Lancaster. — Resident Medical Officer.
Salary, £400 per annum, advancing to £450, with furnished
bouse, coals, gas, milk, and vegetables.
Royal Sea-Bathing Hospital, Margate.—Assistant Resident Surgeon.
Salary, £52, with board and residence,—Apply to the Secretary,
Royal Sea-Bathing Hospital Offices, 30, CharingCross, London.
Boyal South Hants Infirmary, Southampton.—House Surgeon.
Salary, £100 per annum, with rooms, board, and washing.
Stoke-upon Trent Union.—Resident Medical Officer for the Work-
house. Salary commencing at £100, with board, washing, and
furnished apartments at the hospital.—Apply to the Clerk to
the Guardians, Union Offices. Stoke-upon-lrent.
West Herts Infirmary, Hemel Hempstead.—House Surgeon and
Dispenser, unmarried. Salary, £100 per annum, with furnished
rooms, board, fire, light, attendance, and washing.
Whitehaven and West Cumberland Infirmary, Whitehaven.—House
Surgeon. Salary, £120 per year, and £30 annually for dispensing,
with furnished apartments an l attendance.
Brkbher, C. S., M.B., Ch.B.Edin., House Surgeon to the Durham
County Hospital.
Davies, L.G , M.D.Cantab., Medical Officer for the Workhouse and
the Children’s Homes of the Middlesborough Union.
Edington, George H., M.D., M-B.C.S.Bng.. L.B.C.P Lond.,
F.F.P.8.Glasg., extra Dispensary Surgeon to the Boyal Hospital
for Sick Children, Glasgow.
Gallwky, T. J„ C.B., M.D., M.Ch.Irel., President of the Board of
Medical Officers to examine candidates for commissions in the
Army in London.
Hawkins, Wm„ M.B.C.S., Medical Officer for the Up way Sanitary
District of the Weymouth Union.
Livingstone, Thos. H..M.B., Ch.B.Edin., House Surgeon to the
Rochdale Infirmary.
MacVicker, C. G., M.B .B.Ch.IreL, Medical Officer for the Fourth
Sanitary District of the Wells Union.
Maynard, G. D., M.B.C.S.. L.R.C.P.Lond., Junior Out-patient
Surgical Officer to the Boyal London Ophthalmic Hospital.
Morris, J. J. Nixon, L.B.C P.Lond., M.B.C.8., (Honorary) Assis¬
tant Surgeon to the Boyal Albert Hospital, Devonport.
Patch, H. H., L.R.C.P.Lond., M.B.C.S., Medical Offioer for the
Second and Third Sanitary Districts of the Hertford Union.
Bayner, H. E., F.B.C.S.Eng., L.R.C.P.Lond., Medical Officer and
Public Vaccinator for the Frimley District.
Bobinson, E. M.D.Edin., C.M., Medical Offioer for the Frensham
Sanitary District of the Farnham Union.
Taylor, Frank E., M.A., M.B., M.Sc.Vict., M.B.C.S., L.B.C.P.,
Assistant Resident Medical Officer to Queen Charlotte’s Lying-
in Hospital, London.
Tetley, t. W., M.B.C.S., L.B.C.P., a House Physician to the
General Infirmary at Leeds.
Thuhnell, H. L., L.R.C.P.Lond., M.B.C.S., Medical Officer for the
Gravesend Sanitary District of the Gravesend Union.
Wilkin, G. C., L.R.C.P.Lond., M.B.C.S., Medical Officer for the
Second 8anitary District of the leovil Union.
girths.
Colbeck.— On Sept. 5th, at Porehester Terrace, Hyde Park, W.,
the wife of E. H. Colbeck, M.D.Contab., M.B.C.P.l/ond., of a
son.
Wabren-Davis.— On Sept. 5th, at Dorset Square, the wife of John
Warren-Davis, M.B.C.S., L.S.A., of a son.
^Carriages.
Bennett—Dkaxin.— On Sept. 7th, at St. Peter’s Church, Dulwich
Common, William G. Bennett, LL.B., M.B.C.S., L.E.C.P.Lond.,
youngest son of William Bennett, of Worcester, to Jessie, only
daughter of W. H Deakin, of Worcester.
Blompibld—Miles.— On Sept. 5th, at St. Nicholas Church, Sutton,
Surrey, Alfred Bealy Blomfleld, M.B.C.S., L.B.C.P.. L.8.A.,
third son of Josiah Blomfleld, M.D., F.B.C.S., of Peckham. to
Ellen Mary (Nellie), only daughter of John Frederick Miles,
Esq., of 8utton.
Dashwood-Howabd—Betts.— On Sept. 6th, at St. James’s Church,
Hampton Hill, S.W., Arthur Dashwood-Howard, B.A., M.D.,
M.B.C.S., L.B.C.P., F.R.M.H., only son of J. Jackson Howard,
LL.D., F.S.A., of Blackheath, Kent, to Melita Margaret, only
daughter of the late Walter Betts, of Gately Hall, Norfolk.
Newton—Adams. —On Sept. 7th, at St. Stephen’s, South Dulwich,
Herbert W. Newton, M.R.C.8., eldest son of the late Bev. M.
A. Newton, to Florence Beatrice, youngest daughter of Frederic
Emilius Adams, of West. Dulwich.
Bussell—Currie —On Sept. 5th, at Stephen’s Church, Edinburgh,
Francis Rutherford Bussell, M.D., Guildford, Surrey, to Mary
Maxwell, second danghter of James Currie, Trinity Cottnge,
Edinburgh.
Brtdkn.— On Sept. 6th, suddenly, at Culm House, Soutlisea (the
residence of his eldest danghter), of gastro-enteritiB, Richard
Bryden, M.R.C.S.Eng., L.A.H.DubL, late of Uffculme, Devon,
in his 89th year.
Hogben.— On Sept. 4th, suddenly, at hie residence, Strathmigh,
Fifeshlre, Edgar Hogben, M.D., in bis 39th year.
Ireland.— On Sept. 11th, at Mavishush House, Polton, Midlothian,
Margaret, the wife of William W. Ireland, M.D., Medical Super¬
intendent.
Taylor.— On Sept. 8th, after a short illness, Alfred Augustus
Taylor, M-B.C.S., L.S.A., of Kingston Hill, Surrey.
v Google
SHe fgWial gms and Circular.
“SALUS POPULI SUFREMA LEX."
Vol. CXIX. WEDNESDAY,
iShriginal (Eommunicationa.
THE “DE NOYO ” ORIGIN OF SJPHILIS.
By JOHN A. 8HAW-MACKENZIE, M.D.Lond.
In the kind notice of a paper of mine (1) in an Editorial
article in The Medical Press and Circular of
June 21st, request is made for further information
regarding my “ casual ” reference to the de novo
origin of syphilis. I would at once point out I used
the term de novo, as I have elsewhere done (2) in the
sense it has been used by various authorities in the
past.—viz., syphilis arising from promiscuous sexual
intercourse apart from transmission.
The origin of syphilis has at all times been an
interesting question. One set of authorities
have contended for the existence of syphilis
from all time; another set for its introduction into
Europe at the end of the fifteenth century, and
another for its de novo origin not only at that time,
but constantly. The former and latter view was
independently advanced by Fergusson, and I more
especially noted the latter as evidenoe against the
“ extinction ” of syphilis in Portugal, as erroneously
in my opinion credited to him. “ That Columbus,”
he wrote, “ should have brought it from the innocent
natives of the Carribee Islands is a fable too weak to
be credited. The first devastations may have been
contemporaneous with his return from the West
Indies: but he found it in the stews of Madrid or
the sea-ports, amidst the unspeakable abominations
of common prostitution in the same way as at an
after period the troops under the miseries and
privations of the siege of Naples, where the
women who followed the camp must have
been of the moet abandoned and revolting
description, adopted the belief of its having originated
there. In fact, 1 believe, with my friend,. Mr. Guthrie,
that whenever prostitution is foul and unclean,
restricted to few women amidst crowds of men,
there the infection will be generated which after¬
wards spreads through society at large.” (3; “ It
would be altogether foreign to the scope of this
work,” wrote Erichsen, “ were I to enter into the
very curious and interesting question as to the origin
of syphilis, a subject that admits of much dispute,
and which has been keenly argued. After an atten¬
tive examination of it I think there can be little
doubt that syphilis was either introduced into Europe
or originated there de novo towards the end of the
fifteenth century. . . (4)
Holmes Coote supported largely the de novo origin,
while Acton opposed it. “ I may at once state my
opinion,” wrote the former, “ that gonorrhoea and
syphilis are co-existent with promiscuous sexual inter¬
course as practised by the inhabitants of Europe, i.e.,
where one woman receives several men They
scarcely exist among the inhabitants of. the East
where the practice o? polygamy is universal, unless
SEPTEMBER 20, 189 9. No. 12.
indeed it has been introduced, as is the case in our
Indian possessions by the formation of large military
depdts or the construction of cities. The conditions
necessary to call forth the venereal disease seem to be
the same universally, namely, large assemblages of
men with an inadequate proportion of females.
“In 3855 I was stationea for a few months in
Smyrna, and was struck at once with the rarity of
venereal disease—the same was noticed by me when
visiting other places in Anatolia—of syphilis I saw
nothing among any of the inhabitants. It appears
then whenever large numbers of men are so piaoed
that one female has connection with several of the
opposite sex within the twenty-four hours for any
length of time gonorrhoea and syphilis both beoome
common. As regards the first, to which Mr. Acton
has applied the term 4 non-specific,' its spontaneous
origin is admitted. Once developed it may be pro¬
pagated by contact. Upon the question of the origin
of the syphilitic virus there exists the greatest differ¬
ence of opinion, and Mr. Acton hesitates to admit
its spontaneous origin, ‘ All the experiments
made to produce it de novo have completely
failed, and a careful investigation of the disease
shows, on the contrary, that it has been
contracted from a person who has himself con¬
tracted it from another person.’ Now I know of no
series of experiments which any person has tried or
would like to try, even if he had the power to ascer¬
tain this point. Let us for a moment consider the
career of the female from whom a healthy man
contracts a syphilitic sore. Originally virtuous, and,
perhaps, an object of admiration, she receives as many
men during the day as she can bear for the purposes
of maintenance. Many of the lower order of prosti¬
tutes have informed the sister of the ward under my
care that they have admitted seven or eight men a
day, and perhaps even more. . . . It is, I presume,
under circumstances like these that the source of the
syphilitic virus must be investigated. What proe*
then have we that it is not generated every day, and
wherefore should we revive the hypothesis of Van
Helmont, who attributed syphilis to farcy, trans¬
mitted from the horse to the human being, until we
have clearly ascertained that none of our social habits
are in fault ? . . .
“ About ten miles from a station in Asiatic
Turkey, to which I was appointed in 1856, was a
large encampment of native cavalry in the pay of the
British Government. I knew several of the medical
officers, and was informed by them of the frequency
among the men of primary venereal sores about the
anus. The mode of communication may be under¬
stood without description; the vitiated habits of
Orientals have not changed since the days of Cyrus.
But the question arises, Whence came the poison P
Was it introduced by someone who contracted the
disease from a female ? This is the moet ready solu¬
tion of the question; but then it is destitute of proof,
and tlje difficulty of aocess to wonjen in the East is
proverbial. - '■ -
Digitized by CjOO^Ic
292 The Medical Pbkss.
ORIGINAL COMMUNICATIONS.
Sept. 20, 1899.
“ Dr. Gordon, surgeon, late of the 57th, now of the
10th, has shown in an interesting pamphlet not
only that the relative prevalence of different forms
of local ulcers varied according to the station of the
regiment; but from the circumstance of the
Hunterian chancre being most abundant in large
garrison towns in England, such as Chatham, Canter¬
bury, and Dublin, it may be presumed that the filthy
habits of the prostitutes of such stations had some¬
thing to do with the prevalence of this form, which
is the most severe. . . . The prevalence of the
severer forms of sore in densely crowded cities
implies a power of aggravation of the virus through
the deplorable habits of the female. Now if it could
be proved that the poison remained under all circum¬
stances the same, and that increase in its activity
was due to its working upon a constitution on the side
of the man impaired by excess, no particular infer¬
ence already unacknowledged could be drawn. But if
on the other hand it can be shown, as Dr. Gordon’s
statistics seem to prove that the poison may acquire a
positive increase of virulence through habits of excess
in promiscuous intercourse by the woman, I see no diffi¬
culty in imagining, that this is the source whence
the poison may have originated from the beginning;
that Nature has established laws, the transgression
of which is followed by vitiation of the natural secre¬
tions producing poisons capable of acting upon the
human frame in the same wav as the decomposi¬
tion of vegetable matter will produce the mias¬
mata.
“ I admit that the propagation of an unsound
hypothesis is injurious, by diverting the mind from
proper inquiry and by satisfying those who are easily
captivated. We have no other course open, therefore,
than to suspend our judgment whatever may be our
bias, and to admit no new statements unless sup¬
ported by recent investigation and the observation of
facts.” (5)
Acton, in opposition, relies on absence of well
authenticated facts as opposed to convictions and
errors in diagnosis in cases resembling syphilis of
apparently spontaneous origin; he further adduces
the case that came under the care of M. Rossignol
in his Aper$u of the St. Lazare Hospital. It is the
case of a young girl who had connection forty-seven
times in twenty-four hours. No specific disease was
found, but considerable inflammation, which soon
abated by rest, antiphlogistics and low diet. If ever
there was a case he argues, “to produce specific
disease from excessive copulation, surely this
was one.” On the other hand, he quotes
Carmichael : “ From these circumstances we should
be led to conclude that mild forms of disease are
eternally arising from the sexual intercourse
of even pereons in health, and I have so often seen
troublesome ulcers arise in men who had connection
with women above suspicion, while they had on them
at the same time crops of herpes pneputialis, that I
feel the more confirmed in this opinion.” Acton
agreed that excoriations, physically indistinguishable
from chancres might arise. “ We must, however,
frankly admit it,” he goes on to say, “ that in the
present state of science it is impossible to determine
when or under what circumstances the virus and its
effects first appeared ; indeed, the origin of this as of
a thousand other facts is entirely concealed from us,
patent though their existence is. My own opinion is
that syphilis in the human race originally arose from
some poison introduced into the economy from
animals or decomposing animal matter, and thus pro¬
duced, it has been transmitted from one individual to
another.” (6)
Wallace, of Dublin, stated that he was con¬
vinced that no unprejudiced person can consider the
subject without arriving at the opinion that the evi¬
dence of introduction of venereal disease from Americas
into Europe is quite inconclusive; that they have co¬
existed with the earliest era of human society, that in
the Irish annals of an earlier date by many centuries
than the discovery of America, mention is made of a
disease by the name of Bolgach Francach r *which
signifies a French eruption of pustules, and this is
the name by which the venereal disease is at present
designated in Irish; that the pustular primary and
secondary manifestations of syphilis are the original
forms, and would in all probability have long ceased
to exist if it had not been generated anew. He
denied that the venereal disease had undergone
changes in the course of centuries, but that
“its nature is the same as it has ever been,” and
while admitting severity due to bad treatment he also
demonstrated from clinical observation and inocula¬
tion experiments the modification of syphilis by
transmission and propagation, and concluded that
“the venereal poison is from time to time repro¬
duced, and consequently that if all the venereal
poison existing in the world was at this instant anni¬
hilated, the promiscuous intercourse of the sexes or
other circumstances would quickly lead to its re¬
newal ” (7).
Erichsen and others have noted the absence of
constitutional symptoms in the records of contagious
ulcers arising from sexual intercourse previous to the
descriptions of disease at the end oi the fifteenth
century, when it was looked upon as a new and
previously unknown affection. “ If it (syphilis) had
previously existed in the Old World in a mild or
modified form different from what we now observe,
it is certain that about this time it suddenly assumed
greater intensity, all its symptoms being aggravated
in a remarkable and fearful manner, presenting
characters which had not been previously alluded to,
but which have often been reproduced in modern
times; as, for instance, in those severe forms that
were observed in the British armies during the
Peninsular war, and according to Larrey, among the
French troops during Napoleon’s German campaigns.”
The same aggravation of pre-existing modified
syphilis may be adduced in the testimony regarding
syphilis in China. It may of course have originally
been introduced into this country, though it would
appear that it had existed there from time imme¬
morial, and “ as if China had undergone for thousands
of centuries a kind of general syphUisation which has
progressively attenuated the virulence of the infec¬
tion in the organisms affeoted by it.” Nevertheless
“ the venereal affections contracted them by
Europeans assume a character of acuteness and
severity disproportioned to the symptoms experienced
by the Chinese.” (Armand).
I regret that I have no facts to record from
my own personal observation in proof or disproof
of the de novo origin of syphilis. At the same time,
while admitting the alternative views of introduc¬
tion and aggravation into fresh countries, and of
reactivity of pre-existing modified syphilis in epi¬
demic form, it seem8 to me impossible to ignore the
impressions of passed authorities in favour of the
de novo origin of syphilis in Europe at the end of the
fifteenth century, and in later individual cases. At
the present day, while entertaining the microbic
theory of syphilis and transmission, there is not, as
far as I know, any proof that such germs may not
originate also in promiscuous intercourse, retained
and decomposing seminal and genital secretions in
the woman, or by admixture of different virus; that
the virus of local disease may be aggravated into the
infecting; or that non-pathogenic organisms in the
parturient canal may become pathogenic. In the
case of gonorrhoea I have elsewhere ventured to
Digitized by Vj
oogle
Skpt. 20. 1890.
ORIGINAL COMMUNICATIONS.
The Medical Pbbss. 293
express the doubt as to the acquisition by transmission
of the gonococcus in certain cases in women. However
speculative this may be, it is admitted in cases
of vmlvitis in female ohildren and in pyosalpinx of
virgins in which the gonococcus has been present,
acquisition has not been demonstrated, but has been
hypothetically assumed by extra-genital or genital
transmission. “ All contagions, all morbid poisons
must have had an origin. We cannot presume that
they have existed from the beginning; for, as Mr.
Hunter observes, animals are not naturally formed
with disease, or so as to run spontaneously into mor¬
bid aotions, and it is not in opposition to the general
laws of Nature to infer, that if a morbid poison has
commenced at one period from the concatenation or
combination of its essential causes, it may also com¬
mence in a similar way at other periods. On the con¬
trary, such a supposition is in perfect unison with
daily occurrence; for do not certain contagions fre¬
quently spring up, and again die away from combined
causes whose mode of action we are not always able to
appreciate P " (8)
Bibliography.
(1) "The Influence of Climate and PI ice over Syphilis.” The
Journal of Balntolooy and Ctimatologv. April, 1809.
(2) " Syphilis in the Army.” Thr Medical Press and Circular.
February 22nd, March 1st, 1890.
(3) “ Notes and Recollections of a Professional Life.” P. 122.
(4) “ The Science and Art of 8ur&ery." P. 844, Vol. L, Ed. VII.
(5) “ Ou Svphilis.” Chap. I.
(6) “ On Urinary and Generative Organs.” Pp. XXIV., 259, 278.
(7) " Lectures on the Venereal Disease.” The Lancet. 1836.
(8) “A Treatise on the Venereal D i sea s e. ” By W. Wallace. 1838.
Note.—Since the above was written it is interesting to And that in
the case of a common cold Sir Douglas Powell, in his address in
medicine at the British Medical Assodation meeting at Portsmouth,
emphasise* the conversion of quiescent pre-existing organisms Into
virulent and highly contagious ” under the stimulus of a momentary
chill at an open door or a wetting that would fail to affect us on the
mountain side,” and Dr. Burney Yeo on “ Intestinal Antiseptics ”
notes that “ the bacillus coli is a normal inhabitant of the intestine,
and under ordinary circumstances is harmless.'' Under various
conditions, however, it takes on virulent action.
ALCOHOLISM AND EVOLUTION.
By E. MacDOWEL COSGRAVE, M.D.Dub.,
F.R.C.P.I.,
Professor of Biology, B.C.8.I., President Irish Branch (Central) 1
British Medical Temperance Associati
The abstract of Dr. Reid’s article on Alcoholism
in Its Relation to Heredity,” published in the
Medical Press and Circular, of September 6th,
displays a chain of argument apparently intended to
inculcate a “ let it slide ” attituae towards intemper¬
ance, handing on its treatment and correction to the
slow workings of evolution. The chain, however,
seems to have weak links, and the object of this
paper is to point out some of these weak spots. In
order not to misrepresent the author, bis paragraphs
are given verbatim, but the points of criticism will be
better appreciated if read with the entire abstract.
“Every drunkard baa in his nature a marked
capacity for enjoying aloohol, and in addition to this
a keen memory of the delights conferred by previous
acts of drinking. The primary capacity for enjoying
alcohol is an inborn factor, and thus, in harmony
with the teachings of biological theory, it may be
transmitted. The other element, however—viz., the
keen memory of the delights conferred by acts of
drinking—is a later trait, an acquired character, and
this cannot be transmitted to the offspring of the
drunkard.”
As a matter of common experience many people
live for years taking alcohol in moderation because
it is the custom to do so, without experiencing a
marked capacity for enjoying it, and yet afterwards
develop into drunkards. We see this often in the
case of women who, when they get out of health, j
increase their quantum in order to shake off lassitude
and sickness; in doing so they often justify Sir
B. W. Richardson's aphorism—” Those that rely on
alcohol are lost.” The keen memory of the delights
conferred by previous acts of drinking is not as con¬
stant as Dr. Reid think s; it is more often the
awakening to unpleasant reality of aohing head,
sick stomach, and depressed nervous system that
causes a craving for another dose of that which
gives temporary oblivion to physical and psychical
distress.
“ Some men are abstainers or are temperate be¬
cause their innate desire for drink is small or prac¬
tically nil. Others, per contra, relish drink so greatly
and crave it so greedily because, having once had
experience of it, a very intense pleasure is felt and
strong desire experienced. It is from the ranks of
the latter that the army of drunkards is recruited.
Between these two extremes are all shades of
drinkers.”
Here again is justification for temperance work; if
the latter class are kept from having experience of
it by being brought up abstainers, tne strong desire
will not be experienced. Again, in the intermediate
group of all shades of drinkers are many who will
gravitate to one or other extreme according as the
strength of attraction varies. Drawing to the army
of drunkards are the drinkshops, the drinking cus¬
toms of society, &c.; is it not well that temperance
organisations and counter-attractions should do a
little pulling on the other end of the rope ?
“This shows that the effects of intemperance as
aoquired by ancestors are not transmissible, for were
it the case then the constant accumulation of such
effects, generation after generation, would render the
raoe that had longest used drink the most inclined to
drunkenness.''
Dr. Reid here neglects the automatio action which
avoids this increased inclination to drunkenness; in
this the sins of the fathers are visited on the children
to the third and fourth generation—and no farther,
for by that time the race has died out, and so by
natural selection there is a. constant reversion to a
more sober type. It is, of course, a matter of com¬
mon knowledge that the transmission of acquired
characters is not proven, And so inebriety is probably
not handed down; hut as Dr. Sims Woodhead lately
said, “ The taste for aloohol is not transmitted, but
the disposition to yield to its influence.” The off¬
spring of inebriates inherit weakened vitality and
so are subject to vicious example, and when in
sickness or sorrow they have recourse to alcohol,
and find it gives temporary alleviation, they
learn to rely on it, and easily become drunkards.
This is not handing down an acquired tendency,
but it is more than an acquired character.
“The temperanoe reformer’s plan of abolishing
drink is not tne true method of reform. Were such
a procedure to come into force for a time the result
would be that the nation now removed from alcoholic
selection would revert to the ancestral type in which
the tendency to excessive drink was greater, and
directly the opportunity recurred would drink almost
to extinction, like savage man unacquainted in the
past with alcohol.”
This argument has often been brought against the
attempts of sanitarians to prevent infectious diseases.
Measles introduced by sailors has devastated the
native population of islands on which it was pre¬
viously unknown. We are trying to bring up our
people free from measles. Sometime measles will
be re-introduoed and then it will devastate the popu¬
lation—such was the argument used, yet, in spite of
it, sanitarians are labouring to prevent measles, and
in spite of Dr. Reid’s arguments, sanitarians will try
to prevent drunkenness. If Dr. Reid's proposition i»
time, the way to get rid of small-pox would be W
return to universal inoculation and so give evolution
C
294 The Medical Press.
ORIGINAL COMMUNICATIONS.
the best chance of separating off a race for whom small¬
pox would hold no terror.
There is good reason to think that the reverse of
this proposition holds good, and that abstinence from
drink for some generations would lead to such an
improved standard that intemperance would be less
likely to follow the re-introduction of drink. Indeed,
we have a proof of it if we take the individual as
following out the history of his race; those who
abstain until they come to the age of 20 or 30, com¬
paratively seldom become drunkards. By Dr. Reid’s
theory, the tissues kept from alcoholic selection
ought to show an increased tendency to drink to
excess.
Another reason why an appeal to evolution is use¬
less is that we have not only to deal with black and
white, but with intermediate shades. If excess in
drink killed, and all those that survived were healthy,
there would be some grounds for a policy of non¬
interference ; but some who drink more than is good
for them do not die off, and have wives and families
depending on them, and depending unsuccessfully,
for the housing, feeding, and clothing necessary for
healthy lives, so even when the drunkard dies, lives
wrecked by drink remain.
Evolution has the further disadvantage of working
for posterity and doing nothing for the men and
women of our day; and though the exhaustion of the
coalbeds and of the atmospheric air are important
questions, we give them but languid interest, knowing
that there is is enough coal and air to last our time and
to supply our younger friends. Temperance work has
the decided advantage that, whilst it may trouble
posterity and worry evolution, it certainly helps those
of the present. The pressing questions are how are we
to reclaim existing drunkards, how are we to stop the
manufacture of new drunkards ? Temperance
workers may not be adopting the best plars, but
they are the best they know, and they are much
better than allowing the present evils to go on un¬
checked waiting for a far distant and problematical
improvement.
INDICATIONS FOR CESAREAN SECTION
AS COMPARED WITH THOSE FOR
SYMPHYSIOTOMY, CRANIOTOMY, AND
PREMATURE INDUCTION OF LABOUR.
By Professor LEOPOLD,
Dresden.
In the following paper, which was read at the Inter¬
national Congress of Obstetrics and Gynsecology last
month in Amsterdam, and furnished by “ Our Own
Correspondent,” the author makes a very exact clas¬
sification of the various degrees of pelvic deformity
and distinguishes between the cases of primiparous
and those of multiparous women. Three degrees of
contraction ought to be distinguished:
1. The conjugata vera is more than 7 centimetres
in the contracted nonrachitic or rachitic pelvis, more
than 7£ centimetres in the justo-minor pelvis.
2. The conjugata vera is less than 7 —7$ centi¬
metres, but more than 6 centimetres.
3. The conjugata vera is less than 6 centimeters.
In the first group primiparse generally have a
tolerably good labour. The method of proceeding
consists in preserving the membranes and waiting.
The contraction in itself makes no demand on opera¬
tive treatment. When the membranes are ruptured
the colpeurynter may be introduced or the descent
of the head may be facilitated by placing the woman
in Walcher's position. With care and patience many
useless and dangerous operations can be avoided.
When the head does not enter the pelvic brim—
perhaps on account of a bad presentation (the case
Sept. 20, 1899.
approaches the second group)—a distinction is to be
made between cases treated m hospital and in private
practice.
In the hospital, Prof. Leopold does not hesitate to
perform the Caesarean section when all other means
nave proved useless and when mother and child are in
good condition. When the child is in danger he prefers
craniotomy, certainly the only legitimate operation
when the child is dead.
In home practice craniotomy is the only indicated
operation when the head is retained by a pelvis too
narrow to allow the passage of a living child. Though
Pinard has given as his opinion that “ craniotomy
of the living child ought never to be performed ” and
that “ embryotomy of the living child is condemned,”
Prof. Leopold, appreciating the ideal view taken by
the celebrated French obstetrician, agrees with
Charles (of Li£ge) “ that it is not easy to act up to
these rules.” Doubtless the craniotomy of the
living child ought to be avoided as much as possible,
and an operation, inoffensive for the child, ought to
take its place, but in difficult cases in private practice,
craniotomy, which saves the mother, is preferable to
Caesarean section or to symphysiotomy, which give
a considerable maternal mortality.
In the third group Csesarean section alone is indi¬
cated, forceps and version being impossible, and the
extraction of the child after perforation, even after
symphysiotomy, being very difficult, if not counter-
indicated. With multipane the difficulties of labour
are greater because of the greater weight of the
foetus and the lesser intensity of the contractions of
the uterus and the abdominal walls.
In private practice the premature induction of
labour, either by the bougie, or by the intra-uterine
bag, is and will be the choioe operation in the
pelves of the first group, notwithstanding the bril¬
liant results of Caesarean section and of symphysio¬
tomy. With the use of the bougie, the place of in¬
sertion of the placenta is to be taken into considera¬
tion. The converging or diverging of the Fallopian
tubes and the round ligaments enables us to ascer¬
tain this place, and the bougie ought to be intro¬
duced in that uterine part which is opposite to the
insertion of the placenta. During labour, rupture of
the membranes has to be avoided and the descent
of the head to be assisted, for in premature labour the
prognosis of head-presentations is far better than
that of other presentations. By the aid of Walcher’s
position the conjugata vera is widened from J to 1
centimetre.
The results of premature labour are very satisfac¬
tory Many obstetricians have noted from 60 to 80 per
cent, living children, the mother leaving the hospital
the eleventh day. In private practioe the difficulty
for the obstetrician is to determine the stage of
pregnancy, the exact pelvic mensuration, and to
obtain all that is necessary for the child (conveuse.
nurse, &c.). A good deal of the bad results are due
to such precautions being neglected. When the
accoucheur is called and labour has begun with a
multipara of the first group, above all things rupture
of the membranes must be prevented, the oolpeurynter
must be introduced, and tnen wait for complete dila¬
tation. If at that moment the membranes are intact.
Prof. Leopold prefers the podic version followed
by the extraction, facilitated by the enlargement
obtained by Walcher’s position. Although by the aid
of complete narcosis, version is not impossible some
hours alter the rapture of the membranes, the results
for the child are still a good deal lees favourable, the
difficulty or even the impossibility of version necessi¬
tating often dangerous operations.
In the pelves of the second group cianiotomy
should be performed when the child iB dead.
Prof. Leopold prefers also craniotomy to the
other operations when the child iB in danger
oogle
Die
Sxft. 20, 1899.
ORIGINAL COMMUNCATIONS.
or the mother exhausted or ill. When the child is
in good condition, Caesarean section or symphy¬
siotomy can be done in hospital practice (personally
Leopold prefers the first operation).
In private practice these two operations may be,
now and then, preferred to craniotomy, when the
obstetrician is very skilful, and has sufficient
assistance, and when the woman is in very good con¬
dition. In the third class of pelvis. Caesarean sec¬
tion is the only operation indicated, alike for primi or
multipart, symphysiotomy being forbidden by the
excessive contraction of the pelvis.
Conclusions.
I. Before term. —When there has been one or more
difficult labours caused by pelvic deformity, prema¬
ture induction of labour is indicated when the pelvis
is not too much contracted (conjugata vera more
than 7 centimetres in flattened pelvis, more than
7i centimetres in the justo minor pelvis). The best
moment for intervention is the tnirty-fifth week of
pregnancy. Good results are not to be expected
unless the membranes remain intact and there is a
head-presentation.
II. At term. —Craniotomy is indicated: a. When
the child is dead and labour does not ad¬
vance, even when the pelvis is only slightly
contracted. b. When the child is in danger,
the contracted pelvis being an obstacle for spon¬
taneous birth, foroeps and version being too dan¬
gerous or impossible. This rule is valuable equally
for hospital and home practice. The danger for the
mother is too great to risk Ctesarian section or
symphysiotomy when it is not quite sure that a living
onila will be bom. c. When the child is in ptrfect con¬
dition, craniotomy will be performed only as an excep¬
tion in hospital practice. But in private practice it
is indicated when spontaneous birth, forceps and
version are excluded and the termination of labour
is necessary, the obstetrician, all circumstances duly
considered, regarding Caesarean section or sym¬
physiotomy too dangerous. The conjugata vera must
be more than 6 centimetres.
In exceptional cases, when for private reasons it is
important that the child is bom living, should it be
only for some minutes, the advice of a colleague is to
be asked and the family of the woman is to be
acquainted with all the dangers accompanying the
operations by which the child can be saved.
The Cmsarean section has absolute or relative indi¬
cations. In pelves with a conjugata vera of 71—
6 centimetres the indication is a relative one. When
this diameter is less than 6 centimetres the indication
is an absolute one. Ceesarean section on relative
indications requires the fulfilment of the following
conditions: a spontaneous birth being impossible,
foroeps and version inadmissible, the child in perfect
condition, and the woman either in a hospital or in
circumstances quite as favourable as to the operation
itself and as to subsequent nursing.
When the circumstances are not favourable enough,
craniotomy of the living child is to be preferred.
Symphysiotomy is only indicated in pelves with a
conjugata vera of 71 to 61 centimetres; the indica¬
tions are therefore much more limited than those of
Caesarean section and do not all regard the pelves
of the second class. With this restriction sym¬
physiotomy may compete with Ceesarean section on
relative indication, and requires the same conditions.
When these conditions are not fulfilled, craniotomy
must be performed.
The choice between symphysiotomy and Caesarean
section as relative indication depends on the experi¬
ence of the operator. The results of both operations,
performed under the same conditions, are almost
equal for the mother as well as for the child.
_ The Mkdical Press 295
MONISTIC PHYSIOLOGY.
By W. R. MACDERMOTT, M.B.,
Poyntr Paw, Newry.
“ A knowledge of Nature—more exactly scien¬
tific knowledge or knowledge of the physical world
with the help and in the sense of theoretical natural
science—is tne reduction of changes in matter to the
motions of atoms, motions effected by the intrinsic
forces of the atoms independent of time or otherwise,
the resolution of natural events into the mechanics
of atoms.’’
By a coincidence in the mechanics of cerebral
atoms, this passage from du Bois Reymond’s address,
“ Ueber die Grenzen des Naturerkennens,” is not
only quoted, but made the text of two recent works,
Prof. O. Hertwig’s “ Mechanik und Biologie,” and
Prof. Verworn’s “ General Physiology.” (a) The last,
which I only know from Prof. Lee's translation,
strikes me as of interest to us as showing the lines
on which medical science must go in future, in
detail at least. For instance, of what significance to us
must appear the experiments of Demoor, which show
that while the protoplasm of the cell is paralysed by
chloroform narcosis the movements and functions of
the nucleus appear undisturbed, and yet the nucleus
is held by some to be the brain or regulative organ
of the cell. The book abounds all through with facts
and reasonings like this of immediate bearing in
medicine.
It is well that general physiology and therefore
medicine has a nucleus which somehow escapes the
theory narcosis to which its environment is suscep¬
tible. It is Prof. Verworn’s argument in his earlier
pages that physiology is paralysed by the mechani¬
cal theory of which be takes du Bois Reymond as
the exponent, an author who writes not only
ignoramus but ignorabimus against the question
of vital economy. If the reader skipped these
earlier pages and read the technical part, the bulk
of the hook, he would find that Prof. Verwom
systematically explains all vital phenomena by known
mechanical principles, leaving no place for proper
mental operation in the cell or organism. He would
be at a loss in such case to distinguish the issue
between his author and du Bois Reymond, or if he
did recognise it might, irreverently, perhaps, under¬
estimate its importance. One of these writer*,
Yerwom, is alive, and, Hibemice, I cannot resist the
opportunity of wishing him a long life; but he is
evidently a skilled thinker and dialectician, and I dare
much to paraphrase his meaning. Nevertheless,
brevity compels me to do so, referring the reader to
his book for hie own words.
In du Bois Reymond’s view, the oell organism or
any physical item is taken as a real thing in itself,
the operations in which it plays a part being inde¬
pendent of the operation whereby we know them,
which is another real thing in itself. From Pro¬
fessor Verwora’s standpoint, on the contrary, the only
real thing is the thing as we know it, subject to the
conditions of knowing, is an idea. “ Beyond my own
mind I cannot go. My own individuality, indeed, is
only an idea of my mind, and therefore I cannot
finally say the world is my idea, but I must
say the world is an idea, or a sum of ideas,
and what appears to me as my individuality is only
a part of this complex of ideas, just as is the indivi¬
duality of other men and the whole physical world.”
In one view the physical world, or, to take a par¬
ticular, a man’s pnysical being, determines the idea
of that being which otherwise would not even occur
to us. Without an objective ontological base an
(a) “ General Physiology.”
London: Macmillan. 1890.
By Mai Verwom, M.D., Ph.D.
yGoogle
296 Ths M.dioal Pas as. ORIGINAL COMMUNICATIONS.
Sxpt. 20, 1890-
ideal base in ourselves would give no representation
There are many forms of this opinion, one of which,
monistic materialism, i.e., where consciousness is
taken as the product of the physical base, is popularly
thought to be the settled creed of medical men. Our
attitude, however, is one of eclectic agnosticism, that
of innocent lambs who do not think of the thing at
all. There are reasons, however, as I shall end by
showing, tending to force us to forego that easy
going attitude. What from Prof. Verworn s view is
toe meaning of physiology, the base of medical
science P It is an ideal science valid only as such, its
statements purely mental and expressing truth,
reality, causality, through the condition only of
mental operation, the operation of my own mind
which I cannot go beyond.
What I think about in physiology, he may be
taken as saying, are the contents of my own mind in
which alone the idea of connection, causality, inter¬
action exists. “The idea of the physical world is
only a product of the mind, and with the alteration
of an old sentence of the sensualists, it can be
said: Nihil est in univerao quod non antea fuerit
in intellectu .” Our problem “consists not in ex¬
plaining psychical by physical phenomena, but
rather in reducing to its psychical elements
physical like all other psychical phenomena.
Every process of knowledge, including scientific
knowledge, is merely a psychical event; science deals
with metaphysics as in accordance with an ancient
and unfortunate manner of expression it is customary
to term it, and science cannot exist without meta¬
physics. This fact cannot be banished by the method
of the ostrich.’’ Again, “ the sole reality is our mind
and all phenomena are only its contents; explana¬
tion, therefore, consists simply in the reduction of
all psychical phenomena to their elements. In this
sense all science, and, in general, all knowledge, is in
the end psychology. We thus come to the only con¬
sistent standpoint, monism, the unitary view of the
world, whioh seeks to derive all phenomena from a
single cause. *
The proof of all this is rested on the statement
that we have created our knowledge of the physical
world by sense-peiception. “ This is clearest in
persons who are born blind and have built up their
physical world through hearing, touch, &c.” When
made to see by a surgical operation they do not
recognise an object known by touch, a ball for in¬
stance seems something quite, new, and only when
they touch it do they realise its identity. “ At that
moment a new world begins to rise in them.”
I have given Prof. Verworn a fair half of the space
I can take, not enough indeed, but must reserve the
remainder for what will occur to men who want some
base for the study of what is called mental disease.
If only because we see a man’s own mind so often
in an abnormal state, so prone to aberration, weak¬
ness, and decided disease we would hesitate
to take it in a rigidly individualised sense
as the single self-sufficient source of causal
law and governing power. Like most men
who think at all, we sum ourselves as creatures, if
not playthings, of circumstance, and assign to the in¬
dividual mind the subordinate function of metabolism
—accommodation from instant to instant to a .play
of circumstance in general beyond it. The circum¬
stances under which individual minds act, and the
capacities of accommodation of these minds to cir¬
cumstance are> so variable that we habitually reject
the individual mind, the mental atom, as the essential
element in thought. When Professor Verworn
speaks of the contents of the individual mind, we
think of an empty vessel, with a peculiar shape and
capacity of its own. which determines what it will
hold and how it will hold it, but its contents are put
into it. This does not quite mean Locke’s
sheet of white paper, but it does menu , . that
we have no right to reason about the con¬
tents of our mind .as . its own product and
property. Farther while some small part of our
ideas come into our minds as air into our lungs a
large part of them we would say come to us not from
single minds but as the elaborated product of a
series of minds. The evolutionist would generalise
this statement so as to include a pre-mental stage,
and, if not a psychomonist of Professor Verworn a
type, of distinctly physical nature. Again we prac¬
tically hold in our professional view that mental
health depends on mental metabolism, on the stream
of incoming impressions and ideas being assimilated,
and dissimilatea to use the terms we find here, in
which process we believe that the ingested materials
often prove to individual minds undigeetible or
poisonous, and are often rejected as Professor
Verworn rejects the ideas of du Bois Reymond’s
school.
As the contents of the individual mind are foreign
in bulk to it as mind so the contents of each separate
idea are foreign to it as idea. Reasoning from idea
as idea per se is obviously invalid. An idea must be
an idea of something, and for fundamental ideas we
cannot go beyond what each affirms in mind as its
something. If idea affirms itself of idea, of mind,
we must accept its affirmation, and when it affirms
itself of not-idea, not-mind, we must equally aocept
the affirmation. An idea separated from what it is
an idea of, is incomprehensible to us, and denying its
affirmation on the grounds that it is mental invali¬
dates all mental determinations. The conception of
idea apart from object on which Prof. Verworn rests
is a conception which has no plaoe in the contents
of mind. But since idea affirms itself of idea as
object we really have ideal scienoe, a science
of ideal objects. Prof. Verworn cites mathe¬
matics, but mathematics is only a branch of
the scienoe of language, of expression of idea. In
language, perfectly arbitrary symbols are assigned
to ideas, but just because these symbols are common
to numbers of men assigning the same meaning to
them, they evidently compel numbers to think in'the
same way, that is, collectively, not individually. 11
is language, including mathematical or arithmetical
language, that supplies the bulk of the oontents of
individual minds. A man thus cannot take idea
apart from object, and, unable to claim ownership of
the contents of his own mind, he must go behind his
own mind and inquire where they came from.
From sense-perception. That only means that the
vessel is empty, and has capacity for holding what, is
poured into it - or not holding it. Moet of us would
say that without sense-perception we would have no
knowledge, and with it alone we would still have
none. Our mental, like our bodily, food has to
undergo an organic process outside, and independent
of us, before we can assimilate it.
My fragment of criticism of Professor Verwom’s
psycho-monism must conclude with the objection
that it is in opposition to our views of the nature and
treatment of insanity. We hold that a man not only
can but dees habitually go beyond his own mind,
can and does correct mental error arising through
defect in his organisation. The simplest illustration
is where he wears spectacles to oorreot imperfect
sight, but it is the same when he takes oounsel with
friends and submits his mind to theirs. He might be
weak-minded if he carried this too far, but he would
be insane if the mind and judgment of others had no
value or weight with him. The insane treat them¬
selves—for they often treat and cure themselves— by-
acting on this principle of realising and deferring to
the mind of others and to the force of circumstance -
We should allow no theory to obscure a principle of
such utility.
oogle
8ipt. 20, 1899.
ORIGINAL COMMUNICATIONS. Th* Midicax Fbiu. 297
This leads to another position which I think we
would stick to. The true response of healthy mind to
disease is recognition, representation of the disease.
When a man is mad there is true mental representa¬
tion of a disordered physical state; his mind would
really be mad if it gave the normal response. A per¬
son oolour-blind is mentally sane exactly because he
is oolour-blind; a madman suffering from rapid
succession of incoherent ideas is sane from the
point of view that his mind truly represents a state of
object, a cerebral storm. Many of us would hesitate
toaooeptthis purely dualistic conception of mind and
body, tnouph the observation of tne phenomena of
compensation in injury and disease of the brain is
forcing us to adopt it. For my part I believe our
ultimate position snail he that there is immediate pre¬
sentation of all physical state in mind, and not merely
mediate presentation through nerve state; the last
I take, as much dead object to mind as a telegraphic
system, deriving its mental importance from its value
as bodily function.
But practically we allow no theory, and should
allow none to obscure the distinct and useful impres¬
sion that we are dealing with two separate factors in
a patient, one physical the other mental state, each of
which can be controlled or influenced separately.
When bodily disease exists, fortunately as a rule
there is not only true but conscious representation of
it as disease, and in the case of cure mental effort
directed to that end. The number of the insane
would be vastly greater than it is if there was not a
general perception of mental unsoundness due to
personal organisation, and a capacity to travel beyond
one’s own mind to correct it. This mental ability
and effort to transcend personal mind as function of
organisation is at the bottom of more than medicine.
Farther we act on the belief that the physical factor
is capable of control by our minds operating through
physical means, means which usually operate uncon¬
sciously to us. We cure ourselves as we warm our¬
selves, not by ideal operation in our own minds, but
by idea of physical circumstance directed to com¬
mand the object by physical means. One may be
impatient at such an argument as trivial, but the
impatienoe should be witn the occasion for it, a chal¬
lenge to our practical philosophy.
Hugh Miller, in “ Schools and Schoolmasters,” tells
a story of an imbecile fond of snuff to whom mis¬
chievous boys used to give a little in a small deep
can. The imbecile would spend hours trying to get
at the snuff without the idea ever occurring to him
of turning the vessel upside down. We have here
perfect sense perception of object as actually pre¬
sented, but not ideation, which comprehends states of
object contingent and possible though not pre¬
sented. When out of the stores of a richly furnisned
mind Prof. Yerworn displays before us the heritage
of thought, it is to be remembeied that those who
accumulated it acted on the belief that a natural
field existed in which idea and object are distinct
yet inseparable, and that the object in reaction
necessarily forms the idea. The doctrine of psycho¬
monism which challenges that historical base of
knowledge, I think, easily accounts for the imbecile,
but only by a strained and supremely difficult inter¬
pretation for Prof. Yerworn.
OUT-DOOR TREATMENT OF TUBER¬
CULOSIS IN LARGE CITIES.
By DAVID SOMMERVILLE, B.A., MJ)., B.Ch.
The fruits borne by the modern treatment of
tuberculosis warrant the most persevering attention
on the part of the physician, in a large number of
eases formerly left to perish. Almost daily we hear
of the remarkable and lasting effects of the out-door
cure. This cure in essence consists in placing the
patient under conditions in which his vital forces are
so increased that his tissues are enabled to success¬
fully battle with the disease—in short, it is a system
of overfeeding, coupled with an out-door life, in an
atmosphere possessing to the greatest degrees rarity,
dryness, and sunshine.
That some of the Continental sanatoria possess
advantages unattainable in England there is no
denying. Their atmosphere is rarer, dryer, and they
enjoy a larger share of sunlight. The rarity of the
atmosphere compels an increased action of the lungs
in inspiration ; the diminished proportion of oxygen
must oe compensated by a larger intake of air. Per¬
haps the chief advantage of most of the elevated
sanatoria is that they enjoy so much sunlight, a
factor in the life of the organism of the first import¬
ance.
That this treatment can be successfully oarried out
in England is being slowly demonstrated, and even
London, when occasion requires it, can become a
sanatorium. A case that came under my care
recently, adds to the mass of growing testimony in
this direction.
A young man, H. N., set. 21, a native of Ger¬
many, was sent to London to acquire English and a
knowledge of the routine of an English business
house. I saw him in the beginning of April last. He
had then been suffering for more than three months
from repeated “ colds.’" He had always had a weak
chest, and his throat “gave him trouble.” He was
emaciated, weak, and appeared to the most casual
observer quite ill.
On examination, his chest presented typical charac¬
ters of tuberculosis of the lungs. The supra- and
infra-clavicular regions were hollow,- vesicular
murmur at right apex was replaced by fine riles;
signs of consolidation were apparent for some little
distance downwards and inwards from the mid point
of the clavicle on this side. Riles were not heard at
the left apex, but inspiration was ill-defined and of
the cog-wheel variety. Expiration was much pro¬
longed. Sputum was abundant, nummular, streaked
with blood, and a bacteriological examination showed
numerous tubercle bacilli. Haemoptysis at this date
was marked. The pharynx presented a dark-red
congested appearance, relieved here and there by pale
patches. The larynx partook of this congestion to a
considerable degree, the arytenoid folds and mucous
membrane in the neighbourhood of the posterior ends
of the vocal cords exhibiting the same swollen mottled
appearanoe. When we ada to this that an evening
temperature was found elevated to the extent of 1J
to 2 degs. F., there is no doubt as to the nature of the
malady. The pulse was rapid, weak, and very com¬
pressible, average rate 110, but at times very rapid;
on two occasions in the first week of observation it
was found to be 125 and 132 respectively.
My first thought was to send him at once to Nor-
dracn, and accordingly I wrote to his family physician
in Hamburg recommending this course. Cironm-
stanoes prevented his going then, so the next best
thing to do was to work out the Nordrach treatment
in London. In charge of a most capable lady friend,
who devoted her entire time to his care, he forthwith
oommenoed his new life. The daily round consisted
of one or two short walkB in the open air, a certain
amount of driving, according to the condition of the
weather, a rest for half an hour, or longer before each
principal meal, with a superabundance of easily
digested nourishing food.
Two points struck me in the progress of this case:
At first the patient had a very poor appetite and
resented additional food. But on having it plainly
put to him that his life depended on his eating, he
struggled with his meals, and as the quantities of
Google
FRANCE.
Sept. 20, 1899.
298 The Medical Pew?.
various food stuffs eaten increased, the appetite and
digestive ability progressed in like ratio, until in a
few weeks he was digesting well, five pints of milk,
five or six eggs, two large meat meals with milk
pudding, and a number of minor dishes, daily. The
second point is that his circulation improved at a rate
beyond all expectation. Pulse-rate came down to
80, with a corresponding increase in strength, the
dyspnoea that attended at first any little muscular
effort entirely disappeared, and by the end of the
fifth week he had exchanged a condition of great
muscular debility for one of considerable force.
At the end of seven weeks a second bacteriological
examination demonstrated the entire absence of
tubercle bacilli, and the presence of only a few micro¬
cocci. The sputum had greatly diminished in
quantity; the apical r&les had completely disap¬
peared, and the supra- and infra-clavicular hollows
were filling up. The breath sounds were now dis¬
tinctly audible in these localities, and when he
returned to Hamburg at the end of the first week of
June, there was very little abnormality to be detected
on either side of the chest. He had at this date put
on 15 lbs. in weight.
Comparing this case with others sent to Nordrach
I am of opinion that the way in which his friend
managed him in London, in ordering his outdoor
excursions, each with an object, in seeing that daily
the necessary auantity of food was partaken of, and
generally so taking him out of himself that his time
assed in somewhat holiday fashion, conduced more to
is rapid recovery than a corresponding stay at a
sanatorium could have done, especially as he held
such places in disgust from experience previously
had at a noted resort on the Continent. And thiB leads
to the idea that there may be many cases which would
do much better under such separate and agreeable
conditions, than amidst the depressing influences of
a multitude of others in the same condemnation at a
sanatorium.
A somewhat corresponding case in a lady has just
come under my notice, where practically the same
course is being pursued with results that promise to'
be quite as successful.
(Elinkal JRtcorbs.
A CASE OF GUNSHOT WOUND OF THE LEG
SEVEEING THE ANTEEIOE TIBIAL NEEVE.
—SECONDABY SUTUEING TWO MONTHS
LATEE.—EESTOEATION OF FUNCTION OF
NEEVE.
By Philip E. W. de Santi, F.E.C.S.,
Senior Assistant Surgeon and Aural Surgeon to Westminster
Hospital.
An officer of the Indian Staff Corps was on April 8th,
1898, wounded in the battle of Atbara. The bullet
penetrated the outer side of the left leg at the level of
the upper one-third of the fibula; about two inches of
this bone were splintered The bullet then travelled
downwards between the tibia and fibula, and emerged
about two and a half inches below the centre of the
popliteal space.
He was treated by Captains Spong and Dunn, of the
B.AJ4.C., and though there was considerable laceration
of the calf muscles and splintering of the fibula, did very
well.
In June, 1898, I saw him at St. Thomas’ Home, and
found the apertures of entry and exit of the bullet open
and discharging pus. There was complete paralysis of
the muscles supplied by the anterior tibial nerve and
marked reaction of degeneration. Dr. Turney made a
careful electrical examination of the limb and confirmed
the state of affairs. The ext. cutaneous (peroneal)
nerve was intact; sensation but little impaired. I ad¬
vise exploratory operation, and on June 10th Captains
Spong and Dunn being present as well as Mr. Edmunds
and my house surgeon, Mr. Evans, cut down on the outer
side of the thigh and leg, exposing tendon of biceps and
external popliteal nerve; this latter I carefully dis¬
sected downwards to wound scar where it became thick¬
ened, adherent, and embedded in dense cicatricial tiasne.
With difficulty I freed it, and found it partly bulbous ;
the external musculocutaneous was intact.
I next cut down on the interval between the tibialis
anticus and ext. longus digitorum, and found end of
ant. tibial nerve; this was difficult to make out and
very atrophied. There was a considerable interval between
the proximal and distal ends of the divided nerve; but
by stretching of the external popliteal and flexion of the
knee, I was able to bring the two ends together. After
freshening them up, I united them with two chromioised
catgut sutures passed through the substance of the nerve
ends. The wound was entirely closed and healed up by
first intention. The limb wai kept on a Macintyre’s
splint On June 13 th massage was commenced. Jnly
18th he was up and about on crutches: Daily massage
and galvanism ; affected muscles seem fuller, and limb
is not so cold as it was.
August 3rd., 1898.—Dr. Turney reported. "The elec¬
trical examination I have just made is extremely satis¬
factory. The ant. tibial muscles react to the Faradic
current, and though the contraction is sluggish and
requires a larger current than normal, this is a great
advance. To the galvanic current there are still Bigns of
degeneration, and the contraction is notably sluggish.
I think that complete reoovery of function will eventually
occur."
October 3rd, 1898.—Excellent development of muscle;
is able to walk with aid of one stick. Owing to lacera¬
tion and matting of calf muscles, not able to quite
straighten the knee.
March 6th, 1899.—Dr Turney reported:—“ I have just
examined Major H-electrically, and am glad to be
able to give a satisfactory report. The anterior tibial
muscles react to a strong Faradic current, and much more
briskly than they have done hitherto. Although there
is no appearanoe yet of voluntary power, still there is no
doubt that function is present potentially both in nerve
and muscle, and it is only a matter of time when this
becomes apparent."
July, 1899.—A still further improvement. Bides his
horse, and also b : cydes. Ho is still continuing massage
and occasional galvanism.
Jratt ct.
Tfeom our own correspondent. 1
Paris, September 17th, 1886.
Fissures of the Anus.
Fi8surk of the anus is, as everyone knows, an affection
as troublesome as it is painful. Of the different
remedies recommended, forcible dilatation of the
sphincter is the most radical and perhaps the most
effectual. But it is not easy to get the patient to
submit to the operation outside of hospital practice.
Dr. Boas reoommends a much simpler treatment, which
he affirms to have succeeded with him ten times out
of twelve. The principle of the treatment being the
complete immobilisation of the anal region, he puts
the patient to bed for one week, allowing for all nourish¬
ment, milk and light potage.
At the same time he orders ten'drops of laudanum to
be given three times a day, so as to produce absolute
constipation. If the fissure can be brought to view he
powders it with iodoform, calomel, Ac., but with¬
out touching it with any instrument or dress-
>ng. Any antiseptic washing would be. more
hurtful than useful. At the end of eight days he
Digitized by GoOgle
Sept. 20, 1899.
GERMANY.
The Medical PRESS. 299 .
administers a full dose of castor oil, recommend¬
ing the patient to restrain himself from defecation until
he felt that the contents of the intestine had become
completely liquid. The treatment only failed where
complete retention of the faeces could not be obtained.
Abscess or Bartholin's Gland.
M. Jullien, of the Saint Lazare Hospital, treats
absoessee of the vulvo-vaginal gland by injections after
the evacuation of the pus of two or three drops of a
solution of chloride of zinc (1-10) into the gland by
means of an ordinary hypodermic syringe. Immediately
after the injection and for some days intense inflamma¬
tion sets in, but gradually subsides, and some time after¬
wards a small hard, but painless tumour, is felt through
the soft parte. No relapse has ever occurred after this
treatment.
CONGKNITAL AbBENCE OF THE FEMURS.
A confrere reports an interesting case of congenital
absence of the femurs in a child of seven months.
Examination showed that the pelvis was perfectly
normal, but both femurs were absent as well as the
patellae. The legs were composed of only one bone
lying on the pelvis. Abduction and adduction were
limited, and rotation was almost abolished ; the fifth toe
of each foot was also absent. Several surgeons proposed
to remedy the malformation by operative intervention,
and notably by the oreation of an artificial articulation.
Treatment of Dbopsv.
Physiological experiments have shown that the
diuretic action of caffeine is Dotably increased by
the addition of certain hjpnotics, and especially of
chloral or paraldehyde. In renal or hepatic disease
the association of hydrate of chloral at the dose of
twsnty grains with twelve grains of caffeine daily, the
cedeina and anasarca disappear much more rapidly than
when the caffeine is given alone. In the case of cardiac
dropsy, paraldehyde should be preferred, on account of
the depressing effect of chloral on the heart.
(Strataitp.
[from odb own correspondent.]
Berlin, September 16th, 1886.
The Treatment of Ulcers of the Leo.
The Therapeut. Monatsch. contains an article by Dr.
Cipriani on this subject, the aim of which iB mainly
practical. By the method of treatment proposed four
objects are to be gained:—1. Diminution of the pain;
2. Decrease in the size of the ulcer ; 3. Convenience for
both attendant and patient; 4. Cleanliness and ration¬
ality. The technique demands almost always six stages:
—1. Careful washing of the limb with hot water; 2.
Mopping dry with iodoform gauze; 8. The use of eka-
iodoform which is lightly dusted over the ulcer; 4.
Bandaging of the leg from the knee to the ankle with
8trips of linen, four or five layers one over another,
lightly pressed out after being dipped in a solution of
formaline 1 to 2 per cent, in strength, according to the
constitution of the patient; 5. Further application of
linen stripe, dipped in a 2 to 4 per cent, solution of
formaline and well wrung out; 6. A well-applied band¬
age. This procedure is to be repeated every twenty-
four hours.
With this dressing the authc r has seen rapid healing
of extensive ulcers of the leg. Even on the second day
the purulent secretion ceased, also the pain and the
foul smell. Large uloero that had to a large extent de¬
stroyed the skin, cicatrised rapidly, as new skin spread
quickly from small patches of epidermis that had re¬
mained. Even when these patches of epithelium were
absent, and the skin of the margin showed no tendency
to spread inwards, the first step of the treatment must
consist of lengthened warm baths, which should be
followed by careful curettement. This operation will not
be painful, as the hardened and cicatrised tissue will have
become softened by the prolonged bathing. In this way
the edges of the ulcer lose their redness, the swelling
of the adjoining parts' subsides, and the absorbent
power of the vessels is regained, the swollen veins
empty themeelveB, stasis is diminished, and with
it its accompanying morbid changes. The treat¬
ment allows the patient to go about his work,
and in addition to this advantage it has a softening
solvent action. The dressing remains moist long enough,
and it exercises an absorbent antiseptic, soothing, and
refreshing influence. Eczema or dermatitis, sometimes
seen after prolonged use of iodoform, never appears ; this
is attributed by the author to the use of eka-iodoform.
Infectious Inflammation of the Lungs and
P8ITTATS08I8.
In the Col. f. Allg. Gesundheitapflege, Prof. Leiohten-
stern, of Cologne, discusses this subject. The aetiology
of the infectious atypical pneumonia is in many respects
doubtful. PBittatsosis is a name specially given to that
form of atypical pneumonia which can be traced back
to a sick parrot. The subject is of the greater interest
as it is one that has not been extensively studied in
Europe. Psittatsoeis epidemics have been known in
France and Switzerland, and more lately observa¬
tions have been made on atypical pneumonia
and similar forms of disease in Koln, Crefeld, Berlin,
and Essen a Ruhr. The observations made by the
writer himself and a consideration of those of others*
have led him to draw oertain conclusions on the subject.
No certain evidence has been yet adduoed that psitta-
tsosis diseases are attributable to sick parrots. Parrots
might under certain conditions be dangerous to human
beings by microbes setting up diseases, especially forms
of enteritis. Psittatsosis is an atypical pneumonia with
typhoid symptoms. This arises without any interven¬
tion of parrots. Epidermologioal facts, however, are in
favour of the possibility of the disease being transferred
to man by parrots. The prophylaxis consists in per¬
sonal protection, and in the control of supervision of
bird shops.
Fracture of the Larynx.
The Deultch Med. Zeit., 72 99, reports a case of this
rather rare injury. A girl, set. 10, was kicked in the
front of the neck by a cow. The surgeon who saw the
patient shortly after the occurrence found her conscious
she could still speak and cry out, but with an altered
voice. On the anterior surface of the neck, correspond¬
ing to the middle of the thyroid cartilage, was a trans¬
verse erosure of the skin, one ctm. in length, and 0.2
to 0.6 in breadth. There was superficial emphysema of
the face, neck, and upper part of the breast, and over both
shoulders. Death took place in half an hour. Shortly
I before this took plaoe, the emphysema spread over the
Digitized by
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300 ThX MkDICAL PbXSS.
AUSTRIA.
Sept. 20, 1899
whole of the body, even to the tips of the toes. On
palpitation cf the larynx after death—before death this
was not possible—a sensation of grating was felt, and
gliding of one part over another. No post-mortem ex¬
amination was made.
" Whin Should Patixnts with Gall-btonxb bx
Opibatid On ? ”
is the title of a brochure lately published by Dr. Fisck, of
the Kaiser Franz Joseph Hospital, Carlsbad. The author
has operated himself on 12 cases, and on the basis of the
conditions found, as well as his observation over large
numbers of cases not operated on, he endeavours to
arrive at a conclusion as to the best time for operating.
His conclusions are embraced in the following: If
the inflamma tion accompanying the attacks of colic
does not subside, if high fever sets in, if peri¬
cholecystitis comes on, or dropsy of the gall-bladder
indicating closure of the ductus choledoch os, then opera¬
tion must be resorted to. If the inflammatory symptoms
subside, surgical aid is not called for exoept in case of
closure of the duct, or when troubles are caused by
adhesion to the neighbouring organs.
Quicksilvxb and Gout.
The Deutsch Med. Zeit., 71/99, has a short reference to
a case of gout affecting the hand, under treatment by
Professor Rindfleisch. Massage had been applied for
several weeks without the production of any noticeable
benefit. The professor then determined to make use of
raw quicksilver locally. A glass wide enough to admit
the hand, and sufficiently deep, was filled to two-thirds
of its capacity with raw mercury. The patient’s hand
was then inserted slowly and kept in as long as the
pressure of the mercury allowed. A considerable and
equable pressure was felt as the fluid pressed with equal
force on every part of the surface. The hand was placed
in the mercury 20 to 80 times at one sitting, and at the
dose of the second a considerable dimunition in the size
of the hand was observed. In four days of this treat¬
ment, the joint was practically restored to its normal
form.
Thx Trxatkxnt of Anthrax.
The same journal gives a note on the popular
treatment of anthrax in Bupsia. Clean washed raisins, a
few drops of distilled water, and sal ammoniac are
triturated together to the consistence of honey, the
ammonia forming about a fifth part of the whole mass.
This is thickly spread on clean linen dusted with sal
ammoniac, and placed over the abscess, care being taken
that the whole inflamed circumference is also oovered
with the plaster; over this is placed lint and bandage.
The dressing is renewed twice daily. Twenty cases of
anthrax were treated in this way, in some both the
local and general infection being very severe. All the
cases recovered, and in no case was any other kind of
medicinal treatment made use of.
Jlusiria.
[fboh oub own corrxspondxnt.]
ViXHNJi, September 16th, 18M».
DxaXNXBATlVX CHANGX8 IN iNJUBXD NxBVXS.
It has long been established in theory that the centri-
pal part of a motor nerve undergoes degenerativ e
changes when it is severed or separated by disease from
its centre. Sensory degeneration is found on the opposite
side of the lesion, and has been termed asoending, while
the opposite is descending.
In mixed nerves one would expect the analogy to hold
good, but here the theory is disputed.
Elzholz has by experiments demonstrated that peri¬
pheral nerves of a mixed character when wounded or
separated from their oentral connection tend to degenerate
towards the centre, causing atrophy of the ganglionic
cell itself.
The nerve fibres of the afferent nerve are quite entire
microscopically, but their function is lost, which Elzbolz
compares to that met with in cachexia. He relates a
severe case of gangrene, where the central nerves, when
examined, were comparable to an animal’s which had
had a part of the ischiadio nerve removed a short time
before death. In both were found corpuscular bodies about
the size of small leucocytes, which when coloured by
Marchi’s process in Osmium, gave a dark colour, and could
be easily reoognised from the surroundings, lying between
the sheath of Schwanne and the cortical subetanoe; some¬
times, however, in Banvier’s nodules, at other times in
Schwanne’s sheath itself. These bodies accumulate in
the central part of the nerve, forty-eight hours after the
lesion.
Thirty days later these bodies are so transformed into
a fatty condition that they are quite unrecognisable.
Pica Chlorotica.
Cipriani records two cases of patients suffering from
obstinate chlorosis, set. 12 and 23 respectively, who had
been retained in an institution for some time under large
doses of iron in the form of “ T&pferthon7 grams
were given at first, gradually rising to a 100 grams,
without any beneficial effect, while the digestive organs
were seriously impaired by the treatment. He commenced
somatose of iron in 6 gram doses, increasing to 15 grams
per day, with wonderful results, menstrual and nervous
symptoms quite recovering in a few months.
Cybtinuria.
Cohn relates a case of oystinuria of a hereditary
nature. About the beginning of 1897 a girl was handed
over to him from the surgical ward, where she had been
for some time under treatment for a tubercu’ous knee
joint which had ultimately to be operated on. Shortly
after recovery from the operation she suffered severely
from pain in passing water. An examination of the
bladder revealed a stone, which was removed. It was
about the size of a walnut, angular, of a yellow-gray
colour, and consisted of cystin. Other ten members of
the same family had the urine examined for cysrin,
which was present in seven and absent in three.
Schweraensky related a similar condition in a family,
one of the members having been operated on for calculi
which was cystinic in character. He believed this to be
a hereditary characteristic.
Wolff said these were difficult stones to diagnose by the
B&ntgen rays.
“Univxbsal” Colouring Agxnt for Blood
Prxparations.
Miohaeli’s “Universal Method” for colouring blood
seems to meet with general approbation, although some
think there is very little advantage to be gained. The
method may be briefly expressed by saying there are first
two primary agents kept in solution, A and B. A is a
one per oent. watery solution of chemically pure crystals
Digitized by
Google
Sot. 20, 1809.
SPECIAL ARTICLE.
Thx Mxdical Pxsm.
of methylen bine. B is also a one per oent. watery
solution of eoein.
Prom these solutions another mixture is made imme*
diately before use. Of A, 20 grammes are added to
20 grammes of absolute alcohol j of B, 12 grammes are
Added to 28 grammes of aoeton (sp. gr. 66*68) ; the two
well mixed.
The blood preparation which may have been twenty-four
hours in absolute alcohol or exposed to Ehrlich’s copper'
plate fixing is now placed in Michaeli's mixture for one
to ten minutes, or till the red colour has changed to a
blue. A successful preparation will give extensive
colouring of the nucleus, neutrophils eosinophile, baso¬
phils granulations, and blood platelets.
Removal or Lens in Myopia.
Velhagen records the results of fourteen cases he has
operated on for a high state of myopia. In three oases
the vision remained the same after the operation as
before it, in other three it improved one and a half, in
two cases it doubled itself, in two it tripled, once quad¬
rupled, and once increased fivefold.
He thinks the removal of the lens should be carefully
considered before operating, as it is disappointing. If the
myopia can be alleviated by the assistance of glasses, so
that the patient is enabled to perform his duty daily
with anything like comfort, the lens should not be
extracted.
gjttrial Article.
THE LATEST CONCERNING BUBONIC PLAGUE
IN SOUTHERN EUROPE.
We learn from El Siglo M4dico that Dr. D. Carlos de
Vicente, has arrived in Madrid from a sojourn in i
Oporto and Lisbon, where, as is known, he was commis¬
sioned by the Spanish Government to study the bubonic
plague in Portugal. He has given his report to the Sani¬
tary Director-General, and frankly hie opinions are not
optimistic.
Since August 18th the plague has greatly spread. It
assumed the pneumonic form, the most serious type
Added to this the Portuguese Government provides only
the feeblest and least promising methods of sanitation.
As a consequence of persons leaving the infected dis¬
tricts the disease is carried into distant parte.
Dr. Mendoza warns the Government that the plague
owes it virulence to the filthy dwellings and habits of the
people living in the poorer parts of the city. Those
attacked are oonveyed to the Misericordia Hospital, and
none of the hospital patients were found to constitute
new foci for disease, demonstrating the facility with
which the epidemic might be localised and stamped out
if energetic measures were adopted. Dr. Mendoza had
micro-photographs of the plague bacilli taken.
Dr. Cortezo, director of the Sanitary Department of
Spain, h>u> appointed Dr. Ramony Cajal to the direction
of the Central Institute of Serotherapy. The serum
for the treatment of the bubonic plague is to be manu¬
factured in the Central Institute, and its production in
any other institution is strictly prohibited.
A Royal decree orders vessels coming into any Spanish
ports from Lorenzo Marquez or Saint Denis to be
quarantined.
Dr. D. Vicente Leorente has been commissioned to go
to Paris for the purpose of studying the production
of serum toxins and their use.
The precautions adopted in Madrid are:—
The staff of permanent inspectors of goods at each
station is to be increased by two; five extra inspectors
for each station are also nominated, and are to be called
on should urgency demand their services.
Lazarilloa, for the examination of flocks or herds
coming for slaughter from Portugal, are to be organised.
All goods that have passed the frontier are to be care¬
fully examined. Byree to be frequently visited, the
stalls of cattle inspected, their cleanliness seen to, and
the health of the herd noted. Daily inspection of all
the markets. Daily inspection of the publio drinking
water. Dr. Cortezo particularly draws the attention
of the managers of hospitals, boarding houses, and
prisons to the importance of employing a company of
ratcatchers. The sanitary inspector of Valencia, Senor
Leoret, says that the extinction of these fecund rodents
by strychnine, apart from the dangers attending its use,
is not satisfactory; and he advocates obtaining a serum
from the Pasteur Institute in Paris which, while actively
le thal to rats, shall possess the great advantage of being
non-poisonous to man.
Dr. Leoret, after a careful inspection of the ice fac¬
tories of Valencia, reports them to be positively
dangerous to the public health. He proposes to the
Corporation (1) that the manufacturers of ice shall
use well-filtered water, free from micro-organisms; (2)
that they be permitted to manufacture ice from ordinary
water for refrigeratory purposes and external use only;
(3) that the two qualities be kept apart, and that the
public be notified of the difference.
The Governor of Valencia, Benor Diaz Merry, has
published in the official journal of the Province an appeal
and directions to the medical officers of the cities and
sub-districts impressing on them the special nature of
the epidemic which threatens the province, and draw¬
ing attention to the sanitary laws of 1848 and 1856.
Dr. Ferran, who has been commissioned by the Cor¬
poration of Barcelona to study the plague in Oporto,
says that, scientifically speaking, he lookB on the sani¬
tary oordon and fumigations as worthless. He looks on
serum inoculation as the only prophylactic, and having
been inoculated he sees no risk in investigations carried
on by him. Dr. Prio reports that the plague has not
spread beyond Oporto, and he looks forward hopefully
to its being stamped out.
The case of a female child, three years of age, reported
on the 3lBtof Augustas sufferingfrom the bubonic plague,
created a scare in Lisbon, where the case occurred.
The case was examined by Dr. Mendoza, who reported
as follows •’—“ Having made an examination of the blood
and of the secretions of the mouth, I found nothing
characteristic or such as would cause me to treat it as
a case of real infection. The inflammation of the glands
has gone, in one place completely, and in the other it is
very much lessened.”
In a letter addressed to a Valentia paper, the director
of the prison of San Miguel de los Reyes, Senor Millan
Astray, points out the risk they ran from infection by rats.
“ It is clear that the criminals eat the rats, not alone in
this bridewell, but in all of them, in fact they eat them
and relish them in all our prisons.” In the same province
he states that he has seen sellers of water rats, and that
they readily found buyers.
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302 Thk Medical Pbess. THE OPERATING THEATRES» Sbpt. 20, 1899.
These circumstances the worthy gaol-keeper considers
should make them very careful in the selection of a toxic
agent for the rats, and he recommends the use of the
poison agriculturists have bo successfully employed in
France.
The prison of San Miguel is the largest in Spain.
It was built for 3,000 inmates, it oontains to-day only
1,300. Under the care of Sehor Millan Astray it is kept
perfectly clean in every part, and the worthy Senor hopes
that its good sanitary condition will enable them to
keep the plague at arm’s length, though the acquired
taste for rat flesh of thoee under his care gives him
some uneasiness.
Writing of the bubonic plague, and the exoitement its
outbreak in Oporto has caused in Spain, Don Decie
Carlan thus expresses his views in El Siglo Midico :—
" Muoh discussion has taken place of late in all the
important towns of Spain on the necessity of taking
proper sanitary precautions to improve the present
conditions in case the plague should cross the borders.
There is no Governor, nor Aloade, nor meeting of
sanitary committees in which heated and extravagant
speeches on the improvement of the hygienic conditions
of the people, and the removal of unsanitary foci are not
advocated, as well as the examination of unsanitary
houses, and the punishment of those who adulterate
food.
These general measures are not, however, carried out>
for the simple reason that there is no money, and the
treasuries of the city corporations, badly administered
at a rule, are empty.
It is necessary that the example shown by the Cor¬
poration of Barcelona be followed, which without any
fuss, voted 125,000 pesetas for sanitary improvements
and hygiene. This body holds the proper view of
affairs, for in the war against epidemics, as in other
ware, the principal weapon for the fight is money,
money, money.
Procrastination.
Our contemporary, El Siglo Midico, in its last number,
draws attention to the fact that the Royal Order of
January, 1877, ordering the creation of a new cemetery
for Madrid, and the closing of all the cemeteries within
the city, remains a dead letter. This is all the more
remarkable, for the order has since been repeated in
August, 1884, in January, 1890, and in September, 1891.
^he ©pirating ^heairte.
CANCER HOSPITAL, BROMPTON.
Fibro-myomata of the Uterus—Panhysterectomy.
—Mr. Bowreman Jessett operated on a woman, set. 46,
who was suffering from fibro-myomata of the uterus.
The patient had noticed for the last nine months that
the abdomen was getting larger, and during the previous
six months she had had more or less constant metror¬
rhagia. On examination of the abdomen three large
bosses were discovered, one filling the left iliac fossa,
the second, externally to the first, above the umbilicus,
the third, smaller, on the right side. Per vaginam, the
os uteri felt to be pushed down into the pelvis ; by bi¬
manual examination the tumours in the abdomen and
that felt in the vagina were evidently connected. The
os was difficult to define, being drawn high up in front
At the operation the patient was put in the Trendelen¬
burg position; an incision was made in the middle line,
extending from the pubes to about two inohes above the
umbilicus. The mass was readily delivered through the
wound, and the broad ligament on each side was ligatured
close to the uterus and divided, the ovaries and tubes
being left in situ. A flap of peritoneum was then re¬
flected from the posterior wall of the uterus, and
Douglas’s pouch opened up into the vagina. A pair of
long forceps having been introduced through the vagina
by an assistant so as to define the posterior fornix the
vagina was opened on the forceps. Another flap of peri¬
toneum with the bladder was reflected from the anterior
surfaoe of the uterus, and the anterior fornix then opened.
The uterine arteries on both sides were secured by a
ligature left long, and the connecting tissues between the
stump and the uterus divided and the tumour removed.
All bleeding points having been secured, the peritoneum
over the floor of the pelvis was carefully united by a silk
suture, the stumps containing the ovarian arteries being
securely oovered with peritoneum, the ligatures securing
the vessels which had been left long were drawn down
through the vagina, which was then packed lightly with
iodoform gauze. The abdomen was closed by single
interrupted silkworm gut sutures taking all the tissues.
Mr. Jessett Baidthat the question of the best method of
dealing with these fibro-myomata of the uterus was one
of gi eat importance; he was quite sure that the opera¬
tion of the future would be either total removal of the
whole uterus or supra-vaginal amputation of the cervix,
the stump being treated sub-peritoneally. In cases such
as the one just operated on, where the cervix was involved
in the growth, undoubtedly panhysterectomy was the
best form of operation. In cases, however, where the
cervix was elongated preference might be given to
the subperitoneal method. This form of operation, he
said, no doubt oould be performed more expeditiously,
which, of oourse, in patients who were probably reduced
in strength by loss of blood, was an advantage not to be
lost sight of. On the other hand, it must not be for¬
gotten that cases had been reported in which this opera¬
tion had been performed and trouble had been expe¬
rienced by the development of other fibroids in the
portion of the cervix that had been left behind. He
therefore preferred, on the whole, all other things being
equal, the operation of panhysterectomy. In the operation
just performed he pointed out that it might have been
noticed that the ligatures securing the broad liga¬
ments and uterine arteries were left long and drawn
through the vagina. By this means excellent drainage
was formed; moreover, in due course the ligatures were
easily removed. In the suturing of the parietes Mr.
Jessett observed that he had in several instances adopted
the method of uniting, with three layers, the peritoneum
by catgut, the muscles and fascia by interrupted silk
sutures, and the skin by a continuous horsehair or silk
suture, but be had abandoned this form of suturing the
parietes in favour of the one he had just employed,
as in several instances he had experienced trouble
with the buried silk sutures, which caused localised
abscesses, and had to be removed later on.
It is satisfactory to note that the patient made an un¬
interrupted and excellent recovery.
Digitized by
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LEADING ARTICLES. The Medical Pbxss. 303
Skpt. 20, 1899 .
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^he ^Eebical JrcBB anb Circular.
8ALC8 POPOLI 8UPBEMA LEX.”
WEDNESDAY, SEPTEMBER 20, 1899.
SIR MICHAEL FOSTER’S ADDRESS AT THE
BRITISH ASSOCIATION.
Those among us who are familiar with the name
of Michael Foster as the author of various text¬
books on physiology, and as the diligent and inge¬
nious investigator, will view him in a new light if
they will bnt read the masterly address irom the
Presidential chair delivered before the British Asso¬
ciation last week. The genial way in which this
veteran observer handles the most recondite pro¬
cesses of natural science, the happiness of his
phraseology, and the lucidity with which he so
deftly discusses the evolution of science in its
various branches, show him to be possessed of social
and literary qualities which his more strictly scientific
utterances had, perhaps, noc led us to expect-
Whether he discusses individual life as “a link in a
long chain joining something which went before to
something about to oome," or holds forth of “ the long
series of living forms, living now or flitting like
shadows on the screen of the past,” he displays
qualities of diction and thought worthy at onoe of
the foremost exponent of physiological science and
of a master of the English language. He lays
a playful finger on terms such as “ vital force ” and
“ vital principle,” wherewith physicists, even of the
present day, are wont to disguise their inability to
fathom certain biological mysteries which are still
mysteries, but which we have learned frankly to
admit as such pending further knowledge. We are
admittedly but on the threshold of the investigation
of the psychical and nervous events which “ are the
outcome of the clashing of nervous impulses as they
sweep along the closely woven web of living threads
of which the brain is made,” but, he adds, we have
learned by experiment and observation that the pattern
of the web determines the play of the impulses, and we
can already explain many of the obscure problems not
only of nervous disease, but of nervous life, by an
analysis which is but a tracking out of the devious
and linked paths of nervous threads. Wandering
into the enticing field of embryology, we are told
that the life of every living being, from the ovum to
its full estate, is a series of shifting scenes which
come and go, sometimes changing abruptly, some- 1
times melting the one into the other like dissolving
views, all so ordained that often the final shape with
which the creature seems to begin, or is said to begin'
its life in the world, is the outcome of many shapes,
clothed with which it in turn has lived many seeming
lives before its seeming birth. Though he asks the
ever present question whether life in its essence i»
worth more than before the intellectual comets of
the present century shed their effulgence on the dark
corners of scientific research, Sir Michael Foster is
no pessimist. He worships at the shrine of science
with a robust faith, both in the past and in the future,
which it is good to contemplate. The growth of
science, he observes, is that of a living being. As in
the embryo phase follows phase, and each member
of the body puts on in succession different appear¬
ances, though all the while the same member, so it
scientific conception of one age seems to differ
from that of a following age, though it is the
same one in the process of being made, and, as the
dim outlines of the future embryo become, as the
being gets more distinct and sharp, like a picture
on a screen brought more and more into focus,
so the dim gropings and searchings of the men of
science of old are, by repeated approximations,
wrought into the clear and exact conclusions of
later times. Not the least valuable among the many
striking utterances of the master is his robust faith
in science as a means of training. Gently chiding
those who regard science in the light of the dis¬
coveries which, in the Victorian era, have done so
much to render life longer and more comfortable all
round, he points out that man does not live by bread
alone, and the inexorable precision which the
study of natural phenomena inculcates, is of itself*
apart from its material results, a training of the
greatest possible value. As a child in its infancy
looks upon its mother only as the giver of good
things, and does not learn until later how she was also
showing her love by carefully training it in the way it
should go, so they, too, have thought too much of the
gifts of science, overlooking her power to guide-
He insists that the training to be looked for
from science is the outcome, not of the accumu¬
lation of scientific knowledge, but the practice
of scientific inquiry, so that a man may have at his
fingers ends all the accomplished results and all the
current opinions of any one or of all the branches of
science and yet remain wholly unscientific in mind.
If those who are responsible for the education and
mental training of the rising generation, and of
generations as yet unborn, could only be brought to
lay this guiding principle to mind, a great step in
advance would have been taken towards shaking off
the tyranny of methods ill-suited to the requiremente
of the present day.
Digitized by LjOOQle
304 Thz Medical Press.
LEADING ARTICLES.
SECRET COMMISSIONS TO MEDICAL
PRACTITIONERS.
It will be recollected that, some months ago, Sir
Edward Fry, ex-Jnstice of Appeal, made himself
responsible for a charge brought by the London
Chamber of Commerce, that medical practitioners
are in the habit of seeking or accepting secret bribes
from chemists, instrument makers, and undertakers
to recommend them to their patients, and that
these bribes take the form of a specific per¬
centage upon the business done through their
agency. Now, Sir Edward Fry, being a lawyer
of vast experience, must know that such a charge
publicly made against an individual would be amply
sufficient ground for an action for damages against
the person who made the charge, and, being an ex¬
pert in the law of evidence, Sir Edward Fry must be
well aware that no hearsay gossip amongst unknown
persons would be listened to for half a minute as
justification for the accusation. The learned ex-
Justice of Appeal is the Judge most certain to
scout such a method of defence out of Court, and
to charge the jury to find exemplary damages.
We must, therefore, oouclude that, in thus defaming
medical practitioners, Sir Edward Fry feels himself
safe because the libel appears, not over his name, but
as a paragraph in a report of the London Chamber
of Commerce, and is directed, not against any indivi¬
dual, but against a profession. He must, we feel
convinced, be conscious that he does not occupy a .
position oonsonant with the dignity of one of Her |
Majesty’s judges, especially when he finds i
himself obliged to confess that he cannot
present in the Court of public opinion a
single witness to prove his case. The testimony on
which be originally based the defamatory statement
was that of a chemist and an optician whom, how¬
ever, he declines to produce or identify, though
challenged hy the British Medical Association to do
so, and in a letter to the Times last week, he not only
reiterates the accusation, but tries to reinforce his
proofs by the hearsay statements of an equally inno¬
minate undertaker. Sir Edward Fry writes:—“I
make no charge against the medical profession
as a whole. I am sure that many of its
members are as incapable of taking a secret
commission as Her Majesty’s judges of accept¬
ing a bribe.” We cannot, however, accept
such an apology because, in fact, the original libel
was quite general in its soope. He did not say that
some doctors, or a certain class of doctors, or a
limited proportion of the profession, take
bribeB, but he clearly implied that the prac¬
tice is habitual, and is so far universal as to
justify a public pronouncement by a responsible
public body. To that statement, whether uttered by
an ex-Justice of Appeal or by anyone else, we feel able
and that it is also our duty to our profession to give
the most emphatic repudiation which is consistent
with politeness. We are not so stupid or so ignorant of
human nature or of commercial morality as to suggest
that, out of the 35,057 medical practitioners whose
Sept. 20, 1896
names are on the Medical Register , there are
not some—perhaps many — who will sell theii
professional honour for traders’ tips, and n every
trade or profession there always must be such a
leaven. Might we ask Sir Edward Fry whether the
legal profession is inviolate in this respect P Dr.
Saundby, speaking for the British Medical Associa¬
tion, declared that “ inquiries had been made which
resulted in their hearing that presents had occa¬
sionally been offered for various services after the
event, but that there was no case in which a com¬
mission had been offered to a person if he would
do a certain thing.” Sir Edward Fry demands
exact particulars of the persons interrogated in Dr-
Saundby’s inquiries, and of all the circumstances
thereof, the very information which, with reference
to his own inquiries, he is unwilling or unable to give.
We, and our medical contemporaries, have acquired, by
decades of experience of professional practice, an ac¬
quaintance with all the phases of the medical system
which Sir Edward Fry and the other amateurs of the
London Chamber of Commerce cannot presume to,
and we claim for our contemporaries and for our¬
selves sufficient independence of trade interest to
allow us to speak out if we became aware of the
prevalence of the bribery with which we are charged
As we believe that such abuses do not occur in any
material degree we suggest that Sir Edward Fry may
be permitted, without further notice, to incubate his
mare’s nest.
DOGMATISM IN PRACTICE.
It is useful at times to attempt to learn from the
enemy the secret of his strength. In a certain sense
the quacks, meaning by that term all who practise
medicine without holding any legal qualification, are
the enemies of the medical profession, hardly less
than they are deadly parasitic foes to the welfare of
the world at large. But for all that there exists no
community, however cultured, in which quackery is
not at the present moment rampant. The reason for
such a state of affairs is not apparent on the surface
of things, and may repay a little investigation by the
medical profession at whose expense quackery
flourishes. Perhaps the chief element concerned is the
craving on the part of the public for the definite and
the specific in matters medical. The average patient
goes to his doctor to know what is Wrong with him, and
to be told what he must do in order to get right.
Now, as an elementary knowledge of medicine
quickly shows, diagnosis is often hedged in with
many doubts and difficulties. The quack, however,
is hampered with no Bcruples and with no doubts;
his decision is rapid and positive, and those who go
to him are earned away by the sheer force of his
assurance. In other words, the successful quack is
endowed with strong character and is a good judge
of his fellow men. From the very circumstanoes of
the case he is for the most part brought into con¬
tact with folk of the timid and feeble kind, who
want nothing but firm handling hy a man of
stronger will. On the other band, let us turn
Digitized by CjOO^Ic
Ssft. 20, 1809.
NOTES ION CURRENT TOPICS.
to a conscientious physician who investigates
every case brought before him with conscientious
care, and bestows upon it the results of a broad and
experienced culture. Unless he is able to combine
knowledge of men with knowledge of his
profession, he is likely to add to the failures
with which the medical as well as other pro¬
fessions abound. There is not any particular
reason, however, so far as one can see, why the edu¬
cated physician should admit a patient into his con¬
fidence as to the processes which have determined
his conclusions concerning the nature and the treat¬
ment of the ailment before him. The wise man will
state his opinion as to the nature of the malady and
write his prescription. To go further is to court disaster,
especially in these days of universal information, when
a vast fund of ill-digested physiological information
may lurk beneath the attractive exterior of the
budding damsel who sits demurely in the consulting-
room chair. Another great element in the suooess of
quackery is the treatment of symptoms. The vast
mass of patent medicine literature is aimed at sym¬
ptoms, and indeed, for that matter, a great deal of
the therapeutic teaching of the present day is baaed
on a similar principle. Nor can there be any doubt
that many a successful career in medicine has been
secured and maintained by that cheap and easy road
to popularity. Some day, in the greater fulness of
knowledge, it will become possible to treat disease on
a more rational footing. Not so long ago, narcotics*
such as opium and its derivatives, occupied a fore¬
most place in every-day medical practice. The
comparative disuse, however, of drugs of that class
within recent years may be regarded as one of the
most significant facts of modern medicine. Instead
of providing a patient suffering from intestinal dis¬
order with a narcotic euthanasia the practitioner
would now call in an operating surgeon without a
moment's loss of time. As to the regulation of
quackery it is an open question how far any good can
be looked for from the expanding common sense of
the community. Seemingly, the strong hand of the
law is alone equal to the task, and it should be one
of the great functions of the General Medical Council,
as representing-the medical profession, to indicate to
the Legislature the direction in which reforms should
be directed.
fiotto on Cttmirt topics.
The Medical Student and His Prospects.
A recent number of the Referee contains some
pungent remarks anent the terms in which a con¬
temporary thought fit to address the general body of
medical students by way of inaugurating the Educa¬
tional Number, remarks in which, in the main, we
cotdially concur. Why indeed insist upon the fact
if fact it be, that the progeny of wealth and lineage
is conspicuous by its absence” from the medical
schools, unless indeed the intention of the writer was
to impress the student with a becoming sense of his
social inferiority? Perhaps on the whole it isanadvan-
Thi Medical Tr ess. 305
tage that the impecunious scions of the nobility
affect the Ohuroh, the Bar, and the Stock Exchange in
preference to the disseoting room, but anyhow the
fact is devoid of either interest or instruction. Why >
again, insist upon the absolutely superfluous appro¬
val of medicine as a career expressed from
time to time by “ the ohief political personages
of the realm now living as well as their most
notable colleagues who have recently passed away t
thereby allying themselves with eminent occupants
of the judicial bench ” ? The last reference, it may
be assumed, does not include Sir Edward Fry, who
has done what lies with him to undermine public
confidence in the integrity of the profession as a
whole. Surely it is quite unnecessary to trot out such
reminisoences to establish the honourable nature
of the oalling upon which these young—may we say,
gentlemen ?—are about to enter. The history and
traditions of medicine are surely enough in them¬
selves to establish its claim to public consideration
and respect, and it is in the highest degree undesir¬
able to introduoe the spirit of sooial subserviency and
snobbery into an address which, if delivered at all,
should have for object to impress medical students
with a proper sense of the intrinsic dignity of their
calling, apart from meretricious enoomiums and
casual expressions of condescending approval by
persons in no way more honourable than members of
the profession which they patronise.
Typhoid Fever in India.
It is a discouraging fact that typhoid fever in India
seems to defy the efforts of the medical authorities
to circumvent its ravages. From a medico-military
point of view its incidence is extremely serious, inas¬
much as it is responsible for a very large proportion of
the sickness and mortality among the troops, thereby
reducing the fighting effective to an alarming extent
It is evidentthat we have still much to learn in respect
of the propagation of the disease, and there is every
reason to believe that, in India at any rate, water is
not the only, possibly not even the principal, vehicle
of the contagion. It is reported that inoculation is
being tried as a preventive measure, but we have
little confidence in such means unless a determined
effort is also made to ascertain and remove the con¬
ditions under which the disease occurs. The
mischief done by typhoid fever is far greater, as
far as the army is concerned, than that resulting
from outbreaks of plague, and if the same attention
were devoted to the question of its prevention as has
been expended in fruitlessly endeavouring to check
the ravages of the plague it is highly probable that
some tangible results would have been obtained. It
is high time Government took steps to have the
whole question investigated by a body of independent
experts untrameiled by military routine and specially
fitted for the task.
An Epidemic of Diarrhoea.
From all parts of the kingdom reports are to hand
of an unusually severe epidemic of autumnal diarrhoea,
especially well marked in the metropolis. The
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306 Th* Mxdical Pbxbb.
NOTES ON CURRENT TOPICS.
Sxpt. 20, 1899.
diarrhoea is of a very acute character; it is associated
with febrile symptoms and severe colic, and i&
promptly determines an extreme degree of debility.
One noteworthy feature about the epidemic is that
jt does not evinoe any special predilection for the
young, a large proportion of the victims being
adults, and those advanced in years. It apparently
stands in no direct causal relationship to the nature of
the food, and it is highly probable that the source of
the mischief is water, the supply whereof having run
short, with consequent increased liability to contami¬
nation. The autumnal rise in the level of the sub¬
soil water, especially after such a long spell of dry
weather, is invariably followed by an enhanced ratio
of abdominal disturbances of the fermentative type,
and epidemics of this kind often usher in outbreaks
of typhoid fever. It behoves us to enjoin upon the
public the importance at this season of taking special
precautions against the ingestion of contaminated
water. It goes without saying that when th9 water
supply is incrim inated, the liability to infection through
milk rises pari passu, and this is a point worth bear¬
ing in mind.
Political Medicine.
The absurd suggestion that British medical men
should boycott French health resorts because, for¬
sooth, a military tribunal has rendered an unjust
yerdict, is hardly one that can commend itself to our
readers. Medical advice is, or should be, given on
medical grounds alone, and just as science knows no
frontiers, so medicine knows no sentiments other than
-those dictated by the desire to secure the well-being
x>f the patient. A much more serious drawback to
frequentation of French health resorts is the ever-
increasing dearth of English-speaking medical men
who are at liberty to practise their profession thereat
.owing to the absurd and ungenerous restrictions
which the Government, in a narrow and ill-advised
protectionist spirit, has th ought fit to impose upon
4hose who desire to minister to the medical require¬
ments of their fellow countrymen abroad. Unless
the present stringent laws undergo some modification
within the near future, the inability of British
invalids to procure the services of a practitioner of
their own nationality cannot fail to deter many of
them from leaving England in search of health.
The Cost of Vaccination.
Anti-vaccination propagandists invariably lay
great stress on the cost to the country of public
vaccination, and they protest that there is no such
thing as gratuitous vaccination. We need not
discuss what is meant by gratuitous vaccination, but
we may fairly ask whether £100,000 per annum,
which is, roughly speaking, the annual cost of the
vaccination service, is a large sum to pay for the
protection thus obtained. To form an opinion we
have only to contrast this figure with the cost to
individual districts of asingle small epidemic of small¬
pox. The cost of an epidemic of any magnitude would
alone devour a large portion of the sum, and a thou¬
sand oases of small-pox throughout the country would
entail an expenditure of funds more than equal to the
amount annually expended in vaccination, and this
quite apart from the fees which medical men would
wap from the paying patients. It is like whipping a
dead donkey to reiterate the old but still valid argu¬
ment that a good epidemic of small-pox would prove
more remunerative to the medical profession than
would the reoeipts from vaccination fees for a quarter
of a century.
The Depeculiarising Process.
With that blind adherence to surface logic which
is the characteristic of uneducated, or partially
educated, people, an elder in the sect known as the
Peculiar People has been visited with contumely and
threats of violence by his fellow-sectaries because, in
the exercise of his discretion, he determined to “ try
the experiment ” of calling in a doctor to a sick
relative. It may be that the experiment was
only intended to avert the disagreeable con¬
sequences of allowing a child to die without medical
treatment, but it would be more charitable to assume
that the step was prompted by a sincere desire to try
if the doctor could really do what the laying on of
hands had failed to accomplish. Sects such as these
only thrive under persecution, and no doubt this is
why judges and juries display such reluctance to mete
out punishment to the parents of medically
neglected children. In the long run, common-sense
and parental affection may be trusted to get the
better of the medical ostracism which is held to be
enjoined by a violently interpreted text. It is unfor¬
tunate that the victims should be for the most part
children of tender years, who thus incur the rigour
of tenets which they are far too young to approve
or endorse. It is here, indeed, that the law steps in,
because the liberty of self-privation does not extend
to the defenceless young.
Case of Poisoning by Heroin.
It is important to place on record instances of
untoward effects following the use of drugs of recent
introduction, and therefore, to some extent, unfamiliar
to the majority of practitioners. Special interest
therefore attaches to a case of poisoning following
an overdose of heroin, a derivative of morphine,
published in a Spanish contemporary by Dr. Espinosa
de los Monteros. A man, set. 40, suffering from
asthma, was ordered T-5 centigrammes of the drug
(equivalent to about a quarter of a grain) to be given
in six doses. Symptoms of poisoning developed
soon after the first dose, and four hours later the
patient was greatly prostrated, cyanosed and rest¬
less. There was complete amaurosis, the pulse had
fallen to forty per minute and the cardiac action was
very feeble. The patient complained of feeling light¬
headed and the lower limbs were convulsed, with
some twitching of the upper limbs as well.
The axillary temperature was 966 F., and
Digitized by vjOOQ 1C
NOTES ON CURRENT TOPICS. The Medioai Press. 307
Sept. 20, 1899.
there was persistent nausea. On enquiry it
-was ascertained that the dispenser had read
grammes for centigrammes, so that the quantity
absorbed by the patient was a quarter of a grain.
Strong coffee was administered, but the patient lay
for some hours in a semi-comatose condition, and it
was noted that he did not pass water. As he vomited
soon after the administration of a second cup of
coffee, caffein was given hypodermically at intervals
of six hours. The amaurosis disappeared, and sleep
quickly followed the second dose of caffein, the
cyanosis cleared up and the patient gradually made
a good recovery. The case gives us some insight
into the physiological action of the drug and its
comparative innocuousness. It is noted that the
subsequent administration of the drug in the dose
originally ordered was not followed by any untoward
symptom.
A Clergyman as Out-Patient.
A clergyman —according to his own account—
went to a London hospital to get treated for some
illness or other, and has written to the Daily Chronicle
an appalling account of the time he was kept waiting
and the curt treatment he received. First of all, it
would be well to ask, what right had a man of his
position to be attending ahospital intended for the poor?
Could he not muster the small fee required for the
services of a general practitioner without trenching
on the resources of an organisation founded and main¬
tained for his needy brethren ? It is people of that
stamp, namely, those who can afford to pay moderate
fees to qualified outside practitioners, that have to a
great extent created the present hospital deadlock. The
poor who go to certain of the large London hospitals
are asked to contribute towards the cost of their treat¬
ment, because, forsooth, it is to be presumed the
resources of those institutions have been drained
by comparatively well-to-do folk. If a medical
charity cannot support itself without taxing the
poor in that way, then its excuse for existence
appears to have died out, and the needy had
better betake themselves to the Poor-law infirmaries
whither, indeed, they are now driven in shoals by the
overcrowding of the ordinary hospitals. The dis¬
contented clergyman appears to have entertained a
delusion that he could command the best available
ekill at a London hospital. Perhaps he has now to
some extent gauged the value of snap-shot treatment
by students, harried and hurried house residents, and
overworked consultants. When will the hospitals purge
their walla of these unworthy applicants for relief?
Advantages of Provincial Medical Schools.
There can be no doubt whatever that the smaller
provincial schools afford to the medical student in a
conspicuous degree the advantage of acquiring a
knowledge of practical work that can never be derived
from books and lectures. In London the overcrowded
state of the teaching hospitals forbids the individual
handling of that abundance of clinical material which
is essential to the turning out of sound practical
men. Where a student in the metropolis would have
a meagre allowance of one or two beds in the country
he might have a ward full, to say nothing of
the chance of performing many or most of the
minor operations. Of course, it must be admitted
that he would have more teachers in a London school t
but even that is not always an advan tage. Among
the smaller provincial schools, Bristol, one of the
oldest, has always been distinguished for the quality
of its teaching. Of late years the status of the school
has been materially advanoed by its affiliation
with the University, and the erection of hand¬
some new buildings. Quite recently another
great step has been taken to increase the
facilities of students in obtaining clinical material.
The Royal Infirmary, dating from ancient times, has
lately joined forces with the more modern Bristol
Hospital, so far as the training of students is con¬
cerned. A large surgical practice is always to be
witnessed at both institutions, owing to the position
of the town as a large manufacturing centre and Bea-
port. For a student who does not contemplate con¬
sulting or special practice the advisability of spend¬
ing a portion of the whole of bis course of study in
one of the smaller provincial schools is worthy of
consideration.
V egetarianism.
The Annual Congress of the cult of the vegetarian
was in full swing last week in London. It is to be
noted about these meetings that there are always plenty
of curious opinions and statements advanced by
members, and this year showed no falling off in that
particular. A Miss Eccles advanced the idea that
there was nothing in vegetarianism inconsistent with
beauty, whilst in the eating of flesh there was
nothing whatever consistent with it. We may
hazard the opinion that an analysis of the lives
of famous beauties, living And dead, would show
few, if any, vegetarians among them. One speaker
maintained there was a close affinity between art and
vegetarianism, and expressed the belief that the anti,
flesh faith he held was beginning to lay hold of the
artists and poets of the present day. Well, it may be
so, but the fact is not conspicuous among the
Bohemian circles in the metropolis, where art
sits as goddess. Another gentleman, a Dr.
Black, suddenly made a savage onslaught on
the bull fights at Boulogne. He said it was
the duty of the Congress to show they had not
the slightest sympathy with such terrible actions.
Does he imply that those who eat beef must neces¬
sarily be brutalised sufficiently to patronise a bull
fight P An opponent of the movement had the hardi.
hood to declare that flesh-eating was like smoking—
some took it up because they liked it, and vice-versd
One lady eschewed cheese because it was made from
milk and curdled by rennet, which had to be obtained
from the calf 's stomach. De guetibus non eat dis-
putandum.
Digitized by Google
308 Th* MsDIUAL PRESS.
NOTES ON CURRENT TOPICS.
Skpt. 20, 1899.
The Treatment of Urinary Incontinence in
Girls.
Urinary incontinence in girls is a fairly common
and always a very troublesome affection. In a
minority of these cases treatment having for object
to correct abnormal conditions of the urine, or to
destroy intestinal parasites, is attended by a certain
measure of success, but in many, possibly in the
majority, it is the result of a neurosis, and in such
cases treatment by drugs usually fails to afford
relief. We are now in possession of a tolerably large
number of cases of incontinence in which recovery
has followed gradual distension of the bladder by an
innocuous fluid, boracic acid solution, for example-
In a recent number of the Boston Medical and Sur
gical Journal Dr. Haven records two further cases suc¬
cessfully treated by this method in girls, both 18 years
of age He employed a 4 per cent, solution of boracic
acid. In one case the bladder admitted eight ounces
under pressure, and in the other only three and a half
ounces. His plan was to inject until discomfort was
produced, then directing the patient to retain the
fluid as long as possible, usually from ten to fifteen
minutes to begin with, though this period could soon
be extended. Distension was practised every other
day and improvement soon followed. The treatment
was continued until the bladder would admit twenty
ounces, and then all symptoms having subsided it was
discontinued. The total duration of the treatment
was three and five months respectively, but in some of
the previously recorded cases much less time was
required to effect a cure.
Volunteers Medical to Fight the Plague.
In view of the imperious necessity of providing
further medical aid in the treatment of patients suf¬
fering from plague in India, the Government hag
selected twenty medical men and thirty nurses
as volunteers, most of whom will leave this country
for Bombay in the course of the next few days. We
publish elsewhere a list of the volunteers whom we
wish God speed in their noble mission. The spectacle
of a number of young medical men leaving on
such a perilous mission is at least worthy of en_
thusiasm as that of a regiment of cavalry leaving
England on a destructive mission under circum¬
stances which, as far as risk to life is concerned, com¬
pare favourably with those of the non-combatants.
Medical Certificates and Hospitals.
A question of considerable importance to hospital
medical officers has cropped up at the Cardiff
Infirmary. It seems that though certificates to clubs
and friendly societies are given without payment, the
same indulgence has not been extended to certificates
intended to serve as the basis of claims for compen¬
sation. In reality there are two questions at issue—
first, whether such certificates are to be charged for;
and secondly, to whom such fees, if paid, should
belong. Looking at the question on its merits, it is
evident that both custom and humanity justify the
practice of giving certificates testifying to inability
to work for the purpose of obtaining club money. It
is, on the other hand, obviously unfair to expeot
medical officers virtually to act as witnesses in actions
brought to recover compensation without fee or re¬
ward, for that is what it comes to, and we strongly en¬
dorse the action of the medical staff in refusing to be
coerced into doing so. With regard to the question of
the right to fees paid for such certificates the infir¬
mary can have no claim thereto. If the medical
offioer, having refused the certificate,were called as wit¬
ness he would certainly expect to pocket whatever fees
were forthcoming and the giving of certifi¬
cates stands on exactly the same footing. The matter
is being enquired into by a committee appointed for
that purpose, and we trust that they will arrive at this
common-sense conclusion.
The Opening of the London School of
Tropical Medicine.
We are informed that there is to be no formal
ceremony at the opening of the London School of
Tropical Medicine which is to take place on the let
prox. The fact is the hospital buildings which
adjoin the school have not yet been completed, and it
is deemed preferable to defer the real opening cere¬
mony until a later date. It is hoped that an endow¬
ment fund will be subscribed, and should the response
be generous enough a museum and library will also be
established in connection with the school.
Herbalist versus Surgeon.
An odd instance of refusal to pay for medical
attendance was heard last week before the County
Court judge at Stonehouse, when Mr. Elgar Down
sued an ex-patient for his fees in connection with
the treatment of an injured knee. The defendant
based his refusal to pay on the ground of wrong
treatment, but the only evidence he was able to
allege in support of his contention was the assertion
of an old woman who practises as bonesetter and
herbalist. The defendant had been advised to go
into the hospital, but had refused to aocede to the
suggestion because, he said, his brother had been im¬
properly treated there, an assertion which elicited
from the judge the remark that he must belong to an
unfortunate family. Ultimately, of oourse, a ver¬
dict in favour of the defendant was given. We may
congratulate the plaintiff en passant on having been
wary enough in such a case to call a fellow-
practitioner in consultation, a course worthy of
imitation, considering what damage to a surgeon’s
reputation an unfavourable issue must needs have.
A Taboo on Raw Cockles.
Typhoid fever has been somewhat rife of late at
Exeter, and suspicion has been cast upon raw
oockles, a dietetic luxury of which school children in
that part of the country are notoriously enamoured.
A resolution has just been passed by the Exmouth
District Council forbidding the sale of this bivalve
in a raw condition, a decision which appears to have
caused considerable local exoitement. In view of
Digitized by t^.ooQle
Sept. 20, 1 ' C.
SCOTLAND.
The Medical Puss, 309
the fact that the river Exe receives the sewage from
various towns and villages in its wake, it is evident
that the shell-fish grown in its estuary are very
likely to be contaminated, but it is rather a pity that
the order only deals with the local sales. Customers
at a distance are also entitled to protection, and what
is not good enough for Exmouth ought to be dis¬
carded from markets further afield.
Stamp-dicker's Tongue.
Soke months ago a paragraph was published in
these columns upon the subject of “ stamp-licker’s
tongue,” a phrase that was created and evolved in
our own office and thence issued to the world at large.
The article in question enjoyed a wide popularity,
and was quoted by a great many newspapers, both at
home and abroad. The phrase has evidently taken a
place in the English language, for last week we saw
it in a prominent position in one of the London daily
newspapers, to wit, the Daily Chronicle. It has been
dignified, we find, with a further extension to
label-licker’s tongues, and no doubt, as time goes
on, the list of specific articles giving rise to lickers
tongues will be considerably enlarged by journalists
in search of novelty. As to labels, it is interesting to
note, from the final report of the departmental com¬
mittee of inquiry upon certain dangerous trades, the
following passage “ With regard to the practice of
licking labels for use in threadmills and other fac¬
tories, they state that in many cases artificial
dampers are being introduced with obvious
advantages. Therefore, without recommending that
the licking practice be prohibited, the committee
express the hope that manufacturers generally will
abandon a method which is certainly unnecessary,
and which carries with it possibilities of injury.” It i
is even stated that some women lick several thousand
labels daily. Without wishing to cause needless
alarm, we may say that such a proceeding would be
calculated, in our opinion, sooner or later to set up
cancer of the tongue. In that way, moreover, the
poison of syphilis and of other communicable diseases
might be readily distributed upon the article labelled
in bo primitive a manner.
The Toxic Effects of Formaldehyde.
Fobmaujehyde preparations used for antiseptic
and germicidal purposes are quite strong enough to
cause harmful, if not fatal, effects upon those who may
inadvertently, or otherwise, imbibe them. A case of fatal
poisoning, for example, is recorded as having occurred
in a Bchool in Indiana, where a youth, set. 26, drank
about 2 ozs. of a 4 per cent, formaldehyde solution
used for treating seed potatoes. Death occurred
about twenty-nine hours afterwards from asthenia.
Some escharotic changes were visible at the post¬
mortem examination in the stomach, and the mucous
membrane at the upper and middle thirds of the
oesophagus was slightly inflamed. The immediate
effect of swallowing the poison was to cause vomit¬
ing, the vomited matter containing traces of blood. In
the treatment emesis was encouraged with a sub¬
cutaneous injection of apomorphinp, and large
quantities of albuminous water were administered by
the mouth without causing any discomfort while
being swallowed. For a time the man seemed to
make a good recovery, but at the sixteenth hour his
pulse began to fail. Despite the subcutaneous injec¬
tions of strychnine and of seventeen ounces of normal
saline solution, together with doses of nitro-glycerine
and sparteine by the mouth, death from heart failure,
as mentioned above, took place. This is, we believe,
the first recorded case in which a fatal result has en¬
sued from swallowing a formaldehyde solution, and
it is therefore of some toxicological intei'est.
Curious Deadlock in a London Parish.
It will be remembered that during the past summer
a considerable stir was created in the South London
Parish of St. Olave’s over the removal of bodies from
the Church of St Thomas. The Medical Officer of
Health, Dr. Bond, was suspended by the Vestry,
but that step has not received the sanction of the
Government, who have directed the rescinding
of the suspension order. The St. Olave’s
Board, however, have appointed Dr. Dixon Medi¬
cal Officer of Health for Bermondsey, as tem¬
porary Medical Officer in place of Dr. Bond. This
state of affairs presents a curious insight into the
machinery of local health administration in the
metropolis. St. Olave’s includes a small but very
wealthy area, and its good sanitation is a
matter of no little importance not only to
its enormous day population, but also to the many
poor workers who dwell in that quarter. The
sanitary administration, for all its size and com¬
plexity, is entrusted to the care of a Medical Officer
of Health, who also has charge of the health interests
of Holbom. The St. Olave’s Board, having
suspended Dr. Bond turn to Dr. Dixon, who
already divides his energies between the cases of
private practice and the sanitary charge of Bermond¬
sey, with a population of Borne 80,000 souls. So busy
is Dr. Dixon, that important health prosecutions in
Bermondsey are generally conducted by one of his
subordinate inspectors. Of a truth it iB time Mr.
Balfour reformed the terms of these important posts.
garthmb.
[from our own correspondent.]
Larue Charitable Bequests. —By his will, the late Mr.
Walter W. Pollock, of Rhindmuir, has left the following
legacies, viz , Glasgow Royal Infirmary, £10,000; Victoria
Infirmary, Glasgow, £10,000; Royal Glasgow Asylum
for the Blind, £5,000; Western Infirmary, Glasgow,
£5,000; and the Royal Infirmary, Edinburgh, also
coming in for £10,000 by Mr. Pollock’s will.
Deplorable Sanitary Condition of Kilsyth.—
There has been a great increase in the number of cases
of enteric fever and of scarlet fever during the
last few weeks in thin burgh, several deaths hav¬
ing resulted therefrom. The fevers have been spread¬
ing since the end of July, the cause of the
outbreak being attributed to defective and untrapped
drains. It was pointed out at a recent meeting of the
Polioe Commissioners that the origin of the outbreak
310 Thi Medical Fbih. CORRESPONDENCE - . B*pt. 20, 1800 .
was similar to that of the recent Paisley outbreak, there
being no lees than twenty-three direct connections from
the sewers into the water-mains, and it was also
mentioned that during the summer the ash-pits were
allowed to overflow, while the towns’-men were engaged
on work whioh should have been contracted for; liquid
filth from ash-pits percolated through walls into
washhouses and lay in pools around houses, giving off
most offensive stench, whioh pervaded the houses.
The meeting finally agreed that the Sanitary and
Drainage Committee should meet and consider what
steps should be taken to remedy this deplorable con¬
dition of matters, which is a glaring disgrace to the
town.
Glasgow Corporation Bacteriologist. —The sub¬
committee having sent to the Health Committee the two
following names for the appointment of bacteriologist,
which carries with it a salary of .£360 per annum, viz..
Dr. Robert MacNeil Buchanan, at present teacher of
Medical Jurisprudence in Anderson’s College and Mr.
David McCrone, L.R.C.P Edinburgh, at present lecturer
on Bacteriology in St. Mungo’s College and Bacteriolo¬
gist to the Glasgow Royal InBrmary, the voting for the
appointment took place at the Town Council meeting on
Monday last.
CtertBjMmflence
We do not hold ourselves responsible for the opinions of our
correspondent*.
ANTISEPTIC v. ASEPTIC.—A PROTEST.
To the Editor of The Medical Press and Circular.
Sir, —In one of the Notes in the current number of
your journal, under the heading, “ Successful Removal
of Sarcoma of Brain,” occurs the following:—“ The
brain has been brought within range of practical sur¬
gical therapeutics simply and solely by the introduction
of Lister's system of aseptic surgery .” It is against the
words in italic that I indignantly protest Lister
has no claim whatever, and must feel surprised that a
claim is now made on his behalf, to the credit of having
introduced aseptic surgery. It is to the late Mr. Lawson
Tait and myself that this credit belongs; for it was we who
initiated and promulgated, in the face of envenomed
opposition, what is now called aseptic surgery. We were
satisfied with the use of the simple English term
'' cleanliness.” But aseptic is a word to conjure with.
It is due to the memory of the late Mr. Lawson Tait
that this claim, which requires no substantiation at my
hands, should he thus publicly made. As for myself, I
have ceased to expect that the part I have played in this
matter would be publicly acknowledged, though I have
never met with anyone in recent years who would ven¬
ture to my face to contest or fail to admit it.
There appears to me to be much confusion of ideas
prevalent with regard to the meaning of the terms
" antiseptic ” and “ aseptic,” for, while it is quite correct to
speak of having .just done an antiseptic operation, it is
utter nonsense to say that one has just done an aseptic
operation. I have little hope that men will cease to ex¬
pose the ; r negation of such an elementary principle as
the use of words in their proper sense, so long as the
existing prejudice and unreasoning faith remains.
I am, Sir, yours truly,
Geo. Granville Bantock.
crimes of a “ Dr. Collins ” and head it " Modern Sur¬
geons?”
The art and science of nursing has fortunately gone on
progressing side by side with modern surgery; the
modem patient has advantages at the present day when
operated upon, which not even the skill of a Gant and
the wealth of a Rhodes could have secured for him in
the past.
Had not the modem nurse been more highly educated
than her sister in the past, modern surgery would have
been very heavily handioapped.
I am sure Mr. Gant will find very few, if any, of his
oolleagues who will support his views of the nurse as she
is at the present time. The more highly trained she is,
the less likely is she to fall into the errors as depicted
by the imaginative writer.
It is strange how few people can write sensibly of
the hospital nurse; they either describe her as an
angelic being in a costly uniform whose sole duty appa¬
rently is to “ lightly press the fevered brow of a patient
with a cool hand,' or as the extraordinary character
whose sole existence lies in the imagination of a Gant
or a Hall Caine.
The truth is, the modem nurse is as impossible to
describe as the modem physician or surgeon. If she were
mechanical or “ typical ” it would only show that she
was unfit for her work. To be a good nurse she must be
“ personal,” and bring to bear upon her duties indi¬
viduality and tact. The only remark I can add is to hope
that, if Mr. Gant ever becomes ill, he will find it more
easy to meet with an honest nurse than he appears to
imagine. I am quite sure that no accredited association
could supply one a la Gant.
I am. Sir, yours truly,
Alf. BatEman.
40 Devonshire Street, W.
To the Editor of The Medical Press and Circular
Sir, —I for one fail altogether to see the purport of
Dr. Walsh’s criticisms on Mr. Gant’s interesting contri¬
butions on the above topic, nor is there anything I think
that can be regarded as “a prurient and indefensible
attack upon a sisterhood which deserves tender treatment
from all mankind ”
It is impossible to conceal the fact, which Mr. Grant has
not overdrawn, that the tendency of the majority of
trained nurses of the present day, and this no doubt due to
the inate vanity of the female mind, is to supersede the
ordinary medical attendant, and to take advantage of
public credulity, and the practitioner of the rising
generation must have the courage and firmness to put
down any airs on the part of a nurse who attempts
to play first fiddle by giving her as wide a berth as
possible. I happen myself to have been brought into
contact with more than one of these individuals, and there
resides in the locality where I practise what is known
as a parish nurse, appointed by an irresponsible Church
community, a person of some refinement, and a good deal
of mannerism, but as she altogether exceeds the duties of
a nurse and carries on unqualified practice, I have felt
it my duty, in accordance with the edict of the Medical
Council which prohibits unqualified practice, to refuse in
any way to recognise her.
I am, Sir, yours truly,
A General Practitioner.
London, September 16th, 1899.
7e the Editor of The Medical Press and Circular.
NURSE8 OF THE LATEST FASHION.
Sir, —I should like to add my quota of indignation to
that of Dr. Walsh at the publication of the articles in
your paper reflecting so unjustly upon the modern
nurse.
To attempt to convict a whole class of professional
women of education, high training and extreme value,
because one or two of their number fail to attain to the
high standard of their calling and fall by the wayside is
unjust and unfair.
What would Mr. Gant say if some elderly matron were
to write an article in a nursing journal detailing the
CHRONIC PHARYNGITI8.
To the Editor of The Medical Press and Circular.
Sir, —In his letter in your last week’s issue Mr.
Lennox Browne dissents from two statements selected
from my paper on “ Chronic Pharyngitis.”
He first suggests that the importance of nasal obstruc¬
tion as an etiological factor in chronic pharyngitis was
reoognised long before a considerable number of these
cases could have passed through my hands. In proof of
this he quotes from the first edition of his work in
1878, “ten years before I took my degree,” - that
Nasal respiration is often obstructed in cer-
ed by Google
8 KPT. 20, 1899.
NEW SURGICAL APPLIANCE8.
The Medical Press. 311
tain pharyngeal diseases.” This is an abstract
statement showing that the association of nasal
obstruction with " certain pharyngeal diseases ” had
begun to be remarked on, bnt there is not a word of
suggestion that any causal relation existed between the
obstruction and the diseases. Mr. Browne has to oome
down so late as the 1860edition of his work before he can
•how he was alive to the fact that the oondition of the
nose exerted any influence on the health of the throat.
I can go further, and say that even in the 1893 edition
nasal obs tr uction, the prime cause, as I hold, of chronic
pharyngitis, is relegated to the tail of a long list of
causes, a number of which are at the present date
regarded as survivals of a laryngological middle age.
Again, when I said the necessity for rhinoscopy in
throat disease was only pointed out a few years ago, I
was not under the impression that the art of rhinoeoopy
was only then discovered.
I could hardly have gone through the Dublin
School without knowing that the port-rhinal mirror
was used by Sir William Wilde even before Czermak
published his paper in 1869. But from this we have to
skip an interval of time measured by quarter centuries
before we oome to the period when the regular examina¬
tion of the nose in every case of throat disease was incul¬
cated by the teachers in the subject.
And this, 1 think, justifies the statement, that though
the art has long been known, the necessity for its prac¬
tice in diseases of the throat is a matter of quite recent
knowledge.
In conclusion, I have to thank Mr. Browne for his
generous criticism of my paper.
I am, Sir, yours truly,
Robert H. Woods.
89 Merrion Square, Dublin,
September 16th, 1899.
HOSPITAL CARDS AS ADVERTISEMENTS IN
SHOP WINDOWS.
To the Editor of Thi Medical Press and Circular.
Sir,— When will the leaders in medicine and surgery
cease to have their names and qualifications placarded
in this vulgar way P I see the hospital cards in various
colours gradually creeping into the windows of pharma¬
ceutical chemists, druggists, instrument makers, Ac.
What object can there be in so fulsome a display except
letting the public know the names of physicians, sur¬
geons, specialists, and consultants ? Surely our clinical
hospitals have not made their reputations by hospital
cards. I don’t believe any student is attracted to a hospital
through such media. Hospitals are known by the work done
inside their walls—sound teaching, punctuality of the
staff, honest work done in the long run makes the name
of a hospital, and attracts patients and students alike. If
student* before deciding on a hospital would go round
the wards, say in October, and observe and listen, the
hospitals with “drones” would find it easy to accom¬
modate the class, and the genuine teaching hospital would
be filled with young men anxious to learn their profession;
otherwise it is obvious that the purpose and true in¬
terests of any clinical hospital cannot be subserved by
the exhibition in a druggist’s window of a partly
coloured advertisement.
I am. Sir, yours truly,
Dublin Clinical Teacher and Operator.
September 16th, 1899.
SCARLATINA CASES IN BUILDINGS IN CLOSE
PROXIMITY TO GENERAL CLINICAL
H03PITALS.
To the Editor of The Medical Press and Circular.
Sir, —I think it is high time for the authorities to
take the necessary steps to put a stop to the highly
dangerous practice of having hot-beds of so deadly a
disease as scarlatina admitted into wards in close
proximity to the General Hospitals within the City.
Smallpox and cholera are not admitted to such wards—
why scarlatina ? From start to finish scarlatina is most
dangerous, and, from the commencement of the desquam¬
ation stage, sic weeks must elapse before rack cases can be
removed home or to a convalescent home. Independently
therefore of the risk to the patients, nurses, and staff,
the expense of such cases is very great. The beds occu¬
pied with patients convalescing from scarlatina for
such along period as six weeks is not only a great tax on
the hospital funds but a great injustice to other cases,
who are thus debarred from obtaining admission into
the hospital wards.
I am. Sir, yours truly,
PBOQRB83.
September, 1899.
Surgical Appliances.
NEW UTERINE PREHENSILE AND COM¬
PRESSION FORCEP8.
Dr. Alexander Duke, of Cheltenham, has sent us the
following description of a new instrument designed
The instrument here depicted will be
found useful both as a haimostatic forceps
in cases of passive haemorrhage from the
unimpregnated uterus, metrorrhagia, Sec.,
and also in oases of free haemorrhage in
impending abortion in the early months
of pregnancy.
A duckbill or cylindrical speculum is
first to be introduced and the parts
cleansed by hot water (syringing or other¬
wise), my self-retaining tenaculum hooked
into lip of “ os ” will draw cervix within
grasp of forceps, the latter are now to be
closed sufficiently to .arrest the flow of
blood, locked and left tn situ so long as
required, while patient lies quiet on bed
or couch. To the busy practitioner on his
rounds, the value of this instrument (by
the saving of time alone) will be apparent,
more especially in cases of impending
abortion in the rarly months, when by
retaining the blood in utero it will dis¬
tend the cavity, separate the membranes,
and hasten the evacuation of the uterus
when forceps are withdrawn. It will also
prevent the necessity for plugging the
vagina, thus avoiding the discomfort to
the patient by pressure on bladder, Ac.,
and the unpleasant removal of an offensive tampon.
These forceps will in addition be found valuable during
the operations of Bupra-vaginal amputation of cervix
uteri and vaginal hysterectomy in cancerous cases, more
especially when tenaculum or volsella fail to hold.
The convex shape of blades will also prove a guide to
the preliminary incisions in vaginal roof when cervix or
entire uterus is being removed from below, and by o; en-
ing the blades to their full extent and pressing same
upwards will stretch the vaginal fornices and facilitate
the removed of cervix in the operation of abdominal
hysterectomy, the instrument being held by assistant
(like Mr. Bowreman Jeasett’s speculum), the rack at
lock keeping blades in position.
The instrument has been most carefully made by
Messrs. Arnold and Sons, West Smithfield, from my
sketch and description. The rubber cord let into con¬
cave sides of jawB prevent injury to cervix from con¬
tinued pressure. The blades are detachable and easily
sterilised by placing in boiling water. I have found
forceps most useful, and trust they may prove equally
useful to others.
PERSONAL.
Sir William Turner, F.R.S., of Edinburgh, has been
elected president of the British Association at the next
unnnftl meeting, which will take place at Bradford.
Digitized by GoOglC
312 The Medical Press.
LITERATURE.
Sept. 20, 1899.
■jCitentture.
ELEMENTARY PHYSIOLOGY, (a)
This excellent little manual has, professedly, been
prepared for the benefit of “ those who have no previous
knowledge of the subject;" and with the earnestly
expressed hope “ that it may remove some of that deplo¬
rable ignorance which is so often met with, even among
fairly well educated people, as to the general structure
of their own bodies, and the notions which take place
within them during life.”
We congratulate the author on the result of his
labour. He has made an excellent selection from the
vast masB of his material, and has arranged it judi¬
ciously, and with the least possible amount of technical
nomenclature. Following a general introduction, we
have three chapters devoted to a description of the
structure of the body: the skeleton and its articula¬
tions, the muscular system, and the viscera. Then the
author proceeds to deal with the functions: circula¬
tion, blood, diet, digestion, absorption, and metabolism,
respiration, animal heat, excretion, the nervous system,
ana the senses.
The text is illustrated by a series of 125 drawings,
there is an appendix of well-selected practical exercises,
and a series of questions by which the reader can test his
progress and strengthen his memory as he proceeds with
his reading. There is also, we are glad to see, a good
index.
Accordingly, we consider that this volume has made a
thoroughly honest “ bid ” for public patronage. We con¬
gratulate the author on the skill and judgment which
he has brought to bear upon his task, and on the com¬
pletion of the work as it lies before us. We also feel
oertain that it will meet at the hand of the general
reader the cordial reception which it most assuredly
deserves. ___
“TWENTIETH CENTURY PRACTICE." ( b )
This important volume contains nine articles:—In¬
fluenza, by Professor Ditmar Finkler, M.D., Bonn;
Typhus Fever, by Eduardo Liceaga, M.D., Mexico;
Plague, the joint production of. S. Kitasato, M.D., Tokio,
Japan, and A. Nakawaga. B.Sc., M.D., Tokio, Japan ;
Glanders, by Frank S. Billings, M.D., Grafton, Mass.;
Anthrax, by the same writer ; Foot and Mouth Disease,
by Ismar Boas, M.D., Berlin; Actinomycosis, by Emil
Ponfick, M.D., Breslau; RabieB, by Nathaniel Garland
Keirle, M D , Baltimore ; and Pyaemia and Septicaemia,
by J. McFadden Gaston, M.D., Alanta, and J. McFadden
Gaston, jr., M.D., Alanta.
The now vast subject of influenza is very ably treated
by Professor Finkler. The frequency and mortality of the
so widely diffused epidemics of this disease that have
occurred of reeent years have brought it so prominently
before all members of the profession in all civilised com¬
munities, that the subject has been brought broadside
in collision with the proud-crested wave of latter-day
scientific research, and has in consequence been so
thoroughly investigated in all its relationships, that, as
Dr. Finkler truly observes, “ influenza has given us
occasion to test all the modern attainments of medical
science.” We thoroughly admire and proudly sympa¬
thise with the feelings which dictated the following :—
“ It may be truly said that influenza has become the
teacher in many branches, and it has demonstrated to
the world such thoroughness of methods on the part of
physicians and investigators, that our profession has a
right to feel proud of its members.” This truly magni¬
ficent article occupies 249 pages of the volume before us;
and it is hardly necessary to add that it omits nothing
worthy of record that history or scientific research has
hitherto taught the most reliable investigators on the
(a' “Elementary Physiology.” By Beniamin Moore, M.A., late
Sliarpey Research Scholar, and Assistant Professor of Physiology
at University College, London. With 125 illustrations. Longmans,
Green, and Co., London, New York, and Bombay. 1899.
(61 An International Eucyclopaidia of Modern Medical Science.
Bv Lading authorities of Europe and America. Edited by Thomas
8.‘8tedman, M.D., New York City. In 20 volumes. Volume XV.,
Infectious Diseases. London: Sampson. Low, Marston, and Com¬
pany, Limited. 1898.
subject. It is a thesis which we must emphatically say
does the highest honour to the scientific attainments,
clinical discrimination, patient and thorough research*
and philosophical judgment in the aeleotion and arrange¬
ment of material herein displayed by the author.
The second article in position—and in dimensions - is
that on typhus fever. It may look a little strange to
many of us British Islanders who see so much of thin
fever at home to have the future standard of the subject
imported from Mexico. The article is, however, a very
good one. The writer has, of course, to lament the non-
discovery of th9 pathogenic microbe, and also of a
specific remedy for the cure of typhus.
In the article on plague. Dr. Kitasato gives full in¬
structions for the differential diagnosis between the
bacillus pestis of Yersin and that which he has himself
described. “Further bacteriological investigations of
the plague are desirable, sinoe it is necessary that the
scientific world should come to some definite conclusion
as to the etiological bacilli, before ortho-therapy and
preventive inoculation can be instituted on a truly
rational basis.”
“ Glanders ” is ushered in by a definition which we felt
irresistibly impelled to read a second time. It is worded
as followsGlanders is an endogenous, obligatory-
parasitic, invasio-infectious disease, due to the patho¬
genic action of a specific bacillus within the body of a
suitable host, which finds its historico-primary origin
and its present genesis invariably among the solipeds,
principally the horse, from which it is extended to other
animals and to man, directly or indirectly, but not to
cattle and swine." This definition did not lead us to
expect too high a standard of scientific and clinical taste
and discrimination; which, possibly, partly accounts
for the fact that we were not disappointed.
The article on rabies is one which we perused with
pleasure as well as instruction; it is extremely well
written, and displays judgment and power of personal
observation of a very high order.
The volume closes as it began, with an able and care¬
fully-prepared article (Pyemia and Septicemia). In
the introduction the authors express dissatisfaction with
the position of the boundary line netween medicine and
surgery. “ The line of distinction between surgery
and medicine has been generally recognised as
external and internal, but this does not give so
good an idea of the difference as a division into
organic and functional disorders. A mere temporary
engorgement of structures which is not accompanied or
followed by radical changes in the organisation of the
tissues, and which is amenable to the action of drugs
comes properly under the care of the physician. But a
modification of structure as to size, shape, or density,
whether internal or external, belongs to the domain of
the surgeon.” Whether or no the profession on our side
of the Atlantic may think this definition eligible for all
future use, we venture to say that there will be no
second opinion as to the value of the article towards
which it leads. We consider that it is one of the most
carefully thought-out and sensibly-written of the many
which have hitherto appeared in this magnificent
encyclopaedia.
AN EXPERIMENTAL RESEARCH INTO
SURGICAL SHOCK, (a)
This beautifully-printed and well-illustrated volume
places before its readers the results of a series of (ap¬
proximately) blood - curdling experiments on many
quadrupeds’, members of the animal creation, with the
view of throwing some light on the nature of sur¬
gical shock when met with in the lordly biped,
man. The experiments have certainly been carried
out with great care; they were also originally selected
with excellent judgment, as tending in their results
(a) “An Experimental Research into Surgical Shock.” Au
essay awarded the Cartwright Prize for 1897. By George W.
Crile, A.M.. M.D.. Ph.D.. Professor of the Principles of Surgery
and Applied Anatomy in the Cleveland College of Physician* and
Surgeons ; formerly Professor of Physiology in the Medical De¬
partment of the University of Wooster: Attending Surgeon to thfe
St. Alexis and Cleveland General Hospitals, Philadelphia. London :
J. B. Lippincott Company.
d by Google
Digitiz
Sift. 20 1899 MEI)tt5A.L NEWS. The Medical Press. 313
to throw the strongest lights on the. dark places df the
hitherto very obscure condition of snrgical shock.
A great many of the conditions here artificially -pro¬
duced on members. of the quadruped families wfll; we
trust, be seldom met with in our practice bn the ferspns
of our biped confrb-t* ; but we consider the rolnme a
very important one, and one which should be eftitifully
read throughout by every practising surgeon-,'* ft is a
most carefully-prepared contribution to the increase of
our knowledge of one of the most mystari^ii^', 'conditions
with which we have bad to deal. *
. . . , • t f «
pass lists, :
University of Dublin.
At the first Examination for the Degree of Bachelbf in'
Medicine, held this month, the following candidates
satisfied the Examiners : — -■
Old Bwiktion*.—1. Cbemfstrv with O.hnmical Phvsic*.- Ernest
Oeerve Anii>. M.B.O.S.. 1,-B.C.P., D.P.H.. Alfred .tames Bnlper.
M.B.C.8.. L.B.C.P.. Philip Gell Garrett, M.B.C.8.. L.B.C.P.. Ernest
James Miller.
New Bevulations.—1. Elementarr Anatomy ami Hiolovy. Chemis¬
try and Physics. Honour*— First Class.—Arthur Gibson Dunn.
Honours—Second Class.—William Henry Peacock.
Pass List.—John Frederick Bridge. John Wilfrid Caton, Edtrar
Fletcher Edmunds, Evelyn John Evutt, Daniel Richard Gnns.
Francis Jollie Gowans. G*orjre Brittan Gill, William Geonre
Thorraa Henplewhite. William Hugh**. John Tliomas McKay,
Joseph Collinfrwood Stewart.
Chemistry and Phvsies. Freilerick Geonre Armstrong. Walter
Doriald Ormtheni. Wilfred Balph T.evcester~Drawbridve. Martraret
Douglas French, Arthur Henrr Fnllerton. Bryden Glendinning.
William Edward Hopkins. Charles Boliert Lease. George Edward
Victor Morris. Flora Murray, Christie Muthnswamy-Anthonv,
Harry CsrlUe Sturdv. M.B.C.S.. L.R.C.P.. Gavton Warwick Rmith.
Herbert Hoyle Whaite, Auburn Lawrence Wilkinson, John Boliert
Wylie.
Elementary Anatomy and Biology.—Amhroee Harold Bateman.
Harold Linton Currie. William Watkiss Jones, Sidney Nix, Leslie
Martin Bos ten, John Malcolm Shaw.
iftebical Jletos.
Vital Statistics.
The deaths registered last week in the thirty-three great
towns of the United Kingdom corresponded to an
annual rate of 25 2 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 towns, alphabetically arranged,
correspond to the following anrual rates per 1,000:—
Birkenhead 18. Birmingham 28. Blackburn 24, Bolton
33, Bradford 23, Brighton 31 , Bristol 20, Burnley 43,
Cardiff 25, Croydon 18, Derby 26, Dublin —, Edin¬
burgh —, Glasgow —, Gateshead 21, Halifax 19,
Huddersfield 22. Hull 27, Leeds 18. Leicester 25. Liver¬
pool 32. London 22, Manchester 32, Newcastle-on-Tyne 35,
Norwich 23, Nottingham 27, Oldham 25, Plymouth 22,
Portsmouth 21, Preston 28, Salford 31, Sheffield 30,
Sunderland 31. Swansea 22, West Ham 2?. Wolver¬
hampton 36. The highest annual death-rates per
1,000 living, as measured by last week’s mortality.
were . _ From measles, 3‘2 in Burnley; from whooping
oough, 1-4 in Cardiff: from fever, P8 in Sunderland;
snd from diarrhoea, 6‘3 in Nottingham, 6 4 in Sheffield,
7 5 Bradford, 7 9 in Sunderland, 8 4 in Liverpool, 8 8 in
Birmingham, 102 in Brighton, in Leicester, and in
Hull, 11-5 in Manchester. 13 3 in Preston, and 13 8 in
Bolton. The 70 deaths from diphtheria included 24 in
London, 6 in Birmingham. 6 in Liverpool, 5 in Leicester,
4 in Lc<h1s, and 4 in Sheffield. One dea’h from small¬
pox was registered in Hull, but not on9 in any other 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
populations:—Calcutta — .Bombay 36, Madras 34, Pari*
16, Brussels 17, Amsterdam 14, Rotterdam 21, the Hague
18, Copenhagen 22, Stockholm 17, Christiania 20, St.
Petersburg 21, Moscow 29, Berlin 25, Hamburg 22,
Dresden 25, Breslan 27, Munich 23, Vienna 17, Prague
23, Buda-Pesth 18, Trieste 19, Rome 14, Turin (ten
days), 18,Venice 21, New York (including Brooklyn) 19,
Philadelphia 15.
Typhoid outbreak in Kent.
A serious outbreak of typhoid fever in a range of
cottages by the side of the river Stour, at Asford, Kent,
is causing great anxiety to the authorities. Twelve out
of thirty-three persons living in the cottages have
been attacked Owing to the great heat, the infant
mortality for the past month is the highest on record.
Suicide of a Medical Man.
The suicide by prussic acid of Mr. Marwood Sanderson,
F.F.P.S, of Loftns (Yorkshire), which is reported to have
occurred on the 11th inst., naturally caused much local
excitement. The deoeased was 60 years of age, and was
possessed of considerable means. No reason has been
discovered to explain the regrettable occurrence.
Yellow Fever in North America.
Clo8b upon two hundred cases of yellow fever are
reported to have occurred at Key West, and three sus¬
picious cases landed at New York, from a vessel hailing
from Key West, have been diagnosed as yellow fever.
With the approach of colder weather, it is hoped that no
fnrlher spread of the disease will take place.
The Sunderland L.G.B. Inquiry.
An inquiry, ordered by the Local Government Board,
into the conduct of Dr. Barns, a Poor-law Medical
Officer, has just come to an end after a nine days session.
The question under consideration was whether or not the
medical officer in question had been guilty of inebriety
in the discharge of his duties, and the decision of the
Board will be made known very shortly. Dr. Burns was
defended by Lord Coleridge, who made a powerful
speech on his behalf after the evidence had been taken.
The Bubonic Plague in India.
The following gentlemen have been selected as
volunteers to proceed to India for the purpose of minister¬
ing to the requirements of plague-stricken patients :—
Harry Cowper Patrick, M.D., C.M., Glasgow, who
was on plague duty in Bombay between 1898 and 1899,
and was invalided home for enteric fever; Charles
Thomas Costello, M.B., B.Sc., Dublin, who served on
plague duty in Madras last year; William Morrison,
M.D., Edinburgh, B.Sc., Biological and Public Health,
Edinburgh, who has served as Medical Officer in China;
James William Otto van Millingen, M.D., C.M., Glasgow,
who served for two months on plague duty Alexandria;
Reginald A. Farrar, M.D, B.Ch., M.A.Oxon, M.R.C.S.,
England, L.R.C P., D.P.H., Cambridge; Alexander
Samuel Faulkner, F.R.C.S , Edinburgh, M.R.C.S., Eng¬
land, M.R.C.P., L M, Ireland, a retired surgeon-major
of the Indian Medical Service; Edward Lewis Hunt,
M R.C.S., L.R.C.P., who served on plague duty Bombay
1897-98; Henry William Beach, M.R.C.S., England,
L. R.C.P., London, D.P.H., Cambridge, who served
two years plague duty in 1898-99; John Hackett
Walsh, L R.C.P., L.R.C.S., Ireland; John Hanna
Murray, M.R C.S., England, L R.C.P., London, M.B.,
London University, D.P.H., formerly medical officer at
Isolation Hospital, Nottingham ; William Samuel Jagoe
Shaw, M.B., B.Ch, B.4.C., University of Ireland,
formerly assistant medical officer to the Stafford County
Asylum; James Harry Horton, M.R.C.S,, L R.C.P.,
London, Durham prizeman at Guy’s in 1881; Cuthbert
Christy, M.B, C.M., Edinburgh, who served as senior
medical officer in African Field Force, Nigeria; John
Edward Sandilands, M.B, B.C., Cantab., M.R.C.S.,
England, LR.O.P. London, formerly senior house-
surgeon at the Metropolitan Hospital; George Taylor,
M. D., Aberdeen, B.Sc., Edinburgh, who took the
public health medal at Edinburgh in his year;
Harry Cogill, M.R.C.S., England, F.R.C.P., London ;
Edward Head Moore, L.R.C.S., Edinburgh, L.S.A, Lon¬
don, medical officer Falmouth and surgeon-captain in the
Army Medical Reserve; Percy Targett Adams, L.S.A,,
M.R.C.S., D.P.H., England, pro ttm. resident medical
officer to the General Post Office. London ; Mark O’Brien,
L.R.C.P., L.R C.S., Edinburgh, L.F.P.S., Glasgow, who
was this year on the West London Hospital course ; and
Alexander Macbeth Elliott, M.B., C.M., Edinburgh.
y Google
Dii
314 The Medical Press.
NOTICES TO CORRESPONDENTS;
Sept. 80, 1996.
^IxrticcB to
CorreoponbattB, Short 'JDettcro, 4cc.
— Correspondents requiring a reply in this column are par¬
ticularly requested to make uae of a distinctive signature or
initials, and avoid the practice of signing themselves “ Header,”
" Sul ecriher,” “ Old Suhecriher,” Ac. Much confusion will be
spared by attention to this rule.
Local Reports and News.— Correspondents desirous of drawing
attention to these are requested kindly to mark the newspapers
when sending them to the Editor.
Heading Cases.— Cloth board cases, gilt lettered, containing
twenty-six strings for holding the numbers of The Medical Press
and Cibcdlae, 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.
Original Articles or Letters intended for publication should
be written on one side of the paper only, and must be authenticated .
with the name and address of the writer, not neoessarily for publica¬
tion. but as evidence of identity.
Mr. W. 8. Born.—In reply to our correspondent's inquiries the
following works will be found reliable on the subjects indicated
(1) Hutchinson’s Syphilis, 9 b. ; Drysdale’s Syphilis, 5s.; or the
American Text-book, by Bangs and Hardaway, 42s. (2) Shield’s
Clinical Treatise on Diseases of the Breast, 15s. (3) A Physician’s
Sermon to Young Men, Is. (4) AUingham's Diagnosis and Treatment
of Diseases of the Rectum, 12s. 6d., all or any of which can doubt¬
less be had in his neighbourhood of Messrs. Bailliere, Tindall, and
Cox, King William Street, Strand.
Db. J. Stewart. —If our correspondent will supply us with relr
able data, we shall be pleased to investigate ana to state our
opinions.
A Provincial Practitioner will find the subject is handled in a
leader in our present issue.
FriBrn Manor.— The accused is an LL.D., not a doctor of
medicine. Unfortunately the public immediately jump to the con¬
clusion that every “ Dr. mentioned in the newspapers belongs to
the medical profession.
Inquirer.— Burning of the skin by the X-rays has been found to
be due, not to the rays themselves, but to a high-tension induction
current formed near the Crookes’ tube .
Mr. Wilson is thanked for his note. A discussion, however, at
the present moment would be inopportune.
County Asylum, Prestwich, Manchester.—Assistant Medical Officer,
unmarried. Salary commencing at A125, with board, apart¬
ments, washing, Ac.
Cumberland and Westmoreland Asylum, Garlands, Carlisle.—Junior
Assistant Medical Officer, unmarried. Salary £100 a year, with
| board and residence.
Devon County Asylum, Exminster.—Two Assistant Medical Officers.
Salary commencing at £120 per annum for the first, and for
the second £100, with, in both cases, board, lodging, and
washing.
Durham County Asylum, Winterton, FairyhilL—Assistant Medical
Offloer, unmarried. Salary commencing at £140, with board,
lodging, washing, and attendance.
French Hospital and Dispensary, 172 Shaftesbury Avenue, London.
—Resident Medical Officer, unmarried, speaking French.
Salary £80 per annum, with full board.
Great Yarmouth Hospital. — House-Surgeon. Sala’y £90 per
annum, with board, lodging, and washing, and £10 extra for
Go van District Asylum, Crookston, near Paisley. Junior Assistant
Medical Officer. Salary commencing at £100 a year, with rooms,
board, attendance, and laundry.
Manchester Clinical Hospital for Women and Children, Park P’aoe,
Cheetham Hill Road.—House Burgeon. Salary, £80 per annum,
with apartments and board.—Applications to the Secretary,
38 Barton Arcade, Manchester.
Metropolitan' Asylums Board.—Two Assistant Medical 0(Boers at
Darenth Asylum, near Dartford, Kent, and one at the Leaves-
den Asylum, near Watford, Herts. Salary, £120 per annum,
rising, conditionally, to £150, with board, lodging, attendance,
and washing, subject to statutory deductions. Apply at the
office of the Board, Norfolk Street, Strand, London. (See
advert. 1
Stoke-upon-Trent Union. - Resident Medical Officer for the Work¬
house. Salary commencing at £100, with board, washing, and
furnished apartments. — Apply to the Clerk, Union Offices,
Stoke-upon-Trent.
West Riding Asylum, Menston, near Leeds.— Fourth Assistant
Medical Officer. Salary commencing at £100, with board and
apartments.
^jpomtmentB.
Clares, H. W., M.D.Brux., L.R.C.P.Lond., M.B.C.S., Medioal
Officer for the No. 1 Belief District, Kensington.
Elme8,T. Francis, L.B.C.S., L.B.C.P.Edin., L.F.P.S.Glasg., Resi¬
dent Medical Offioer to the St. Pancras Hospital, London, N.W.
Ensor, E. T u M.D. Univ. N Y„ L.R.C.P.Irel.. L.F.P.8.Glaag.,
Medioal Officer for the Workhouse for Able-bodied Men and for
the Casual Wards, Kensington Union.
Farrar, R. A., M.D.Oxon., L.R.C.P.Lond., M.B.C.S., D.P.H.Caa-
tab., has been appointed under the Indian Government to take
up Plague Duty.
Gamble, M. F. H., L.B.C.P., L.B.C.8.Edin ,L.R.P.S.Glaag., Acting
Medical Superintendent, pro Um., for the 8anbury Lunatio
Asylum, Victoria, Australia.
Lort, Arthur George Bateman, L.S.A.Lond., Medical Officer for
the Chudleigh District of the Newton Abbot Union.
Orherod, E. W., L.B.C P.Lond., M.B.C.S., Medioal Officer for the
Southern Workhouse and Sanitary District of the Union.
Wilson, A. Garrick, B.A., M.B Cantab., M.B.C 8 , L.R.C.P.Lond,,
House Surgeon to the St. Mary's Hospital, London.
AGE AND SLEEP.
Tes^au says that negroes live to advanced age because they sleep
so much. He believes that a man has just so many hours to be
awake/and that the more of them he uses up in a day the shorter
his life! will be. A man might live to be two hundrwl if he could
sleep most of the time. The proper way to economise time, there¬
fore, is to sleep whenever there is nothing better to do.
A Third Year’s Man.— The results will not be knodn before the
end of October.
Incontinence oi Urine in Eldbklt or Nervous Women.—
When there is a frequent desire to pass water, or it runs away in
the act of coughing, sneezing, or laughing, it is generally due
to the want of-power in the vesical sphincter, in such cases
tincture of cantharides will be found of the greatest service if given
in small doses of one minim in water three or four times daily.
A New Feature in Bacteriology.— One of our non-medical
contemporaries is responsible for the followingMrs. Malaprop’s
country visitor had a sore back, and her kind hostess insisted on
her seeing a distinguished bacteriologist, because, as she said, she
had hdarO so much about recent advances in backteriology that she
felt suCre he would do her friend good.
lacatttieB.
Dobie—Morrell —On Sept. 8th, at All Souls’, Belvedere, William
Henry Dobie, M.B., C.M.Edin., M.R.C.S., son of William
Murray Dobie, M.D., of Chester, to Alice Fanny, younger
daughter of Commander George Trueman Morrell, B.N., retired,
of Belvedere, Kent
Heron—Bowlbt.- On Sept. 12th, at the Parish Church, Down¬
patrick, co. Down, J. Matthews Heron, M.D., of Downpatrick,
to Annie Margaret Warner, eldest daughter of Lieut. Colonel
P. E. Bowlby (late 48th Begiment), Bathdune, Downpatrick.
Retnoldb—Alletson. — On Sept. 14th, at St. Lnke's Church,
Liverpool, Cecil Arthur Reynolds, M.B., B.Ch. Oxon, eldest son
of Henry Reynolds, J.P., of Norton Lodge, Halton, Cheshire, to
Elizabeth, eldest daughter of Samuel AUetson, of Liverpool.
Scharlieb—Tweedt.— On Sept. 14th, at St. Andrew's Church,
Redruth, Cornwall, Herbert Johann Scharlieb, M.D.Lond.,
F.R.C.S.Eng., second son of the late William Mason Scharlieb,
Esq., of the Middle Temple, barrister-at-law. and Mrs. Mary
Scharlieb M.D., M.L.Lond., of London, to Edith, elder daughter
of Charles Tweedy, Esq., of Redruth.
Young—Chaplin.— On Sept. 16th. at St. Jude's Church, South
Kensington, Hy. W. Pennyfather Young, B.A. M.D.Cantab.,
M.R.C.S., son of the late Tbos. Young, of Eastbourne, to
Constance, daughter of the late James H. Chaplin, of Lloyd’s.
Athy Union. -Analyst to the Board of Guardians.—Applications
to the Clerk of Union.—(See advert.)
Barn wood House Hospital for the Insane, Gloucester.—Junior
Assistant Medical Officer. Salary commencing at £120 per
antium, with’ board,' 4c.
Cambridgeshire, Ac., Lunatic Asylum, Fulbourn, near Cambridge.—
Assistant Medical Officer. Salary, £140 per annum, with board,
lodSfftgirtHd attendance In the Asyimtf.—AppHcaticmirto-the'-
Clerk to the Visitors, Cambridge.
Statkfi.
Budd.— On Sept. 13th, at his residence, 8 Gay Street, Bath, Samuel
Punnett Budd, M.B.C.S., L.S.A., aged 55 years.
Ezabd.— On Sept. 10th, Helen Mary Ezard, wife of Edward H.
- - Beard; M-.D., D.-Scr, of Lewisham High Road, o a t e—d-ioto
her rest, aged 37 years.
Digitized by
She Slnlual gtoss and Circular.
M 8ALU8 POPULI SUPREMA LEX."
Vol. CXIX. WEDNESDAY, SEPTEMBER 27, 1899. No. 13.
(Original Communications.
INFLUENCE OF POSITION ON THE
FORM AND DIMENSIONS
OF THE PELVIS, (a)
By Prof. E. PINZANI, M.D.,
of Fla.
Walcher's paper, published in 1889, on the
variability of the conjugata vera, being of practical
interest, gave a new direction to previous researches
on the mobility of the pelvic articulations, I feel
obliged to state here, that according to some authors,
the merit of having made practical use of the current
ideas concerning the mobility of the pelvic articula¬
te ns is not due to Walcher, the position he describes
having being recommended in difficult labours, by j
Scipione Mercurio (1595) according to some, by J
Sebastian Melli (1721) according toothers. Allowing |
the question to pass whether Melli might possibly
have copied the design of Mercurio, I wish to observe
that neither the one nor the other can have had in view
enlargement of the pelvic dimensions, as in their day
the mechanism of the sacro-iliac articulations was
unknown. Moreover it ought to be said that though
the positions described by Mercurio and Melli have
some analogy with Walcher’s, there is nevertheless
a fundamental difference, as in the former the lower
extremities of the woman are always supported,
whilstinthelatterthey are hanging, and by their weight
draw the anterior pelvic ring downward and forward.
I have examined sixty-two women during the puer¬
peral state, successively in Melli s and in Walcher's
position. In seventeen cases exact mensuration of
the diagonal conjugata gave no difference, in the
other forty-five cases there was a difference from 1 to
8 millimetres in favour of Walcher’s position. Re¬
searches on five feminine cadavers gave the same
result for the conjugata vera. Therefore I think,
and Pestalozza is of my opinion, that the position
with hanging thighs ought to bear Walcher's name.
Changes in the “pelvic dimensions. Antero-posterior
dimensions .—When a woman is placed on a table,
with the head and shoulders slightly elevated and the
buttocks somewhat projecting beyond the edge, a
cushion being placed under the sacrum, the thumbs
being placed on the superior iliac spines, whilst an
assistant places the lower extremities first in the
lithotomy and then in the horizontal position, finally
abandoning them to their weight, the following is
observed:—
The iliac spines describe part of a oircle in a
forward and downward direction, the lumbar lordosis
increasing at the same time. Moreover when the
lower extremities are in complete extension and
allowed to hang downwards, the iliac spinal action
continues without the lumbar lordosis being further
(a) Abstract of paper read before the Internationa^ Qronco¬
logical Coogrear, Amsterdam, August 1899,
increased. There is first an increase of pelvic inclina¬
tion, limited by the tension of the ligamentum longi-
tudinale anterius and the intervertebral joints. By
this tension the sacrum is fixed. The anterior pelvic
arch being drawn further downward, the effect will
not be perceived for the entire pelvis, but only for
the iliac bones, without change of place in the sarcum.
The transverse axis for the moment of the iliac bones
lies behind the second sacral vertebra. This axis
being situated under the promontory, the symphysis
must be removed from the promontory bv the rota¬
tion, whilst it approaches the point of the sacrum;
the sagittal diameter of the brim being consequently
increased and that of the outlet diminished. This
action of the iliac bones is limited partially by the
sacro-iliac articulations, partly by the posterior
ligament, and somewhat by the muscles of the
abdominal wall and by the psoas.
I need not say that pregnancy will be, generally,
favourable to this dislocation of the iliac bones,
but I ought to add that individual conditions may
diminish, even in pregnant women, this mobility.
At the present moment there is no doubt that the
conjugata vera increases progressively, when the
woman is brought successively in the lithotomy
position, the obstetrical position and Walcher's
position. Difference of opinion exists only as to the
degree of the augmentation. According to the
researches of Walcher, Duhrssen, Fothergill, and
Kiister, the increase of the conjugata varies from 8
to 15 millimetres. Of those who object to those
elevated cyphers, I quote Varnier, who says that
there ought not to be a comparison made between
the dimension found in the lithotomy position, never
used in obstetrics, and that of Walcher, but between
the measures found in the latter and in the obstetrical
position. In this way an increase of 2 or 3 milli¬
metres ad maximum can be obtained, according to
his researches. Later experiments of Fehling con¬
tradict partially Yarnier’s pessimism. The results
of cadaver-experiments by Walcher, Klein, Varnier,
and Pinard, and Kuttner being incongruous, and on
the other hand the clinical observations of Kalt,
Wehle, and others showing a considerable increase, I
resolved to make some researches for myself.
In 102 women, nearly all in the second week after
confinement and the others in an advanced state of
pregnancy, I have measured with the finger with the
utmost exactness, the diagonal conjugata in the
lithotomy position, in the obstetrical position, and in
Walchers position. By the change of the first posi¬
tion into the third I have found an increase in the
average of 7*5 millimetres maximum 17, minimum 2
mm. Between the first and the second position the
difference was on the average 1*9, maximum 0 mm.
Between the second and the third position (101 cases)
the average of the increase was 6*1, maximum 12,
minimum 2 mm.
The mensuration in the five female bodies gave
smaller differences.
Is it true that the increase of the conjugata vera
Digitized by CjOO^Ic
316 The Medical Pbe3s.
ORIGINAL COMMUNICATIONS.
Skpt. 27, 1899.
corresponds exactly to that of the diagonal conjugata P
According to Klein the c. vera is less, according to
Kiittner more increased than the diagonal conjugata.
In the five bodies I examined the difference between
conjugata vera and c. diagonals was the same in all
three positions.
I do not exactly know why in the corpse the effect
of the alteration of position is less than in the living.
My researches confirm the results of Klein, that in
contracted, pel vis the difference between the length
of the diagonal conjugata in the obstetrical and in
Walcher’a position is on the average 8'7 mm. i.e.,
superior to the general average difference (6T mm.)
Moreover I found a great variety, from one case to
the other, in the degree of the increase.
The coccy-pubic diameter will, as I have mentioned,
be shortened in a higher degree than the conjugata
increases. I do not know whether exact mensura¬
tions of this diameter have l)een made, except those
of Kiittner and those 1 have communicated at the
Fifth Congress of the Italian Obstetrical and Gynae¬
cological Society. I have been able to continue these
researches, and in the five corpses I examined I saw
by changing the lithotomy into the obstetrical
position, an average diminution of the coccy-pubic
diameter of 5'6 mm., and of 9'2 mm. by changing the
latter position for that of Walcher. The entire
difference between the two extreme positions was
thus on the average 14'8 mm., and has varied between
26 and 9 mm.
I need not say that the antero-posterior diameter of
the wide part of the excavation does not or almost not
change.
Transverse diameter of pelvis. —Kiister thinks that
the movement executed by the sacrum is exactly the
contrary to what has been observed in rachitic pelves,
and conforming to this idea he says he has observed a
diminution of the distance of the iliac spines. I
have examined in regard to this point 127 women in
the puerperal state, and found that by Walcher'a
position this distance and that of the cristse was not
altered in 24 cases, was diminished in 22 and in¬
creased—average 5 mm.—in the other 81 cases. The
experiments on the five corpses gave the same
results. Contrary to Kiister’s opinion I believe that
the action of the sacrum is not exactly opposed
to that which occurs in rachitic pelves. In
Walcher's position the postero-inferior part of
the iliac bones is drawn towards the median line
and the postero-superior part muBt make a movement
in the inverse direction. By this movement there
must be a tendency to increase the transverse
diameter of the brim. And really, my mensurations
in five cadavers, have given by the change of the
lithotomy position into that of Walcher, an increase
of this diameter of 3‘2 mm., on the average, 4 mm. in
maximum, 2 mm. in minimum. My results are thus
in contradiction to those of Klein.
Variations of the form of the pelvic cavity. —After
my five cadaver mensurations I have constructed a
design of the schematical form of the pelvic cavity,
in Bagittal sections, in the lithotomy position and in
that of Walcher.
I shall not speak of the practical consequences of
these considerations because they are clear enough,
having moreover mentioned them in my paper read
at the Fifth Congress of the Italian Obstetrical and
Gynaecological Society.
The professorship of Ophthalmology in the
Egyptian Government School of Medicine at Cairo
is now vacant. The appointment carrie swith it the
surgeoncy to the Kasr-el-Ainy Hospital, and is likely
to have many applicants. Particulars will be found
in our advertising columns, or may be obtained of
Mr. Hallett at the Examination Hall, Savoy, London.
ACUTE INFECTIVE ARTHRITIS
AND CELLULITIS.
By JOHN O’CONOR, M.A., M.D., T.C.D.,
Senior Medical Officer, British Hospital, Buenos Ayres, Argentina.
In my first paper (1) on this subject, I suggested
the expediency of substituting the term Acute Infec¬
tive Arthritis for Acute Articular Rheumatism, as I
contended that the latter was not consistent with the
pathology of the disease, which in my opinion is an
infective malady very analogous to gonorrhoeal
arthritis and pyaemia.
In more recent papers (2) I adopted the heading
Acute Infective Arthritis and Cellulitis, for I found
in some cases on which I have operated, that there
was considerable cellulitis around such points as the
ankle, wrist, and phalanges without any sign of
arthritis after arthrotomy. Since those papers were
published I have had the opportunity of finding both
conditions co-existing in the wrists and ankles.
In a recent series (3) of twelve unselected consecu¬
tive cases of “acute rheumatic arthritis” incision,
with irrigation and drainage, immediately cured the
local trouble,and, moreover, caused prompt subsidence
of the general toxtemic symptoms.
Being the first surgeon who advocated and prac¬
tised arthrotomy in gonorrhoeal (4) and “ acute rheu¬
matic ” arthritis, I was anxious to hear what results
this treatment would give in other hands, and I was
gratified in seeing (5) that Dr. John Homans had
found it most satisfactory in a case of gonorrhoeal
arthritis. So far as I am aware, no other Burgeon has
tried it in “ acute rheumatism,” but I was pleased to
read a temperate criticism (6) of my paper (7) by Dr.
Ewart, in which he admitted that there are some
cases which do not respond to the “ usual treat¬
ment,” and that “the so-called rheumatic cases
fall into two clinical groups, those which promptly
recover under the usual treatment, and those whicn
do not.” In making this statement, Dr. Ewart has
obviously struck a keynote, viz., that the second
group cannot be diagnosed until after a useless and
positively detrimental treatment has had a trial, not
to mention loss of valuable time.
Even admitting the empirical existence of two such
gioups, the question naturally arises, does metastatic
endo or pericarditis ever supervene in cases where only
one joint, or two symmetrical ones, are attacked P
From an experience of twelve years’ hospital prac¬
tice. I can certainly answer this in the affirmative.
In fact, the worst case of “ rheumatic ” endocarditis
I have ever seen occurred in a patient who had only
both knee-joints affected.
Dr Ewart suggests the term, "for want of better,”
“ acute rheumatoid arthritis,” What purpose the
meaningless word “ rheumatoid ” can serve I fail to
comprehend, unless to mystify our sense of percep¬
tion.
If anyone is interested in my views as to the patho¬
logy and treatment of this common complaint, I
should like to refer him to the “ Annals of Surgery,”
February, 1898, and April, 1899.
The two following cases, which are at present under
treatment, tend to prove the practical truth of the
above statements.
Case XI.—P. G., married man, labourer, ast. 34,
was admitted to hospital on July 18th, complaining
of pain in the left ankle and both shoulder-joints.
Temp. 103 4 degs., pulse 80, tongue furred, profuse
perspiration, urine scanty, high coloured, no albumen,
lungs and heart normal; with a history of rheumatic
fever two and a half years ago.
July 19th. Left ankle became swollen, pains i
the shoulders continued, and pain developed in le
knee. Salicylate of soda, grs. xx, ordered ever
8kpt. 27. 1899.
ORIGINAL COMMUNICATIONS.
Thk Medical Pbem. 317
three hours, jointa enveloped in warm wool, and sheets
removed from bed. Milk diet and a saline purge.
20th.—Left ankle more swollen, red, and very
painful, left knee swollen and distended with fluid.
2l8t.— Right ankle and right knee became swollen
during the night. As patient was becoming pro¬
gressively worse with both knees and ankles swollen,
tender, and painful, and pain in both shoulders, with
general symptoms more marked, medical treatment
was abandoned.
22nd.—Arthrotomy of both knees and ankles was
performed, and turbid serum removed from each,
the joints were irrigated with ] in 2.000 corrosive
sublimate lotion, drainage tubes inserted into knee-
joints, and sterilised gauze into ankle-joints. As
considerable cellulitis existed on the dorsum of feet
free incisions were made into affected areas, and
wounds irrigated and stuffed with gauze. Although
pain was complained of since udmission in both
shoulders I refrained from opening the joints, as I
hoped the removal of the toxin from the other jointa
would effect a cure.
Second morning, temperature had fallen to 99
deg8„ sweating had ceased, and patient expressed
himself as absolutely free from the former pains,
excepting an occasional twinge in the shoulders.
Fourth morning, temperature remained normal,
general symptoms had completely vanished, drains
removed, free action movement of each joint without
pain; as patient complained of hunger full diet was
ordered. An uneventful convalescence ensued, and
he was allowed out of bed as soon (August 14th) as
wounds were sufficiently healed.
Case XII.—J. B., ait. 37, coachman, became sud¬
denly ill on July 14th, with shivering, fever, and pains
n shoulder ana left knee. On examination he had
tempei ature 102 3 degs., profuBe sweating, dirty tongue,
high coloured, scanty, non-albuminous urine, pulse
100, and loss of appetite. The left knee was painful
to touch, but no swelling was found in it or shoulders,
lungs and heart normal. “ Rheumatic fever” being
diagnosed, soda saylic, grs. xx, was given every three
hours, and warm wool and blankets applied.
July 16th.—Left knee-joint swollen and distended,
temperature reached 102 degs. each night, with a
slight morning remission, pains continued In
shoulders, general condition worse; treatment con¬
tinued as before.
22nd.—Swelling, tenderness and pain of left knee
increased, some swelling noticed on the palmar sur¬
face of metacarpo phalangeal joint of right middle
fingers, and a coarse friction sound elicited for the
first time, on auscultating praicordiura. Patient
looked very ill, with face flushed, pulse 110, tempera¬
ture 103 degs., respirations 34, and he had no desire
for nourishment. Six-hour hypodermic injections of
strychnine and digitalis ordered.
24th.—As the condition was becoming grave, medi¬
cation was given up and arthrotomy of left knee per¬
formed, and eight ounces of turbid serum evacuated.
The joint was irrigated and a large drainage tube
inserted. Two incisions were made into swelling in
finger, serum oozed from the cut surfaces, and steri¬
lised gauze was placed in wounds
25tn.—All pains had departed, sweating ceased,
temperature luO degs.; patient appeared a different
being.
August 1st.—Pericardial friction sound less dis¬
tinct; temperature reaches 100 degs. at night, and
falls to normal each morning. Knee normal in con¬
tour, no pain or tenderness on manipulation, active
movement through a right angle. Middle diet asked
for, and given.
7th.—No abnormal sound found on auscultating
cardiac area. • Temperature remained at normal.
Patient able to ait up in bed and partake of full diet.
Convalescence was rapid, and he was allowed out.
of bed with his colleague on August 14th.
In both these cases I forgot, in the hurry of con¬
cluding operation, to insert waiting silkworm-gut
sutures, which I have frequently found most useful
in accelerating the healing of knee wounds.
In conclusion, I wish to lay particular stress on a
most important detail in the operation. Take care
to establish thorough drainage, for an open non¬
draining knee-joint is a terrible surgical precipice.
In order to avoid risk the joint capsule should be
freely incised, and a well perforated drainage tube of
at least one-third of an inch in diameter inserted into
synovial pouch.
Given ordinary cleanliness and free drainage,
arthrotomy (8) is one of the most simple and safe pro¬
cedures in surgery, and rarely takes me more than
five minutes to perform.
Finally, in the disease acute infective arthritis and
cellulitis, do not wait for a cardiac murmur to con¬
firm the diagnosis; operate immediately effusion is
detected in a joint or joints. By so doing, metastasis
can be certainly prevented.
(1) “Glasgow Medical Journal,” October, 1897 ; ‘ Annals of Bur
gery,” February. 1 h98.
(2) “ International Medical Magazine,” June 15th, 1898 ; “Annals
of Surgery,” April. 1899.
«3) “ Annals of Surgery.” April, 1899.
(4) ”Gla«gow Medical Journal," October, 1897 ; “ Annals of Sur¬
gery,” February. 1898.
(5) • Boston Medical and Surgical Journal," November, 1898.
(6) “ Lancet,” July 22nd, 1899.
(7) ” Lancet ” July 8th. 1899.
(8) ” New York Medical Journal." November, 1896, and Medical
Press and Cihitlar, January 26th, 1898.
A PLEA FOR MORE EXTENSIVE OPERA¬
TIONS IN THE TREATMENT OF
MALIGNANT DISEASE OF THE
JAWS, (a)
By J. PAUL BUSH, M.R.C.S.,
Surgeon, Royal Infirmary, Bristol.
The following cases of malignant disease of the
jaws are, I think, interesting, not only on account of
the magnitude of the operations, but also because
they were looked upon by Borne as cases too extensive
for operative interference.
M. W., a young woman, set. 16, was sent to me for
consultation at the end of last year. Some nine or
ten months before she noticed pain in the upper jaw,
and a month or so later her friends noticed that the
upper lip appeared swollen The upper jaw was
enlarging in size, but the pain ceased.
Six weeks previously she had been admitted into a
hospital, where a small tumour the size of a hazel nut
had been removed from the left of the middle line.
The operation wound had healed, but at the end of a
couple of weeks the tumour was seen to be growing
again, and now rapidly. The growth- had been exa¬
mined microscopically, and diagnosed as sarcoma.
Four weeks after this first operation she was seen at
the same institution, when the tumour was growing
so rapidly that it was decided that nothing more
could be done. When she came under my notice
there was a moderately firm swelling situated more
to the left but invading also the right superior
maxillary bone, extending from above the first left
molar, across the middle line to above the first right
bicuspid tooth. This growth pushed forward the
nose, and extended into the mucous membrane
of the floor of both nares, which were con¬
siderably narrowed. There was also marked
bulging down of the palate on the left Bide. The
tumour was not growing from the margin of the
(a 1 Abstract of paper communicated to the Surgieal Section, Porto'
mouth meeting, British Medical Association, August, 1899.
Digitized by G00gle
,318 ThK McDICAL PfiXBfl*
ORIGINAL COMMUNICATIONS.
S*pt. 27, 1899
gum and the teeth, but appeared to grow from within
the antrum. I kept her under observation for ten
days, as !it was thought we could do very little for
ber, during which period the swelling increased in
eize, the teeth became loose, and pain became
extreme. At the earnest request of herself and her
friends I decided to operate, this I did by the usual
incisions on each side of the noee and division of the
lip, after cutting through the vomer I was able to
turn the nose upwards ; I then sawed through the
lower portions of the nasal processes downwards and
outwards to immediately in front of the first molar
on each side, having previously cut through the
mucous membrane of toe f palate with the knife, I
chiselled through the line of articulation of the palate
with the superior maxillary in the mouth, and so
removed the bodies of both superior maxillary bones
together with the tumour.
There was considerable haemorrhage, which was
stopped by a large plug of iodoform gauze. The nose
was fixed into position, and the divided lip sutured.
She made an uninterrupted recovery, and went
out of hospital the end of February. About three
weeks after operation my colleague, Mr. W. R.
Ackland, made her a temporary upper jaw. This
she only wore for some hours in each day to prevent
the upper lip and nose from falling in. In March
last there was no sign of any recurrence, and I re¬
divided the upper lip and performed a modified
operation as for hare-lip, as the mucous membrane
had been drawn upwards by the cicatricial tissue.
An excellent permanent jaw with teeth was now
fitted by our dental surgeon, and, thanks to his
manipulation, the girl’s appearance is so good that
she has obtained a situation in a fashionable drapery
establishment in the West of England. Very few
would notice anything wrong in her appearance.
Under the microscope the tumour is evidently a
•rapidly growing small spindle celled sarcoma.
This case at any rate to me is most instructive, as
it was doubtful whether one ought to attempt
removal. So many months have now passed and
the patient is so well that there is every reason
to believe there will be no recurrence.
J. J., a man, set. 60, came to see me at the Bristol
Royal Infirmary in April, 1899, with ahistory of a sore
tongue for six months. He had seen several doctors
but they all advised him that nothing could be done
to relieve his cancer, as it was too far advanced.
When I saw him an extensive epitheliomatous
growth involved the anterior half of the tongue, and
the whole of the floor of the mouth. Both eub-
maxillary glands were affected, and there was a large
mass of glands leading from these into the lympha¬
tic glands of the neck on both sides.
The pain was extreme and the patient could not
talk or move his tongue, and could swallow liquids
only with great difficulty. Under chloroform I made
a central incision through the lower lip down to
the hyoid bone and then carried it horizontally
on each side of the neck to just below the
angle of the jaw. By these incisions I was able to
tie first one and then the other lingual artery close
to the hyoid bone. I then sawed through the lower
jaw on each side in front of the angle, and, having-
tied several vessels in this position, I cut away the
entire tongue from its attachments to the epiglottis
and. cutting freely with the scissors, cleared the
muscles attached to the hyoid bone, thus taking away
the body of the jaw, to which was firmly attached a
large mass of infected salivary and lympnatic glands
on each side of the neck. 1 further cut away all
doubtful tissue and skin. At this stage of the opera¬
tion considerable difficulty was experienced on
account of the patient ceasing to breathe; but this
was remedied by passing a silk suture through the
soft parts immediately in front of the epiglottis, and
by an assistant holding it forwards and upwards. A
large number of vessels were ligatured and the re¬
maining skin was brought together in the middle line
and sutured, a large tube was placed in the cavity and
brought out immediately at>ove the hyoid bond.
Thus the whole of the tissues above the level and the
hyoid bone as far as the epiglottis posteriorly were
removed.
On being put to bed it was found that the glottis
became closed unless dragged forwards continually.
My dressers remained for some horn's with the patient
gently pulling on the silk suture above referred to.
The patient was carefully fed with a tube, and no
nourishment was allowed to get into the mouth
cavity.
The difficulty in the breathing ceased by the end of
48 hours, and in less than three weeks he was being
fed with soft solids, and he went home some six weeks
after operation.
He came a four hours journey to see me a few days
ago, when he told me he was as “ jolly as a sandboy,”
and doing some work. He has grown a moustache
and beard, which helps to hide his deformity. There
is as yet no sign of recurrence; he is absolutely free
from pain, and is talking fairly distinctly. He
has put on two stone in weight, and taking
plenty of nourishment. He says he much prefers
feeding himself with a short tube, as it makes
him cough sometimes when he feeds without one.
Under the microscope the growth is a typical
epithelioma. In this case it is as yet too soon
to imagine it will not recur, but even should it
do so, we have given this man some months of com¬
fortable life.
CARDIAC OVERSTRAIN IN THE
YOUNG, (a)
By F. J. POYNTON, M.D.,
Casualty Physician to St. Mary's Hospital; Clinical Assistant to the
Hospital for Sick Children, Great Ormond Street.
In this paper Dr. Poynton considered some of the
problems that arise when dealing with the question
of athletics as a cause of cardiac overstrain. The
subject, one of growing importance, was by no means
easy to investigate, because of the difficulties that
surround accurate observation, and there was for this
reason a danger on the one hand that an alarmist
view might be taken of the question, and, on the
other, that the damage that prolonged physical strain
entailed upon the heart might be underrated. If,
for example, a man who had been a good athlete and
still took part in competitive exercises consulted a
doctor for symptoms which were referable to the
heart it was at once apparent how difficult it must be
to estimate the actual part taken by the physical
exertion, and if there be no valvular murmur the
actual condition of the heart. Da Costa, Professor
Clifford Allbutt, and others had contributed
important clinical facts upon this subject, but there
was still of necessity a lack of accurate knowledge
upon the question.
Dr. Poynton then described some investigations that
he had made at one of the large public schools by
the following method, The subject lay upon the
back with the left arm slightly abducted, and the
deep cardiac dulness was percussed out and deli¬
neated upon the chest wall with a dermatographical
pencil. The position of the impulse was noted, and
any murmur or accentuation of sounds recorded, and
the result transferred to tracing paper. This paper
was then named and dated after the following land-
fa) Abstract of a paper read before the British Medical Association
at Portsmouth, August, 1899.
, y Google
Sift. 27, 1890. ORIGINAL COMMUNICATIONS._Tin Mbdical Prim. 319
marks had been made: the left nipple, the midsternal
line, and xiphisternal notch. Finally, the pulse-rate
and any peculiarities either of the chest or general
physique were registered upon the paper, which was
then preserved as a permanent record. Advantage
was taken of the fact that the foot-races were held at
the end of the Lent term, and fifteen likely athletes were
examined upon the 6th of February, ana upon the 6th
of April, the day after the final heats nine of these
boys were re-examined. The author pointed out
that the results were too few for definite
conclusions to be drawn, but the method appeared to
be one that might be of considerable value, especially
if applied to adults who were passing their athletic
rime; that is at the time when pathological evi-
enoee would be most likely to become manifest.
It was of interest that in none of these cases was
there any tachycardia, though in several an enlarge¬
ment of the heart to the right and to the left and
upward was apparent.
Dr. Poynton then briefly considered the question
of athletics at the great schools. In some cases there
were boys who could not possibly indulge in the
games, but there were also some of the more weakly
boys whose games were curtailed rather than stopped.
It was to this question of curtailing games that he
drew especial attention, as being one of much diffi¬
culty and importance, It necessitated an accurate
knowledge of the exertion value of the chief
games, which he ventured to think was not pos¬
sessed sometimes even by experts upon diseases of
the heart. It was important, because athletics took
a very prominent part in a boy’s life, and to interfere
with them needlessly was to interfere with much of
his life at school. It was difficult, because all the
ordinary school games, if played well, involved con¬
siderable exertion, and advice to play them badly
could hardly be given. The competitive exercises,
running and the like, were violent, not only because
of the continued exertion required, but tecause of
the tendency there must neoeesarily be to better one’s
best when face to faoe with an equal or superior.
The serious effect of such a form of exercise upon
a damaged heart had been generally recognised, and
was illustrated in this paper by the case of a young man,
*>t. 26, who had been “out of sorts ” for some days, and
went for a row in a four-oar boat to shake off the malaise.
On landing after thiB exertion he felt very ill, and
died in three days with extreme tachycardia. At the
necropsy Dr. Poynton found evidence of a previous
pericarditis and valvulitis. Both forms of football
were pointed out as violent exertions, and from the
sudden strains that resulted from ” tackling” liable
to injure the aortio area of the heart. This danger to
the aortic valves from a sudden strain, hod been
insisted upon by Professor Clifford Allbutt, and was
illustrated in this paper by a striking case. A coast-
guardsman, aged between forty and fifty, was in the
habit of playing football every Saturday, and after
one of these games, while sitting at home in the
evening, thought he heard a steamer. He was so
convinced of this that he actually went out of the
house to look for her, but the sound was due not
to a steamer, but to a murmur caused by a ruptured
aortic valve. Hockey avoided the sudden wrenches of
football, but was too fast a game for a boy with a
really weak heart. Racquets and fives were not
unoommonly thought to be a mild form of exertion,
but in reality were if played at all well most trying,
and boxing was quits , out of the.-question. Cricket
was on the whole a milder form of exercise, though
fast bowling and much running between the wickets
involved violent exertion. Among gymnastio exer-
cises some were admirable as examples of graduated
movements, but others such as climbing the rope,
were far too severe a strain fora weak heart.
THE USE OF ANTI-8TREPT0C0CCIC
SERUM.
By FRANK F. BOND, M.R.C.S., L R.C.P.,
House Physician, Westminster Hospital.
I PROPOSE to base my remarks on some cases
which have come under my observation in the wards
of this hospital, and I snail deal principally with
the treatment of facial erysipelas, several cases of
which have recently been successfully treated
here by the anti-streptococcic serum. This form
of treatment is now extensively used in the hospital
in the various forms of streptococcus infection, and
in no disease are the results more favourable
than in erysipelas The administration is com¬
menced immediately after admission, and continued
daily, usually in ten cubic centimetre doses, until the
temperature falls to normal. In a moderately severe
case three or four injections are generally sufficient
for this purpose. The serum employed is the liquid
n ar&tion supplied by the Institute of Preventive
icine. It can always be obtained in London at a
few hours’ notice either from the Institute or from
any of the large wholesale druggists. It is injected
with the usual antiseptic precautions, the skin being
carefully washed ana carbolised and the syringe
being rendered aseptic by boiling. The only local
treatment employed consists in the protection of the
affected part from the air by means of a lint mask,
which is dusted with a powder consisting of two parts-
of zinc oxide and one of starch, and the patient is
liberally supplied with brandy, the usual dose being
half an ounce every three hours. No other medicinal
treatment is used.
The notes of four cases recently treated in this
manner are given below:—
Case I.—A woman, tet. 27, was admitted to West¬
minster Hospital at 4 p.m., on May 19th, 1899. She-
first noticed a tender swelling on the mucous mem¬
brane of the right nostril on the 17th. A few hours
afterwards the outer surface of the nostril was red
and swollen, and by the next morning the rash had
extended to both cheeks. It continued to spread until
admission. On admission there was extensive erysi¬
pelas of the face and neck. The whole faoe was-
involved, and the swelling extended upwards over
the forehead as far as the roots of the hair. Both
ears were affected, and the rash extended downwards
into the neck as far as the level of the hyoid bone.
The eyelids were considerably swollen, and partially
closed. The temperature was 103 degs. F., and the
patient was quite unconscious. Immediately after
admission, ten cubic centimetres of anti-streptococcic?
serum were injected into the subcutaneous tissues of
the abdominal wall, and the treatment described
above was commenced. During the night the tem¬
perature ranged between 101 degs. and 103 degs. The
patient was delirious and did not completely regain
consciousness until five o’clock on the following
morning. At 8 a.m. on the 20th the temperature
had fallen to 101 degs., but during the day it rose
again, and at 4 p.m. itstood at 104 4 degs. At 9.30 p.m,
a second injection of ten cubic centimetres of anti¬
streptococcic serum was administered. The face at
this time was still considerably swollen, and the eye»
almost closed. The eyelids were bathed with a weak
solution of boric acid. On the 21st the temperature
fell to 99*8 degs., and did not atony time subsequently
reach 100 deg, The swelling of the face was consider¬
ably less, and the eyes were fully open. Two mom
injections of serum were administered, one on the
21st and one on the 22nd. The temperature fell to-
normal on the morning of the 22nd, and remained
at that point. On the 24th, the rash had almost-
entirely disappeared, and the face was desquamating
in large flakes. She was well enough to get up oa
the 25th.
C
820 The Medical Press. OKIGINAL COMMUNICATIONS. Sept. 27, 1899.
Case II.—A girl, set. 16, was admitted at 5 p.m. on
May 20th, 1899. The patient had first noticed a red
tender spot immediately below the left alse nasi that
morning. She had observed no abrasion there
previously. The swelling rapidly spread to both
sides of the face. On admission there was a red
brawny swelling involving the nose, the upper
lip and both cheeks, extending on both sides
as far as the prominence of the malar bone6.
The nose and upper lip were much swollen,
and there were a few vesicles on the alse of the
nose. The temperature was 100 degs. The treatment
was commenced at 9.30 p.m. on the 20th, ten cubic
centimetres of serum being injected. The tempera¬
ture at that time was 100 - 2 degs. On the morning of
the 21st the temperature had fallen to 98 degs. At
noon a second injection of the serum was given. The
temperature at midnight rose to 99 2 degs, but fell
next morning to normal, and did not subsequently
rise above 99 degs. A third injection was administered
on the 22nd. Un the 24th the nose was still a little
swollen, otherwise the rash had disappeared. Slight
desquamation was taking place along the edges of
the alee nasi, the rest of the skin was normal. She
was able to leave her bed on the 25th.
Case III.—A man, set. 36, was admitted at 4 p.m.on
June 3rd. He noticed pain and swelling of the left
cheek at about 3 p.m. on June 2nd. The swelling
rapidly extended over the greater part of the face.
On admission the whole of the left side of the face
was involved, and the rash had extended across the
middle line as far as the prominence of the right
malar bone. He said he felt drowsy, and complained
of a tingling sensation in the face. The temperature
was normal. Ten cubic centimetres of anti-strepto¬
coccic serum were administered at 5.30 p.m., and the
patient was treated in the ordinary way. On
the 4th the face was still considerably swollen,
and the left eye partially closed. He vomited once
in the early morning. The temperature rose in
the afternoon to 99 2 degs., but dropped to normal
in the evening. He still complained of feeling
drowsy. No more serum was administered. On the
morning of the 5th the rash was subsiding, and the
eye was fully open. He stated that he felt quite
well. Desquamation had commenced. By the 7th
his face was normal, and he left the hospital on the
9th.
Case IV.—A man, ret. 48, was admitted to the sur¬
gical wards on May 10th, 1899, suffering from right¬
sided mastoid abscess, which had perforated the bone
and extended down into the neck, for which he was
operated on by Mr. de Santi. He stated that
seven weeks before admission he had erysipelas
of the right cheek. He did very well until the even¬
ing of May 29th, when his temperature suddenly,
rose to 103dcg8. It came down to normal, however
the next morning, but on the 31st it rose to 101'6
degs., and on June 1st to 102 degs. During that day
he complained of tingling in the left cheek, and on
the following morning there was well-marked erysi¬
pelas on the left side of the face, apparently having
no relation to the operation wounds, which were on
the right side. He was transferred to the isolation
wards on June 2nd, and at 5.45 p.m. ten cubic centi¬
metres of anti-streptococcic serum were administered.
The temperature at that time was l03 - 2 degs., and
the pulse rate 120. There was a deep red blush on
the left cheek, and the left side of the face, and a
lighter red discolouration over the whole left side of
the face, extending up into the scalp, and also
across the middle line to the right side of the
face and neck. There was very little discolouration
in the neighbourhood of the operation wounds, and
the wounds theta selves looked healthy. There were
patches of redness all over the back, extending down
to the lumbar region. The patient was delirious
during the early part of the night. A hypodermic
injection of a quarter of a grain of morphine with
atropine (gr. 1-120) was given at 12.30. He slept
well until 5 a.m. when he was quite rational, and said
he felt much better. The temperature at 11 a.m. on
the 3rd had fallen to 99'2 degs., the pulse rate being
100. The face was in much the same condition as the
night before. The patches of redness had disappeared
from the back below the angles of the scapulae. A
second injection of serum was given at 11 a.m.
On the morning of the 4th the temperature had
fallen to 97'8 and the pulse rate to 96 degs. The face
was less swollen and not so red. The rash had almost
entirely disappeared from the back. At 6.30 p.m. on
that day the temperature suddenly rose to 101 - 6 degs.
Ten cubic centimetres of serum were given at once, and
the temperature fell again, standing at midnight at
992 degs. Next morning it was 97'4 degs.. and did not
at any time subsequently rise above normal. From that
time the patient improved rapidly, and the rash had
entirely disappeared by the 8th. Desquamation con¬
tinued for four or five days after the disappearance
of the rash.
The success of the treatment in these cases is very
marked, especially in Cases 1 and 4; the disease in
these cases was very extensive, and the constitutional
symptoms were severe, but within a few hours of the
administration of the first dose the temperature was
considerably reduced, and the patients expressed
themselves as feeling much better, and three or four
doses were sufficient to overcome the disease. It
may be mentioned that the injections did not
cause any cutaneous symptoms, such as are
sometimes seen after the administration of the
anti-diphtheritic serum, with the exception of
some slight tenderness at the point of inoculation,
which passed off without treatment in the course of
a few hours. The site chosen for the injection was
the subcutaneous tissue of the anterior abdominal
wall, in the iliac region.
The serum has also been used in other suppurative
and pysemic processes, with varying success; in some
cases no benefit whatever has been obtained from its
administration. But in these cases it is necessary
to remember that the anti-streptococcus serum is only
claimed to be of value in cases of streptococcus infec¬
tion, and that it will obviously be of no service in
diseases due to the presence of other organisms. A
case in point occurred at this hospital a few
weeks ago. A woman was admitted suffering from
ulcerative endocarditis, following parturition. On
admission her blood was examined bacteriologically
and found to be sterile. Anti-streptococcic serum
was administered every day for a fortnight, but with
no signs of improvement. Subsequently her blood
was examined a second time, and the presence of
staphylococci was demonstrated. No streptococci
were found. In this case the anti-streptococcic
serum could not be expected to produce any benefit,
seeing that the disease was due to other organisms.
It is therefore advisable, before, pronouncing this
method of treatment to be a failure, to make sure
that the disease for which it is used is due to the pre¬
sence of streptococci; but it is not necessary to wait
for the result of the bacteriological examination
before commencing the treatment, as by so doing the
disease is allowed to progress, and the chance of
saving the patient's life may be lost, whereas, even if
the injection do no good, it does not appear to pro¬
duce any ill effects.
It is understood that Dr. Moorehead has withdrawn
his candidature for the Professoriate of Medicine in
Queen’s College, Belfast, vacated by the death of Dr.
Cuming, and that Dr. Lindsay, who has been temporarily
doing the duty, will “walk over” for the appointment.
Die
oogle
Sept. 27, 1899.
ORIGINAL COMMUNICATIONS. The Medical Press. 321
RECRUDESCENCE OF PLAGUE IN
THE EAST.
By Professor W. J. SIMPSON, M.D., F.R.C.P.,
D.P.H.
The sudden disappearance of plagne from Europe is
not to be accounted for by the commonly-received
view that it was due to advancing civilisation. The
absence of plague—even fora long period—is no abso¬
lute proof of the immunity of the locality. The city
of Bombay was free of plague for nearly two centuries,
and yet it would be impossible to Btnte that the city,
taken as a whole, is less protected now by sanitation
than it was during the two oenturies, or that the
people and its government are in a less civilised state.
Since its appearance in China the plague—notwith¬
standing the slow character of its extension—has
travelled a great distance. In the first two years
it travelled 3,000 miles westward to Bombay,
and in the next three years it continued its
course at about the same rate. Since its advent
plague has caused in India over a quarter of a million
deaths, the worst feature being its annual occurrence.
Poona was but recently in the throes of its third
epidemic, over 150 of her inhabitants dying per day,
which, in a town of such small dimensions, is an
enormous mortality, as may be gathered from the
statement that if a similar mortality prevailed in
London the metropolis would lose over 10,000 persons
a day. The mortality in Poona is all the more
serions as, from a personal inspection of the town
and of the interior of the houses. I can state that, if
inefficient drainage be excepted — which allows of
waterlogging of the soil—it is no worse as regards
sanitation and over-crowding than hundreds of towns
of a similar size in Europe, and is certainly in a much
better condition than many.
The re-appearance of plague in Egypt after an
absence of fifty years, with its extension into Por¬
tugal, is a matter of profound interest, because it
indicates that this plague from China partakes rather
of the nature of a pandemic than an epidemic, and
possesses that which other plague epidemics for
nearly the last 200 years have lacked, viz., the
quality of diffusiveness, which defies the precautions,
even as revised by the Venice Conference, and
hitherto adopted against its progress. The commer¬
cial conditions in the West are more favourable
to its diffusion than those of the East. No danger prac¬
tically existed of plague spreading from India to
Europe by sea, as the commercial intercourse between
India and Europe is maintained by Europeans who
belong to a superior class, and who have hitherto
enjoyed an exceptional immunity from plague. The
danger to Egypt of infection by plague has been not
so much in its commercial relations with India but in
its religious pilgrimages, which bring Egyptian pil¬
grims in the Hedjeiz into very close relationship with
Mahommedans from infected centres. The com¬
mercial relations between Egypt and Europe are, on
the other hand, of the most intimute nature, kept up
by fishermen, traders, and travellers, and extending
to all classes, and including those likely to be affected
with the disease.
Two discoveries of the first magnitude have been
made, the one by Kitasato, showing that the bacillus
is the cause of the disease, the other by Haffkine
proving that from this bacillus a prophylactic may
I* prepared which has strong protective powers.
These, combined with the fact that plague is a disease
which only slowly gains a firm footing in a locality
renders the checking or mitigation of an outbreak
more hopeful and certain than before.
The danger of extension, as in some other infec¬
tious diseases, lies in our ignorance as to medium
Hn d agents by which the bacillus gains access to the
is) Abstract of a communication raad l efore the Sinitory Institute,
Southampton, August, 1888.
body, causing a dependence on general rather than
special measures of defence. It seems to me to be
of paramount importance that the governments of
those civilised countries- which are affected with
plague should not be content in merely endeavour¬
ing to combat the disease by every known method at
their disposal, such as isolation of the sick, evacua¬
tion and disinfection of infected houses, &c.; but they
should systematically, as a part of the sanitary
defence of the country, establish laboratories and
special departments for organised research and
inquiry into the mode of spread of the disease, for it
is only by the adoption of these methods that success
is likely to be attained.
To the precautions advised by the Venice Con¬
ference to prevent importation, I think two others
should be added, viz., use should be made of the pro¬
tective power of Haffkine's prophylactic, and rats
should be dealt with at infected ports, on the voyage
on ships from infected ports, and on arrival in
healthy ports.
In connection with the checking or stamping out of
plague, when it breaks out on land, the early noti¬
fication of disease is of immense advantage, for it
allows measures to be early and promptly applied, so
that the sick can be isolated, the inmates of the house
removed and watched, and the house disinfected.
It iB possible with proper organisation to deal with
plague as with an outbreak of small-pox. Large
supplies of Haffkine's prophylactic are necessary in
order that every possible contingency may be pro¬
vided against, and the preparations of these supplies,
which require time and a skilled organisation, ought
not to be left to the last moment to meet plague. The
organisation for defence requires to be placed on as
complete and in as efficient a state of preparedness in
every respect as the army and navy of the country
would be if there was danger of invasion. The sani¬
tary organisation of the country inspires confidence
that all will be done which our present knowledge
suggests, to protect the country against disease. But,
as Btated previously, that knowledge is very imperfect.
In the case of an outbreak of disease, such as
typhoid fever, in this country, a scientific investiga¬
tion is undertaken as to its cause and mode of spread.
It is known that typhoid fever is caused frequently
by contaminated water. This, however, does not pre¬
vent further investigation being made in order to
ascertain if any new facts can be discovered
with reference to the epidemiology of the
disease. A similar inquiry is certainly called for
in regard to the plague, which is a disease that this
generation is happily not familiar with. The import¬
ance to this country of observing its behaviour as
modified by conditions in Europe is such that the
study of it in its epidemiological, prophylactic, and
curative aspects should be undertaken by Govern¬
ment. To this end it would appear to me advisable
that a small commission of experts of physicians,
epidemiologists, and bacteriologists should be sent
to the Peninsula for that purpose. It is a matter of
imperial concern and admits of no delay.
[Subsequently a resolution confirming the sugges¬
tion for an official investigation put forward by the
author was unanimously adopted by the section.—
Ed. M P. and C.]
A Case of Catalepsy.
A pupil-teacher, set. 16, living at Rodey (France), has
just recovered from a well-marked cataleptic condition
lasting thirty-six days. 8he passed the first month at
home, remaining all the time plunged in a deep sleep,
and as no improvement took place she was taken to the
hospital. The patient recovered consciousness within a
few days of her admission, without any treatment except
i measures designed to reduce her comfort to a minimum,
•rad is now convalescent.
Digitized by CjOOglC
322 The Medical Press.
GERMANY.
Sept. 27, 1809
ftermattp.
[FROM OUR OWN CORBESPONDEKT.]
BERLIN, September 83rd, 189P.
The Pathogenesis and Treatment of Eclampsia.
In a recent number (September 6th), I gave an account
of a brochure on this subject by Dr. Siegfried Flatau, on
the present occasion I propose to devote a short space
to a paper on the same subject in Volkmann’s Sammlung
from the pen of Professor H. .Fehling. The subject is
an exceedingly important one, and up to [the present ad¬
vances into the etiology of eclampsia have been tlow.
As regards pathological anatomy Professor Fehling
says that the organs principally implicated as shown
by morbid changes are the liver, the kidneys, the organs
of the fcetus, and some light has been thrown on the
subject by animal experiment. The liver changes are
by no means constant, and where present they are
very varied in kind and intensity. Kidney disease or
albuminuria has almost always been found, but
the form of kidney disease has varied exceedingly (acute
nephritis, chronio nephritis, frequently with reoent
ohanges), and above all a striking want of proportion
exists between the severity of the clinical symptoms and i
the intensity and extent of the kidney disease. In the
case of a dead foetus, changes in the kidneys and liver are
present, analogous to those in the eclamptic mother.
The urine of eclamptic and also nephritic patients is
in cases of intravenous injection far more poisonous
than normal urine. In the former, in many oases throm¬
boses are caused. The serum of eclamptics has not been
proved to be more poisonous than that of healthy indi¬
viduals, although the contrary his been stated. From
all this it follows that whilst clinically eclampsia
remains one disease, the anatomical condition and
experimental results in individual cases are very
changing.
The French theory of a hepatio toxemia can be as
little maintained as the old French’s theory of uremia.
It is not impossible that a part of the liver changes are
really consequences of the violent shocks.
According to the author, in arriving at an explanation
of the pathogenesis of eclampsia, too little attention
has been paid to the products of conception, to the
fcetus itself. He is inclined to the following view in
building up the foetus, materials and regressive meta¬
morphoses are formed which find their way into the
maternal circulation by way of the placental veins and
the inferior cava; these increase the toxicity of the
maternal blood and put a greater strain on the excreting
organs, the liver and kidneys. It has been determined
that there is an accumulation of fibre-giving material in
the blood of eclamptics, of globules, as an indication
of disturbed tissue change, by which the occurrenoe
of creatine, creatinine, leucomaines, and carbarnic acid
can be explained. By the accumulation of globules in
the blood, the epithelium of the kidney first suffers
injury, albuminuria is the first symptoms of the intoxi¬
cation of the pregnant system. Through this injury to
the renal epithelium, further accumulation of poisons
takes place, the liver participates in the injury, and at
last the attacks break out. If the foetus is the fount of
the injury, the frequency of eclampsia in twin preg¬
nancies is explained.
Prophylaxis is the chief thing, with systematic ex¬
amination of the urine. If albuminuria comes on, strict
rest in bed and a milk diet are the best remedies
(Tarnier). According to the author’s experience the
attack oomes on in half the cases during pregnancy t
and when they once occur labour almost always oomes
on. Early rupture of the membranes acts favourably-
The author ruptures the ir embraces at once after the first
attack, and he is in favour of early delivery by forceps
and moderate incisions with living children, and with dead
by perforation. He is not in favour of Csesarean section*
the less so as in a divided operation in one case the first
fit came on. Venesection should be useful as it un¬
burdens the overcharged circulation; excitation of the
excretory organs, the skin and kidneys is better. He
therefore injects i to i of a litre of physiological saline
solution subcutaneously thrice daily, and applies hot
wet cloths over the loins. Narcotics (morphia, opium,
chloral, chloroform), if used at all, should be made use
of with caution.
It is unfortunate for the practitioner that in the case
of a rather frequent and very dangerous disease there
should be such little unanimity as to its nature and
aetiology, and consequently of the correct and best treat¬
ment to be applied.
Wound of the Left Ventricle—Recovery.
Sanitate Rath Dr. Pagensteoker, Elberfield, reports the
following cure in the D. Med. Wochensch., 32/99:—
A lad of 17 was stabbed in the breast by a comrade
with a dagger-like knife. The writer saw the boy half
an hour after the receipt of the injury. There « as deep syn¬
cope^ small punctured wound in the left intercostal space
below and inside the nipple. The pulse could not be
felt, there was scarcely any respiratory movement, and
the conical reflex was abolished. Cardiac dulness in¬
creased to the left, the Bounds were distinct but
very feeble. Operation was performed sixteen hours
after the injury was inflicted, by this time dulness had
extended over the whole of the left chee*. The fifth rib was
cut down upon and a portion 6ctm. in length resected from
the cartilage outwards. On enlarging the opening, the
wound in the pericardium was plainly to be seen, it was
smooth and sharp-edged, and was about 2otm. in length.
This opening was enlarged, and the edges held by for-
oeps. The wound in the ventriole now became visible.
It lay 3 ctm. above the apex, was 3} ctm. in length, it
was sharp-edged, and gaped only slightly. A small
stream of bright red blood trickled out persistently.
There was no or very little blood in the pericardium.
Three deep sutures of celluloid thread and one
superficial one were placed in position. The hemor¬
rhage caused no difficulty, the only one experienced
lay in inserting the uppermost posterior suture, as it
was only when the heart rolled forwards that it oould be
inserted. By this suture the heart could be drawn
forwards, so that all difficulty now ceased. The deep
suture did not go through the endocardium. The
manipulations did not interfere with the movements of
the heart. The bleeding ceased on tying the sutures.
On enlarging the opening in the pleura, in order to arrest
any possible haemorrhage there, a big wave of dark fluid
blood and clot flooded the field of operation, and after this
came bright fluid blood. The whole thoracic cavity was
quickly filled with sterilised and iodoform gauze alter¬
nately packed in, whereby at last the bleeding was
stanched. The wound in the pericardium was made
smaller by catgut sutures, and the ends of the sutures of
Google
Digitized by
Sift. 27, 1899.
AUSTRIA.
f'H* MxDICAL PbXSS. 323
the myocardium, that had been left long, were brought
out through the opening to serve as a drain. The after
course was favourable. On the ninth day two sutures
come away on pulling on them, and in ten days more the
remainder were removed. Complete recovery took place.
The operator saw the patient 10 months afterwards, and
found him in good and blooming health.
JUwtria.
[from OUB OWN oobbbsfondbnt.]
Vinii, September 23rd, 18W>.
Official Export on Bubonic Plaque.
The Imperial Commission appointed in 1897 to pro¬
ceed to Bombay for personal examination and scientific
inquiry which might guide the Austrian Government in
its management of the disease, should it unhappily be
conveyed to the Empire, have just issued their report in two
parte. The first deals with the history of the disease,
and is illustrated with five plates; the seoond may pro¬
perly be called the scientific and experimental. On
February 20th, 1897, Drs. Mailer, Albrecht, Ghon, and
Poch arrived in Bombay on their scientific expedition,
and, as previously arranged, proceeded at once to Arthur
Road Hospital, where a temporary laboratory was
arranged for local investigation.
From February to April 22nd the inquiry seems to
have been of a general character, clinical and post¬
mortem. After this date the Commission began to
oollect and preserve specimens for more minute examina¬
tion, histologically and bacteriologically, on their return
to Vienna, which they reached on May 17th. The
report goes on to record the catastrophe which ooourred
last year when Dr. Muller and two of the attendants
succumbed to the disease. It condemns the unsuitable
rooms for such pathological examination, and affirms
that their half-equipped improvised laboratory in India
was much superior to that of Vienna.
Dr. Muller’s report consists of the clinical history of
one hundred cases with detailed analyses of the urine
and blood. The complex symptoms and buboes are
described at great length, the latter occurring as pri¬
mary lesions as well as secondary, undergoing great
changes during the course of the disease. The primary
fresh pneumonia cann ot be distinguished from the
croupous form of pneumonia. The sero-sanguinolent
form of pneumonia with profuse sputum is a good
augury for reoovery. A thick deposit on the fauoes and
pharynx is also a common symptom.
Muller dissents from the older established view of the
plague carbuncle and cutaneous uloers being the primary
gate of invasion. He is of opinion that these are local
secondaries or lymphatio metastases, just as the bubo is
the bacterial metastasis. Bare cases with lymphan¬
gitis asoendens as a primary affection were admittedly
observed. The primary gland swelling of the skin seems
to be the initial point.
The channels of invasion are evidently in the order of
their importance—the skin even when no obvious lesion
exists, the tonsils, and the lungs. Intestinal infection
cannot be supported by any inference. Of all the cases
examined only one had secondary uloeration of the bowel.
Bacteremia is a common attribute of the initial
stage of the disease, but is not constant enough to found
I
a conclusive opinion on; indeed many severe forms of
bacteremia recover. The rapid forms of death are due
to cardiac failure. The rapid small pulse with little
fever is a bad omen. This condition of the heart often
occurs when the disease is well advanoed, and usually
proves fatal. A common associate in the symptoms is a
cerebral disturbance resembling that observed in tuber¬
culous meningitis, which Mailer interprets as evidence
of absorption of bacillary products of a toxic nature.
The complications are pus formations and op en buboes;
As to the epidemiology of the disease, it may be
mentioned that none of the medical staff or nurses of
Arthur Road Hospital have at any time fallen victims
to the disease, even when they have had open wounds on
their person; thus wound infection cannot be accepted
as a channel of admission. The most successful treat¬
ment is extirpation of the primary gland swellings.
The pathological part, based on 48 post-mortems, is
given by Albrecht and Ghon. They divide the cases
into (1) primary buboes in the neck, axilla, and
inguinal region; (2) where no positive proof of
primary bubo exists unless general swelling of
all the glands be reckoned as such; (3) and
lastly, two cases of secondary infection terminating in
marasmus. Both authors agree in the characteristic mor¬
bid appearance of enormous haemorrhagic infiltration
of the lymphatic glands which goes on to necrosis and
formation of a creamy pus. Secondaries may be traced
along the lymphatic vessels to fresh inflammatory
haemorrhages. In the effused blood and primary affected
glands large members of the p lague bacilli can be found
also in the perivascular spaces, more particularly the
venous terminals in the sub-endothelial haemorrhages
which seems to be the invading point of the bacilli
in entering the circulation. The spleen is greatly
enlarged, giving a peculiar deep red on section, and is of
firm consistence.
The pneumonia is lobular with confluent centres. The
section is speckled red and yellow, but not granular,
while multiple metastatic centres are strewn over the
surface. As the disease advances the bacilli increase in
the blood till bacteremia is produced frequently, pro¬
ducing different degrees of ecchymosis in the skin and
mucous membrane. In a few cases pytemia may be
the immediate cause of death.
The histological and bacterial examination point con¬
clusively to the lymphatic tissue as the principal
nutrient of the bacilli, which make their way into the
surrounding tissues and along the various vessels. Their
product acts as a toxic to the cells, and finally produces
necrosis. This poisonous product acts violently on the
cerebral tissues and heart.
Albrecht and Ghon, in summarising their results, are
inclined to believe the mode of infeotion to be through a
lacerated or abraded surface of the skin. The germ
having gained admission incubates for from four to seven
days, and this is speedily followed by primary bubo or
swelling of some of the glands. This view is supported
by the absence of lymphangitis, which is a rare excep¬
tion in the disease. Experiments on animals are followed
by similar results.
Pooh’s part of the report deals with the experiments
of injection and transmission. The secondary disease of
the throat is not due to poison from the lung trid the
sputa, but rather to the general glandular enlargement
oogle
Digitized by
324 The M bdical Pbess.
THE OPERATING THEATRES.
Sept. 27, 1896.
‘SEIte ©porting Wciz&txtB.
CANCER HOSPITAL, BROMPTON.
Abdominal Hystebectomy fob Chbonic Fibboid
Thickening of the Utebus. —Mr. Chas. Rtall operated
on a married woman, set. 35, who had been suffering for
many years from menorrhagia, dysmenorrhcea, and
frequent attacks of abdominal pain. She had
been curetted several times without any relief. On
examination, the uterus was found to be retroflexed and
fixed in Douglas’s pouch, and the fundus enlarged
to about the size of a cricket-ball. It felt as
if the site of a small fibroid tumour. It was there¬
fore decided to perform hysterectomy because no
relief had been afforded by former treatment, and the
abdominal route was selected for operation owing to the
apparent fixation of the uterus in the pouch of Douglas,
and the more ready means of dealing with adhesions
through an abdominal incision. After the patient had
been anaesthetised the abdomen was opened through a
median incision, and the patient was placed in the
Trendelenburg position. It was found that the fundus
uteri was adherent to the peritoneum of Douglas’s
pouch and to the sigmoid ; the adhesions were carefully
broken down and the uteru." drawn out through
the abdominal wound; on examination no tumour
could be found, but the uterus was greatly en¬
larged, its walls were hard and thickened, and beneath
itB peritoneal investment one could distinctly recognise
great excess of fibrous tissue. The cervix appeared
normal. Hysterectomy was then performed in the usual
way, a small cervical stump being left behind, and the
pelvic floor was completed by suturing together flaps of
peritoneum removed from the anterior and posterior
surfaces of the uterus. The abdomen was then
closed in thrte layers. Mr. Ryall said that the
case was of interest because of the nature of the trouble-
Here was a patient suffering from chronio symptoms
which could not be relieved by lees severe means; drugs
and curetting he considered to be absolutely of no
use in these cases of chronic fibroid thickening of the
uterus ; the disease was a fairly common one, though the
literature on the subject was very limited; it was essen¬
tially inflammatory in origin, and might occur as &
sequela of septic endometritis, though it has been known
to take place in virgins where such a cause could not be
discovered. The pathology of the affection consisted in
the thickening of the uterine walls by fibrous tissue, and
in the disappearance in part of muscle fibre;
there was always associated hyperplasia of the endo¬
metrium. The result is that the uterus loses its tone, its
cavity becomes enlarged, and the organ itself is liable to
displacement, owing to its increased weight, as well as to
its loss of tone. With regard to the formation of flaps
in the operation, he pointed out that the anterior flap:
was dissected from the uterus from above downwards,
and, after the cervix had been cut across, the posterior
flap was di ssected from below upwards, as he found that
this latter procedure was a great saving of time and
trouble. In the ordinary method of dissecting
the posterior flap from above downwards he always
had found a difficulty in separating the peritoneum
from the uterus, which difficulty is obviated by em¬
ploying the method he had utilised. He considered
the closure of the abdomen in three layers rendered the |
patient less liab le to hernia, and common-sense, ho
thought, dictates that in the olosure of any wound, it is
more anatomically correct to approximate similar
divided structures. He said he thought it a good plan
to get the patient’s bowels to act in twenty-four hours*
time after the operation.
It is satisfactory to state that the patient made an
uninterrupted recovery, and was allowed out of bed
three weeks after operation.
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“ 8ALUS POPULI SUPREMA LEX.”
WEDNESDAY, SEPTEMBER 27, 1899.
PUBLIC ANALYSIS AT SECOND HAND.
The responsibilities attached to the post of public
analyst are heavy and onerons. Not only do they
demand the exercise of the highest technical skill,
but they involve the giving of evidence which may
determine grave issues, not only affecting property
but also the liberty and even the lives of individual
citizens. To take one further detail, their labours
are essential to the maintenance of the purity of the
food of the people, an object of prime import¬
ance to the welfare of the community. Nor
is there any need to insist upon the personal
nature of the work of the public analyst.
As a rule, he is chosen on account of his high scien¬
tific qualifications, and the condition is implied that
evidence given by him in court is the result of his
own observations and investigations. It is not a
little startling, then, to learn that it is the custom of
at least one well-known Public Analyst to hand over
bis laboratory work to a subordinate. This informa¬
tion is gathered from the report of the prosecution
last week of an ice-cream vendor by the St. Olave’s
District Board of Works in South London. A sample
of the stuff purchased from one of defendant’s
barrows had been sent to Dr. Stevenson, the Board’s
Analyst, and a certificate had been received
oogle
Digitized b;
8«pt. 27, 1899.
LEADING ARTICLES.
signed by that gentleman stating that the ice-cream
contained twenty millions of microbe organisms per
one cnbio centimetre. Dr. Stevenson attended as a
witness, and in the course of cross-examination
admitted that the analysis had not been made by
him personally, but by his bacteriological assistant.
This admission was naturally seized upon by counsel
for the defenoe, who urged that according to the
Act the public analyst must do the work himself.
The magistrate agreed with that contention and
dismissed the summons. He observed that be
would have accepted the certificate without
suspicion as the result of an analysis made
by Dr. Stevenson himself, but for that gentleman's
admission. The state of affairs thus disclosed can¬
not be regarded as anything other than serious.
Here we have a highly-paid expert coming into
court and signing certificates of analysis which
clearly misled the magistrate as to the authenticity
and weight of the special evidence furnished by the
analysis. Well may one ask how many of our
fellow citizens are being convicted upon the analysis
made by an unknown and irresponsible assistant.
It is obviously the fact that it is impossible for many
public analysts to analyse every sample them¬
selves. The obvious answer is that a man
holding such a post should not undertake
more work than he is able to perform. It may
interest our readers to consider some of the facts
concerning these appointments as disclosed in the
pages of the “ Medical Directory ’’ under the heading
of Metropolitan Vestries. We find that Dr. Stevenson
holds the post of Public Analyst to the counties of
Surrey and Bedford, and to the parishes of St.
Leonards, Shoreditch, and St. Pancras, and to the
Board of St. Olave’s, Southwark. When we recall
the fact that the same gentleman is Official
Analyst to the Home Office, lecturer at Guy’s
Hospital, and examiner both at Cambridge and
London, there is little wonder at his inability to
undertake complicated bacteriological examinations.
This question of plural public health appointments in
London, and to a less extent in ot her parts of the United
Kingdom, has grown to be little short of a scandal.
Pursuing our inquiries, we find Dr. W. R. Smith acts
as Public Analyst for Woolwich and for Lee. He is
also medical officer of the large district of Woolwich,
holds a Professorship at King’s College, and is medical
officer of the Sohool Board. To ask a man holding
so many offices in places miles apart to conduct minute
chemical and biological analyses on the result of which
may hang issues of vital individual and general import¬
ance is to run the risk of disaster, for human capabili¬
ties are finite. Dr. Muter and Mr. Stokes hold the
posts of Public Analyst to four Vestries ; Mr. Colwell
and Mr. Cassell to three and many others to two. In
some cases the Medical Officer of Health holds the
post, but that we regard as inadvisable, for the sani¬
tary duties of the smallest parish in London, if pro¬
perly discharged, are far more than enough to occupy
the full time and energies of any single man.
The fact that many of the Vestries want as
Thi Medical Pangs. 325
little as possible done in the way of efficient work
should not be permitted to stop the way. Plurality
has been the bane of sanitary administration in the
metropolis. In the particular department with
which the analysts are concerned it has no doubt
done much towards encouraging the adulteration
that pervades the national food supply to a well-nigh
incredible extent. It is to be hoped that in the re¬
adjustment of parochial affairs which will take place
shortly under Mr. Balfour’s new Act that the unde¬
sirability of plural appointments will not be lost
sight of by those who are entrusted with the respon-
sible duty of electing public officers.
THE VACCINATION QUESTION.
“ Time hath my lord a Wallet at his back wherein he
puts alms for oblivion; a great sized monster of in¬
gratitudes.”
It is well for us at this near end of a century, when
a balance of accounts must interest many, to be
careful how we allow alms to be put into Time's
Wallet. There seems to be a singular desire on the
part of some to do this in the matter of vaccination.
They apparently wish that Jenner bad never lived,
and they would like to wipe his name out of their
list of creditors. How is it that this idea has arisen ?
Is there any justification for it ? After all, what are
really the questions we have to consider when deal¬
ing with vaccination from all points .of view. Is
vaccination of value in preventing the malign influ¬
ence of a terrible malady or not ? In asking this
question we desire it to be understood that we our¬
selves entertain no shadow of doubt that the answer
must be emphatically in the affirmative, and
we put the question simply to formulate the
opposite opinion. Knowledge of every kind can
be used for good or bad. There are some who
fully admit the value of vaccination, but do not
admit that the liberty of the individual should be
interfered with in any such way as the legal enforce¬
ment of vaccination inflicts on them. The right of
the individual to deal as he pleases with his child is
in the opinion of some not to be questioned. The
relation of the individual to the State has from
earliest times been one of greatest interest; and how
far the State may interfere with the parent in his rela¬
tion to bis child has been a subject of much contention.
If a parent thinks that he ought to be left free to
do as he pleases with his child, he may make up his
mind to choose some other country than this, for we
shall certainly not agree to let parents do what they
please, if what they do, in public opinion, is injurious
to the child. If a man had to deal with a question
of purely personal and individual interest it would be
a very different matter, though the question might
arise whether we should care to let those live among
us who might become dangerous from being, like an
explosive machine, liable to damage others as well as
themselves. The question whether vaccination will
prevent small-pox or not prevent it cannot be raised by
any but those who are wilfully ignorant or maliciously
inclined. What Jenner proved years ago time has
Digitized by Google
326 Th> Medical Panes.
LEADING ARTICLES.
S*ft. 27, 189b.
■Co nfir med, and to no one in the profession is the
world more indebted than to Edward Jenner. Why
then are there many good and sensible men who
would leave a parent to do as he likes in having his
■children vaccinated or not P If we go into this ques¬
tion carefully we find that the reason given is that
the advantages of security against small-pox are
counterbalanced by the risks of injury that may
be done by vaccination. What are those risks
which seem to alarm some people so greatly P
Is there any sense in the view that it is better to run
. the risks of small-pox than the risks of vaccination ?
■This is a question which cannot be decided by any
but the members of the medical profession, and if
they are not able to decide it we cannot be surprised
at any view being taken of it by others. There is
undoubted evidence that if vaccination is not pro¬
perly performed it is possible that under exceptional
circumstances ill results may arise, and if it can be
shown that the profession has neglected to protect
the public against such risks, or at least to ex¬
plain them clearly, the consequences must be un¬
pleasant. The use of calf lymph in preference to
human lymph is an acknowledgment of this possi¬
bility, and of the disquietude of the popular mind on
the subject. The disease that has been most
feared is syphilis, and there has been a great change
• in opinion since Jenner’s time on this particular
point. It is well to give John Hunter credit
for the work he did; at the same time it is unwise
to claim for him more than he deserved. Those who
-are contantly harping on the memories of the past
are not the men who contribute to progress.
They are generally men who have done nothing
themselves, and are jealous of those contemporaries
who have done something. Now, there is not the least
fioubt but that a healthy child may possibly infected
with syphilis if vaccinated with lymph taken from a
syphilitic one. It is of no use to deny this, for to do
so is practically to deny the truth. It is better
honestly to admit the validity of the charge that is
thus made against it, and to do the best to make some
■compensation for what was done, not in malice, but
in ignorance. But having^disposed of the possibility
of syphilitic infection by vaccination, the question
that would at once be asked is whether there are not
other maladies that may be similarly communicated.
If the lymph that is used is not healthy lymph,
it must be allowed that some ill consequences
may follow its inoculation. The simple fact is
that if lymph is taken later than is proper,
or if, in preserving it on points or in tubes,
proper care is not observed, there are un¬
doubtedly risks of infection with a poison which may
seriously injure a healthy child. While admitting
the possibility of transmission of inoculable diseases
by careless vaccination we recognise that the proved
cases of such transmission have been so extremely
rare as oompared with the enormous number of vac¬
cinations that we may claim that the exception proves
the rule that the operation is of infinite value,
and entails little risk. Nevertheless, we are
bound to satisfy the apprehensions of parents
until we are able to assume them that
there is no risk whatever. The great principles
of antiseptic surgery depend on the prevention
of infection from the use of instruments in surgical
operations which might possibly convey a poison. If
it can be shown that those principles can be applied,
and they most certainly ought to apply, to vaccina¬
tion ; and that if they are, the fears of many may be
allayed, it is probable that the real cause of opposition
to vaccination will be removed; that cause being the
fact that some have suffered from neglect of the pre¬
cautions which would have prevented the injuries
apparently due to it. Even such an easy and com¬
monly neglected matter as the treatment of the
vaccine pustule in its various stages when an open
wound is liable to infection, requires attention, and
many of the troubles that have followed vaccination
coaid be traced to their neglect. We might criticise
the Royal Commission and the work it did. It hardly
struck one as having been constituted on a strictly im¬
partial basis, for it was distinctly composed of some
who held strong views on one side, and some on the
opposite side; and the witnesses were treated
as though they always appeared for the prosecution
or the defence. This is a subject, however, which
we can defer for future consideration. At present
we are more interested in showing what is due to
Edward Jenner when balancing the accounts of the
nineteenth century and in not letting Time’s wallet
get almB it has no right to.
THE TREATMENT OF GLAUCOMA BY RE¬
SECTION OF THE CERVICAL
SYMPATHETIC.
Thb etiology of glaucoma still remains a problem
which ophthalmologists have failed to solve. It is
true that we are a little nearer that solution than was
the case when Graefe alighted upon that brilliant
method of treatment which has since saved so many
eyes from becoming blind from glaucomatous tension.
But the fact nevertheless remains that beyond the
knowledge that the glaucomatous process is mainly
associated with increased intra-ocular tension,
nothing very definite is known concerning this most
serious and mysterious malady. However, it is not
from any lack of investigation that this present un¬
satisfactory state of affairs exists. Ocular patholo¬
gists and others have from time to time carried out
painstaking researches with a view to throwing light
upon the mystery. Various theories have been
evolved tending to show the ocular conditions present
in, and the causes which underly, an attack of glau¬
coma. But it cannot be said that any of these theories
are satisfactory, or that they supply the deficiency in
our knowledge in regard thereto. On the other hand
it might be considered that, after all, whatever the
true etiology of the disease may be, the bright feature
concerning it is the Buooess of its treatment by iridec¬
tomy. The brilliant results of this treatment are
likely to be maintained as long as glaucoma remains
a disease to be treated. But here the “ rift within
Digitized by CjOO^Ic
8 kpt. 27. 1809.
NOTES ON CURRENT TOPICS. Thk Medical Pbess. 327
the cloud ” is that these results can only be said to
apply to the acute cases. In chronic glaucoma
iridectomy has often little, if any, restraining in¬
fluence upon the disease. Herein, then, becomes
apparent the significance of the insufficiency of our
knowledge regarding its etiology, for while an early
iridectomy for acute glaucoma may permanently
restore the vision of an eye, in the chronic cases the
glauoomatous processes may, nevertheless, progress,
with scarcely any peroeptible increase in the tension.
Thus, in the latter cases, it is quite possible that an
iridectomy, if performed, might be productive of
more harm than good, and in many of these
it is an open question whether the operation should
he performed at all. In view, then, of these
facts it is not surprising that investigators
should have gone further afield than the ocular
region in order to throw light upon the etio¬
logy of glaucoma, and in this connection attention
has been drawn to the influence of the cervical sym¬
pathetic upon the disease. The pioneer in this field of
inquiry has been Jonnesco, of Bucharest, who has
now upon eight occasions, resected the cervical sym¬
pathetic for the relief of glaucoma. The cases upon
which the procedure was practised varied greatly in
the degree of their intensity, but in all the
results, as claimed by the operator, were most grati¬
fying. For example, there were noticed immediate and
lasting reduction of the tension—presumably where
this existed—marked contraction of the pupil,
cessation of the ciliary pain, and of re¬
lapses. noteworthy and lasting improvement of the
vision in those cases in which atrophy of the optic
nerve bad not previously ensued. Thus it can be
readily gathered from these results that the operation
in its beneficial effects eclipsed those which would
probably have followed the performance of an
iridectomy, and the good influence thus brought
about is attributed by Jonnesco to the
physiological effect upon the eye caused by
the removal of the sympathetic ganglia.
The disturbance of the nutrition of the eye upon
which glaucoma presumably depends is further
regarded by Jonnesco as a nerve change due to an
irritation of encephalic or medullary centres from
which fibres pass to the sympathetic. By removal,
then, of the superior cervical ganglion, the pathway
of evil influences, by which disturbing nutritional
changes can ensue in the organ of vision is thus cutoff.
However, it is not needful here to discuss further the
results which Jonnesco claims to have obtained. It
is natural that he should be enthusiastic in regard to
his novel procedure, and it is natural also that he
should have evolved theories in support of his ingeni¬
ous contentions. But, obviously, before his treat¬
ment can come to be regarded as sound in principle*
it will have to be put many times to the test by
independent observers. Meanwhile, from the point
of view of the patient, it may be said that an iridec¬
tomy is a trifling mutilation in comparison
with the procedure required for the removal of
the superior cervical ganglion, and moreover, if the
latter operation were to supplant the former in the
treatment of glaucoma, the question would come to
be raised whether the general surgeon would not
supplant the ophthalmic surgeon in its performance
$ait b on Cnrrntt Sopite.
Morbid Self-Assurance.
Thk confidence in self which begets what is gene¬
rally known as self-assurance is a very variable
quantity. Often conspicuous by its absence it
occasionally presents itself in an extreme degree
without warranting the suspicion of mental degene¬
racy. In this, as in respect of many other mental char¬
acteristics, there is what may be termed a normal for
each individual, and, however exaggerated, this, the
salient feature of a given temperament, may be, it
cannot be regarded as a disease. It is, of course,
quite otherwise when it develops late in life. A
degree of self-assurance which would only excite
amusement in an adolescent might justly excite grave
apprehensions in a man who has passed the meridian
of life, and who has previously been of a modest
and even retiring disposition. An unduly in¬
flated idea of the importance of self, if of
fortuitous occurrence, is often the first outward
and visible manifestation of incipient general para¬
lysis of the insane, a malady which is so often
ushered in by the mania of grandeurs Following
up a line of research which he has made peculiarly
his own, Dr. Harry Campbell recently brought
before his fellow members of the British Medical
Association an interesting little monograph on this
very subject, wherein he makes it clear how difficult
it must always be to draw a line of demarcation
between constitutional and morbid self-assurance.
Apart from personal idiosyncrasy circumstances of
environment exert a powerful influence in developing
an exaggerated idea of the importance of self. The
privileged position accorded in the old world to the
scions of noble families irrespective of their intel¬
lectual attainments or moral qualities tends, as a
natural and inevitable result, to foster this morbid
sense of self-importance. Conscious that merit alone
does not explain or justify the deference shown
to their persons, they are driven to assume that
there must be something inherently superior in
their composition, and this belief expresses itself
in gesture and behaviour. As we have already
pointed out it i6 difficult, if not impossible, to assign
a limit to physiological, as distinguished from patho¬
logical, self-assurance, and the physician is fain to
look out for corroborative evidence of nervous
degeneration before .he can safely classify it as a
symptom of disease. Nevertheless, in an exaggerated
form, self-assuranoe is unquestionably a deformity,
akin to the detormities which impair the symmetry
of the body. It is quite possible to be deformed yet
healthy, and so, in this respect, it is possible to dis¬
play this intellectual asymmetry without a sufficient
impairment of mental equilibrium to warrant inclusion
Digitized by Google
328 The Medical Press.
NOTES ON CURRENT TOPICS.
&EPT. 27, 1899.
among the insane. When this want of balance affects
only one intellectual feature it may pass muster as
ecoentricity unless, indeed, ittakesaform susceptibleof
causing damage to the community. When this is
the case, Society quits the philosophical consideration
of such anomalies and promptly sequestrates the
victim of the anomalous tendency.
Motor Carriages and Country Practice.
Recent improvements in the mechanism of vehicles
propelled by benzoline motors, and their sale at a price
which, if still excessive, iB yet within reach of the
country practitioner, are sure to lead to their taking
the place of the grey cob and gig. The advantages,
in point of view of convenience and cost of mainte¬
nance, of these self-propelled conveyances are obvious,
but, on the other hand, they are complicated and
somewhat fragile mechanisms. In large towns
nothing more than temporary inconvenience is likely
to be occasioned by a break-down, since every
facility is at hand for carrying out repairs.
Such is not the case in the rural districts, and if their
use becomes general, a post-graduate course of in¬
struction in the anatomy and physiology of the
motor-car will become absolutely necessary. This is
never likely to form part of the medical curriculum ;
but a working knowledge of their mechanism is really
indispensable, unless their owners are prepared to put
up with unexpected and disconcerting mishaps-
Often a little adjustment of a valve or the tighten¬
ing of a nut is all that is required ; but, failingspecial
knowledge, the country boors will be treated to the
spectacle of the grey-haired physician engaged in
trundling his recalcitrant motor back to the stable-
He would be jeered at as were the men in the fable
who carried the donkey, and with less reason.
Primary Syphilis in a Leper.
Instances of primary syphilis in a leprous subject
are sufficiently rare to confer interest on all well-
authenticated cases of the sort. In a recent number
of the Vratch Dr. Messaroche records the case of a
man, set. 44, who presented himself in the condy-
lomatous stage of syphilis, but who also presented
two small brown patches on the abdomen together
with a hard swelling of the left testicle and oedema of
the scrotum of some standing. Under the influence
of specific treatment the syphilitic symptoms promptly
disappeared, but as these subsided a further crop of
similar brown patches made their appearance on
the skin of the abdomen and these patches were
anaesthetic. The subsequent history of this patient
confirmed the double diagnosis and left no
doubt in the minds of observers that the case was one
of syphilis in a leper. The points to note are that
in this case the leprous taint exerted no modify¬
ing action either on the syphilitic infection, which
ran its usual course, or upon the action of the anti-
syphilitic remedies. It was noted that the adminis¬
tration of iodide of potassium appeared to favour the
spread of the leprous cutaneous manifestations.
The Mercenary Doctor.
An inquest was held a few days smoe at Scarbo¬
rough on the body of a child who had died without
medical treatment owing to the refusal of a local
practitioner to attend when summoned late at night.
Several members of the jury waxed very wrath and
passed some very severe strictures on the doctor’s
“ heartless conduct" in thus refusing to attend*
merely (!) because he was told that no fee was to be
bad. As the medical practitioner in question hap¬
pened to be the police surgeon it would perhaps have
been policy either not to answer the bell or to have
responded to the summons—but the virtuous indig¬
nation of the jurymen is oertainly out of place and
one wonders what their attitude would be if roused
in the small hours to furnish bread or brandy to a sick
or starving person, especially if they were duly
warned that the applicant could not pay. We are
strongly of opinion that it is the duty of the public
to provide medical attendance in urgent cases at all
hours of the day and night, irrespective of the means
of the sufferers, but if public opinion coincides with
ours, it is only necessary to follow the example of
most foreign municipalities in organising a night
service of medical men who are willing to undertake
this class of work at stated fees payable out of the
city funds. To pretend to impose this duty on
private practitioners without fee or reward is unjust
and even preposterous. Gratuitous medical attend¬
ance at hospitals and dispensaries has led the public
to suppose that they have a vested and inalienable
right to prompt attention, even when they are not
prepared to pay for it, and this pauperisation is the
natural outcome of a vicious system, against which
the profession have at last begun to kick.
The Prolongation of Life in Incurable
Cases.
From time to time we are asked to discuss the
ethical question whether it is right for the medioal
man to avail himself of the means which science
places at his disposal to prolong life in cases
which are of their nature hopeless. Every practitioner
must have asked himself this question when con¬
fronted with the spectacle of a patient whose unhappy
existence he is perhaps reluctantly the means of
prolonging. To this question, however, there can be
but one answer, that the duty of (the practitioner is to
alleviate suffering and to prolong life under all circum¬
stances. To admit any exception to this rule would be
to introduces dangerous element into medical conduct,
for by so doing the medical man would virtually be
assuming the right to decide when life should come to
an end, a responsibility which few, we hope none, would
knowingly accept. Moreover, medical science is not
infallible, and it is net within our power in a given
case to be absolutely sure that the condition is as
hopeless as it seems. We are constantly being re¬
minded of instances of recovery after the sufferers
have been “given up ’’ by the Faculty, and deceptions
in the matter of prognosis are sufficiently frequent
to make one hesitate to state dogmatically that
Digitized by LjOOQle
Skpt. 27, 1899.
NOTES ON CURRENT TOPICS.
The Medical Press. 329
death is imminent and inevitable. Lastly the patient
has a right to be heard, and although it is by no
means uncommon for people to declare that they
would welcome release from suffering, in the majority
of cases life with all its pains is preferred to the
grim and uncertain future. Again, if the principle
of non-intervention were conceded in cases of incur¬
able disease it would logically apply with equal force
to the weakly and the infirm among the young, a con¬
clusion from which humanity recoils with a shudder.
Lunacy in Scotland.
It is a significant fact that the steady increase in
tbe proportion of lunatics which, south of the Tweed,
is ascribed to life at high pressure, obtains also in
the country north of that boundary where one might
have supposed that the conditions of existence were
less exacting. Reoent returns show that in Scotland,
during the years 1859-63, the average number of
patients was 5,129, while for the last statistical year
the number had risen to 12,482, entailing an expendi¬
ture three times in excess of that for the earlier
period. No doubt a share of this startling difference
may be put down to tbe more ample accommodation
provided for a class of lunatics who were formerly
allowed to wander at large, but this cannot explain
the extraordinary increase manifested during the last
two or three years, 487 new cases in 1898 as compared
with an average of 245 for the five preceding years.
As might be expected, the incidence of lunacy falls
principally upon the inhabitants of towns and cities,
the rural returns remaining almost stationary. It is
not the half-starved proprietors of three acres and
a cow who
“ Go mad and beat their wives,
And, after shocking lives,
Plunge razors and carving knives
Into their gizzards.”
but the anxious busy tradesman, the rained stock¬
broker, the harassed doctor or the disappointed
barrister. Agricultural pursuits involving a labori¬
ous life in tbe open air, comparatively free
from intellectual preoccupation and professional
stress, are eminently favourable to mental equilibrium,
while, on the other hand, the abuse of alcohol and
tobacco and the manifold opportunities for nervous
excitation which characterise city life, tell heavily
on those whose nervous organisation is inherently
deficient in stamina.
The Cure of Inebriety by Restraint.
The report of the Dalrymple Home at Rickmans-
worth, near London, presents some very interesting
figures. Since its establishment it has treated 518
patients, whose average age was 36*3 years. Of these
35 were medical men, and the influence of idleness
and opulence in encouraging intemperance may be
discerned in the fact that 124 were men of property
with nothing to do, and 56 were merchants. The
result of the treatment is, however, the most
important consideration, and we derive from
the report that, of the 518 cases, 169 did well
after their liberation, and 27 were improved,
but of 97 nothing had been heard, and it was known
that 181 had relapsed into inebriety. This would be a
disappointing result did we not realise that, by the
law under which such institutions are administered,
the term of restraint was voluntary, and usually was
totally insufficient to admit of complete recovery,
being on an average only about six months. The
inebriate was seldom willing, even in his most peni¬
tent mood, to sign himself in for a longer period, and
the expense of his maintenance in the institution was
so considerable that his friends were not willing
either. Everyone experienced in this form of disease
knows that a permanent cure cannot be looked for
unless the patient can be isolated from alcohol for at
least a year, and the principle of restraint is there¬
fore not discredited by the relapse of many after half
that period.
Alcohol Dressings in Psoriasis.
The most recent method of treating psoriasis is
that suggested by Dr. H. Lau, to whom it occurred
that spirit dressings might be expected to have a bene¬
ficial influence upon the oedema and congestion of
the papillae which characterises this affection, and the
experiments which he carried out appear to have
fulfilled his expectations. His method consists in
applying every evening to the affected areas com¬
presses of absorbent cotton steeped in rectified
spirit containing 2 per cent, of salicylic acid. The
compresses are covered with a layer of protective
and left on all night. The next morning the patches
are scrubbed clean by the aid of soap and a sterilised
nail brush. Should the skin become chapped or
excoriated he interrupts the treatment for a day or
two and applies lanoline ointment. He asserts that
the results are, at least, as good as those obtained by
tar, pyrogallol, chrysarobine, &c., and tbe spirit
dressing has the advantage of beng cleanly and easy
of application.
An Infectious Diseases Hospital for
Dublin.
The conference of the Sanitary Boards of the
Dublin district held last week, under the auspices of
the Public Health Committee of the Corporation,
inspires us with the hope that at length something
practical may be done to avert the dangers to the
citizen which the present slip-shod system of sanita¬
tion involves. It is scarcely necessary to spend time
in enunciating the necessity for enlarged and more
effective provision for infectious diseases within the
district. The existing accommodation for such cases
consists practically of one special hospital of 120
beds (of which about eighty are usually occupied)—
one branch of a general hospital containing 120 beds,
and such minor accommodation as can be offered
by small wards in two or three general hos¬
pitals. Such accommodation for infective diseases
is, doubtless, enough for every day use, but
insufficient for occasional exacerbations of disease
which are quite frequent in all large cities, and
altogether ridiculous as a provision when a serious
epidemic occurs. When such a catastrophe has hereto-
e
NOTES ON CURRENT TOPICS.
Skpt. 27, 1899.
330 Th* Mbdioax Pubs
fore arisen the sanitary authorities have sought to meet
it by setting up shanties of corrugated iron and wood
which temporarily protected the fever patients from
the weather, and this they would have to do if a grave
epidemic broke out to-morrow. It goes without
saying, therefore, that increased permanent accom¬
modation for infective cases must be provided, and
Sir Charles Cameron suggests two alternative
methods, the immediate object of which is to
provide funds for the erection of one, or perhaps two,
hospitals for infective disease. The first is that all
the sanitary authorities in the vicinity of the city
shall combine to form a Hospital Board which shall
obtain, by provisional order, the requisite power to
tax the whole area for the purpose, and the second
is that the Corporation alone should undertake the
cost of building and maintenance, receiving from the
extra-corporate sanitary authorities a contribution,
per week, for each fever patient whom they send
into the hospital. It may be stated at once that the
first of these propositions is the best, but that the
eeoond is much the most easily carried out, because
the first would involve an application for a provisional
order, and would thus involve the letting out of a thou¬
sand oppositions. Among the opponents would be (1)
the hospitals which would see their function, pro tanto,
abolished and their students forced to go elsewhere
for the study of infective diseases; (2) the denizens
of the localities where it might be proposed to erect
the new hospitals would certainly avail them¬
selves of every legal formality to thrust off the
incubuB of the infective hospital on their neighbour!
(8) the Dublin ratepayers, who, having recently had to
swallow the nauseous dose of £91,000 for providing
villas for artisans, are firmly determined to block
every proposal for large expenditure of money
on any scheme which is not absolutely indispensable ;
and (4) the boards of guardians, who, probably, would
resist any scheme which would merge their control
and influence in a central hospital board, while com¬
pelling them to contribute to the expense. Notwith¬
standing these hindrances we trust that the proposal,
for a provisional Order and a combined hospital
board will be adhered to as being the only stable alter¬
native. That, in a city like Dublin, it should be
neoessary, as Sir Charles Cameron expresses it, to
“ hawk about ” an infected patient, failing to find
aooommodation in hospital, is an intolerable bar"
barianism, and, if the provision of sufficient accommo¬
dation can be obtained without architects’ vagaries
and builders’ jobs, it ought to be done without
further parley.
The Patient Stomach. \ 1 '
The rush of modern civilisation leaves little time
for the average man to think of anything outside the
immediate tether of his own absorbing pursuits. He
is content to eat, drink, sleep, and take his pleasures
as they come, without encroaching upon the period
of his scant recreations by such solid labour as that
involved in consecutive thinking. In this way eating
and drinking are regarded much as breathing, or the
complex nervous and muscular acts that take place
in walking or talking; all are accepted as matters of
course. Indeed, it is just this easy way of treating
vital functions that only too often leads to their
abuse. Let the reader pause for a few moments and
think how he treats, and has been in the habit of treat¬
ing, his own patient stomach. Does he begin the day
with a heavy breakfast, including several cups of
strong tea ? Does he take a meat lunoheon, with
wine or other alcoholic drink P Does he indulge in
afternoon tea and wind up with a dinner of half a
dozen courses, tempered with more alcohol P If a
man does he distributes odd alcoholic drinks over the
whole day’s programme ? If of either sex, is tobacco
included in the daily trials of the stomach P A
steady course of public dinners would, in time, ruin
the digestion of a rhinoceros or an ostrich. The
three square meals a day of the average country
house quickly upset the digestion of the visitor, who is
used to think highly and live plainly. Indeed, no great
intellectual activity can be permanently associated
with gluttony. The amount of abuse the modem
civilised stomach can withstand is an eternal monu¬
ment to the perfecting powers of the evolutional sur¬
vival of the fittest.
A “Certified" Midwife and “Stillbirth.”
Last week a coroner’s inquiry at Westminster
upon the infant child of a single woman revealed a
state of affairs that deserves more than passing com¬
ment. It appears that the “ certified ” midwife took
women into her house for confinement. The child
was stillborn, but no attempt was made at artificial
respiration. The medical evidence showed that the
child was prematurely born, and the lungs were net
inflated. These facts alone suggest a serious state
of matters, the investigation of which may be left in
the hands of the police. There is a further serious
element in the case, however, namely, this midwife
was in the employ of the Western Dispensary. It
is obvious that no public medical charity should
employ a midwife except she be of approved skill
and of the highest character. Most people
will form their own conclusions as to how
far those conditions were fulfilled by this
particular woman. Does no responsibility rest with
the honorary medical staff of this institution ? We
find that Dr. Allchin is honorary consulting phy¬
sician, and Mr. Thomas Bond consulting surgeon,
while Dr. J. B. Potter is the honorary consulting
accoucheur. Surely these gentlemen cannot wil¬
lingly be associated with such proceedings as those
that formed the subject of the above-mentioned per¬
tinent inquest. It is, of course, a well-recognised
fact that honorary medical staffs absolve themselves
from the acts of the committee of management.
Sooner or later, however, a day of reckoning must
come between the medical charities, so called, and
the main mass of general practitioners, and those
consultants who are wise will disassociate themselves
from institutions in the management of which
medical men have no voioe.
Digitized by
8 kpt. 27. 1899. NOTES ON CURRENT TOPICS. The Medical Pbcm. 331
Sanitary Removal by Force.
Last week an incident occurred in South London
which is fortunately rare in the annals of preventive
medicine. Diphtheria has recently raged in a cer¬
tain quarter of Southwark, and a boy of ten was cer¬
tified to be suffering from the disease. The family
in the house consisted of father, mother, and four
children, the latter aged respectively 17, 15, 13, and
10 years. The mother violently resisted the removal
of the child, and tore up the certificate. Thereupon
an application was made for a compulsory removal
order to a hospital to Mr. Slade, who granted the
order. The English Act states very definitely that
proof must be given that the patient is without
proper “ lodging or accommodation ” before an order
for compulsory removal be made. It is to be
presumed that an experienced magistrate like Mr.
Slade demanded full and satisfactory evidenoe as to
the patient’s surroundings before he took the extreme
steps of signing such an order. Anxiety to avoid
running counter to the prejudices of the people was
evidently a main principle in the mind of the framer
of the Act. We note, however, with no little wonder,
that the application in this highly important matter
was made by a sanitary inspector, and it is to us
perfectly incomprehensible how a London magistrate
should listen to anyone but the responsible Medical
Officer of Health of the Parish. If this outraged
mother is of the ordinary British bull-dog breed, the
Yestry,whose zealous sanitary inspector has procured
this ill-starred magisterial authority, may expect
further legal complications in other and higher
courts.
The Outcome of Midwivee’ Registration.
The State Board of Health of Illinois affords us an
object lesson which enables us to anticipate the
probable working of Midwife Registration if it should
be introduced into this country. The State Board,
finding that the registered midwives had gone in
wholesale for practice as physicians and surgeons,
has found it necessary to issue to each of them a
peremptory circular which warns them that “ mid¬
wives are forbidden by the law to call or advertise
themselves as physicians or doctors, and prohibited
from using any drug or medicine and from attending
other than oases of labour,” and it threatens that a
“ violation ” of the regulations will subject (you) to a
prosecution and will be deemed a “ sufficient cause
for revoking (your) certificate.” Inasmuch as the per¬
emptory infliction of such a penalty would be found
extremely difficult in Great Britain, it stands to
reason that we should be the more cautious in giving
midwives an inch, being convinced that they would
certainly take the proverbial ell.
Dermatology for the General Practitioner.
Like all special branches of medical scienoe
dermatology is more or less buried beneath the mass
of its own learning. The accumulation of facts has
gone on at a great pace, while the generalisations in
causation and treatment have in many cases yet to
be made. In the case of ringworm, for instanoe,
immense strides have been made in the differentiation
of the fungus, but the cure of the disease has not
been advanced one jot. If the general practitioner
desires to refer to any special condition, he finds
himself confronted by many large books of reference,
but he may as well look for a needle in a hay¬
stack as attempt to identify any condition with
the name of which be is not already acquainted.
For many conditions there are half a dozen names,
and the medical leaders in each town insist upon
opposite theories. Yet there are some who advocate
adding the diseases of the skin to the already
bewildering curriculum of the medical student. As
yet no satisfactory classification of the subject has
ever been devised, which is another way of saying
that the fulness of knowledge is not yet at hand. A
short, terse, plainly written book on dermatology,
dealing only with the commoner conditions likely to
be met with in every-day practice, would be likely to
fill a gap in the shelves of the general practitioner.
Hospital Reform Association.
The forthcoming Conference under the auspices of
the above body is likely to prove of an interesting
and instructive character. We think the Association
has been well advised in asking gentlemen to take up
specific points in their papers rather than to deal
with the whole question of Hospital Reform. There
can be no doubt that more light is wanted on the
subject of inquiry into the circumstances of
patients. Then again the subject of patients’
payments is one that requires to be dealt with
in a vigorous way, For our own part, we look
upon the out-patient payment system as likely to
increase rather than diminish the amount of abuse
already rampant in our out-patient departments.
We should like to hear the experience of the staff of
the London Hospital on this particular point—that
is to say, if they have not altogether surrendered their
consciences and beliefs to the lay philanthropists
who know little and care less about the interests of
general practitioners. We are glad to hear that
representatives of provincial charity organisation
societies have promised to attend the conference.
Sanitary “Trop de Zele.”
We have repeatedly remonstrated with sanitary
authorities who seem to have striven to bring the
Adulteration Acts into disrepute by instituting
prosecutions on the most frivolous grounds. No doubt
it iB a technical infraction of the law that soda-water
should not contain the ultimate atom of soda, and
that a dispenser should add two grains of iodide cf
potassium more than the prescription indicated, but
we should think that a fine of one penny and no costs
would “ fit the crime ” We make this observation in
view of the decision of Mr. Rose, the magistrate at
the West London Police-couit, who dismissed the
last-mentioned prosecution because, as be said, he did
not think that the Act of Parliament was made to
cover such homoeopathic infringe ments.
Digitized by LjOOQle
332 The Medical Press.
SCOTLAND.
Sept. 27, 1899.
Gelatine Injection for the Cure of
Aneurysm.
The recent announcement by M. Lance reaux that
aneurysm, even of the aorta, may be consolidated by
the hypodermic injection of gelatine, has been con¬
firmed by Professor Stoicesco, of Bucharest, in the
Journal de Medecine Interne. If the statements of
these physicians are to be believed—and they are
entitled to every confidence—we are about to enter
on a new phase of the treatment of an affection
hitherto regarded as almost hopeless.
M. Scheurer-Kestner.
This gentleman, who died last week, was best
known to the public as an apostle of the Dreyfus
cult, but he was also a distinguished chemist. During
the sixties he was an active member of the Paris
Chemical Society, and published a learned work on
the “ Elementary Principles of the Chemical Theory
of Types Applied to Organic Compounds,” besides
many other paperson chemical questions. He after¬
wards became the manager of an important chemical
factory.
The Serum Industry.
The development of the treatment of various dis¬
eases by inoculation with serums has been followed
by a severe run on the Pasteur Institute, which has
been engaged for a considerable time in preparing
them. The anti-rabic serum is, of course, of old
standing, but more recently a demand has arisen for
anti-tetanic, anti-diphtheritic, and, lasty, anti-plague
serums, Most of the latter has been sent to Portugal
and itB vicinity, but the directors of the Institute
assure us that they have still an abundant supply of
all these prophylactics on hand.
PERSONAL.
Professor Sims Woodhead, M.D., F.R.S., will deliver
the Introductory Address at the Royal Veterinary
College, London, on Monday next, at 12 o’clock.
Mr. James Prior, M.R.C.S., who has occupied the
post of house-surgeon to the Dewsbury and District
Infirmary for the last four years, has, on resigning
the post, been presented with a clock in oak case in
recognition of his past services.
Dr. M. A. Adams, who did such good service in the
r ecent typhoid epidemic at Maidstone, and who has held
the position of Medical Officer of Health to the borough J
for upwards of twenty years, has now resigned the
appointment to the great regret of the Council.
Dr. E. Symes Thompson, M.D., F.R.C P.. Gresham
Professor of Medicine, will commence a course of four
lectures at the Gresham College, Basinghall Street, on
Tuesday next, at 6 o’clock, on “ Earth, Air, Water and
Insects in Relation to Disease.” These “ Foundation ”
lectures are free to the public, and will be continued on
Wednesday, Friday, and Saturday at the same hour.
Dr. Reginald Farrar, M.A., M.D. Oxon, D.P.H.
Cantab, who has been selected to go on the Plague Com¬
mission in India, is a son of the eminent author and
preacher, Dean Farrar, of Canterbury Cathedral. Dr.
Farrar is a former House Surgeon of St Bartholomew’s
Hospital, London, and has recently filled the poet of
Surgeon to the Rutland and Stamford General Infir¬
mary, and to the Post Office.
At the election last week of a bacteriologist for the
City of Glasgow, a good many personalities were intro¬
duced into the contest. Dr. Erskine, in urging the
claims of his candidate, volunteered the statement that
the City Council had not much respect for the profes¬
sion. Another Councillor who knew what “ doctors’
certificates” were worth, would not give a snap for
them. Eventually Dr. Robert Buchanan, of Anderson’s
College, was elected by 29 votes to 27 of his opponent.
Jtoilattb.
[from our own correspondent.]
Edinburgh Institute of Public Health.— The
plans have now been passed for this new institution in
connection with Edinburgh University, the cost of the
erection of which will be entirely defrayed by Sir John
Usher, Bart., of Norton. The building will consist of
three stories, consisting of a centre block and two
wings. The ground floor will be occupied on the east
wing by a large museum and the janitor s premises.
In the centre there will be research rooms, a gas
analysing room, and lavatories, and in the western wing
there will be workrooms and cellars. The first flocr
would consist in the east wing and centre, of chemical
laboratory, optical room, water analysing room, research
rooms, and reading-room ; while the west wing of this
and the top flat would be occupied by a very extensive
lecture theatre, capable of holding a large number of
students. Besides the theatre, the third storey will con¬
tain a bacteriological laboratory, observation and re¬
search rooms, and adjuncts to the professor's labora¬
tory.
Glasgow University Lord Rectorship.— It has been
officially stated that owing to certain considerations
affecting his position in the diplomatic service. Lord
Cromer has found it impossible to contest the election
for the Lord Rectorship, and his Lordship’s decision to
withdraw from the contest has caused universal regret,
which, however, is modified by the fact that the Con¬
servative students have approached Lord Kelvin, who
has consented to become the Unionist candidate, as
there is no impediment to his being returned as Lord
Rector, as he has recently resigned his chair as a Pro¬
fessor at the University. As it will be fully a month
yet before the students will be up, it is not quite fully
known how they will, as a whole, consider the change of
candidates, but at the same time the feeling among
Conservative clubmen in town is that Lord Kelvin’s
popularity will make him oven a more favourable candi¬
date than Lord Cromer, as the occasion will thus enable
the students to pay the highest honour in their
' power to a favourite teacher and friend, both to them¬
selves, to the University, and to the world generally.
Large Bequests to the Glasgow Infirmaries.—
The agents for the trustees of the late Mr. Alexander
Boyack, of Partick. Glasgow, have intimated that the resi¬
due of the deceased’s estate has been bequeathed in equal
proportions to the Glasgow Royal and Western Infirma¬
ries ; and it is further stated that the bequests represent
a sum of .£13,500 to each infirmary. Lately, the Royal
Infirmary has fallen heir to very large sums of money,
which ought to go far towards the rebuilding of the in-
i firmary, unless the directors put them into the sinking
Digitized by
8 m . 27, 1899.
CORRESPONDENCE.
The Medical Press. 333
fond, and go a-begging for more funds to carry out the
reconstruction scheme. With regard to the reconstruc¬
tion the matter seems to be at a standstill, in
consequence of which complaints are being freely
made regarding the undue delay on the part
of the managers and professional staff in settling
the plans of the interior which must first of all be com¬
pleted before any practical step can be taken by the
executive committee of the subscribers towards obtaining
elevation plans. The explanations given at a recent
meeting'we re ascribed to the difficulties experiened by
the managers in satisfying the many requirements
demanded in a modern hospital; it is, however, expected
that the bl ock plans will be in the hands of the executive
not later than the end of October.
(tarftepmtanta,
We do not bold ourselves responsible for the opinions of our
correspondent*.
THE ALLEGED INCREASE OF LUNACY.
To the Editor of The Medical Press and Circular.
Sir,— My attention has been directed to three editorials
of very grave importance, published respectively in your
issues of August 16th, 23rd, and 30th, on *‘ the alleged
increase of Lunacy,” my name being mentioned in con¬
nection therewith. It is a matter for congratulation
that a journal of such high standing has taken ,up the
question and opened a debate upon it in a way which I
venture to predict will eventually lead to far-reaching
results. As a close student of this painful subject, for a
long series of years, and one who contends that the
increase is not only real, but of great magnitude, I
hope you will give me space for a statement in your
columns, which I will make as brief as possible.
The article of August 16th deals with the fifty-third,
the last report of the English Lunacy Commissioners,
which, like all their reports, from first to last, shows a
substantial annual increase in the number of registered
insane. This report begins as follows: —“ The total
number of lunatics in England and Wales on
January 1st, 1899, was 105,086, being an increase on
the corresponding number on January 1st, 1898, of
3,114, the largest increase we have yet had to record.”
The second article opens with the following observa¬
tion :—“ We are driven irresistibly to believe that
sooner or later the conclusion which will infallibly
impress itself upon the public is that insanity is not
increasing.” I have great respect for the authority of
the Medical Press and Cibcular, but I must distinctly
and emphatically traverse this statement, or rather
opinion.
You say: “ Mr. Corbet, M.P., who has written much on
the. subject, appears to rely mainly on the official
statistics.” And again: “ Mr. Corbet is going on the
broad ground of a crusade in the cause of humanity.”
Both these assertions are strictly accurate, and con¬
stitute in my judgment a solid foundation. Basing
myself upon official statistics, and in the cause of
humanity, I have through the medium of papers pub¬
lished from time to time in the Fortnightly Review, the
Westminster Review, and other magazines, endeavoured
to bring the public mind to realise the terrible fact of
the progressive increase of insanity. The subject is
such an exceedingly distressing one that very few outside
of those who are immediately interested care to read
About it or to familiarise themselves with the gruesome
details.
For myself, except by giving prominence to the state¬
ments of high medical authorities on the predominant
factor in the propagation of insanity (heredity), I have
never ventured beyond statistical facts,, feeling, as a
layman, unqualified to deal with psychological mys¬
teries.
The following passage in the article of August 16th
has particularly impressed me: —“ In the cause, and for
the sake of a great variety of interests, it is now
obviously desirable that the much-debated question of
insanity should, if not cleared up—which it can never
quite be so long as the existing conditions of human
nature exist—be at least put on a more satisfactory
basis.” This is wise counsel, and the readers of the
Medical Press and Circular will do well to take it
seriously to heart. The first thing to be cleared up,
however, is whether the immense increase of the numbers
of registered lunatics, coupled with the great cost of
providing expensive and ornamental asylum accommo¬
dation for them, together with the large annual increase
of maintenance expenditure, indicates an actual increase
of lunacy or not.
In one of its articles the Medical Press and Circular
says :“We know the greatest statistician this country ever
produced (Dr. Neilson Hancock)could prove anything”
from statistics. This is a doubtful compliment. My first
paper on the subject was read at a meeting of the
Statistical 8ociety of Ireland in 1874, presided over by
Dr. Hancock, whose authority as a statistician could not
be doubted. At that time—to come to dose quarters
with the question of real or apparent increase—the
registered insane, in Great Britain and Ireland, were, in
even numbers, 77,000, having advanced to these figures
from 56,500, at which they stood at the beginning of the pre-
cedingdecade—-thus showing a rise in ten years of 21,500.
This rate of increase has gone on, without intermission
from year to year, and decade to decade, until the
numbers have reached, in even figures, the enormous
total of 139,700, England 105,100, Ireland 19,600, Scot¬
land 16,000, or an actual increase in round numbers of
63,000 insane persons. For a long series of years the
annual increase averaged about 2,000, but for the last
five years it has risen to 3,600, while in the last year of
all, namely 1898, the increase has run up to 4,150, the
largest ever recorded. It is difficult, in the face of these
figures, to Bee where any room for doubt as to the reality
of the increase exists. Especially when one reflects that
concurrently the asylums have teen doubled in number,
more than doubled in capacity and expenditure, and are
yet unable to keep pace with the demands upon their
resources.
The accumulation of numbers from a variety of causes
it still, it appears, chiefly relied upon by the upholders of
the “ apparent increase ” theory. It cannot be denied that
the prolongation of the lives of the insane consequent
upon improved methods of treatment, the comforts by
which they are surrounded, and the nutritious food they
get must necessarily cause some accumulation of num¬
bers ; but a careful study of the information furnished
by the Medical Officers of Asylums will convince any
reasonable mind that the true cause of the increase is to
be found in quite another direction.
The Special Report of the Inspectors of Lunatics
called for in 1893 by Mr. John Morley, then Chief Secre¬
tary for Ireland, and furnished from information sup¬
plied by the Resident Medical Superintendents of Dis¬
trict Asylums, which is before me as I write, contains
incontestable proof not only of the reality of the increase
but of its origin and magnitude. Of the twenty-two
asylqjns, most of them having had to be enlarged several
times in consequence of overcrowding, all had a sub¬
stantial increase to record, heredity being the main
cause assigned.
The Richmond district was naturally given the
greatest prominence. Here is what the inspectors had
to say about it“ The actual increase in the number
of persons of unsound mind under treatment in this
asylum during the last ten years has been remarkable—
rising from 1,055 at the end of 1883 to 1,467 at the end
of 1892.” The inspectors go on to observe:—“ The
question of heredity as a source of causation is dis¬
cussed with much force and intelligence in the report,
but no sufficient body of specific facts is, it is stated,
available to throw light on the point as to whether the
improved treatment of the insane may not indirectly
tend to perpetuate, or at least increase, the prevalence
of insanity. At the same time. ... it is not thought
that the facts warrant the conclusion that there has been
zed by GoOgle
334 The Medical Press.
CORRESPONDENCE.
Sept. 27. 1899.
during the period any very marked increase in the
tendency to insanity amongst the inhabitants of the
district.”
These are ominous reflections, indicating, as they do,
a possibility that the present costly system of housing,
treating, and curing (?) the insane may be after all
entirely wrong ; that so far from tending to arrest the
spread of insanity this lavish expenditure has had an
opposite effect, resulting, as it has done, in a great
annual increase in the numbers of the insane popula¬
tion.
What is the fact ? Since those reflections were made
by the Inspectors who described the increase of 412, for
the ten years ending 1892 as “remarkable,” the increase
in the Richmond district has further increased by 600,
not in ten, but in seven years.
It is necessary to make a brief retrospect in order to
realise how universal and continuous the increase has been.
On examination before the Select Committee of 1859,
when the registered insane in England and Wales were
only 35,982 as against 105,086 at the present time, Lord
Shaftesbury, who filled the office of Chairman of the Eng¬
lish Lunacy Board for forty years previously, stated, even
at that period: “ The increase of lunacy is certainly unques¬
tionable,” prefacing his reply to the question (No. 61)
by saying, “ I am almost afraid of giving an opinion, as
it may be the commencement of the most awful contro¬
versy, for there is a great difference of opinion on that
point.” 1 he " awful controversy ” predicted by Lord
Shaftesbury has been slow in coming, owing to a variety
of causes, but it has come at last, and here we are, forty
years after, debating whether an increase from 86,982 to
106,086 in England and Wales with proportionate in¬
creases which bring the total in Great Britain and Ire¬
land up to nearly 240,000, is real or only “ apparent.”
Every way one turns it is an all-round increase—increase
of numbers, of asylums, of expenditure, of admissions,
of dischargee, of deaths, and the worst feature of it is,
that in spite of all that human sympathy and medical
science can do the increase under each of these heads
grows larger and larger every year, like a ball
of snow that gathers bulk as it progresses. All
this, as suggested in the Medical Press and Circular
article of August 16th, requires to be checked, but how
is it to be done so long as the fact of any actual increase
is denied, while the only official solution offered is to
keep on building costly asylums to provide accommoda¬
tion ad libitum for the ever increasing increase of num¬
bers ? The disentanglement of this moet perplexing
problem rests with the medical and surgical professions,
who alone are qualified to consider it and to suggest a
remedy for the evil. As all attempts made in Parlia¬
ment to induce the Government to promote an inter¬
national conference on the subject have failed, the
medical and surgical bodies in Ireland might themselves
take the matter in hand.
In conclusion, I am not an alarmist, at least not a
false alarmist, but simply one who has had special op¬
portunities of noting the increase of insanity for over
thirty years, and can now only raise the danger signal.
I am. Sir, yours truly,
W. J. Corbet*
Spring Farm, Delgany, Co. Wicklow.
CURIOUS DEADLOCK IN A LONDON PARISH
To the Editor of Thb Medical Press and Circular.
Sib,—T here is nothing so very singular in a difference of
opinion between the Local Government Bo«rd and a
sanitary Board which is attended with a certain amount
of delay in settling matters as to constitute a “ curious
deadlock.” There has been no interruption to sanitary
administration in the St. Olave's District. That might
have been the case if the St. Olave’s District Board had
not had the good sense to appoint a temporary Medical
Officer of Health to aot during the holidays, and until the
difference between that Board and their own medical officer
had been determined. The Board selected me, without my
knowledge or consent, presumably because I was already-
acquainted with the distriot, resided close to it, and
was in a position to aot at once, if any emergency arose.
I am pleased to inform you that the course adopted
involved no pecuniary loss to Dr. Bond, whose salary i»
paid in full. If that had not been the case I should have
been happy to have acted for him. If you object to Dr.
Bond being permanently appointed to two districts, or to
my being temporarily so, I would remind you that there
are several districts in London and elsewhere, under
the charge of one Medical Officer of Health, in which
the area, population, and ratable value exceed that of
Holborn, St. Olave, and Bermondsey combined. It is
not correct to say that my energies are divided between
the cases of private practice and the sanitary charge of
Bermondsey, as I am not engaged in private practice,
and the Vestry has not contracted with me, and does
not pay me, for the whole of my time. Neither is it
the fact that important health prosecutions in
Bermondsey are generally conducted by one of the
subordinate inspectors. They are conducted by the
clerk and solicitor, with the assistance of the Medical
Officer of Health and the Chief Sanitary Inspector. In
minor cases the magistrate is generally satisfied with the
evidence of the Inspector only, which I believe is cus¬
tomary in other districts. All prosecutions are directed
by the Vestry, on the report of the Public Health Com¬
mittee, after hearing the opinion of the sanitary officers.
I am, Sir, yours truly,
John Dixon.
183, Jamaica Road, Bermondsey,
September 21st, 1899.
[The facts that Dr. Bond is suspended by St. Olave’s,
while his reinstatement is ordered by the Local Govern¬
ment Board, that Dr. Bond is drawing salary for doing
nothing, and that Dr. Dixon has been appointed to
supersede Dr. Bond appear to justify the term “dead¬
lock.” We do not blame Dr. Dixon for holding a “half
time” appointment, but we altogether condemn the
system that permits the existence of suoh a poet. Our
impression that Dr. Dixon is not conspicuous in sanitary
prosecutions in his own parish may possibly be a miscon¬
ception, but the actual evidence in court of the Medical
Officer of Health is usually regarded as crucial. We
are glad to publish Dr. Dixon’s statement that he is not
engaged in private practice, as the ground is thereby to
some extent cleared. The general impression in his own
district, however, is that, at any rate, until quite recently,
he has been engaged in extensive practioe.—E d.]
HOSPITAL REFORM.
To the Editor of The Medical Pbiss and Circular.
Sib,—I t will be a source of gratification to many of your
readers to know that there is every prospect of a success¬
ful gathering at our conference on the 10th and 11th of
October next. Our aim has been to have the subjects
set down discussed by men who have had personal ex¬
perience of them; and when I mention the following
names it will be allowed that we have been successful
in that respect. Dr. Arnold Lea, Manchester; Dr. Ber¬
tram Rogers, Bristol; Dr. Brown Ritchie, Manchester;
Colonel Montefiore, London; Mr. C. W. Warren, London ;
Dr. Francis Waring, Brighton, Dr. Richardson Rioe,
Coventry, Mr. H awkins-Ambler, F.R.C.8.E., Liverpool,
are gentlemen who have devoted a great deal of time
and study to the subjects which they propose to treat.
Mr. Timothy Holmes, F.R.C.S., has, I am glad to say,
promised to preside at one of the meetings, and the
Rev. Russell Wakefield, Rector of St. Mary’s, Bryanston
Square, at another. The absence of so many men from
home at this time has prevented our making arrange¬
ments for the chairmanship of the third meeting, but I
have no doubt that we shall succeed in obtaining the
services of a competent chairman before long.
zed by GoOgle
8kpt. 27, 1891
CORRESPONDENCE.
The Medical Press. 336
Having done so much on our part, it now remains
for the general practitioners of the country to support
our efforts. Conferences in London cannot be held
without incurring expenses, and we shall be glad to havp
contributions towards defraying them.
I am, 8ir, yours truly,
T. Gabbett Hobdxb,
Hon. Sec.
Cardiff, September 23rd, 1899.
THE ABUSE OF MEDICAL CHARITIES.
To the Editor of The Medical Press and Circular.
Sir, —A few weeks ago you referred to a case in which
Sir Sydney Water low maintained that a clerk in reoeipt
of £200 a year would be unable to pay a surgeon the fee
for an ordinary operation. It so happens that I am in
possession of the facte of a case where an applicant
was rejected from St. Bartholomew’s Hospital some
weeks ago, and in my own mind I have little doubt
he was tne “ clerk ” to whom Sir Sydney referred. The
facte are these. Some years since, this person had a
son who suffered from nasal obstruction. He obtained a
personal letter of introduction from a private patient to
one of the surgeons of the hospital. Tne boy went into
hospital, and the surgeon perfoimed the operation.
This same applicant wanted a similar operation
performed on a second son, and naturally turned again to
8t. Bartholomew’s. On this occasion, however, hiB cir¬
cumstances were taken into consideration by the com¬
mittee, who rejected his application, and the surgeon
turned a cold shoulder to him. He then went to a
small special hospital, and one of the surgeons per¬
formed the operation for five guineas, while four guineas
a week was paid for the boy in a private hospital. This
clerk, it is true, has only £200 a year salary. His wife,
however, is a Court milliner, and part of their house is
let off to consultant at a high rent. They live in a style
that cannot be approached by many a consultant and
specialist and general practitioner whose interests are
ignored by philanthropists of 8ir Sydney Waterlow’s
stamp.
I am. Sir, yours truly,
London, September 23rd, 1899. Ignotus.
NURSES OF THE LATEST FASHION.
To the Editor of The Medical Press and Circular.
Sib,—A llow me to endorse what Dr. Walsh has said
with regard to Mr. Gant’s article on what he is pleased
to call “ nurses of the latest fashion." As a contribution
to the economics of nursing, Mr. Gant can hardly be ex¬
pected to be taken seriously, despite the all-embracing
title he has selected. If that gentleman had beaded his
paper “ Some N urses of the Latest Fashion,” and had
stated clearly whether the characters were imaginary or
drawn from active life, then possibly no great exception
could have been taken to the subject, although doubtless
opinions might have differed as to the good taste or
otherwise of his contribution As matters stand, if Mr.
Gant has really had any experience such as he desoribeB,
it would seem to be his duty to the profession to publish
the names of the nursing institutions concerned. But
even in that case, to brand all nurses as bad because a
few may have criminal tendencies does greater credit to
Mr. Gant’s imagination, than to his reasoning powers.
The title of Mr. Gant’s articles, to which I have already
alluded, makes it impoeible to conclude that his attacks
are not levelled at the entire nursing sisterhood. I am
sorry that such egregious material mould find any place
in the pages of a sober medical periodical.
I am, Sir, yours truly,
Sydney Stephenson.
33, Welbeck Street, W.
To the Editor of The Medical Press and Circular.
Sib,—A lthough I agree with your correspondents,.Dr.
Walsh and Dr. Bateman, as far as they appear to go,
that nurses of the latest fashion are an arduous class of
workers, there can be no doubt that the tendenoy of the
majority of the present day is to assume a false position
before the public, nor do I think Mr. Gant can be
accused of any exaggeration on account of the style in
which he has so ably depicted them.
I remember myself, some years ago, attending a
rector’s wife, since deoeased, who resided in a country
village, and on that occasion I suggested at the bedside
milk as an article of diet, whereupon, to my surprise, the
nurse suddenly blurted out something about milk caus¬
ing phlegm. The family being highly eduoated and
somewhat highly connected I thought I displayed better
form by remaining mute, but on going down stairs the
son. who, by the way, was a late Fellow of his college,
took me to task for not showing more decision. I, how¬
ever, pointed out to him the necessity of preserving
equanimity in a sick room, and advised him to quietly
follow the directions, but told him plainly to laugh up
his sleeve, and he appeared satisfied.
On another occasion more reoently in this very district
I happened to attend a confinement, and to my great
astonishment on visiting the next day the room was
taken possession of by two females, one of whom turned
out to be the superintendent, who was attired in a some¬
what ghastly uniform, the like of which I had not seen,
and who had been called in as a kind of consultant, but
although I had the responsibility of the case, I was
treated as though a nonentity.
Many a few of your readers may have read the life
of the late Sister Dora, a name that will be justly
cherished in this country, but it is impossible to con¬
ceal the fact that there was here a type of mind which
made it difficult even in an organised institution to con¬
duct business, and, if I am correct, it is easy to oonoeive
the difficulties which confront the majority of medical
practitioners with *’ nurses of the latest fashion,’’ and
this is, of course, accounted for owing to the difficulty of
keeping the female mind under proper control, so, under
all circumstances, I think now if your corre spondents
need shed tears over a class whom the present state of
society regard as indispensable.
I am, Sir, yours truly,
Clement H. Serb.
Queen’s Road, Peckbam, S.E., September 25, 1899.
[It is only fair to Mr. Gant to point out that, in his
introductory remarks, he expressly repudiated any desire
to formulate an indictment of properly trained and cer¬
tificated nurses, or of nurses as a class. His strictures
obviously apply only to certain, possibly numerous,
exceptions, occurring in the ranks of those whom we may
dub the unqualified. It is well-nigh inconceivable that
women who have been through the prolonged and exacting
training and supervision which certification implies, or
ought to imply, would display such deplorable moral
characteristics. The weakness of moral fibre which
characterised Mr. Gant’s heroines would scarcely have
escaped notice during their period of probation, and
we all know the severity with which suoh delinquent
tendencies would be treated by the ladies who direct
our large nursing institutions. We repeat, then, that
Mr. Gant's remarks were intended to warn the profession
only against soi-disant nurses, whose aptitudes and trust¬
worthiness are, to putit gently, matters of conjecture.
Ed.] __
The Mortality of Foreign Cities
The following are the latest official returns, and repre¬
sent the last weekly death-rate per 1,000 of several of the
populations .—Calcutta—.Bombay 37, Madras 31, Paris
16, Brussels 19, Amsterdam 12, Rotterdam 20, the Hague
14, Copenhagen 24, Stockholm 17, Christiania 21, St.
Petersburg 22, Moscow 27, Berlin 25, Hamburg 19,
Dresden 26, Breslau 30, Munich 24, Vienna 18, Prague
24, Buda-Pesth 21, Trieste 25, Rome 13, Turin 16, Venice
16, Cairo 45, Alexandria 38, New Vork 16, and Phila¬
delphia 16.
Digitized by GoOglC
336 Th* Mxdical Press.
LITERATURE.
Sift. 27, 1890.
(Dbituarg.
SURGEON-MAJOR-GENERAL LITHGOW, M.D., C.B.
Mxdical circles in Edinburgh were last week sur¬
prised to hear of the sudden death of Surgeon-Major-
General Lithgow at his country house near Mel¬
rose. He had only been ill for a few days, and
little word of the fact had reached Edinburgh or
the Edinburgh Royal Infirmary, of which he had
been the medical superintendent since December, 1892.
His military career was most distinguished and suc¬
cessful j the Scotsman gives the following description:—
“ Major-General Lithgow oould almost be said not to have
had any illness of consequence until the last and fatal
attack occurred. He was attached to the Army for
thirty-six years, frequently on active and foreign service,
and -never required a single day's sick- leave.” In his
last poet he proved himself just, able, seemingly severe
as befitted his responsible position in the control of a
vast institution, in reality one of the kindest of men,
duty for him came before pleasure, went often against
inclination, but was done, and done rightly.
ME. JAS. VOSE SOLOMON, F.R.C.S., OF
BIRMINGHAM.
We regret to announce the death of Mr. James Vose
Solomon, F.R.C.S., who died on Wednesday at bis
residence, Handsworth, at the age of 82. Mr. Solomon
was a native of Birmingham, where his father was a
physician practising in this city. He studied at Birming¬
ham and St. Bartholomew’s. In 1838 was admitted to
the licentiate of the Society of Apothecaries. He also
became a member of the Royal College of 8urgeons,
England, and in 1854 he was elected a fellow of the
college. Among general appointments he held were
those of surgeon to the gaol, to the General Dis¬
pensary, to the Orthopaedic Hospital, and to the Bir¬
mingham Police. In the development of the Birmingham
Eye Hospital he played an important part, and for
many years he was the honorary surgeon to the
hospital. For some years he was the professor of
ophthalmic surgery at Queen’s College. In 1869 he
founded the Birmingham and Midland Counties Branch
of the British Medical Association, of which he was the
first president.
^Literature
A SYSTEM OF MEDICINE, (a)
This system of Medicine is now rapidly reaching its
completion, and as this is the penultimate volume the
Editor’s troubles will soon be at an end. He still con¬
tinues to bemoan hiB own shortcomings, but he should
take heart of grace and remember that he is now fairly
convalescent. We are not aware that any sequel®
follow the production of a work of this description, and
we have no reason to suppose that there will be a
relapse in the shape of a System of Forensic Medicine,
or even of Materia Medica. The compilation of this
work must have been in itself a liberal education, and
if the Editor has read all the contributions of his
" many writers,” he should have added very considerably
to his stock of knowledge.
This, the seventh volume of the System, is devoted
entirely to diseases of the nervous system, a subjeot
which was commenced in the preceding volume, and will
be concluded in the final one. The present instalment
contains Diseases of the Spinal Cord, Diseases of the
Brain, and a Bomewhat indefinite group called “ Other
Diseases of the Nervous System.” Many of the articles
are exceptionally good, and, taking it all round, it is
probably the best and most important volume of the
series. Some of the contributors are “ nerve specialists,”
whilst others are physicians attached to general hopitals.
The article on “ Myelitis,” by Dr. Frederick Taylor, of
(a) “A System of Medicine.” By Many Writers. Edited by
Thomas Clifford Allbutt, M.D., F.B.C.P., F.R.S. Vol. VII.
London: Macmillan and Co. 1999.
Guy’s Hospital, is a sound and careful bit of work. He
explains very clearly the nature of the different varieties
of this disease, and the reader is made familiar with the
importance to be attached to acute and subacute, chronic,
transverse, diffuse, focal, and disseminated inflamma¬
tion of the spinal cord. The charm of this contribution
is that that the information is conveyed in language
which is comparatively free from technicalities.
The article on “ Diver’s Paralysis oi Caisson Disease,”
is contributed by Dr. Andrew H. Smith, of New York,
who had exceptional opportunities of studying the
disease in connection with Brooklyn Bridge and the
Hudson River Tunnel. His suggestion that the patients
should be treated by placing them under atmospheric
conditions similar to those which produced the disease
is ingenious. He thinks that a chamber should be con¬
structed in which a cot containing the patient oould
be placed, and to which compressed air could be admitted
through a pipe connected with the caisson. The chamber
would resemble a horizontal boiler of convenient dimen¬
sions, having a door or opening at the end. It would be
properly ventilated, and would be lighted by electricity
from without, the light being admitted through a series
of portholes or bull’s eyes. It would, of course, be furnished
with a telephone so that communication could be kept
up between the patient and his attendants. With the
addition of a portable earth-closet and other similar
appliances it could be made quite a charming temporary
residence.
The article on “ * Disseminate ’ Sclerosis ” is by Dr.
Risien Russell. The nomenclature strikes us as being
somewhat strange, for by most writers the disease is
spoken of as “ disseminated sclerosis,” whilst by others
it is called multiple or insular sclerosis. This is one of
the great drawbacks of the nerve specialist; he n#*ver
seem8 to be happy unless he can coin a new name for an
old disease, and the result is that his nomenclature be¬
comes day by day more and more complicated. The
author passes somewhat lightly over the differential
diagnosis of disseminated sclerosis and paralysis agitans,
and thinks that, in spite of tremor being common to
both, it is not easy to suppose that any real difficulty in
diagnosis could arise. As a matter of fact, students at
examinations constantly do experience this difflou’ty,
and are rarely able to state the points which distinguish
the two diseases.
‘‘Tabes Dorsalis,” by which, of course, is meant
locomotor ataxy, is the joint production of Dr Ormerod
and Dr. Mott, the latter being responsible for the patho¬
logy and morbid anatomy of the disease. Both contri¬
butors have done their work well, and the article is one
of the best in the book. Dr. Ormerod is by no means
satisfied chat all cases of locomotor ataxy are syphilitic
in origin. He points out that it is impossible to main¬
tain that tabes is pathologically identical with syphilis,
and urges that generally speaking, it is not amenable to
anti-syphilitic treatment. The ever-increasing tendency
to name symptoms after some particular individual is
well illustrated by the complaint. Thus we have
“Westphal’s sign,” or loss of knee-jerk, the “Argyll-
Robertaon’s sign,” reflex iridoplegia, or loss of pupil¬
lary reflex under the stimulus of light, “ Rom Derg’s
symptom,” or staggering when the eye3 are shut,
and finally. “Charcot’s disease,” or joint. Moreover
an allied condition, Hereditary ataxia is commonly
known as “ Friedreich’s Disease ” or congenital ataxia.
To make things still more complicated in some cases,
two totally distinct diseases have been named after the
same individual, and in more than one instance several
authors claim the honour of having the same
disease named after them. This savours of puerility,
and does not add to the dignity of neurology. Dr.
Ormerod has, of oourse, simply followed a well-estab¬
lished custom in naming names, and has done nothing
to add to onr difficulties. Both he and his ooUeague
have done their work well, and Dr. Mott’s contribution
to the pathology of tabes is of the greatest possible
value.
Syringomelia, or cavity of the cord, is not an espe¬
cially interesting subject. The most prominent symptom
of the complaint is what Charcot called “ dissociated
anaesthesia,” that is, a loss of sensation of pain and
Digitized
■oogle
Skpt. 27, 1899.
LITERATURE.
temperature in a part, with retention of tactile sense in
the analgesic area. The majority of the patients do
not know that they suffer from this condition until
their attention is called to the fact. It is urged that
the sense of pain is a great protection as it gives warn¬
ing of injury and assures care and rest of the part. If
a man is burnt and does not experience any pain he is
generally satisfied whereas he ought to recognise that he
is suffering from an abnormal condition and take steps
to get himself cured ?
There is some doubt as to whether amyotrophic
lateral sclerosis constitutes a separate disease apart
from progressive muscular atrophy and chronic bulbar
paralysis, but Dr. Beevor has made the most of the
material at hi* disposal, and contributes a very interest¬
ing article
Infantile Paralysis, or Poliomye.itis Anterior Acuta
is dealt with at considerable length by Dr. Allan Starr,
of New York, who enters pretty fully into the subject
of treatment. He thinks that massage is of the
utmost importance in these cases. He makes a sugges¬
tion, however.which causes us to wonder if he employs the
term in the same sense that it is employed by Conti¬
nental writers. He says that among the poorer classes
it is well to instruct the mother how to do this so that
it should be given with persistence. This, of course, is
absurd if he is using the term massage in the sense in
which it is employed by Metzger, Von Mosengeil, and
other writers. The statements made by an American
writer on massage in an early volume of this work were
of such an extraordinary description that one cannot
help thinking that the term massage is used by a certain
section of the profession in the United States to indicate
a mode of procedure to which the name would not be
applied in this country. If this be so it is oertainly strange,
for Douglas Graham, of Boston, is a recognised autho¬
rity on the subject, and would certainly not countenance
the idea that a person without anatomical or physiolo¬
gical knowledge would be competent to treat a case of
infantile paralysis by massage.
Fender's article on the “ Regional Diagnosis ” of cere¬
bral diseases is an admirable summary of the whole sub¬
ject. It must be remembered that it is only within the
last twenty years that the chaotic darkness of clinical
medicine has been illuminated by experimental methods
in this particular department. Before that little or
nothing was known on the subject beyond the facts that
in hemiplegia the lesion was in the opposite hemisphere,
that a lesion of Broca’s convolution was the cause of
oertain forms of aphasia, and that Jacksonian epilepsy
was due to irritation in the Rolandic area. Now all this
is changed and thanks to the researches of Ferrier,
Beevor, Horsley, and Schafer, we know exactly what
symptoms, irritative and destructive lesionR of the
various lobes and centres of the brain will produce. It
is an enormous advance and one of whioh English physio¬
logists naturally feel proud. It is a curious circumstance
but one which has been ascertained experimentally and
verified clinically, that injury, even amounting to re¬
moval of the prefrontal region, gives rise to no discover¬
able symptom either sensory or motor. Injuries to
other regions—the Rolandic, for example —produce well
marked effects, all of which are duly set forth in this
article. We have only one criticism to offer. We are
afraid that the average reader who has not a brain, or
a working model of a brain, before him will have much
difficulty in following Dr. Perrier’s article without con¬
stant reference to the diagrams on p. 274. It isannoying
to have constantly to refer back, and the difficulty could
easily have been obviated by printing these outlines on
a separate sheet, set out in such a way as to be visible to
the reader at any point of the article. We are glad to
find that Dr. Ferrier acknowledges his indebtedness in
the preparation of his contribution to Dr. W. Aldren
Turner and to Dr. Ashley Mackintosh. This is as it
should be, for it is only right that the devil should
have his due. We trust that all the other contributors
have been equally conscientious.
Another first-class article on the “ General Paralysis
of the Insane ” is by Dr. Savage and Dr. Goodall, of
Caermarthen, whilst Sir Wm. Gower's deals with the
subject of epilepsy. Epilepsy affords ample scope for
T he M edical Pbess. 337
the di-cussion of treatment, of which the author hak
availed himself fully. He still thinks well of borax,
which he gives in doses of from 4 to 10 grams three 1
times a day. He mentions the psoriasis which it so
often induces, and finds that it Bpeedily disappears when
arsenic is added to the borax mixture.
The subject of “ Chorea ” is dealt with by Dr. Risiem
Russell, who contributes seven articles to this volume,
not including an article of which he is joint-author.
This is certainly rather a large allowance for a physician
whose name until the last year or two was comparatively
unfamiliar to the medical reader. We do not suggest
for one moment that the confidence is misplaced, or that
the work is not admirably done, but there are now so
many young physicians devoting themselves to the
study of neuropathology, that it seems almost a pity
not to have given more of them an opportunity of dis¬
tinguishing themselves.
One word more and we have done. These volumes
when first issued presented an extremely attractive
appearance in their scarlet and go'd covers. Some of
them, although not exposed to sun or damp, and kept
in a room not lighted by gas, now present a very dingy
appearance, the original scarlet, especially at the backs,
having assumed a dirty brown and in places a blackish
hue. This is a great pity, and probably points to some
faulty method in the binding department
We shall look forward with much pleasure to the
publication of the eighth and concluding volume of
this valuable and useful System of Medicine.
SELECTED PAPERS ON STONE, (o)
The first of these interesting papers is an abstract of
the Bradshaw Lecture, Royal College of Surgeons,
1896. In it the author does not entirely view with
satisfaction the almost entire disappearance from
modern surgery of lateral cystotomy. Among other
subjects, castration and vaseotomy for enlarged
prostate are dealt with, and a note of warning is
given to surgeons on the uselessness of either opera¬
tion in cases of fibrous or carcinomatous prostate;
the utility of perineal lithotrity in some cases is men¬
tioned, and also the importance of litholapaxy in chil¬
dren, and regrets are expressed that the Rontgen rays
have not been found sufficiently reliable for the diagnosis
of vesical calculus. The next paper contains a disserta¬
tion on a table of 110 cases of litholapaxy, after which
comes an article on vasectomy, followed by an interest¬
ing chapter on saccules and pouches of the urinary
bladder. A short paper is devoted to cases in which
a non-malignant communication exists between the
bladder ana intestines; the next paper describing
a new operation for extroversion of the bladder contains
a very instructive case; this is followed by chapters on
treatment of albuminuria by reni-puncture, on some sup¬
purations of the urinary organs, on urethral stricture
and its treatment, on some forms of acute urine fever ;
on a mode of stretching some urethral strictures, this
includes a description of an instrument constructed on
the lines of a Holt’s dilator, which should admirably
answer the purpose for which it is intended; next come
some notes on hsematuria, followed by an instructive case
of large pelvic hydatid treated by perineal incision and
drainage ; the last paper deals in a practical way with
urethral irrigation. These various papers condensed in
a volume of 190 pages will well repay perusal, the precepts
laid down being always sound, and the author’s ideas being
always set forth in a practical, plain, and concise
manner. The illustrations are not many, but they bring
under the reader’s eye very clearly the various condi¬
tions, Ac., which they are intended to depict.
“ASEPTIC SURGERY.” ( b )
In the preface to the second edition of this very useful
work the author says that no alterations of any moment
have been made in it, yet we are glad to give a hearty wel-
(a) "Selected Papers on Stone, Prostate, and other Urinary
Disorders." By Reginald Harrison, F.R.C.S. 190 pp. London:
Churchill.
(b) “Aseptic Surgery,” By C. B. Lockwood, F.B.C.9. 246 pp*
Edinburgh ana Loilaou V Young J. Pentlahd.
Digitized by G00gle
338 The Medical Pbiss.
LITERATURE.
Sept. 27. 1899.
come a second time to a book which contains such a
large amount of invaluable information and of useful
advice to all, from the highest to the lowest, who practise
the art of surgery. Almost the first phrase in the intro¬
duction should be regarded as a golden rule; Mr. Lock-
wood writes:—“ It is quite impossible to practise aseptic
surgery with success unless not only the surgeon and his
assistant, but also the Bisters and thenursesnave a clear
and distinct knowledge of its principles.” Starting from
this standpoint it is evident that the perusal of the
succinct but lucid descriptions in the 200 odd pages
that follow will amply repay all those concerned in the
author’s dictum. Part I. gives a short but very clear
account of the various micrococci and bacilli. Part II.
deals with the sources of infection divided into infection
by air, by water, by contact, by the human skin, with a
passing reference to auto-inoculation and to immunity.
In Part III. disinfection and antiseptics are dealt with,
the author keeping? strictly to the definition he had
already laid down in his introduction, that the former
kills the bacteria outright, whilst the latter prevent or
retard their growth. The last Part (P. IV.) is de¬
voted to surgical technics. Some very useful and prac¬
tical hints are given to the surgeon, to the assistants,
to the nurses and sisters. With regard to the disinfec¬
tion of the skin of the patient we quite agree that it
should not be done in a routine manner, for, as the
author says, “the methods which are necessary to
disinfect the harsh, thick, neglected skin of hospital
patients would be harmful to the delicate skin of a
child or lady.” Next the preparation of the instru¬
ments, ligatures, &c., is given, and some surgeons
might with benefit bear in mind, as Mr Lockwood
very justly says. . . . “ how irrational it is to disinfect
instruments and then allow them to touch what is in¬
fected.” The author prefers the biniodide of mercury
lotion to the perchloride solution, he give his reasons,
and they certainly seem conclusive. A few necessary
words are said about the operation itself; the applica¬
tion of the dressings is fully dealt with, and the after
treatment briefly touched upon. The last chapter gives
a summary of the good results of aseptic surgery. The
idea of the whole work may be summed up by a sen¬
tence of the author’s in dealing with the field of opera¬
tion. He says:—“An operation founded on the prin¬
ciples of aseptic surgery is a bacteriological experiment.”
some cases of persistent gleet. We heartily agree with
Mr. Dalton when he says, “the supposed development
of strioture from too rapid a cure of gonorrhoea is a myth,
the more speedy the cure, the less likelihood of a stric¬
ture forming.”
LECONS DE CLINIQUE CHIRURGICALE. (a)
This volume contains twenty clinical lectures given
during August and September, 1897, at the Hotel Dieu,
Paris. The author in his preface expresses his regrets
that circumstances prevented their earlier publication,
and expresses a hope that his readers will find in his
work the exposition of new and personal ideas. These
hopes will be found ably carried out. In the lecture
on Uranoplasty, Delbet discusses at length the
question of the age most suitable for operation,
and follows Tr&at in choosing the sixth year as
the most favourable; before that period he considers
surgical intervention to be coupled with many dangers,
not the least of which is ulterior atrophy of - the maxilla.
All the following lectures are certainly of great value ;
among those of special interest we may mention the
one on 9 ongenital thryro-hyoid cyst, in which the ana¬
tomy and pathology of the affection are fully dealt with ;
the one on cicatricial stricture of the oesophagus in
which the advantages of retrograde catheterism of the
tube after gastrostomy are fully explained; a very instruc¬
tive dissertation on fracture of the spinal column, and an¬
other on cirsoid aneurysm; the text of the lecture on carpus
curvus is embellished by several illustrations, which help
the reader to realise the anatomy of the displacement;
the valvular insufficiency of the internal saphenous vein
1 in cases of varicose veins of the lower limb is brought
i forward in the twelfth lecture; the next deals in a most
efficient manner with the complications and deformity
following Dupuytren or Pott’s fracture, and the opera¬
tive measures for their relief; the fourteenth and
fifteenth lectures describe intestinal occlusions, the
. former (illustrated) by twisting of the whole of the
small intestine, the latter by chronic obstructions; the
next two lectures are taken up by the treatment of
| hydatid cysts of the abdomen ; and, finally, the last two
deal with appendicitis and salpingitis and their treat¬
ment. The style and language are vigorous, clear, and
eminently practical, and the type essentially readable.
“ON THE ORIGIN AND PROGRESS OF RENAL
SURGERY.” (a)
This volume comprises the three Hunterian Lectures
for 1898, together with a fourth lecture, which was
originally published in the Edinburgh Medical Journal
for January, 1899, and which has been revised with
additions. It is hardly necessary for us to say thtft these
lectures, coming from a purgeon whose name is so in¬
timately connected with renal surgery, are well worthy
of being published in the form of a book. They
practically embody all that is known up to the
present dlay on the subject, together with the lessons
the author has derived from his own great experience.
The fourth lecture on “Rupture of the Ureter” is
specially interesting in view of the rarity of the lesion,
and of the difficulty in the diagnosis owing to the paucity
of the symptoms; it is at the same time very instructive,
and much may be learnt by its perusal and by the con¬
sideration of the eleven oases regarded as subcutaneous
ureteral injuries, the abstracts of which are given with it.
The work contains some excellent illustrations.
* GLEET AND CHRONIC DISEASES OF THE
URETHRA AND PROSTATE.” (6)
There is nothing very new in this little book, but the
descriptions of the methods of treatment are good and
practical. The application of irrigation to the urethra
by means of the instrument used by the author should
be of great use, and is well worthy of a trial in trouble-
fa) “ On the Origin and Progress of Benal Surgery.” By Henry
Morris, F.B.C.8. 285 pp. London: Cassell and Co., Limited. 1898.
(b) “ Gleet and Chronic Diseases of the Urethra and Prostate."
J)y Gerald Dalton. 48 pp. London: Henry Klmpton. 1888.
YEAR BOOK OF PHARMACY, (b)
Of the leading contents of the volume we may fitly
ive first place to the account of the liquefaction of
ydrogen recently accomplished by Dewar. Its lique¬
faction has been accomplished by submitting the gas to
the combined influence of a temperature of 205 per
cent. C. and a pressure of 180 atmospheres, under which
it assumed the form of a colourless liquid.
The researches of M. Constan and of von Haussen
have resulted in producing a new class of oxidising sub¬
stances known as percarbonates, of which the potassium
salt K 3 C a 0 ? is a good example. It splits up when heated
into potassium carbonate, carbonic anhydride, and
oxygen, and decomposes water at the ordinary tempera¬
ture with liberation of oxygen and the formation of
potassium bicarbonate.
Messrs. Porsbrand and Richelmann have isolated from
coffee a new alkaloid which differs from caffeine by its
insolubility in chloroform, its failure to give the mer¬
curial reaction, and by its forming a precipitate with
picric acid.
The influence of alcohol on the digestive action of
pepsin is discussed by C. Symes and also by R. H.
Chittenden, Wendel, and Jackson. The effect of boric
acid in retarding the assimilation of proteid and fatty
food is shown by the investigations of Chittenden and
Gies. The whole book is worthy of careful reading by
(o) “ Leson* de Clinique Chirurgicole.” By Pierre Delbet. 372 pp.
Pane: G. Stejnheil. 1899.
(b) " Year-Book of Pharmacy : Comprising Abstracts of Papers
Relating’ to Pharmacy, Materia Medico, and Chemistry. With the
Transactions of .the-. BHttah* Pharmaceutical Conference at the
Thirty-fifth Annual Meeting h#)d at Belfast, August, 1898.” Lon¬
don : J. and A. Churchill, 1898.
ed by Google
Sept. 27, 1899.
MEDICAL NEWS
The Medical Press 339
iHebical
the general practitioner, and makes a useful addition to
the medical library.
4 TRAGIC DEATH
A curious case of accidental poisoning has
occurred to both doctor and patient at Eastbourne,
necessitating the holding of an inquest on the body
of Dr. Dick of that town. From the report to hand
it would appear that on the 14th inst. a patient called
at the surgery and was given a bottle of medicine,
which she took home. After taking the first dose she
became ill, and on Dr. Dick calling nest day he was
informed of the circumstance. In order to assure
his patient that there was nothing wrong with the
medicine he drank a quantity in her presence, and
before leaving the bouse took a second dose with the
same intent. On his arrival home, however, he fell
against the door, foaming at the mouth and betray¬
ing other symptoms of poisoning. He had strength
enough to suggest the stomach pump, and medical aid
was immediately summoned, but he succumbed; while
bis patient, who bad swallowed one dose only of the
medicine, recovered. At the time of our going to press
we hear the analysis of the medicine showed it to
contain a large quantity of strychnine.
Xaboratorp Jlotes.
FLUORINE PRODUCTS.
We have reotived from Messrs. T. Christy and Co.
samp es of three new products with fluorine as a basis,
viz., Antitussin, Fluor-Rheumin, and Epidermin, together 1
with a substance to which the name Malarin has been
given. Anti-tuuin is an ointment containing difluordi-
phenyl, and it is introduced as “a certain cure for
whooping-cough and diseases of the throat and neck,”
a rather large order in its vagueness. It is directed to
be rubbed in vigorously over the previously-cleansed
akin of the neck, breast, and back, and it is said to
•* cure ” whooping-cough in about a week. Fluor-
rkemmin is an ointment containing one in flve of fluor-
phenetol-difluordiphenyl, and when rubbed well into
the skin over the affected parte it is claimed to be an
exceedingly efficient drug in the treatment of various
forms of rheumatism and neuritis. Epidermin contains
one part of fluorylol and four parts of difluorphenyl
mixed with ninety-five parts of a fatty base. It is
powerfully antiseptic, and appears to be a preparation
well adapted for the treatment of oertain affections of the
akin. Malarin. This is described as a condensation
product of aoetophenon and phenetidin. In virtue of
ita molecular constitution it is an energetic antipyretic
though practically non-poisonous. Its effects are pro¬
nounced even on the normal temperature, and this too
in comparatively small doses (4 to 6 grains), without
any corresponding influence on respiration or on the
pulse. The antipyretic action is associated with a
hypnotic effect, which soothes the nervous system at
the same time as it reduces the pyrexial temperature.
Malarin promises to be a useful addition to the series of
agents at our disposal for reducing fever and abolishing
painful manifestations of various origins.
We should like, however, to enter a formal protest
against the system of nomenclature which here reaches
its unwelcome apogee. The pnly admissible plan of
naming new products is to select a syllable or syllables
from their chemical description roughly indicative of
their nature. All names based on supposed therapeu¬
tical action are objectionable because they are apt to
prove misleading, and they savour far too much of the
popular nostrum.
Deaths From Small-Pox at Mexborongh.
A death from small-pox is reported from Mexborough
in the person of a child eighteen months of age,
imported from Hull.
Vital Statistics.
The deaths registered last week in thirty-six great
towns of the United Kingdom corresponded to an
annual rate of 21*1 per 1,000 of their aggregate population,
which is estimated at 12,786,832 persons in the middle
of this year.
Birkenhead 17, Birmingham 26, Blackburn 20, Bolton
22, Bradford 19, Brighton 25, Bristol 16, Burnley 28,
Cardiff 16, Croydon 13, Derby 15, Dublin 35, Edin¬
burgh 20, Glasgow 22, Gateshead 25, Halifax 17,
Huddersfield 17, Hull 21, Leeds 18. Leicester 19, Liver¬
pool 30, London 18, Manchester 26, Newcastle-on-Tyne 24,
Norwich 10, Nottingham 21, Oldham 17, Plymouth 17,
Portsmouth 18, Preston 31, Salford 32, Sheffield 21,
Sunderland 29, Swansea 20, West Ham 19, Wolver¬
hampton 31. The highest annual death-rates per
1,000 living, as measured by last week's mortality,
were :—From measles, 14 in Burnley; from scarlet
fever, l’l in Bradford; from fever, 10 in Sheffield, 11
in Halifax, and 1-4 in Birkenhead ; and from diarrhoea,
5'8 in Hull, 5'9 in Birmingham, 6'5 in Nottingham, 6 9
in Manchester, 7‘2 in Liverpool, 8 0 in Brighton, 10O in
Wolverhampton, and 16 0 in Preston. In none of the
large townB did the death-rate from whooping cough
reach 1-0 per 1,000. The 73 deaths from diphtheria in¬
cluded 22 in London, 10 in Leeds, 8 in Sheffield, 6 in
Leicester, 6 in Birmingham. 4 in Liverpool, and 8 in
Portsmouth. Three dea’hs from small-pox were regis¬
tered in Hull, but not one in any other part of the
United Kingdom.
Stale Medicine.
Mb. Braxton Hicks, the coroner, recently volunteered
the advice to the public never to take stale medicine, he
having just recovered Lorn illness caused by a dose of
cough linctus which had undergone decomposition.
Gresham College.
The subject of the lectures to be delivered by Dr. E.
8ymes Thompson, the Gresham Professor of Medicine, on
October 3rd, 4th, 5th, and 6th (6 p m.). will be “Earth,
Air, Water, and Insects in Relation to Disease.”
University of Durham—Faculty of Medicine.
At the Examination for Degrees in Medicine and
Surgery during September, the following Candidates
passed the Second Examination for the Degree of
Bachelor in Medicine —
Honours—Seoond Class.
Manning, Brneet J., St. Ma rj'n Hospital.
Waters, James B., College of Medicine, Newcastle-upon-Tyne.
Brunyate. Annie T., London School of Medicine for Women.
Clapham, 8tanley C., M.B.C 8.. L.R.C.P., Guy's Hospital.
Ellis, Henry R., M.B.C.8., L.R.C.F., St. Bartholomew's Hospital.
Emmerion. William M., College of Medicioe, Newcastle.
Fox, Ida E., London School of Medicine for Women.
Molony. Lucy S., London School of Medicine for Women.
Nevin, Robert W. College of Medicine, Newcastle.
Robertson, Monica L. M , College of Medicine, Newcastle.
Butherfoord, Thomas C., Ft. Thomas's Hospital.
Benton, Ralph College of Medicine, Newcastle.
Turner, Sydney D., M.R.C.8., L.R.C.F., St. Thomas's Hospital.
Walker. Norman B., College of Medicine, Newcastle.
Wetherell, Marmaduke C., Guy's Hospital.
Society of Apothecaries of Loudon—September, 1899.
The following candidates passed examinations during
September, in:—
Surgery.— N. H. Borineriee I Sections I. and II.?, A. F. Carlyon
(Sections I. and II). A. McC. Dallas (8ection I.), E. F. Lamport,
A. Orme (Section II.). and W. Rigby (Sections I. and II.).
Medicine. W. P Allen, A. F. Carlyon (Sections I. and II.), F.
Elias, F. Marriott, H. J. Pickering (Section II.), W. Rigby (Sec¬
tions I. and II.), L. L.G. Thorpe, H. E. Weeton (8ection II.), and
H. Wiiittaker.
Forensic Medicine.-W. P. Allen, A. F. Carlyon, R. F. Ellery, F.
Marriott, W. Rigby, and L. L. G. Thorpe.
Midwifery. F. P. Bush, W. Rigby, W. C. 8t an ham , and G. H.
Watson.
The diploma of the Society was granted to the following candi¬
dates, entitling them to practise medicine, surgeiy, and midwifery :
—N. H. Bonnerjee A. Orme, W. Rigby, A. F. Carlyon, and L. L. G.
Thorp-.
Digitized by Google
The Medical Pbbss. NOTICES TO CORRESPONDENTS.
Sept. 27, 1899.
fioticts to
dorrtopoitbento, Short 'jtetUra, &c.
MT Correspondents requiring a reply in this column are par*
ticularly requested to make use of a distinctive ligruUur* or
initials, and avoid the practice of signing themselves “ Header,"
*' Subscriber,” “Old Subscriber," 4c. Much confusion will be
spared by attention to this rule.
Local Reports and News.—C orrespondents desirous of drawing
Attention to these are requested kindly to mark the newspapers
when sending them to the Editor.
Heading Cases.— Cloth board cases, gilt lettered, containing
twenty-sir 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 passed through
the poet.
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.
w Original Articles or Letters intended for publication should
be written on one side of the paper only, and must be authenticated
with the name and address of the writer, not necessarily for publioa-
Egyptian Government School of Medicine, Cairo.—Professor of
Ophthalmology. Applications to F. G. Hallett, Esq., Secretary,
Examination Hall, Victoria Embankment, London.—(See
advert.)
Go van District Asylum, Crookston, near Paisley. - Junior Assistant
Medical Officer. Salary commencing at £100 a year, with rooms,
board, attendance, and laundry.
B
Resident House Physician* for six months. Honorarium £25
each. Also an Assistant Resident Medical Officer. Salary
£100 per annum, with board and residence.
Nottingham Hospital for the Insane, the Coppice.—Assistant
Medical Officer, unmarried. Salary £150 per annum, with apart¬
ments, board, attendance, and washing.
Leeds Hospital for Women and Children.—Non-resident House
Surgeon for six month*. Salary at the rate of £125 per annum.
Huddersfield Infirmary.—A Senior House 8urgeon and a Junior
House Surgeon. Salaries £80 and £60 per annum respectively
with board, lodging, and washing.
Loughborough and District General Hospital and Diepensaiy,
Loughborough.—Resident House Surgeon. Salary £100 per
annum, with furnished rooms, attendance, and board.
Fulham Parish, London.—Resident Medical Superintendent of the
Infirmary and Medical Officer of the Workhouse. Combined
Salary at the rate of £300 per annum, with residence, fuel,
lights, and washing.—Applications to the Clerk to the Guardians,
75, Fulham Palace Road, Hammersmith, W.
Royal South Hants Infirmary, Southampton —House Surgeon.
Salary, £100 per annum, with rooms, board, and washing.
Victoria University, Manchester.—External Examinership in
Anatomy for three years. Applications to the Registrar before
Nov. 1st.—(See advert.)
^pponttnuntB.
tion. but as evidence of identity.
FILTHY LUCRE.
The bacteriology of coins would certainly constitute a fruitful
field of investigation. If one would take the trouble to wash a
handful of money in a detergent alkaline solution, the turbidity of
the resulting liquid would not fail to surprise. In a more en¬
lightened age the Government may perhaps make arrangements for
the periodical cleansing of the coinage, but this very hygienic
measure is not yet within view. One can only wonder av the care¬
lessness of 'bus conductors and others who deliberately stick coins
between their lips while counting out the change.
Dr. E. White (Burlington, Canada).—The subject of “Dry
-Catarrh of the Middle Ear ’’ will be found fullytreated in an article
which appeared in the first week in January, 1898, of this journal by
Dr. Dundas Grant.
THE INDIAN MEDICAL SERVICE.
The next Examination for Appointments in Her Majesty's Indian
Medical Service »ill beheld in London in February next. Regula¬
tions may be obtained at the India Office, particulars of which will
be found in our advertisement columns.
L. G. M.— Night terrors in the young are very commonly associ¬
ated with the presence of intestinal parasites, but the condition has
also been noticed in association with circulatory troubles, inch as
incipient cardiac disease. Circulatory weakness, associated with
too rapid growth, has also been credited with it* production.
Barnes, J. Sandbrt, M.R.C.S., L.R.C.P.Lond., Junior Medical
Officer to the Borough Asylum, Portsmouth.
Brown, E. Archer. M.B.Edin., M.R.C.S., L.R.C.P.Lond., Second
Assistant Medical Officer to the St. Marylebone Infirmary,
Notting Hill, London.
Buchanan, B. McN., M.B , C.M.Glasg., F.F.P.8.Glaag., Bacterio¬
logist bv the Corporation of Glasgow.
Forsyth, C. E , M.B., Ch.M.Aberd., Assistant Medical Officer to
the County Asylum, Dorchester.
Hungerpokd, Geoffret, L.R C.P. and L.R.C.S.Irel., Assistant
Medical Officer to the Wonford Hospital for the Insane,
Exeter.
Huskib, J.. M.B., C.M Edin , Public Vaccinator and Medical
Officer for the 8outh Sefton 8unitary District of the West
Derby U nion.
Joyce, R. C., M.B., C.M.Edin., Medical to the Standard Colliery,
Ynyshir, South Wales.
Maclean, Madge S.. M.B., C.M.Glasg., House Surgeon to the
Victoria Hospital for Sick Children, Hull.
Milton, John Penn. L.R.C.P.Lond., M.R.C.S.. Medical Officer
and Public Vaccinator for the Parishes of Pen ran oe Civil,
Penzance-in-Maldrow, and Paul, Cornwall.
Owen, B., L.B.C.P., L.R.C.S.Edin., Public Vaccinator for the
District of Sefton North of the West Derby Union.
Pearce, G. H„ L.R.C.P., L.R.C.S.Edin., L.F.P.8 , Medical Officer
of Health by the D&rton Urban District Council.
Williams, W. J., L.R.C.P.Edin , L.F.P.S.Glasg., Medical Officer
to the Carnarvon Isolation Hospital.
THE WEIR-MITCHELL TREATMENT
A correspondent asks whether there exists a recent monograph
on what is commonly described as the Weir-Mitchell treatment. If
not, where can detailed information thereof be obtained ?
Dr. R. N.—Carbolised solutions, whether in oil or water, dull the
edge of all cutting Instruments. Ifleftlongin ordinary spirit steel
instruments rust. It is best to keep surgical needles in a saturated
solution of ordinary washing soda, or. if preferred, in a saturated
solution of chloride of calcium in rectified spirit.
THE TREAT MENT OF STUTTERING.
girths.
Acheron. —On Sept. 22nd, at St. Honan's Road, South sea the wife
of Surgeon J. H, Acheson, R.N., of a daughter.
Battle.—O n Sept. 18th, at Harley Street, London, W., the wife of
W. H. Battle. F.B.C.S., of a son.
Macevoy.— On Sept. 18th, at 41 Buckley Road, Brondeebury, N.W.,
the wife of H. J. Macevoy, M.D., B.Sc.Lond., of a son.
Jones.- On Sept. 23rd, at 8 Church Terrace, Lee, S.E., the wife of
George Jones, M.B., of a daughter.
M. L. asks whether there is any institution in London where a
working man who stutters could undergo a course of traini g with
the object of overcoming the defect. He adds that anything
beyond nominal fee* would be quite out of the question in this c.ise.
Nurse J.—To remove blood from the hands always use clean water
and a nail brush first, as soapy water does not readily dissolve in¬
spissated blood.
SOMEWHAT IGNORANT!
Doctor (to dispensary patient): "Now, remember, my man,
three or four drojs of this mixture three times a day—and inhale."
P..tient: “ Be I to take it in four or six ale, gov'nor ? "—Ex¬
change.
Vacancra.
Bethnal Green Infirmary.—Medical Superintendent for the New
Infirmary, Cambridge Heath. Salary £500, with unfurnished
apartments, coals, lights, and washing. Apply to the Clerk to
the Guardians, Offices, Bishop’s Road, Victoria Park, N.E.
Borough of Maidstone.—Medical Officer of Health. Salary £200 per
annum and £150 a year for water analysis. Applications to the
Town Clerk. Maidstone.
Cumberland and Westmoreland Asylum, Garlands, Carlisle.— Junior
Assistant Medical Officer, unmarried. Salary £100 a year, with
board and residence.
Durham County Asylum, Winterton, Ferryhill.—Assistant Medical
Officer, unmarried. Salary commencing at £140, with board,
lodging, washing, and attendance, jj
Carriages.
French—Deacon.— On Sept. 18th, at Christ Churoh, Lancaster
Gate, London, Louis Alexander French, M.B.C.S., L.R.C.P., of
Emperor’s Gate, to Florence Elizibeth. youngest daughter of
the late Samuel Deacon, of Polebrook Hall, Northamptonshire.
Foot -Co alb*nk. —On Sept. 19th, at St. Alban's Church. Tedding-
ton, Lieutenant Charles Montague Foot, B.N., youngest son of
the Rev. C. N. Foot, of Teddington, to Nora, eldest daughter of
Isaac Coalbank, M.R.C.8., of Teddington. No cards.
Griffith—Williams.— On Sept. 19th, at St. Mary's, l.isoa,
Edward M. Griffith, M.D., son of the Rev. E. M. Griffith,
Rector of Clocaenog, North Wales, to Muriel, daughter of the
Rev. Basil Williams, M.A., Vicar of Bisca, Monmouthshire.
Laver—Conor. On Sept. 21st, at St. Andrew's, Ashley Place,
London, 8.W.. Philip Guyon Laver, L»R.C.P., M.R.C.S., second
son of Henry Laver, M.R.C.S , J.P., of Colchester, to Constance
Mary (May), only daughter of Colonel Cecil Conor, lateComdg.
1st Batt. Duke of Wellington’s Regt.
Collingwood. —On Sept. 23rd, at Ringwood, Hants, David Colling-
wood, M.D., F.R.C.S., late of Sydney, aged 41 years.
Rope.— On Sept. 13th, at Hatley Street, London, W., Henry John
Rope, F.R.C.S.. of St. Mary’s Court, Shrewsbury, aged 51 years.
White. Ou Sept. 24th,at Eastbourne, Joseph White, F.R.C.S.Edin.
of Southwell Gdns., S.W., lnte of Nottingham, aged 77 year?.
Digitized by C. iOOQle
She fHfdial
O
'tm and (Timtlar.
“SALUS POPULI SUPREMA LEX."
Vol. CXIX.
WEDNESDAY, OCTOBER 4, 1899.
No. 14.
Dtcmtit Clinical lecture.
A NEW METHOD OF ESTIMATING
LITHATES IN THE URINE.
By Drs. FREUND and TOPFER,
Diractora of Pathological Chemistry in “Bndolf-Stiftung," Vienna.
[FROM OUR OWN CORRESPONDENT.]
At the laboratory class of the Rudolf-Stiftung
Freund explained a handy clinical method for deter¬
mining the amount of urea present in the urine, which
he and his colleague, Dr. Topfer, had practised in
the laboratory during the past year with entire satis¬
faction.
The following method was the result of laborious
experiments in accurately eliminating the total
nitrogen contained in the extractives, and after a
perusal of Prof. Gottlieb’s method of estimating
urates in the different tissues of the body.
Freund said the methods usually given in class-
books for the estimation of urates were neither
speedy nor accurate.
Whether we applied Bunsen’s method, or the Bun-
sen-Pfluger analysis, there were errors to be found in
our results; with the phosphate of Tungsten, boiling
with phosphoric acid, or “ caustic baryta-chlorbaryum”
in alcoholic ether, no better results can be obtained
by the precipitates. In all these different forms of
analysis we have no assurance that the whole of the
urates are estimated, neither can we eliminate the
other cognate bodies containing nitrogen. It was
strange, however, that the most insoluble salt was so
little used as a test for urates in their estimation,
knowing that it was an acknowledged axiom in
chemistry that the most insoluble salt in the group
was the most suitable for titration. In the usual text¬
book the detection of urates is described as giving
characteristic reactions with nitric and oxalic
acids which are insoluble in ether or amyl-alcobol,
which is usually attributed to Brucke’s observations.
With this information before them Freund and
Topfer have endeavoured to perfect a system of titra¬
tion founded on the insoluble oxalate of urea in the
urine, which is an important constituent in morbid
conditions of the body. In health this constituent is
variable, but an average has been taken of 10 to
16 grammes (154 - 3 to 246’8 grains) of nitrogen in l - 5
litre (0*33 gals, or 2‘64 pints) in the 24 hours, or a
percentage of nitrogen equalling 0 67 to 107 ; or, in
other words, N—14 is equivalent to C H,N a O = 30,
giving a percentage of r4 to 2'3, which would equal
-1‘5 to 34 grammes per 34 hours. But this total of
nitrogen eliminated by the kidneys is not all urea
(C H 4 N,0).
According to Pfliiger and Bohland the average
amount of nitrogen used up as urea is 86'6 per cent,
of the total nitrogen eliminated, the extremes being
84 and 90'3 per cent., thus leaving 13’4 per cent, of
the total nitrogen in combination with uric acid,
xantbin bases, kreatinin, hippnric acid, initial al¬
bumen, ammonia and other extractive or pigmentary
substances. In febrile conditions the same authors
found this relation disturbed to an average of 84•6,
extremes, 81 "9 to 86 6. Averages of separate authors,
however, cannot be accepted as accurate standards,
as they vary so widely, as for example, Bbdtker, who
fixes it in the healthy at 90'1 per cent, of the total
nitrogen excreted. Hjoqvist records two perfectly
healthy men who regularly passed 91 per cent, of the
nitrogen in that form of urea. The diet has a
marked influence on the elimination of urea, but in
this analysts differ. According to Gumlich, living on
A mixed diet gave 85T urea, p.c, N H 3 4 39, re¬
mainder 10 36.
Animal diet gave 86‘8 urea, p.c., N H s 4'84, re¬
mainder 8 - 39.
Vegetable diet gave 80‘5 urea p.c., N H 3 4'29, re¬
mainder 15'73.
Camerer obtained still moie varying results with
the bypobromite of soda :—
Mixed diet, 88‘3 urea, 1*50 uric acid, 0 27 xan-
thin.
Animal diet, 93-3 urea, 1*29 uric acid, 0‘10 xan-
thin.
Vegetable diet, 86 4 urea, 1*84 uric acid, 0'49 xun-
thin.
From these results we need not be surprised with
the pathological variations. In two cases of phos-
S horus poisoning that recovered the urea was 80«
T H! 13. Two fatal: urea 55T, N H 3 37 6, remainder
17 3. In another hepatic case with extensive degene¬
ration of the liver the urea was 85 per cent. Atro¬
phic cirrhosis has a reduction of CH^NjO, but the
N H 3 is doubled, thus increasing the total amount of
nitrogen eliminated although the urea is reduced.
In catarrhal icterus the changes are slight. In cases
of syphilis and carcinoma of the liver the urea is
also found to be diminished, while the N H 3 is in¬
creased. Prott records cases of carcinoma of the
liver with 77 of urea and 2 83 of uric acid ; Gumlich
82 - 6 of urea and 5‘3 N H ;1 ; cirrhosis of the liver 73 - 8
of urea and 10‘7 N H s .
An interesting experiment in this connection is
recorded by Hahn and Nencki, who operated on
healthy dogs. Their results led them to conclude
that the healthy dog eliminated one part of ammonia
for every 40 to 70 parts of urea. In order to deter¬
mine the changes occurring in the liver an Eck
fistula was made in the portal vein and hepatic
artery ligatured, when the ammonia rose to one in
13 to 33 of urea. If poison were used it rose as high
as 7'6 to 16T of urea to one of ammonia.
By destroying the liver by injecting sulphuric acid
in the gall ducts the relation of ammonia to urea
was little if anything altered till the terminal
symptoms of coma set in. By tying the gall duct the
elimination of urea and uric acid is increased.
Although these relations of 86'6 per cent, of urea and
four of ammonia are given as averages, Bodkter
tes many with 90 or 91 per cent, of urea and 7T1
Digitized by
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342 Thb Medical Press. _ORIGINAL COMMUNICATIONS._ Ocrr. 4, 1899
of ammonia with functional derangement of the
liver or congestion, and no other morbid condition
present.
Having learned from the foregoing that the urea
<C H 4 N g O) eliminated in the urine during twenty-
four hours averages 86 6 per cent, of t he total nitrogen,
the rest being ammonia (N H 9 ), uric acid
(C s H 4 N 4 O s ), xanthin (C 5 H 4 N 4 O s ), hippuric acid
(C B H„ N 0 3 ),kreatinin (C 4 H 7 N. O), thiocyanic acid
(0 N S H), indoxyl (C s H 7 NO), albumen, &c. From
this it would be easy to estimate the total nitrogen as
is usually done, ana deduct the urea. We have also
seen that the N H s is three to four per cent, the total
nitrogen in health, but according to Hahn and Nencki
the ammonia may be raised to four times this quan¬
tity by tying the hepatic artery. In this case the
ammonia may be suddenly raised in the urine, while
the urea may be greatly reduced, and the esti¬
mate giving still the 86 6 per cent, of
urea. If the urea could be estimated absolutely
this error would be averted, and a better value of
secretion obtained. With this object in view Freund
and Topfer directed their attention to a method that
might be both practical and accurate for daily use.
For this purpose the oxalate of urea is the most
reasonable to work with (C H 4 N 2 0 2 ) + C 2 H 2 0 4 ,
which, when concentrated, throws down rhomboid
crystals easily soluble in water but difficult to dis¬
solve in ether, and by some in alcohol and amyl-
alcohol. To arrive at their present knowledge
several essays had to be undertaken with control
experiments.
The first was performed by taking a small quantity
of urine, 5 to 10 cubic centimetres, to which
was added oxalic acid, gently evaporated to concen¬
tration, and finally washing the crystals with ether.
It was found that the urates in the oxalic acid and
ether solutions when filtered were almost negligible.
• It was suspected, however, that some went off with
the oxalic acid in evaporation, although it must have
been very small. Another hypothesis was that it
formed the oxalate of Boda, but the oxalate of lime
gave no credence to this. Chalk was added to the
ether washing, but with no better result. The experi¬
ment was next performed in cold water with the same
result.
It next occurred to them that no positive error
would arise if alcohol were first added to the 5 or 10
cubic centimetres of urine, and accordingly as much
alcohol as urine was taken. Again, at the point of
evaporation, when all the water was driven off, a
little more alcohol was added to prevent a syrupy
consistence. It was then nibbed up in this water-
free alcoholic solution, and again evaporated with an
oxalic ether solution.
This result was not so satisfactory as was antici¬
pated, as the oxalic ether solution was prevented
from acting uniformly owing to the dryness of the
alcoholic solution.
It was finally arranged to add the oxalic ether solu¬
tion to the alcoholic extract after partial evaporation,
which hud the desired effect of depositing the urine
crystals in pretty white masses that were easily
filtered out and washed with ether to cleanse them of
all soluble matter. After many experiments testing
the solution for urates, it was finally resolved that
the quantity left in the solution after crystallisation
and washing with ether was so small that a factor
was useless; besides, it could not be calculated on
the ether, as there was alcohol in the solution of
crystallisation, notwithstanding the evaporisation
before adding the ether.
The urate rhombic prisms of oxalic acid
((C H 4 N a O),C s H, O) are now dissolved in distilled
water and transferred to a Kjeldahl flask, and titrated
with a fourth normal solution of soda with phenol
phthalein indicators. After repeated analyses by
this method, it is found that the difference between
the actual drying and weighing, and triturating of the
nitrogen varied between 0 012 to 0 025 per cent, of
the solution giving a difference of 0 013,
The utility of the method, it may be perceived,
rests on the fact that the urates alone are estimated,
not the total nitrogen in the urine as is obtained in
the formula CH t N a O + (Na Br O), = 3 Ba Nr +
CO a -+■ N,' + 2H, O as usually given for the estima¬
tion of the urates, but correctly speaking is an esti¬
mate of the total nitrogen present in the urines.
In order to obtain more exact data for this method
a known quantity of pure urea was dissolved in a
definite quantity of distilled water, and the different
forms of analysis applied.
Amount of Urea present.
Experi¬
ment.
Amount of Urea
added per cent.
Triturated with
Oxalic Acid
Method.
1 The Estimation
i of Nitrogen
, present.
I.
II.
III.
IV.
i 3'94 per cent.
3 94 „
394
394
P.c. P.c.
I 3 89; 3 90
1 3-88; 3 89
3-89; 3 89
3 88 ; 3 87
i P.c. P.c.
1 3 92; 3 91
3 90; 3 92
3-89; 3-89
I 3 93; 3 92
These parallel results must convince the severest
critics that this is a trustworthy method of estimating
the urates. The presence of albumen or sugar in the
urine does not interfere with accuracy of the results.
After long practice with this method of analysis
Freund and Topfer put it forward as unassailable.
In conclusion the method modified may lie briefly
repeated. About 5cubic centimetres of normal concen¬
trated urine to which an equal quantity of a 95 percent,
of alcohol is added. (It is always better to take two
similar samples as controlling each other). Place on
a water bath and evaporate, nibbing well with
more absolute alcohol. To the alcoholic extract
70 cc. of a pure ether oxalic solution is added and
allowed to crystallise; the crystals are again washed
well with ether and filtered, about 80 cc. more of ether
being required. After drying filter and dissolve
the crystals in a Kjeldahl flask with two drops of
phenolphthalein and titrate them with a fourth normal
soda solution. One cubic centimetre of this \ normal
solution corresponds to 0'015 grammes of urea,
C H 4 N a O.
OPEN-AIR TREATMENT OF
CONSUMPTION.
By JOHN C. THOROWGOOD, M.D., F.R.C.P.,
Consulting Physician to the City of London Hospital for Diseases
of the Chest, Victoria Park.
Coincidently with Koch’s discovery of the
tubercle bacillus, now recognised as the essential
accompaniment of the worst cases of tuberculosis,
there has come over all thinking people a great and
most advantageous change in the methods of treating
cases of pulmonary consumption. Many years ago
the victim of phthisis could not be kept in too warm
an atmosphere. The ingress of fresh air was care¬
fully excluded from the apartment, and if change of
air was made part of the treatment, the invalid
was usually sent to some most enervating
climate where, in a short time, stomach and liver
troubles were added to complicate the disease already
established in the chest.
Things now are changed indeed. The consump¬
tive invalid is encouraged to face cold in the moun¬
tain parts of Switzerland or in Colorado and Denver
City. Cough mixtures are thrown away; tonics
taking their place, and, as the digestive powers in_
Digit
■oogle
Oct. 4, 1899. ORIGINAL COMMUNICATIONS. Thi Medical Paisa. 343
crease, a liberal and abundant supply of good food
with moderate allowance of wine is urged upon the
now hopeful patient.
My own experience affords to me instances of com¬
plete recovery from phthisis due to a sojourn in the
cold of Canada, and that, too, in the case of one who
had frequent severe attacks of haemoptysis, and who
was liable to subacute inflammations.
Everyone cannot manage to go far away from
home for a cure, and for such we have now well-
planned establishments for the open - air cure.
This, I need hardly say, is no new thing,
bnt as put before invalids, it comes as a
new method of treatment and so let them
take it, for the idea that he is trying a “new
cure" does much to help both doctor and patient.
Abundant evidence is now at hand to show that the
consumptive invalid must be on a dry soil. This is
most essential; next the elevation’should be moderate,
for cutting winds will not help the treatment, though
these even are not so pernicious as sudden draughts
in badly arranged apartments.
An objection I have found raised to the Sanatorium
plan is that it is not well to have many consumptives
under one roof. I do not think this much of a draw¬
back. Cases must of course be selected with a certain
amount of discretion and experience, and then the
community is likely to be a cheerful one. In the
consumption hospitals of London and in the provinces
the patients seem, as a rule, happy and cheerful,
though few of them like the idea of quitting Ventnor
or Bournemouth to return to work in smoky London.
As experience increases it will be found that some
—I should say the majority—do best, as far as cure
goes, from living near the sea.
Sea air contains a certain amount of saline matter,
and what better inhalation can a patient have than
constant small doses of chlorides of sodium and
other salts deadly to the tubercle bacillus in the
longs P
A sea voyage in a sailing ship to Melbourne and
back is the best way of using this saline inhalation.
To undertake such a cure requires courage, and
though I have been amazed to see the wonderful
good that this voyage can do even in advanced con¬
sumption I would not advise any one far gone in the
disease to try the ocean cure.
I have noted many cases in every walk of life who
have made the Australian voyage, and my own expe¬
rience is most favourable. Patients have returned
home improved both in general health and in
physical signs to a degree I could never have
expected. Many years ago I remember how very
strongly my late teacher, Dr. Walshe, urged on a
young chemist in Regent Street, who had one lung
well on in phthisis, to take the Melbourne voyage.
Soon after his arrival we heard of him as perfectly
well and growing quite fat.
So there is in the open-air treatment and its con¬
comitants very much to cheer and encourage the
tuberculous invalid, and he must not be faint-hearted,
but make up his mind to do the cure thoroughly in all
points.
THE FREQUENCY OF SICKROOM
INFECTION IN TYPHOID FEVER, (a)
By HERBERT PECK, M.D.,
Medical Officer of Health, Chesterfield Rural District.
He said it was generally accepted that the immediate
cause of enteric fever was the bacillus typho-abdomi-
nalis of Eberth, and that invasion might take place
in various ways. On the other hand, cases of the
(a) Abstract of paper read in the Section of State Medicine,
British Medical Association Meeting’, Portsmouth, August, 1399.
disease were rarely traced to a definite source of
infection, so that a well-known medical officer
recently stated, “ In probably over 80 per cent, of the
reported cases of typhoid fever, the origin of the
infection cannot be ascertained with any cer¬
tainty.” (1)
He attributed this to the fact that many cases
arose under conditions in which it was impossible to
say which of several causes may be to blame. This
was more frequently the case in urban than in rural
districts, but the number of cases in rural districts is
often too small for sound deductions.
His deductions were based upon inquiries into 206
cases of typhoid fever notified to him while Medical
Officer of Health of the West Lancashire Rural
District during the six and a half years ending
September, 1898.
Definitions. —He said: Before giving particulars
concerning the class of cases with which this paper
chiefly deals, I consider it advisable to define as
accurately as I can the class of cases included under
each heading of the following table.
Soil Infection. —This includes the cases attributed
to emanations from soil containing typhoid bacilli.
The experiments of Dr. Robertson (2), and Sidney
Martin (3) have established the long suspected fact
that typhoid bacilli can exist for prolonged periods
in organically-polluted soil and even increase in
number.
The nine cases ascribed to this cause occurred at
intervals during a period of several years in a hamlet
which had been put in a sanitary condition and pro¬
vided with a public water supply, after being in an
insanitary condition for many years, during which
cases of typhoid fever frequently occurred. It is
possible that one or more of the patients acquired the
disease in another manner, but I ascribed them as I
have done after careful consideration.
Drain Efihivia .—In these cases sewer gas was
found to enter the houses in which the patients lived,
from either broken or defective fittings.
Pollution of Watercourse. —Five of the patients
under this heading lived in two houses which had
nothing in common except that they lived near a
ditch or watercourse into which the excreta of typhoid
fever patients had been thrown. Owing to drought
very little but sewage from an infected nouse higher
up was passing down the stream.
Two other cases occurred simultaneously on two
dredgera working together on a canal which was
polluted with sewage at that point.
The other cases occurred in persons living on the
banks of ditches or streams into which filth was
surreptitiously placed, and which were sometimes
very offensive.
Manure. —Enormous quantities of manure are im¬
ported into the district, but the only classes of
manure to which I attributed an outbreak of typhoid
fever were “ black manure,” which consists of human
excreta mixed with ashes and cinders, and “ Oldham
shoddy,” which consists of human excreta mixed with
refuse from cotton or woollen mills.
One case was that of a child who searched among
manure for marbles, and the remainder those of men
who had been working among it or who had it stored
near their houses.
Water. —Many cases were probably due to this
cause, but only one oertainly—a woman who drank
water polluted with the sewage of a neighbouring
town, the only one in the house who suffered at that
time.
Importation. —This term includes (a) Where the
patient had been away from borne for more than
fourteen days, and returned ill; ( b ) where the
patient returned home after an absence of not less
than one week, and sickened within five and fourteen
days; (c) where the patient worked in n neighbouring
Die
Google
344 The Mbdical Prims. ORIGINAL COMMUNICATIONS.
Oct. 4, 1898,
district on premises which inquiry, made at my
request by the officials of the district, showed to be
insanitary.
Sickroom Infection .—I have used this term to in¬
clude cases due to the ingestion of specific bacilli
directly derived from excreta, and suspended in tbe
air of the sickroom or infected part of the house,
whether this took place in the act of eating or drink¬
ing, the swallowing of saliva, or in any similar way.
The significance of the term will beoome more
apparent upon a perusal of the cases ascribed to this
cause.
Several Possible Causes .—This term covers those
which occurred under circumstances which rendered
it impossible to ascribe the origin of the disease to
any one defined cause, with a reasonable degree of
certainty.
No Ascertainable Cause. — This term explains
itself.
Summary of Casks.
Cases.
Soil Infection .
9 equal to
4-37
Drain Effluvia .
Pollution of TFater-
21
”
10 2
course
9
n
437
Manure ...
6
291
Water .
1
•5
Importation .
25
1213
Sickroom Infection
28
13-5
Several Possible Causes
69
336
No Ascertainable Cause
38
>•
18-44
Total 206
of the whole
)»
M
>»
I. The patient, jet. 35, frequently visited her mother
and sister, living in another district, when they were
suffering from tne disease, and fell ill as they were
recovering.
II. A woman, sat. 29, came home from service in an
early stage of the disease. Her sister, net. 11, Blent in
the same bedroom throughout the illness, and deve¬
loped the disease in a typical form about a fortnight
after her recovery.
HI. A gentleman came to his country house while
suffering from the disease, and one of the maid¬
servants went down with it during his convalescence.
She did not see her master during his illness, nor
did she wash any infected clothing, and is believed
to have contracted the disease through eating deli¬
cacies which had previously been in the sickroom.
IY. A priest, set. 30, attended patients suffering
from the disease, and was taken ill with typhoid
fever three weeks later.
V. A woman, set. 37, who had been frequently from
home, developed the disease and died. Her child,
set. 9, frequently sat with her mother, and was taken
ill the day she died. An elderly woman came from
some cottages half-a-mile distant and nursed her
through her illness, also washing her clothes, and
developed the disease as her patient recovered. I
know from personal observation that she sometimes
took food in the sickroom. She returned home and
was nursed by her daughter, set. 25, who, notwithstand¬
ing my remonstrances, slept in the sickroom and de¬
veloped the disease nine days after she had disin¬
fected and cleaned the house.
A child, set. 4, was also taken ill, but the
medical attendant did not regard her complaint as
typhoid fever, though there was considerable gastro¬
intestinal disturbance.
YI. A woman, set. 30, was taken ill with typhoid
fever, and was nursed by a midwife. Her nurse
returned to her home in a neighbouring township at
the conclusion of her illness, and developed tbe
disease about a week later. I can only attribute her
illness to her swallowing her saliva or eating in the
sick loom, as I know she did on at least one occasion.
Several members of the family living in tbe house
adjoining that of the nurse frequently visited her,
and three of them were taken ill, but only one was
notified as suffering from typhoid fever.
VII. A woman, set. 29, drank water from a brook
polluted with the sewage of a neighbouring town,
and was taken ill with typhoid fever between two
and three weeks later. Her husband nursed her
through the illness and then developed it himself,
whereupon he went to stay at the house of his father
a quarter of a mile distant.
His brother, ait. 6, was taken ill as he got better.
The house was of only one storey, and the sickroom
door was often left open and so ventilated into the
house.
VIII. A sailor, set. 42, came home from a long voy¬
age, and was reported the same night as suffering
from typhoid fever, from which he died. His father
slept in the sick room, and was taken ill with the
disease nine days later. A woman, set. 32, nursed
them, and was taken ill between four and five weeks
after the return of the first patient. She was
removed to a local hospital where she died. A boy,
set. 7, slept in a room communicating with the sick¬
room of the first two patients, and developed the
disease six weeks after the return of his uncle, the
first patient, from sea. Fourteen days later hie other
uncle, net. 27, who slept with him until the com¬
mencement of his illness, also went down with the
complaint.
I had recently condemned the premises on which
these cases occurred as unfit for human habitation,
but they were carefully attended to throughout the
series of coseB, for which they were in no way
responsible. The water supply was the same as that
of a dozen other households which did not suffer
from the disease. The excreta were disinfected with
corrosive sublimate solution, 1 in 960, from the com¬
mencement of the outbreak, and I can only attribute
the disease to the fouling of the bed linen.
IX. A young man, net. 21, stripped off tbe wall¬
paper of a room in which there had been a case of
typhoid fever and be gam to be ill twelve days later.
He was reported ©» tne sixteenth day to be suffering
from typhoid fever:
X. A girl, net. 8j. was allowed to steep in the same
room as a patient suffering from tbe disease (which
he probably contracted outside the district), the
medical attendant saying that this was " quite safe.”'
She was taken ill nineteen days after the first patient.
XI. A girl, ait. 17, slept in a room leading from the
sickroom of a typhoid fever patient and began to be
ill three weeks after the latter, the disease being
well marked,
XII. A woman, net. 26, worked on a canal boat and
probably contracted the disease outside the district.
Her brother, net. 29, attended to her on the boat and
began to be ill twenty-one days after she did.
XIII. A girl, ait. 7, contracted the disease and died.
Her sister, net. 18, came home about a week before
the death and attended to her, being assisted in the
task by her father. Both father and daughter con¬
tracted the disease and the latter died.
XIV. The first patient was one of two mentioned
as having contracted the disease while working on
canal-dredgers, and was brought home ill, but died
twelve days later. His sister, net. 7, was frequently
in the sick room, and was taken ill with the disease
twenty-two days after his return home.
XV. A girl, net. 7, was “ feverish ” and suffered
from diarrhoea, but was not seen at that time by a
medical man. A brother and two sisters slept in the
same bedroom, and developed the disease simul¬
taneously about five weeks after the commencement
of her illness. Their mother nursed them, and deve¬
loped the disease four weeks later.
Their next-door neighbour assisted them with the
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4, 1899.
THE INTRODUCTORIES
The Medical Press. 340
housework during the illness, and a child which she
frequently brought into the sickroom developed the
disease.
XVI. A person suffering from typhoid fever was
frequently visited by his uncle, eet. 40, who spent
many hours at his bedside. The latter lived at a house
about two miles away, and took to his bed twenty-six
days after his last exposure to infection.
Conclusions and Remarks.
The sixteen groups of cases described above include
28 which may be accepted as cases of “ sickroom
infection,” equal to 13*5 per cent, of the cases inves¬
tigated. Four other cases were probably also due to
this cause, but I prefer to exclude them rather than
weaken a good case by the employment of doubtful
evidence. It is also probable that other cases are
inoluded under the headings “ Several Possible
Causes ” and “ No Ascertainable Cause."
My conclusions are(1) That sickroom infection
is more common than is supposed, and does not
receive the attention it deserves; (2) That sickroom
infection is much commoner in the small and often
crowded bouses of the poor than in the larger bouses
of the well-to-do.
Though it appears remarkable that so little import¬
ance should be attached by the medical profession to
this mode of infection, reasons for it are not hard to
find. I think the chief of them are the difficulty of
excluding other possible causes, and the comparatively
small number of cases met with by individual prac¬
titioners. Another is the fact that it is the practioe
in some general hospitals to treat typhoid fever
patients in the same wards as patients suffering from
other diseases. I do not consider the practice wise,
for accidents may happen even iD a hospital, though
there is a great difference between the amount of
risk incurred in a hospital, where the excreta are
cremated or carefully disinfected, and the stock of
linen is practically unlimited, and articles are
removed as soon as soiled, and in a cottage, where
the importance of the disinfection of the excreta is
not understood, and the stock of linen limited, so
that soiled linen is sometimes used for days and even
weeks. In connection with this latter point I may
say that only two of the cases detailed, viz., Noe.
III. and XVI., occurred in houses with more than
three bedrooms, and these did so under peculiar
circumstances.
Under the conditions usually met with in small
houses, opportunities are afforded for the drying of
portions of the excreta of the patient, and the diffu¬
sion through the air of the sickroom of the typhoid
bacilli, and possibly their spores. Those who have
noticed the comparatively bulky motes illumined in
a sunbeam will understand how this occurs.
Dr. Philip Boobbyer (4) found that 85 3 per cent, of
the cases which occurred at Nottingham during the
ten years ending 1896 happened in houses of five
rooms or under, and 14'7 per cent, in larger houses.
The sanitary condition of the larger houses may have
been better than that of the smaller, and their occu¬
pants may have been more intelligent or docile than
those of the cottages, but my own experience teaches
me that this sidelight of Dr. Boobbyer’s inquiry into
“ Endemic Typhoid Fever in Nottingham ” tends to
prove my contention that a larger number of cases of
typhoid fever than is suspected is due to what has
been called “aerial” and “direct” infection, but
which I consider might be more appropriately called
“ sickroom infection.”
Biblioqbapht.
(1) and (2i “ Notes on an Experimental Investigation into the
Growth of Bacillus Typhosus in Soil.” By John Robertson,
M.D.,B.8c., in Br,tuh medical Journal, January 8th, 1898.
(3) Report by Dr. Sidney Martin “ On the Growth of the Typhoid
Bacillus in Foil,'’ in Twenty-Seventh Annual Report of the Local
Government Board.
(4) “ Endemic Typhoid Fever in Nottingham." By Philip Boob¬
byer, K.B., in Journal of the Sanitary Institute, January, 185*9.
OPENING OF THE MEDICAL SCHOOLS:
INTRODUCTORY ADDRESSES.
WINTER SESSION, 1899.
ST. GEORGE’S HOSPITAL.
MEDICINE, OLD AND NEW.
By W. Howship Dickinson, M.D., F.R.C.P.
The orator commenced by congratulating his listeners
on having selected medicine as a calling. He contrasted
the physician's objects and aims with those of the advo¬
cate and the clergyman, pointing out that medicine is
wholly beneficent, at least in intention. The opponent
is disease, and is always in the wrong. The advocate
iB bound to a side which may not be that of justice.
No such partisanship directs the efforts of the phy¬
sician, all rejoioe in his success and agree in lamenting
his failure.
After a brief review of the history of therapeutics, and
the change that characterised the modern treatment of
disease, the orator observed, that in reoent days anti¬
pyretics have oome into fashion which, if ever useful.
I take leave to think are more often injurious. If
Nature raises the temperature of the body, Art is
invoked to lower it, as if the danger lay in the
temperature rather than in the condition which caused
it. No doubt a very high temperature is in itself
injurious, but it is more to the purpose to say that a
person has a high temperature because he is ill than that
ne is ill because he nas a high temperature. I have
known the body heat to reach 111 deg. and recovery to
occur without the employment of any special means to
make it less. Let us not be in haste to attack the
temperature as if it constituted the whole or chief danger.
I regard it not so much as a danger as a sign of danger.
Antipyretic drugs are, as a rule, depressing; it may be
that some, who might have survived their disease, have
succumbed to the oombined effects of the disease and its
treatment. Increased temperature represents increased
combustion, and occurs especially when there is a poison
to be got rid of. I have often asked myself whether this
destructive process is not also a purifying one, whereby
offending matters in the body are burnt and purged
awav.
After an allusion to the methods of treating tuber¬
culosis, for example, the orator called attention to the
progress effected in the substitution of scientific for
empirical methods, which had enabled us to recognise
ana isolate the essential principles of many diseases
and morbid processes, and had oompassed achievements,
mostly in prevention, but to some extent in cure, which
we ourselves must wonder at and which our forefathers
would have regarded as impossible.
Passing on to the consideration of diseases due to
bacilli, and how far we can prevent or control the
morbid prooeesee with which they are connected, the
orator observed that three methods present themselves.
(1) Killing or excluding the microbes. (2) Establishing
immunity in the individual. (3) Employing antidotes
in the shape of the antitoxins.
Antiseptics had done much in surgical practice to
prevent infection, and if our present knowledge does not
enable us to cure zymotic disease, it has provided us
with means of prevention which have done muoh and
promised mote.
The great discovery of Jenner, on the one kand,
and the discovery of antitoxic serum—serum made pro¬
hibitive of a disease by acting upon it with material
which that disease has generated, on the other—marked
steps in the evolution of medical science.
What with Jenner’s fundamental discovery, re¬
marked the orator, the super-additions which modern
scienoe has built upon it, and the new modes of creating
antidotes to disease by the use of its own products, we
see a wide prospect of relieving the ills of mortality,
limited though it be by the prejudice of the vulgar and
the subservience of politicians who value the votes of
their constituents more than their lives. This brings us
within sight of the “conscientious objector,” though
one does not Bee how conscience is concerned
D
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346 The Medical Press.
THE INTRODUCTORIES.
Oct. 4, 1899.
in a matter which is not one of religion or
morality, bat of expediency. The conscientious
objector is himself to be objected to as one who presumes
without special knowledge to decide upon a question
where special knowledge is required. Ignorant he neces¬
sarily is, but he is less to blame than his betters, who
bave endorsed his ignorance and allowed it to influence
legislation. Liberty is an excellent thing, but to give
liberty to spread small-pox may be thought to be carry¬
ing it too far.
The orator concluded his address with the observation
that if we regard medicine as a science, if that can be
called a scienoe which is a quintessence of many, it is of
all the most progressive, and it is that which of all others
tends most directly to the benefit of mankind. Those
are to be congratulated who have ehosen this vocation,
whether it be looked upon as an intellectual pursuit or
as affording opportunities for doing good.
UNIVERSITY COLLEGE HOSPITAL.
By G. F. Blacker, M.D., M.R.C.P.Lond., F.R.C.S.Eng.,
Aisitfjint Obstetric Physician to University College Hospital, and
Obstetric Physician to the Great Northern Central Hospital.
In welcoming the new comers, he observed that their
support was the more welcome seeing that it was un¬
certain whether the medical school of University College
will oontinue to be associated with the college in which
during all the past years its work has been done, and
what is to be the exact position with regard to the new
university from which they hoped ro much. They
would, he said, shortly be bidding adieu to the old
buildings, and this carried him back to the
beginnings of our hospital and the men who
formed its staff in the year of its opening,
1834. The North London Hospital, as we learn from
Mr. Nixon’s history, practically made a beginning
as the University Dispensary, 4, George Street, Euston
Square. The management of the dispensary was in
the hands of a oommittee of the proprietors of the
University of London elected by the council. At a
special general meeting of the oouncil of the University
of London held on September 30th, 1828, the attention
of the proprietors was called to the great advantage of
having a hospital for clinical instruction attached to the
university, and under the control of the council. After
some little delay a start was made in May, 1833, and on
the 22nd of that month the foundation-stone was laid by
the Duke of Somerset. In 1840, as further accommoda¬
tion was urgently neoessary, the south wing was com¬
pleted and opened, and at the same time out-patient
accommodation was provided. The north wing was
built during the year 1846, giving the building its
present form. The staff of the hospital at its opening
■was as follows:—The physicians were Ellioteon, Thomson,
and Carswell; the Burgeons were Samuel Cooper, Liston,
and Richard Quain, and the obstetric physician was
Davis. The opening of the hospital in 1834 marked a
most important epoch in the history of medical education.
Medical teaching at that time was mainly in the
hands of the private schools, anatomy was almost
solely taught in them, and so, too, were many of the other
subjects. At this time the system of election to the
staffs of the large hospitals was a most vicious one. It
was the custom for the surgeons to take private pupils
or apprentices who paid them enormous fees—a thousand
guineas was not an uncommon sum—on the understand¬
ing that when the time came they should be appointed
to the post of house surgeon or house physician under
their respective patrons. By this invidious custom many
men who were most worthy of obtaining posts upon the
staffs of the large hospitals entirely failed to do so, and
the abuse prevailed to such an extent in the case of the
two united hospitals of Guy's and St. Thomas’s that nearly
every member of the staff was either a relative or had
been a pupil of Sir Astley Cooper. At the smaller hospitals
a similar system prevailed; an appointment was obtained
mainly by the expenditure of money or by intrigue. The
degradin g system of canvassing the whole of the governors
was insisted upon, and votes were openly bought and
sold; worse than this, the result of an election often
depended solely upon the amount of money the unfortu¬
nate candidates were able to lay down, since an appoint¬
ment was frequently gained by the wholesale creation
of faggot votes at the last moment until one or other of
the candidate’s resources failed him. It will ever be to
the honour of our college and hospital that this per¬
nicious system was not allowed to prevail within its
walls. From the very commencement the appointments
were made by selection -, and personal intrigue, family
influence, and monetary considerations were never per¬
mitted to influence the result. Their hospital was the
first to adopt the system of throwing the resident
appointments open to competition, any student of the
hospital being entitled to compete if he had attended a
certain number of lectures.
The lecturer then gave biographical sketches of past
members of the staff, touching on their claims to fame
and to the esteem of their professional descendants.
The lecturer concluded hiB address with the remark
that he could place before them no better incentive to
work than a recital of some of the memories and tradi¬
tions of their school. But it would not do for them to
ever rely upon the traditions of the past; it is necessary
for them to build up traditions of their own. It would
be their duty to see that they make a good use of the
opportunities afforded to them by that magnificent
building now in course of construction, and to make their
work in that new building worthy of those traditions of
University College and the present hospital. He pointed
out to the students that as medical men they were
called upon to play a two-fold role. It was their duty
not alone to acquire as complete a knowledge as they
could of purely professional matters, but they should
seize every opportunity of improving their general
education and of acquiring a knowledge of the world.
Their success in life would depend as much upon the
latter as upon their professional attainments. Though
no doubt the competition in the medical profession is
ever increasing, yet the opportunities afforded them of
fitting themselves to emerge successfully from the
struggle were greater now than they ever were. At the
same time they must remember that more is expected of
them, since the education of the general public in scien¬
tific matters is much higher now than it was a few years
ago. If they will but make good use of the opportunities
afforded them they would have no difficulty in acquiring
a sound knowledge of medicine and surgery, but at the
same time they should make it part of their education to
cultivate a healthy interest in all the many details of life
metwithoutsidetheprofession. It is by no means certain
thata man’s business is the most important part of hiB life,
says Robert Louis Stevenson in his most fascinating
“ Apology for Idlers.” Perpetual devotion to what a man
cam his business is only to be obtained by perpetual
neglect of a great many other things. It is well to
remember the old saying which tells us that if a man
reads too hard he will have little time for thought, and
Robert Hall’s summary of a certain learned but dull
personage, “ He had so many books upon his head that
they pressed too much upon his brain.” He is but a poor
doctor whose sole attainment is his knowledge of physic.
CHARING-CROSS HOSPITAL.
THE OUTLOOK IN MEDICINE.
By Dr. Mitchell Bruce, F.R.C.S.
The orator premised that the Outlook in Medicine as
a useful art is hopeful at the present time, as evidenced
by the fact that the scientific method was now being
pursued in every department of it. He insisted on the
importance of etiology as a branoh of study, and inci¬
dentally on the importance of the role now played by
bacteriology in that connection. In respect of individual
susceptibility, he pointed out that we had within us a
natural disposition to keep well which, if cultivated,
would preserve us from evil when others who neglected
the laws of healthy living were struck down
around us. The body was automatically guarded
against the incursion and action of injurious
influences by possessing provisions for resistance which
were capable of being cultivated, strengthened, and
THE INTRODUCTORIES.
The Medical Press. 347
Oct. 4, 1899.
artificially reinforced. Many of these were anatomical
and physiological arrangements, which must be kept in
perfect working order; bat more powerful and complex,
however, than these was the provision for combating
destructive micro-organisms, the disoovery and study
of which had inaugurated a new era in medicine in
respect both of prevention and treatment. The
micro bee of disease did not have it all their own way
in the human body. From the moment rf their invasion
the ultimate cells of the blood and organs rose against
them and produced a chemical antidote to their
poisons, antitoxins to the toxins, and, by-and-by, if the
patient survived sufficiently long, the antitoxins in¬
creased sufficiently to destroy the toxins, and recovery
was the result. Naturally it had occurred to the
pathologist to ask the physician, Why should we not
hasten the formation of anti-toxic in the blood, so that
an infectious disease shall terminate not after a week,
but after a day ? This question had been answered
practically by the injection of the antitoxins of
diphtheria and other diseases, which saved the lives of
so many persons every year.
After gratefully acknowledging the liberality of the
public to hospitals, particularly Charing Cross Hospital,
Dr. Mitchell Bruce pointed out that with support of
hospitals, if hospitals are properly served, goes support
of scientific medicine, and indirectly the support of pure
science itself. He alluded to the great strides taken in
this direction in the provinces, and deplored that no
similar munificence had been displayed in the metropolis.
Would London ever do the same, he asked, in a con¬
certed and successful fashion ? When had we heard of an
Owens or a Whitworth immortalising his name by a
noble gifttothe University of London ? The metropolis,
he observed, appeared to possess no municipal pride in
this direction.
After some remarks on the way in which public opinion
had been enlisted on the side of compulsory and preven¬
tive hygiene, the orator went on to observe that the
position of the profession as a profession, and the work
of each of the students, would be something very
different from those of their predecessors. They were
contracting new obligations to others, and therefore new
obligations to themselves as students, as men about to
enter a career involving the management of a multitude
of complex and delicate social duties. Twenty years ago
students learned medicine with a view to practise it as
successfully and scientifically as they could ; to become
the trusted and faithful friends of sick persons of every
rank of life who might ask their assistance; to take an
honourable place in the community, wherever their lot
might be cast; and to play an active and useful part in
social reforms, like their neighbours, when the occasion
arose. How different was the prospect before each of
them now ? how much greater the authority and powers
they would wield when they became practitioners ? how
much more grave their responsibilities ? how muoh need
for increased intelligence, tact, patience, consideration,
high sense of duty, and therewith the development of the
faculties demanded in the conduct of public business ?
He then discussed how these considerations must bear
upon their course of study, and showing how necessary i
it was to educate the public in the laws of hygiene, !
beginning with the young.
Tn connection with the present movement in support
of the open-air treatment of tuberculosis, would it not
presently occur to people, he asked, that if consumption
can be arrested by means of fresh air it might be pre¬
vented by the free enjoyment of fresh air; and not only
consumption but a host of other diseases ? One of the
chief benefits of the present stir in this direction would
be that individual men and women would be convinced
of the value of a pure atmosphere to themselves indi¬
vidually, and let a little fresh air and light into and
through their houses.
In conclusion, he urged that they must be prepared to
take part in the social life of the community, of which
they,as students, would now form part; adding that
there was no reason why the student Bhould not open his
mind at the same time to the elevating and refining in¬
fluences of literature, of history, of modern languages,
and of the fine arts, those parts of his mental equipment
which enabled a man to enter with success into the dis¬
cussion and management of the affairs of his personal,
domestic, and social life; which endowed him with what
are known as judgment, intelligence, tact, and clear¬
headedness ; which contributed so much to the formation
of hjgh character and sound moral principles; and which
secured for him public respect and confidence.
ST. MARY’S HOSPITAL.
ON SOME MOTIVES AND METHODS IN
MEDICINE.
By H. O. Plimmkr, M.R.C.S., F.L.S.
The study of medicine is divided into two great
divisions, the first relating to practical usefulness, the
second relating to scientific investigation, and each cf
these divisions can l»e attractive to men who are entering
life, according to their disposition of mind, both dispo¬
sitions of mind being equally noble. It is usual to tell
students that the profession of Medicine is the best and
noblest of professions, but it is not in itself so. It is
only as noble as you choose to make it, which is quite a
different thing. To many members of our profession it
remains always nothing better than a trade, and some
members of it, again, are, at best, nothing better than
artisans.
With regard to facts, do not attach too much
importance to them in themselves, or to their acquisi¬
tion. John Hunter, whose use of facts was as masterly
as Darwin’s, and whose methods should be a model to all
. of us, says, “Too much attention cannot be paid to facts,
yet too many facte crowd the memory without advan¬
tage, any further than they lead us to establish
principles.” It is these principles we should use
directly in the practice of our profession. Regarded as a
mere means of gaining a living, medicine is a poor
trade for an honest man, and there are many easier
and better fitted for that purpose. But to those of you
who would be seekers after truth, or whose aim is that of
usefulness to others, it is certain that you will not be dis¬
appointed in the profession you are entering to-day.
Theauthor adopted John Hunter’s definition of medical
science as “ the experimental analysis of life in health
and disease,” and he pointed out that the object of
experimental methods in pathology is to simplify its
many problems. One of the greatest advances
made in modern times being the recognition of
the fact that disease must be studied by experi¬
ment. It has taken several centuries since Bacon’s
era to discard fancies and theories, and to bring the
experimental method into this branch of science.
Contrasting the value of the information afforded by
experimental methods as compared with mere observa¬
tion, he observed that simple observation oertainly
furnishes a certain number of valuable hints and sug¬
gestions, but nothing more, and it would be quite as
senseless and impossible to try to establish a system of
of scientific etiology from examination of a dead body fs
to try to establish the principles of mechanics by looking
at a broken machine.
The etiology, for instanoe, of those diseases only
which can be reproduced at will, can be accurately
regarded as known. This brings us to the logical con¬
clusion that our ignorance of etiology must be very
great, especially about those diseases which cannot be
reproduced by any means at present in our power, even
when the symptoms and pathological anatomy of such
diseases are well known, as is true, for example, in tetanus
and cancer. By the experiments which scientific medi¬
cine has undertaken, the contagium vivum of many of the
most deadly diseases has been isolated, and thereby
is fulfilled the first condition for guarding against
such diseases: the first condition and the basis for the
great ideas and principles of prophylaxis have been
attained.
Wo are in this hospital very favourably situated with
regard to investigation and experimental work, for here
clinical and experimental werk, when necessary, go hand
in hand. In some London hospitals scientific and
experimental work is discredited and not allowed; but
here, thankB to the large mindedness of our staff, every
348 Thb Medical Press. LUNACY DEPARTMENT. Oct. 4, 1899-
facility is placed in our hands for investigation and re¬
search ; and I feel sure that this plasticity of mind,
with regard to all the great problems at present before
us, will bear fruit. It should stir us all, here at 8t.
Mary’s, to take every advantage of the opportunities and
help given to us, and to do the best that is in us.
I know you 'will not misunderstand me with regard to
what I have said. As one who has been in practice, I
know well the great importance of clinical medicine. I
know well how important it is that every symptom
should be accurately studied and recorded; how
important it is that every gross post-mortem appearance
should be minutely recorded; and how essential it is
that our powers of accurate observation should be
trained to the uttermost, till they become as nearly
photographic as is possible. But it seems to me that
the same amount of energy expended on experimental
science will give infinitely greater results, so that any
of you who may feel drawn to this kind of work need
not feel uncertain of reward of your work, or of finding
suitable objects to work on.
The orator concluded with a touching reference to the
extraordinary stimulus which Pasteur gave to scientific
investigations in disease, of so pronounced a character
that medicine had really been revolutionised, and he
reminded them of Renan’s dictum: " La raison triomphe
de la mort, et travailler pour elle, c’est travailler pour
l’^ternite.”
LONDON SCHOOL OF MEDICINE FOR WOMEN.
By Mrs. Garrett Anderson, M.D., Dean.
Speaking broadly, the work in a medical school may
be divided under four headB—the study of the healthy
body, the study of disease, the study of all the methods
for investigating or curing disease, and the art of
applying these methods. The study of the problems
or life and of disease is no longer a matter of learning
from books and repeating from memory. The experi¬
mental method has revolutionised the teaching of
physics, chemistry, physiology, and pathology. Large
and costly laboratories are now absolutely necessary if
the students are to keep up with what is required of them
by examiners. There can be no doubt that the experi¬
mental method of teaching is the true one, whether
much or little of any subject is wanted as a foundation
for the scientific study of medicine.
The study of pathology, or the causes and effects of
departures from health, ought, if possible, to precede
work in the hospital wards. The student Bhonld know
what disease is before he attempts to recognise it in
individuals. All honest quackery is based upon complete
ignorance of pathology ; dishonest quackery on the con¬
viction and the hope that the patient is completely
ignorant of it also. In studying how to investigate the
meaning of symptoms in a patient, the best rule is to
look at everything and to guess at nothing. In the words
of Sir Wm. Gull, “We make more mistakes by not looking
than by not knowing.” The organisation of the Royal
Free Hospital as a teaching hospital has made great
progress in the 22 years ainoe women were admitted as
students. It is a very difficult and complex business to
change a hospital that has been without students into
a first-class hospital school. Students want a great deal,
and it is no easy matter to provide properly for them.
When they are no longer students they want from their
hospital the opportunity of gaining experience as
practitioners. Much is being done at the Royal Free
Hospital in this direction. The influence of competition
is now beginning to be seriously felt by the schools that
admit women, and it is an influence that will be felt
more and more as time goes on.
As to the cost of a medical education people get as a
rule what they pay for, neither more nor less, and if a
medical student wants a great deal of the best teaching
it will cost more than the minimum of teaching of a less
ambitious type would. The hospital that gives resident
posts to women graduates will be noticed very favourably
by students. The London School of Medicine for Women
is now being rebuilt. Fifteen thousand pounds ha«
already been spent on the building, and <£12,000 mor e
has to be spent. It is to be hoped that the work will be
completed next year, and that the debt on the building-
will be gradually extinguished.
No apology is necessary at this time of day for the
study of medicine by women. It is generally recognised
now that women have exactly as muoh right to practise
medicine and to support themselves by doing so as men 1
have. They are doing excellent and highly skilled work
in medicine proper, in surgery, and midwifery in almost
all parts of the world, and so long as theii work con¬
tinues to be good they are sure to prosper.
^Cuitacj! gqmrtmetti.
ASYLUM REPORTS.
English Asylums.
Gloucester County. —The Committee call attention,
to the large increase in the number of patients charge¬
able to the county, viz.;—897 as against 820 at the dose
of 1897, a net increase of 71. This increase is entirely
attributable to a diminished death and recovery rate, a*
large proportion of hopeless and incurable cases having
been admitted during the year. Unhappily the same
experience is widespread wherever there are asylums^
and the serious result is being forced on the notice of
asylum authorities that asylum b are not regarded bo*a
fide as asylums but as convenient receptacles for the
flotsam and jetsam of humanity. The report of the-
Commissioners is very satisfactory, but they should dis¬
tinguish between wet beds on the male side and wet
beds on the female side. The Chaplain’s remarks on the
spiritual and moral treatment of some idiots—or, he
should rather have said, imbeciles, are forcible and sym¬
pathetic.
Dorset County. —This report is voluminous, and in
some respects interesting. Dr. McDonald expresses his
views at some length, and warmly commends the open
door system, which he has introduced with, evidently,
satisfactory results. The percentage'of admissions to the-
numbers resident is not high, and the recovery rate is
lower. Dr. McDonald says, “ There is much force in the
statement put forward a few years ago by an eminent,
physiologist, * that the raoe is degenerating,’ and there
wouldseem to be a curious link of connection between this
so called degeneration, and the practically proved falling
off in the recovery rate in the public asylums of this
country. While there is food for tho ughtand suggestion,
in thiB statement, one [is compelled to ask does it not
also beg the question ? Is it the truth or only
half the truth? The race has probably been de¬
generating in the estimation of its wise men for
centuries. The level of intelligence and education,
has been raised, but this serves all the more to mark
contrasts which in pre-education days were less notice¬
able. If scrofula and phthisis are signs of degeneracy
surely pro (anfo these signs are diminished to-day com¬
pared with thirty years ago. Their relation to idiocy
and mental disease has been pretty well established by
Ireland and Clouston. Old age has as muoh to do with-
diminished recovery percentages as anything. The fifth
commandment is not respected as it used to be. The cost
of clothing is very low. The dietary is varied, which is
commendable, but two courses each day at dinner would
give more variety still, and meet the individual cravings
of so many patients more fully. The report altogether
is full of detail, and gives evidence of the superinten¬
dent’s desire to be up to date in all departments of the
management.
Middlesex County. —The report of the Visiting Com¬
mittee is rather a long one, but of no very special interest.
It has been found necessary to raise the charge for
maintenance from lls to lls. 0d. a week. There is here
as elsewhere necessity for increased accommodation.
More than 10 per cent, of the admissions were senile cases,
5 per cent, were general paralytics, and 7 5 per cent,
were epileptics. The death-rate from phthisis is some¬
what large. The Commissioners speak in high terms of
praise with regard to the condition of the wards and
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Oct. 4, 1899.
LUNACY DEPARTMENT.
dormitories, and the good order and tranquil behaviour
of, the majority of the patients.
W 1ST So ssex, Chichester.— The second annual report
gives abundant evidence of posh, energy and enterprise
in the management, and the results in so short a
time seem to ; be very satisfactory. Already, how¬
ever, further accommodation is required and plans
for new wards for 300 patients are about to be sub¬
mitted to the Commissioners in Lunacy. Influenza has
visited the asylum with the usual experience that the
officers and staff have been more severely attacked than
tire patients. Dr. Kidd mentions a physical cause of
insanity, especially of melancholia, viz., defective and
decayed teeth. He observes “ it is remarkable how fre¬
quently melancholics are found to have thoroughly bad
teeth, and it is no wonder that indigestion, loss of appe¬
tite, refusal of food, and a train of other symptoms
obtain.” He therefore recommends the engaging of a
visiting dentist. The pathological laboratory is reported to
have been well fitted out and put into good working order
by the medical officers, who have devoted a great deal of
tune and attention to this work. Like many other super¬
intendents, Dr. Kidd would like to see the opprobrious
word asylum dropped, and hospital substituted.
Carmarthen. —Here, as elsewhere, there is evidence
that the Commissioners make a point of reducing the
number of wet beds. “ In 9 cases out of 628, or 1-4 per
cent., were patients’ beds wetted last night.” This is a
question agitating some Commissioners and super¬
intendents over much. There are extremes with all
hobbies. The record stated is a very fair one. Dr.
Goodall is evidently trying in many ways—medical and
administrative, to bring the asylum here up to the
standard of modern ideas, and he has had many difficul¬
ties in taking over the command of an old asylum,
Dxbby Borough Asylum. —The Commissioners reports
do not appear this time. This is unusual. Dr. Macphail
has nothing of special interest to report unless it be his
summary of ten years' results. Influenza is now coming
to be recognised as a cause of insanity. In ten years
there have been 88 cases, or 8*9 per cent. Dr. Macphail
observes regarding the alleged increase of insanity :—“ I
Am of opinion that the only true tost of the increase
or decrease of insanity in a district, is to take the cases
occurring for the first time in each year, to exclude all
readmissions, and to compare with the population over a
series of years. This has been done in the case of the
borough, and a tabular statement shows that there has
been no increased ratio of new cases.
The Lawn, Lincoln. —Structural and other improve¬
ments oontinue to be made in this well-known hospital
home for private patients. There is a persistent move¬
ment in the direction of social and administrative
novelties and changes calculated to make the Lawn
more attractive to its residents. The average number of
patients is in exoees of the previous year. “ The com¬
mittee have felt themselves justified in raising the
ordinary weekly payment to 40s., but while this low rate
might suggest to outsiders the idea that the comforts and
equipments of the Lawn are not first-class, the Committee
desire to emphasise their contention that in no institution
in the kingdom where the mentally afflicted are provided
for can better surroundings be secured, and the percent¬
age of recoveries and reliefs testifies to the advantages
secured’by a term of residence at this institution for
those requiring treatment. ” We have quoted this pas¬
sage, because we believe it is no overstatement of fact.
Dr. Bussell’s report gives an idea of the freedom enjoyed
by Lawn patients. “ As in formerly ears many have had
leave of abeenoe to spend various periods with their
friends or at health resorts.” A party of ladies and
gentlemen, under the charge of the assistant Medical
Offioer, spent three weeks at St. Leonards. The annual
ball, as usual, was a fancy dress affair.
8COTCH A8TLUM8.
Roxburgh, Berwick, and Selkirk. —This, as usual.
Is a careful production, and the statistics and financial
statement are full of detail. Dr. Carlyle Johnstone is
evidently following closely on the heels of the latest
asylum developments in Scotland, though he is not one
to accept blindly new views, however attractive they
The Medical Press. 349
may appear. The night service is improved. A new
female hospital has been erected, and it will probably
illustrate still further the matured views of asylum men
regarding the requirements of an asylum hospital.
Aberdeen Royal. —The reports are very satisfactory,
and Dr. Beid enters fully into a description of changes
and extensions which will materially increase the efficiency
of the asylum management. A most amicable settle¬
ment has been arranged between the Parish Council of
Aberdeen and the directors of the Royal Asylum,
whereby the former becomes a Lunacy District Board
for the city of Aberdeen, and will undertake to build a
new asylum to accommodate the pauper lunatics
chargeable to the city, these being meanwhile provided
for in the Aberdeen Royal Asylum.
Dundee Royal. —The financial position of this
asylum seems to be steadily improving. The following
extract from Dr. Rone's report is worthy of quotation
as coming from the pen of Miss Honnor Morten, having
appeared in the Evening Telegraph: —“ There is one
word to be said to the would-be nurses who storm our
hospital portals. Why not beoome asylum nurses?
There is no disease that requires more careful and
skilful nursing than mental disease. The era of trained
nursing in asylums has dawned, and men and
women endowed with sympathy for suffering, and
with good health and intellectual gifts may find a
new vocation in tendance on the insane. . . . The
work is among the highest to which it is possible to
put the hand, but it calls for some self-sacrifice,
surely, if we take the degrees of comparison, it is
well to be a ‘home’ nurse, and capable of caring
for one’s relations; it is better to be a ‘ hospital ’ nurse,
and equal to attending on the stranger who is physically
ill; but it is best to be an ‘ asylum ‘ nurse, and minister
to the mind diseased.” It seems absurd that the medical
report Bhould be cut down, at the discretion of the Com¬
mittee, for publication, but so it is.
Glasgow District, Woodielbe. —This, in many re¬
spects, is a thoroughly business-like report. The
Brabazon scheme of occupation, of a varied character,
for patients, who would otherwise be left in an idle,
uninterested condition, is here in operation. It is said
to afford mnoh interesting and profitable employment to
a number of suitable patients. A committee of about 12
ladies, chiefly from Leneie, attend at the institution for
two hours every Friday, and teach ten male and thirty-
five female patients the various occupations introduced
by the Brabazon Society. The kinds of work taught
consist of Smyrna rug making, painting on cards and
match-boxes, making paper flowers, lamp shades, &o.
Dr. Blair includes in his report a special pathological
report by Dr. Marr, the senior assistant. Dr. Marr
considers that asylum pathology needs a man for this
alone. He is right.
Montrose Boyal. —Dr. Havelock’s report covers many
topics, general statistics, night supervision, regarding
which he has some sensible remarks, sewage disposal—
he favours bacteria beds, which scientifically is the beet
idea—the opening of Carnegie House, an extension of
the private asylum, named after Mrs. Susan Carnegie,
who founded the Montrose Asylum in 1781, erection of
new villas, Ac.
Lanark County. —Dr. Campbell Clark, in a lengthy
report, refers to several matters of interest. He has
now focussed to a point the possibilities of spleen
extract in the treatment of mental cases. Its chief use
is in the treatment of adolescents, especially males.
He makes appropriate reference to the decease of two
old stagers, and points out the “fact not sufficiently
realised by the general publio, that an insane person
may have a social and industrial value, as great as an
average sane person of the same class. There are men
and women patients living obscure lives in asylums,
of whom it may as truthfully be said * well done, thou
good and faithful servant ’ as of workers outside.’ The
Commissioners specially commend the night supervision,
and the industrial occupation of the patients. The
asylum now has accommodation for 950 patients, and
private patients are received from the district and from
beyond it at very low rates of board.
Digitized by GoOgle
350 The Medical Press.
Oct. 4. 1899
FRANCE.
Irish Astluhs.
Londonderry District. —Apart from overcrowding
the Commissioner regards the condition and management
of the asylum as most satisfactory. The medical clerical
work is well done, and the attendants are carefully
trained. Dr. Hetherington reports 10 deaths out of 44
as caused by consumption, “ a disease,” he observes, “ to
which the insane are particularly liable.” True, under
certain conditions, and one of these is overcrowding. In
Table I, we find the following statement: “ Limits of
Accommodation (Dormitory), 166 (male), 178 (female);
total, 844. Remaining in asylum December 31st, 1898,
males, 243, females, 223; total, 466. This tells its own
tale, and we are sure that Dr. Hetherington is fully alive
to the evils attending it. The cases of escape and aoci-
dent are very few considering the risks from overcrowd¬
ing. Speaking of the good results the Commissioner
refers to the overcrowding as apt to be lost sight of in
view of these results. One dormitory according to
regulation scale should have 36 patients. It actually
accommodates 60. In the outside corridor 20 patients
sleep at night. “These figures,” quoting from the
inspector “are given because some persons may be
deoeived by the favourable results obtained in the
management of the institution. The congested con¬
dition of the asylum renders it a hot-bed favourable to
the rapid and dangerous development of zymotic disease
which may at any time be introduced.”
Down District. —Dr. Nolan remarks: "Emigration
of the young and wage-earning has been stated to be
a contributing factor in the increased number of ad¬
missions of senile cases to the publio asylums. It is
worthy of note that in the Report of the State
Commissioners in Lunacy for New York no less than
35'5 per cent, of the insane in the asylums of
that State were bora in Ireland. It would seem
as if the conditions which necessitated emigration
were potent causes of insanity, and it is possible that if
they had remained at home some of those who compose
this 35 per cent would have increased the home asylums
population.” Here we are dealing with unknown
quantities and unknown factors, and must reserve
opinion. It is more than likely that the first part of
the foregoing quotation contains a sound conclusion.
The disease most prevalent among the patients was '
consumption, which caused no less than 39 6 per cent, of
the deaths, and here there is no charge of overcrowding
by the Visiting Inspector. The conditions are probably
those which at one time made the Inverness Asylum a
hotbed of phthisis, viz., insanitary, ill-ventilated homes,
and insufficient food of physiological quality. Dr. Nolan
has done his best under the circumstances by adopting
the latest views in his attempts to stamp out, or at least
reduce, the ravages of the disease. Antiseptics, open-air
treatment, the testing of the milk supply, have all been
resorted to.
Cork DisTRicT.— There is, and has been for some
time, considerable overcrowding, and steps are in con¬
templation for some relief to this state of matters. Dr.
Woods labours under serious disadvantages. Much has
been done already to bring the administration up to
modem requirements, but he has to deal with conditions
which have been in existence for years, and which are
growing, and paralysing as they grow. The site of the
asylum, though from the oesthetic point of view an
ideal o ftp, is a troublesome one for extension owing to
elevation. Dr. Woods now repeats the hope expressed
in 1895, “ that special provision would be made for the
treatment of acute and recent cases; and the more I
have since thought on this subject, the more convinced
I am of the great want of means at our disposal for
their proper treatment. No part of the existing
building can, I think, be fully adapted for this purpose.
We would require a hospital, in the truest sense of the
word, with at least 100 beds for each side of the house.”
In the management of such an institution there must
be many anxieties not dreamed of in a modern,
uncrowded asylum, and the complimentary remarks of
Sir George O’Farrell are well deserved.
cfratire.
[from odr own correspondent.]
Pams. October 1st, 1886.
Treatment of Dysentery.
Amonq the substances employed in rectal injections
against dysentery nitrate of silver takes the first rank,
white permanganate of potash is but rarely used. Yet
this last agent, according to Dr. Gastinel, constitutes a
remedy of considerable value. By experiments he has
made he found that enemata of permanganate of potash
eased better than morphia all the painful phenomena of
dysentery, arrested the alvine evacuations, and effected
a rapid cure, especially when they were associated with
a large dose of calomel.
His treatment consists in administering at the outset
an enema composed of ten ounces of a solution of per¬
manganate of potash (1—1,000), to which is added an
equal quantity of water sufficiently hot to raise the
mixture to 112 degs. F. The patient lies on his left side
for the first part of the enema, on his back for the
second, and on his right side for the remaining third,
and retains the injected liquid one or two minutes. If
the visit is made in the evening no more is done. The
following morning a second enema is given, followed in a
few hours by the ingestion of 15 grs. of calomel. If the
patient is seen for the first time in the morning an
enema is ordered at once, and when ease has been pro¬
cured, that is to say at the end of an hour, the calomel
is given.
These enemata are repeated generally every twelve
hours, and as the character of the excretions has been
modified, only one is given daily, and finally only every
two or three days ; while at the same time the strength
of the solution is diminished. The enemata are some¬
what painful, but bearable, the pain not exceeding
half an hour; while it is followed by a considerable
relief of all the symptoms.
In children M. Gastenel employs the same treatment,
but naturally the strength of the solution is much
weaker (02 per cent.), while the dose of calomel is in
proportion to the age.
Infantile Eczema.
According to Professor Marfan, of the Hopital des
Enfante Malades, infantile eczema is due to dyspepsia.
The malady exists principally on the face and. on the
bead, extending to different parts of the body, only after
having occupied these regions. It commences in the
third or fourth month, and, if left to itself, disappears
only after weaning. This eczema, says M. Marfan,
affects sometimes a special form, the moisture disappears,
and the affoction thereby merits the name of dry eczema
but this transformation seems to take place especially
when the general condition is modified, when, for
instance, the child who had been fat seems to waste away.
What constitutes the real danger of infantile eczema is
that frequently the surface of the disease becomes
infected and produces divers complications, and in
particular impetigo; sometimes broncho-pneumonia
supervenes.
The cause of this eczema resides generally in over¬
feeding provoking digestive troubles. Consequently it
is of paramount importance to regulate the regime.
Once a fortnight the child, if over six months, should be
( put on water diet up to noon and erery half-hour one of
Digitized by VjOO^IC
Oct. 4, 1899.
GERMANY.
The Medical Puses. 351
the following powder* given: Calomel ± gr., sugar
x grs., divide into four powdera. These doses are ex-
tremsly small, but calomel should never be given to
children under three months, and later, the above dose
should not be exceeded, which will always be found
sufficient for the purpose, and never provokes that
dysentery so often witnessed in infants. As local treat¬
ment, picric acid might be employed in solution (1 per
cent). Later on sine ointment will be beneficial. But
this local treatment, concludes M. Marfan, will be of no
account if the regime is not regulated, both as to the
quantity of milk to be given, and to the precise hours
the child should take it.
&rnnatt|>.
[fbom oub own correspondent.)
Berlin, September 30th, 18S6.
At the Free Society of Surgeons, Hr. Konig intro¬
duced the subject of
Child Tuberculosis,
with special regard to treatment of older persons. He
said that although in childhood generally conservative
treatment did as well as resection, the conditions of the
knee-joint were particularly unfavourable. In the cap¬
sular, as well as in the osteal form of disease, deposits of
fibrine became organised, encapsulations took place
in the joint, by which several independent compartments
were formed, so that when an injection of iodoform or
the like was made, only a portion of the diseased part
came into contact with the medicament.
In spite of all exertion, therefore, occasionally the
disease made progiess, and nothing remained but to
resect. In older people the condition was essentially the
same ; here such a knee was occasionally seen to heal,
but a long time was required for it; two years was not
reckoned high. These patients were accustomed to go from
one hospital to another, and when one had treated them for
a year or so with injections, firm bandaging, stasis, &c.,
without arriving at any desired result, the duty came
upon one to set them on their feet again, so that they
could do without further hospital treatment. The
speaker resected in people who were 70 years old and
more, age was no reason for abstaining from it. He
even resected phthisical patients, so long as their condi¬
tion allowed it. If large abscesses were present these
were widely opened and treated openly. In a patient
operated on a few weeks previously, on opening the
joint the speaker only found a quite small collection of
matter in the meniscus; from here a passage opened to
the pitella, in which there was extensive infiltrating
tuberculosis. It was impossible to locate the collection
before operation, even the Rdntgen rays failed.
Hr.V. Bergmann also resected early in older people, but
he remembered from his Wurzburg days that he did not
always succeed, and once had to amputate. In the 4} years
that he was there he amputated at the thigh 98 time* for
tuberculosis. In the case of children he considered it
advisable to be as conservative as possible, on the one
hand on account of the disturbance of nutrition, and on
the other hand on acoount of the contractions that
followed early operation, for this latter reason even
arthrectomy was to be feared.
Hr. Bennecke read a paper on
Operation in Basedow’s Disease.
Among the 25 strumectomies that had been carried
out in the ('harite during the last 3J years, partial ex*
tirpatdon of the thyroid was performed three times for
Basedow's disease. The patient died of collapse, and the
other two were then shown. He was of Konig’s opinion
that the symptoms of Basedow’s disease were set up by
an intoxication in consequence of morbid excretion of
the thyroid.
The first of the two patients shown was 17 years old,
and had been operated on 2\ years. She had then a
large goitre, exophthalmos, vascular murmurs, pro¬
nounced palpitation, tremor, a pulse 120 to 140. At the
operation, the trachea was seen to have become very
membranous. A few hours after the operation a severe
attack of dyspnoea came on, it was caused by after
hemorrhage, and the coagulated blood had compressed
the softened wrindpipe. After removal of the clots the
breathing was restored and healing of the wound took
place without further disturbance.
The effect of the operation was decidedly favourable,
the exophthalmos and the tremor disappeared, slight
attack of dyspnoea and tachycardia indeed came on at
intervals, but much more rarely and with less violence
than before, so that the patient was able to follow her
employment, which entailed a daily work of eleven
hours.
The second case was that of a woman, set. 27. On her
admission into the Charite in May, she was suffering
from uncommon nervous excitability, so that she could
not lie still a moment, but threw herself about. There
was extreme exophthalmos, moderate goitre, free
breathing, and a pulse between 120 and 160 per minute.
The immediate result of the operation was the cessa¬
tion of the nervous unrest, the patient lay quietly in
bed. A week after the exophchalmos began to recede,
continued to improve for several weeks, and then
remained in the state it had then reached. The pulse soon
after the operation was between 70 and 90; it was now
about 100. The general condition had improved a good
deal, but there was still some palpitation. In one case
examined microscopically there was slight colloid
degeneration. The follioles were mostly lined with a
single layer of epithelium and empty.
Hr. Wolff had never seen a cure after operation for
Basadow’s disease, but considerable improvement, but
in the first case shown it appeared to have taken place.
Hr. Hahn said that the milder cases of Basedow offered
the best chances for operation. In 80 strumectomies he
had operated five times for Basedow’s disease, and in one
case certainly with complete recovery.
Hr. Doebellin reported on
Eleven Cases of Injury to the Extensor Apparatus
of the Knee
that had been treated in the Charite since 1896. Ten
were cases of complicated fracture of the patella, most of
them came under treatment at once, and in all cases
sutures were applied openly. The results were extra¬
ordinarily satisfactory in all. The same gentleman
showed a woman who, in 1893, was operated on for
Phlegmonous Hernia, the Contents of which were
Bladder Wall.
In 1898 a protrusion had been observed in the old
cicatrix for some time from whioh a warm fluid trickled.
She was admitted into the Charite, and three hours
Digitized by
Google
352 The Medical Pbebo.
THE OPERATING THEATRES.
Oct. 4, 1899.
after the commencement of the symptoms it was seen
that the thin bladder wall had perforated into the
cicatrix, and that about 80 ctm. of small intestine
had become prolapsed. Theee after careful cleansing
with physiological saline solution were replaced, and
recovery was uninterrupted, although a large colony of
staphylococc us aureus grew afterwards upon the agar-
plates that h ad been pressed upon the prolapsed intes¬
tine before their replacement. The cicatrix had again
become thin, but the patient would not agree to any
further operation:
Hr. Franke showed a man with
Ruptured Urethra
in consequenc e of fracture of the pelvis. Urethrotomy
was performed, and the urethra was found torn through its
whole circumference. The proximal end which lay about
8 cm. from the distal, could not be drawn down to allow
of the two ends being united by suture. The bladder
was therefore drained through the perineum ; later on
the tube was withdrawn, and the wound healed by
granulation.
There was now no fistula, the whole of the urine
passing by the natural orifice, and a bougie could be
easily passed along the whole of the urethra, and as this
could be done without drawing any blood, it showed that
the whole tract was properly covered with epithelium.
Qnfstxi*.
[prom our own correspondent.J
ViBHHi, September 30th, 1869.
Cinnamic Acid and Tuberculosis.
For some time past cinnamic acid has been used in
the wards of Prof. Stoffella in cases of tuberculosis with
considerable advantage, and in order to bring thin form
of treatment before the profession at the very earliest
date, the professor undertook to write an article on the
subject for one of the Vienna journals.
This new drug was held out as a specific in the cure of
tuberculosis according to the records given by his assist¬
ant, Dr. Hoff. During the following week a letter
from Feodor 8chmey, of Upper Silesia, appeared in
the same journal disclaiming Stoffella as the clinical
discoverer of this drug, and referring him to papers
written on the subject a year since. From these
records it seems that cinnamic acid has been used
in the treatment of consumption for a very long
time, and haB been administered in the form of
“ Pern-Cognac,” which contains five grammes of
cinnamic acid in a litre, or seven grains to the ounoe.
To-day Stoffella humbly apologises, but repeats his
perfect confidence in the results obtained from his clinical
observation.
Infarcts in the Liver.
Professor Chiari has so frequently met with infarcts
in the liver that he now pauses to ask the reason why, as
they seem to him to be principally due to a mechanical
effect produced in the vena port, and the hepatica
artery. These conditions he divides into sources:—(1)
the closing and contracting of a large branch of the vena
port accompanied with feeble action of the left
ventricle and a congested state of the venous system of
the body which would produce a congestive hyperemic
centre, or the so-called atrophic infarct, also known as
Zahn’s “red infarct.” In its description it cannot be
differentiated from the common congestion usually met
with. This form develops rapidly and may remain
stationary for a long time, ultimately producing in¬
duration like other congestions of the liver, or it may
recede and disappear altogether. Closure of the inter¬
lobular branches will not produce analogous hyperemia,
but tying or thrombotic closure of the trunk of the vena
portae will produce the same cyanotic atrophy and in¬
duration of the whole liver. Chiari describes 17 cases
he has recently investigated, all occurring from hyper-
femio congestion, the result of ooolusion of the vena
port®; 15 of these’had the characteristic “ atrophic red
infarct.” In all, the heart’s action was feeble during
life. In none were the branches of the vena portae
closed.
The second class of cases is due to closure of the
smaller interlobular branches of the vena port®, with
multiple necrotic centres in the liver with or without
htemorrhagic centres, or amende or haemorrhagic infarcts.
He recorded a number of cases under this head occur¬
ring from emboli and thrombosis of the smaller inter¬
lobular branches whose clinical history all point to
eclampsia puerperalis before death. Schmotely con¬
cluded that this eclampsia was due to a toxin produced
by the coagulation of the blood in the liver.
The third class is due to the alteration in the liver
cells and neighbouring structures, with necrosis of the
vascular tissue producing ancemia and haemorrhagic in¬
farcts in the liver and closing the smaller branches of
the arteria hepatica. This form of infarct is evidently
due to the closing of the vascular system and arteria
hepatica propria with ultimate necrosis of the liver. He
illustrated this class by appropriate examples.
Cardiac Changes in Chlorosis.
Gautier records 22 cases of chlorosis in whom 20 of
them had all the dimensions of the heart increased, viz.,
enlargement of the cavity, extension of area, and hyper¬
trophy of the cardiac muscle.
In a large number of the cases these increased
dimensions and the chlorotic pallor receded after a
short course of treatment. In discussing the cause of
the dilatation and hypertrophy Gautier attributed the
entire blame to the reduced functional action of the
cardiac muscle which disabled it from fulfilling its
proper function in the inoculation.
<1 '\u (Donating ^Theatres.
KING’S COLLEGE HOSPITAL.
Stacbb’s Operation fob Suppuration in the
Mastoid Antrum. —Mr. Carlsss operated on a woman,
sat 28, who had been suffering from a discharge from the
right ear for eight weeks. The cause of the otorrhoea
was not very obvious; the initial attack was aoute, and
perforation must have occurred within a few dayB. On
admission, the discharge from the ear was not very pro¬
fuse, but the patient had the evidences of mastoid suppu¬
ration, which bad been evident for about a week;
the temperature ranged about 100 degs., there was some
headache, and the tissues lying over the mastoid prooees
were congested, pulpy, and cedematous. The right disc
was a little hazy, the patient was occasionally Bick, and
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THE OPERATING THEATRES. Tn Medical Press. 353
Oct. 4, 1899 .
seemed a little doll. Dr. Pritchard had seen the case,
and agreed that it was one for immediate operation.
The patient having been anaesthetised an incision
was made behind the ear immediately posterior to
the crease of skin at the base of the auricle; the
tissues were thick and infiltrated, but there was
no pus superficial to the bone. The auricle was
stripped up and drawn forward so as to expose the
posterior margin of the meatus and the supermeatal
spine. A triangular hole was now cut into the bone by
a small chisel about a quarter of an inoh broad imme¬
diately below the spine, and at the first stroke of the
mallet the chisel entered the antrum, the external wall
of which was not more than a line in thickness, and pus
escaped at once. The opening in the outer wa’l of the
antrum was enlarged by cutting pliers, sharp spoon,
and gouge, and the limits of the cavity were defined,
by the probe. The whole of the outer wall of the posterior
part of this cavity was removed, and it was found that
there was no connection with the lower mastoid cells.
The passage into the attic was then carefully defined
with a probe, and the bridge of bone lying over this was
removed as far as the bony meatus, so that the tympanic
cavity and the antrum should be freely opened super¬
ficially. Both these cavities were well curretted, and
all granulation tissue removed therefrom. The carti¬
laginous meatus was separated from its posterior
attachments, and its deepest portion incised in a T-
shaped manner, the corners at the base of the T being
cut away with scissors, the cavity thus formed was well
flushed with 1 in 60 carbolic lotion, and packed tightly
through the meatus with iodoform gauze. The auricle
was then replaced and the inciiion closed with stitches.
Mr. Carless said that this was by far the most
satisfactory plan of dealing with suppurated mas¬
toiditis ; by its mean b the antrum and tympanic
cavity could be thoroughly curretted and well drained
through the meatus, which was enlarged for the
purpose, all the dressings being subsequently con¬
ducted through that passage. It was also advantage¬
ous from the oosmetic standpoint sinoe the scar was
hidden behind the ear, and the wound usually healed
by first intention. The greatest care had to be exercised
in order to avoid wounding the facial nerve,
especially when cutting through the narrow passage
leading to the attic. It was, he thought, always
advisable in these cases to keep a probe in the passage,
and never to cut behind it. The anesthetist should also
be instructed to carefully watch the patient's faoe for any
sign of twitching as indicating that the nerve had been
touohed.
GREAT NORTHERN H09PITAL.
Double Ovaeiotomt. —Ms. Petton Beale operated
on a woman, ret about 30, who had been admitted with a
very large abdominal tumour of three months’ duration.
The only history obtainable was that the abdomen had
gradually and steadily enlarged, with amenorrhoea, for
the last two months. On admission, the abdomen was so
tense that respiration was extremely difficult, and an
immediate operation was deemed neoessary. The abdo¬
men was therefore opened in the middle line, and a large
left ovarian cyst immediately presented. This cyst was
about thirteen inches in diameter, and seemed
to completely fill the abdomen. Some of the
fluid was withdrawn, and the oyst pulled freely
out of the wound; it was then seen that there were
several smaller cysts springing from the same ovary,
and the ovary, together with about one inch of the
Fallopian tube, was removed. It was then found that the
right ovary was also cystic, consisting of one cyst about
the size of a festal head, together with two smaller ones.
The same course was adopted with these. On examining
the ovaries after removal no trace of any new growth
could be seen in connection with them or with the
cysts. Unfortunately they were not examined by the
pathologist. Mr. Beale said that owing to the
patient's condition he did not feel justified
in attempting to shell out the cysts; more¬
over, there appeared to be very little ovarian
tissue present, and under these circumstances be
deemed it advisable to remove both ovaries and their
tubes, which were firmly adherent to the smaller cyst.
Prior to the operation the abdomen was so tense that no
physical signs of fluid contained within the cyst wall
were obtainable ; in fact, the only thing which could be
ascertained for a certainty was that the mass was un¬
connected with the uteruB. 'The abdomen was closed in
the usual way without drainage.
The patient made an uninterrupted recovery, and left
the hospital in three weeks after the operation in good
health.
It is interesting to record that this patient was re-'
admitted three months later suffering from numerous
solid nodular tumours in the abdominal cavity and
scattered throughout the abdominal parietes, including
many in the skin. She was suffering great abdominal
pain, and had great difficulty in passing water. On
examining the bladder with the hand the organ was
found to be nearly filled by a hard nodular mass. Per
vaginam the vagina and uterus were both freely in¬
volved in a new nodular growth. Per rectum Douglas’s
pouch was filled with the same growth, and the walls of
the rectum also. An exploratory laparotomy was per¬
formed, and it was then found that the whole of the
mesentery was the seat of what appeared to be multiple
sarcomata, the whole of the parietal peritoneum wa9
likewise studded, together with the bladder, uterus,
kidneys, liver, and spleen. The patient died about a
week subsequently, and the growths were found on
microscopical examination to consist chiefly of myxo¬
sarcoma. Mr. Beale afterwards said this case showed
how very important it was not to lose sight of oases
which had undergone ovariotomy. It was only by accident
that the woman presented herself at the hospital a seoond
time, for she had been admitted to another institution
and transferred to the Great Northern when it
was found that a previous operation had been performed
there. The case was of interest, because at the first
operation there was no trace whatever of any new growth
in any of those parts found subsequently to be affected,
nor were any of the cyst oontents permitted to escape
into the abdominal cavity, and, seeing that the whole of
each ovary was removed, it must be assumed that the
malignant growth started in the peritoneum, and then
spread to the various viscera. He laid stress on the
fact that at the first operation he had carefully examined
all the abdominal visoera, as he said that it was most
important that this should always be carried out
as a matter of routine, especially in cases of ovarian
disease.
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354 Ths Medical Press.
LEADING ARTICLES.
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Letters in this Department should be addressed to the Publishers.
^Lhe Jttcbkal frcss attb (Circular.
“ SALUS POPOLI SUPEEMA LEX.”
WEDNESDAY, OCTOBER 4, 1899.
THE LEICESTER GUARDIANS VERSUS THE
LOCAL GOVERNMENT BOARD.
The crop of troubles sown by Mr. Chaplin’s
revolutionary Vaccination Act is springing up with
remarkable quickness and vigour. It is now two
years since that most retrograde of measures was
indelibly stamped upon the archives of Mr. Balfour’s
administration. The reasons of the concession to the
clamours of a noisy section of faddists was obviously
political, that is to say, with a view to ingratiate
popular prejudice, and thereby to catch votes at :
future parliamentary elections. At the time when
the Bill was before the House, we ventured to
predict that so far from conciliating the anti¬
vaccinationists, the proposed measure would
simply encourage them to demand an ell for every
inch they had been granted. That expectation has
been amply fulfilled by the subsequent course of
events, which has brought about that most undesir¬
able of all constitutional maladies, to wit, a direct
conflict between local authorities and the Local
Government Board. Half-a dozen boards in diffei’ent
parts of the United Kingdom are up in arms because
Mr. Chaplin, in order to keep any semblance of con¬
trol over the unvaccinated in anti-vaccinationist
districts, has been obliged to take the extreme
step of asserting the vaccination officer’s inde¬
pendence of his own local authority, so that all
prosecutions are to be undertaken under the
tegis of the Central body at Whitehall, and indepen¬
dently of guardians on the spot. This state of affairs
is certain to be resented by all Englishmen, who
have always asserted the powers and rights of the
purse. Those who pay the vaccination officer, they
Per. 4, 1899.
maintain, have the right to direct his actions in so
important a matter as the undertaking of legal pro¬
ceedings. That position is made possible only by
the tacit admission contained in Mr. Balfour’s Act
that the doctrine of conscientious objection to vac¬
cination is sound and can be maintained by the
individual at all hazards to the welfare of the com¬
munity. At any rate, the dissenting boards of
guardians have refused to engage or to pay a
vaccination officer who is not under their complete
control. Leicester, which has always been a strong¬
hold of the anti-vaccinationists, has defied the re¬
peated directions and warnings of the Local Govern¬
ment Board. A mandamus has now been served on
the Leicester Guardians, and if, as appears likely to
be the case, they prove obstinate, before Christmas
they will be lodged in gaol. A greater triumph than
the threatened martyrdom could not be imagined for
the Anti-vaccinationists; but it is to be hoped that
the close of the nineteenth century will not be
destined to witness so undignified a proceeding. At
the same time we profess no feeling of sympathy with
Mr. Chaplin in his present troubles. Small-pox, before
the introduction of vaccination, caused a mortality of
7 to 9 per cent, of persons buried in London during
the seventeenth and eighteenth centuries, a mortality
that rose in epidemic years to 15 or even 18 per cent.
Contrast that terrible state of affairs with the fact
that since 1885 London has been almost immune
from the ravages of that loathsome malady. This
improvement, in the opinion of most modern autho¬
rities in preventive medicine, was in the main due to
compulsory vaccination, but it is this benefioent
instrument that has been deliberately pithed and
undermined by Mr. Chaplin’s weak-kneed attempts
at statesmanship. The need of an adequate
representation of the medical profession in both
Houses of Parliament was never more apparent than
| in the history of this last Vaccination Act. Nemesis,
however, has followed hard on the heels of legislation.
A stand-up fight is taking place between the local
authorities and the Central Government, and has up¬
set the great guiding principle of conciliation that
has become a first law in national administration.
The anti-vaccinationists are greedy for fresh conces¬
sions, and are eagerly clutching at the crown of
martyrdom now dangled before them by Mr. Chaplin.
The Government that hoped to catch the votes
of dissentients from vaccination are likely
to rouse their bitterest opposition, for grati¬
tude is as little known to the faddist as
reason. Lastly, it remains to be seen what the ful¬
ness of time will bring forth with regard to the
disease around which so much social and legislative
conflict has been waged. If the anticipations of
some of our sanitary experts be correct the future
outlook is not free from grave anxiety. There are
many matters of preventive medicine that press for
treatment at the hands of Government. If, how¬
ever, the administration that passed their Vaccination
Bill in the teeth of universal scientific condemnation
are inclined to push that disastrous policy, it is to be
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LEADING ARTICLES.
The Medical Press. 355
Oct. 4 1899
hoped that they will be turned from the error of their
ways and in future will confine their energies to
class legislation and to a spirited foreign policy.
The voice of science is the voice of truth, and cannot
be disregarded by any government without the
certainty of near or remote disaster. It is to be hoped
that one day a large portion of the treasure now
spent by Great Britain in acquiring and protecting
foreign countries may be spent upon preventive
measures that affect so deeply the general welfare of
ourselves and our o. fellow countrymen at home.
A PROCTOLOGISTS VIEWS ON CONSTIPA¬
TION.
The average physician usually views constipation,
so to speak, from the mouth, and treats it accord¬
ingly. In a recent number of the New York Medical
News, Dr. A. B. Cooke deals with the subject from
another point of view, that of the proctologist, one
of the latest additions to the category of specialists.
It is necessary, to begin with, to distinguish clearly
between constipation and mere costiveness-
Neither hard stools nor dry stools, nor other
kinds of stools, he tells us, constitute constipa¬
tion, for these expressions are merely descriptive of
physical properties, and costiveness embraces them
all. Correctly speaking, constipation is the condi¬
tion of which costiveness is merely a symptom.
Costiveness adds the author, is not necessarily a
disease which constipation always is, and, though
usually associated, the former may exist without the
latter. Then, again, constipation is a relative term,
seeing that remarkable differences in individual
habits are not incompatible with ordinary health,
and, while two motions daily may be the normal
output for one person, another may find life
tolerable with an interval of days, and even weeks,
between the alvine dejections. These considera¬
tions lead us up to a definition of what con.
stipation really is, viz., a diseased condition of the
alimentary canal characterised by a modification of
function which results in the pathological retention
of fiecal matter. We are all of us acutely conscious
of the importance to the maintenance of a proper
standard of health by methodical evacuation of the
intestinal contents, and we can appreciate the
appositeness of the remark attributed to “ the old
physician,” that if his bowels moved naturally he felt
sure that he would not die that day. In the hurry
and turmoil of modern life, particularly in our large
cities, attention to this function is made a matter of
convenience, and disease is the harvest of neglect.
One of the most obvious and familiar causes to
which the author calls attention is the habitual use
of purgative medicines, fostered and encouraged by
conscienceless advertisers whom he would gladly see
suppressed by legislative enactment. In this country,
at any rate, public opinion, we fear, is not yet ripe
for legislative interference with the intestinal func.
tions, but undoubtedly the medical profession, by
educating the public on this matter, might accom¬
plish much. Without going into the details
of the author's elaborate classification of the
causes of constipation, there is one point
which is specially worthy of attention, viz.,
painful affections of the anus. Defsecation is
largely a voluntary process, and the prospect of acute
pain unquestionably acts as a deterrent which tends
to the formation of a disastrous habit, productive of
further local mischief and constitutional disturbance.
Even more, the consciousness that defeecation is
going to be painful has a directly repressive effect on
peristaltic movement, thus fostering a tendency to
fascal accumulation. We emphasise this fact
because minor, but nevertheless painful, affec¬
tions of the anus do not, perhaps, receive the
attention which they merit from this point of view.
The practitioner is but too apt to accept the patient's
bashful, incomplete statements without taking the
trouble to ascertain for himself the condition of this
aperture. We would impress upon him the desira¬
bility of his cultivating proctology as an accomplish¬
ment, for by so doing he will be enabled to remedy
many cases of obstinate constipation, and to save
his patients much avoidable suffering.
THE WINTER SESSION.
The opening of the Medical Schools for the winter
session seems to have been shorn of part of its
importance as an academical event by the fact that so
many students now find it advantageous to com¬
mence their studies in May instead of October. More¬
over, the [ceremonial with which in years gone by
teachers and students were wont to invest the occa¬
sion has been greatly curtailed, indeed, in about
half the schools, not even the time-honoured intro¬
ductory lecture has been maintained. The truth is
that this lecture has become a burden too great to be
borne, either by the younger member of the staff,
upon whom the irksome task devolved, or by the
students who had to listen to it, at any rate, after the
first time. Occasionally the services of an oratorically
disposed outsider have been requisitioned, but the
experiment proved a hazardous one because no lay¬
man could possibly l>e in a position to discuss the
aspirations of the medical profession in any save the
most general way, and there are too many ethical pit¬
falls into which the unwary and the inexperienced-
might fall, to the confusion of their sponsors. Still-
the opening of the winter session cannot but be a red-
letter day in the calendar of the neo-student. It is
the occasion on which he is first introduced to his
new and strange surroundings, and comes into
contact with the men with whom he will, for
five long years at least, have to work cheek by
jowl. It is some time of course before the new
student can find his way about, and still more
before he begins to feel at home. He soon learns to
appreciate the abyss which separates him, a first
year’s man, from his fellows of the second and subse¬
quent jears; indeed of the latter he sees very little,
they having abandoned the dissecting room and
physiological laboratory in favour of the wards
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356 Thk Medical Press
NOTES ON CURRENT TOPICS.
Oct. 4, 1899.
Before he has recovered his equanimity the new
student has to run the gauntlet of the secretaries of
the various athletic clubs to which he is cordially
invited to subscribe, an invitation which he has
seldom the courage or even the desire to withstand,
glad as he usually is to sink his individuality in an
organisation of some kind which shall mitigate the
lonesomeness of the d/but. Then he has to
set about providing himself with books and
instruments, and we get the petite bourse where
superannuated editions and implements are offered
for sale by the wily seniors. After taking cognisance
of the schedule of lectures, the hours at which they
are to be delivered, and the various ways in which the
day8 are to be employed, the new students pair off,
Borne to set their lodgings in order, others possibly to
places of refreshment or amusement by way of
inaugurating the new life. And there we leave them
with all the novelty of their career fresh upon them,
full of hopes and aspirations, in some instances to be
amply fulfilled, in others condemned beforehand to
disappointment.
tflotte mt Current
The Use of Diphtheria Antitoxin in
Australia.
Db. Ramsay Smith, Senior Physician to the
Adelaide Hospital, South Australia, has been taken
to task by a medical man in the Colony for not treat¬
ing diphtherial patients under his care in the hospital
with antitoxin. The criticism was based upon a
statement of Dr. Smith’s to the effect that antitoxin
had never been used, and there had never been a death
from diphtheria in the hospital. Whereupon the some¬
what out-spoken comment of the practitioner was: “ I
must conclude that either the diagnosis was greatly
at fault or that Dr. Ramsay Smith has had phenomenal
good fortune, or that some other method of treat¬
ment has been employed which has not occurred to
the rest of us poor mortals, and which is only vouch¬
safed to and permitted to be used by such deified
individuals." The burden of the criticism further
proceeds "the public have a right to expect that
they will be treated in a public institution by the
most up-to-date and approved methods, and that a
medical man holding such a responsible position as
Senior Resident Physician will be cognisant of, and
ready to use, all the latest and best known remedies.
In a letter to an Australian contemporary, Dr-
Ramsay Smith publishes a spirited reply. He
explains that the credit of the good results of the
treatment of diphtheria at the Adelaide hospital is
due not to him, but to the Hon. John A. Cockbum,
M.D., the present Agent-General for South Australia,
and that if the criticising practitioner desires to
learn what the method of treatment is, it will only
be necessary for him to attend at the hospital, and
ascertain for himself. No doubt, many in this
country would be glad to be informed as to this
method, and Dr. Smith would be conferring a favour
upon the professon generally by making known
through the medium of a medical journal the means
by which he is able to obtain such successful results
in diphtherial cases without resorting to antitoxin-
Clearly there can be no necessity for using the anti¬
toxin, even in Australia, if other means can be
employed which prove to be equally successful. We
trust to hear more from Dr. Ramsay Smith upon this
subject.
Bile as an Antiseptic.
It is an experience common to all progressive
learned professions to witness a constant dismissal of
beliefs as their knowledge of exact law6 is extended.
In the medical world to-day’s abandonment of yester¬
day’s entrenched position is a lesson acquired by the
student before he is out of his apprenticeship. For
all that, it will come to the middle-aged practitioner
as somewhat of a shock to be required to unlearn the
conviction impressed upon him in bis earlier days
that one of the functions of the bile in the human
intestine was its action as an antiseptic. The
chief reason for that cherished conclusion was the
observation that the fasces became particularly offen¬
sive when the flow of bile was obstructed. A German
investigator, Morse, has made an experimental
research into the power of bile to control the pro¬
cesses of putrefaction and fermentation both inside
and outside the body. Briefly summed up, the con-
elusions were that bile exerts no influence on the
putrefaction of albumen in the intestine; that the
presence of bile apparently increased the bacterial
putrefaction of albumen outside the body : that fer¬
mentation of carbo-hydrates was increased in the
presence of bile, and that concentrated bile retarded
the growth of bacteria, but the action ceased after
twenty-four hours. These experiments are of suffi¬
cient suggestive importance to demand careful test¬
ing. The fact that a great deal of intestinal diges¬
tion appears to be carried on by bacterial agency
would, if proved, go a long way to disprove the
assumed antiseptic properties of bile. It should be
remembered, however, that the teachers of a genera¬
tion ago were not in possession of the data afforded
by modem bacteriology.
Coroners' Courts.
Grim though its purpose be, the coroner’s court
but too often sadly lacks the dignity which magis¬
trates and judges contrive to import into the proceed¬
ings in their respectives spheres of influence-
For this the satellites of the presiding genius
are to some extent responsible. The coroner’s
officer, for example, has a nasty little habit
of soliciting gratuities from son-owing rela¬
tives, the mortuary keeper follows suit, and last, but
not least, there is the crowd of seedy looking soi
disant reporters who assemble when there is any
family scandal, and who hold out itching palms to
be covered as the price of silence in the press, a
bargain which, even when made, is not un-
frequently violated, to the distress of the rela¬
tives who were hoping to be spared the further
Digitized by Google
Oct. 4, 1899. NOTES ON CURRENT TOPICS. Tk* Medical Pbess. 357
pang of publicity. Even professional witnesses are
not exempt from the attentions of the coroner’s
officer who, as cashier, seldom fails to lay siege to the
odd shillings when paying over the fees, a pretension
which every self-respecting medical man shonld take
care to resent. A coroner’s court is a gruesome place
at best, but the presence of these callous solicitors
adds considerably to its repulsiveness. Coroners
themselves might do much to purify the courts from
these flaws, especially by selecting their officers from
among a less venal class of men, or, at any rate, by
repressing their tendencies. In this they would
certainly receive the support of the constituted
authorities, and the hearty approval of public opinion.
Homoeopathic Assurances.
In the course of a series of lectures on the homoeo¬
pathic treatment of tropical diseases reoently de¬
livered by a Dr. Hayward, some very remarkable
statements were made which, we fear, would not bear
close scrutiny. We are told that while the average
mortality from yellow fever is 27 - 7 per cent,, the mor¬
tality under homoeopathic treatment is only 7. As
the actual statistics are not given in the report before
us we cannot very well criticise them ; but we should
imagine that the number of patients suffering from
this fell disease who underwent homoeopathic treat¬
ment must be far too small for it to be possible to
base any trustworthy conclusions thereupon. A
similarly bold and equally unauthenticated state¬
ment is made in respect of cholera. Coming to
typhoid fever we are assured that, though a germ
disease, homoeopathic medication does much to
modify the course and shorten the duration thereof.
Statements such as these may pass muster with the
uncritical laity, to whom the lecturer was addressing
himself, but must excite contempt among those
who know what little influence purely medicinal
treatment has in any of these diseases. It is this
very want of candour on the part of the practitioners
of that ilk which makes it well-nigh impossible for
self-respecting practitioners to meet them on cordial
terms, and so long as the arts of the mountebank are
resorted to to boleter up this particular system so
long will its adepts be ostracised by their fellows.
It goes without saying that if homoeopathy accom¬
plished even a fraction of what its advocates claim
for it, it would long since have brushed all alternative
methods of treating disease out of the field.
Mr. Chamberlain and the Malarial Inquiry.
It would seem that some friction is likely to ensue
between the Liverpool School for Tropical Diseases
and that which is being organised in London. It
will be remembered that the whole inquiry into the
question of the malarial bearing mosquito has been
carried on by Major Ross, in connection with the
former School, and that the Malarial Commission
sent to the Gold Coast by the Liverpool School
authorities is, under Major Ross, still prosecuting
its inquiry. Despite, however, the valuable work to
*hich this Commission has specially devoted its i
energies, it would appear that quite recently a '
despatch was sent by the Secretary of State for the
Colonies to the presidents of the various colonial
branches of the British Medical Association, and
among them the branch at the Cape of Good Hope,
requesting that medical men practising in tropical
lands should send specimens of the various species
of mosquito, in malarial districts, for investigation to
the School of Tropical Diseases in London. This
fact, taken in conjunction with the refusal of Mr.
Chamberlain to grant any official assistance to Major
Ross’s inquiry, appears to be rather significant.
Clearly, if the Liverpool School of Tropical Diseases
requires official assistance, it should be granted. Why
should the Colonial Secretary favour the London
school? Each school is working upon the same lines
and has the same objects in view, namely, the dis¬
semination of the knowledge of tropical diseases. To
encourage, however, any rivalry between the two
institutions is a policy which c ann ot be deemed Wise,
and we, therefore trust that in the future the Secre¬
tary of State for the Colonies will be careful to
extend the same patronage and assistance to the
Liverpool school, as in the past he has done to that
established in London.
English Medical Men in the Transvaal
The Boers are no res pec tors of persons, and their
treatment of English medical practitioners with
whom they may happen to have a grievance leaves a
good deal to be desired, as the following example will
show :—A practitioner was summoned to attend the
little child of a Boer, but refused to respond
to the summons inasmuch as another medical
man had charge of the case. In consequence of this
refusal the Boer lodged a complaint against the
practitioner at the next meeting of the local govern¬
ing body of the district. Accordingly, a resolution
was passed by the latter pledging the members thereof
to boycott the practitioner, and a young practitioner
from a neighbouring part was invited to settle in the
district, and was promised the support of the local
authorities. This perfectly unwarrantable step was
taken merely because the medical man in question,
by acting in accordance with professional usage, dis¬
pleased a person who was the patient of a confrfre.
Medical practice under such conditions could scarcely
be enviable, but now the time seems to have arrived
when old scores will have an opportunity of being
paid off.
An Anti-Vaccination Congress.
It is absolutely essential for the anti-vaccination
faddists to keep on moving, and continue to make a
show of resistance to Jenner’s prophylactic. The
latest information respecting their movements is
that they intend to hold an International Congress in
Berlin in the course of a few weeks, at which it is
anticipated that representatives from all the Euro¬
pean countries and the United States will be present.
Moreover, it is announced that “ Doctor ” Phelps, of
London, will address the Congress. We confess
that this is the first that we have heard of
such a gentleman. Probably an ardent anti-vacci-
Digitized by Google
358 The Medical Press.
NOTES ON CURRENT TOPICS.
Oct. 4. 1«U9.
nationist of this name, who is generally described
with a military title, is here meant, and if so, we
would suggest that he would be better employed in
volunteering for service in South Africa than in dis¬
seminating nonsense upon public platforms. How¬
ever, some satisfaction may be derived from the fact
that probably the anti-vaccinationists have been
woefully disturbed by the recent progress of vacci¬
nation in this country, as shown by the official
returns. The Act of 1898 was a concession in their
favour, and the results of its working must have
greatly astounded them. Indeed, judging from the
official returns, despite the conscience clause, vacci¬
nation seems to have been made more or less popular
by the Act of last year. Thus, Lord Lister’s “ tremen¬
dous experiment ” has proved, quite beyond expecta¬
tion, to have been an excellent thing. All that is
now wanted is for the anti-vaccination party to enter
upon a well-earned retirement, and thus, with as little
fusB as possible, admit their defeat.
The Medical Society of London
The 127th session of the Medical Society of London
will be inaugurated on Monday next, October 9th,
by an address to be delivered by the President,
Dr. Frederick Roberts. This will be followed by a dis¬
cussion on “ Personal Experience in Relation to Serum
Therapeutics and Antitoxin Treatment.” It is
announced that the Lettsomian Lectures on “ Cancer
of the Breast ’’ will be delivered in March and April
by Sir William Mitchell Banks, and the Oration in
May by Dr. Kingston Fowler.
How are We to Peed our Babies.
The question of the proper feeding of babies is
one not only of weight to the individual, but of the
utmost collective importance to the community.
Healthy babies mean a healthy nation, and vice versa.
Of course, it may be taken as an axiom that the
proper food for the infant is mother's milk, nothing
more and nothing less, but unfortunately Nature’s
pabulum is not always available under the stress of
modern civilised life. Then comes the great problem
which heads this paragraph, namely, How are we to
feed our babies P To that anguished question we
doubt if many medical men could give a clear and
properly substantiated answer. For some inscrutable
reason or the other the curriculum that exacts from
the student a minute knowledge of the finest ramifi¬
cations of remote branches of nerves and arteries,
does not ask for any proof that he has considered the
crucial point as to how the young of his species
should be nurtured. That is possibly because the
exigencies of consulting practice have not brought
the facts of the case before his examiners, who
are, as a rule, quite ignorant of the needs of general
practice. There can be little doubt that a well-
written aDd carefully edited summary of all kinds of
baby feeding, natural and artificial, would be of great
value to the general practitioner. We wonder when
the common sense of the main mass of the profession
will insist upon the rational education and examina¬
tion of medical students.
The Antidotal Properties of Permanganate
of Potassium.
The case with which permanganate of potassium
gives up its oxygen when brought into contact with
oxydisable substances renders it of extreme value as
an antidote in respect of many, if not indeed of mcst,
of the alkaloids. It is admittedly the most efficacious
agent we possess in cases ofj poisoning by opium and
its alkaloids, and it has been estimated that a given
weight of the salt will neutralise a similar quantity
of morphine. This valuable property, however, is not
limited.to alkaloids of the morphia series. Stokvis
recommends it as an antidote in poisoning by
phosphorus, which it transforms into orthophosphoric
acid. Autail has shown that it neutralises the toxic
properties of oxalic acid, the cyanides, strychnine,
colchicine, and muscarine. Lacerda long since re.
cognised it in the treatment of serpent bites, while
Durante and Giodano found it equally of service in
attenuating the symptoms resulting from the bites
of insects. Somewhat later Hugouneng demonstrated
its antidotal action in respect of caffeine, cocaine
and alkaloids of the atropine group, and still more
recently Paratore has shown that curare, nicotine
and aconitine are also destroyed thereby. Com.
parative experiments with the permanganate
show it to be far more trustworthy than
tannin or iodine in the treatment of strych¬
nine poisoning, whether employed hypodermi¬
cally or for washing out the stomach. It would seem
indeed that the permanganate is the agent par
excellence to which the physician ought to have
recourse whenever he is confronted with a case of
suspected alkaloidal poisoning. In view of these
marked antidotal properties, it is possible that the
administx-ation of permanganate might prove of
service in the frequent cases of ptomaine poisoning,
the lethal agent in these cases being presumably
alkaloids, alkaloids, moreover, which are peculiarly
susceptible of oxidation.
Workmen’s Injuries.
All humane men most welcome the principle of
compensation for injuries which is now enforced
under the Employers’ Liability Act; but the working
of the measure still requires amending in details
before the working-man will secure its intended
measure of justice. A case settled last week in
Marylebone County Court brings some of these
defects into relief. A workman engaged in cutting
mouldings by means of a machine slipped and fell
with his left hand against some rapidly revolving and
unguarded knives, whereby four fingers and a thumb
were instantly cut off. Plantiff was entitled, according
to the statement of counsel, to one pound a week for
life. The judge, however, fixed the sum of £200 to
be paid in full satisfaction of all claims by the plain¬
tiff against the defendant. With regard to that part
of the decision, most folk will be inclined to think
that defendant was let off very lightly in commu¬
tation of a life-charge ot a sovereign a week. Four
years’ purchase, for instance, would not satisfy the
learned judge who settled this case as a basis for
Digitized by Google
Oct. 4. 1899.
NOTES ON CURRENT TOPICS.
Th* Medical Press. 359
arbitration in selling a house, or in fixing
the amount of his pension. That is not all the fault
we have to find with Judge Stonor, however,
for in addition to awarding that comparatively trifling
recompense for so terrible a mutilation, he ruled that
no costs would be allowed. Anyone who knows
the cost of legal proceedings, especially when under
taken by poor persons on somewhat speculative issues,
will be able to form a pretty shrewd estimate of the
extent to which the £200 will be further whittled
down. A short amending Act is evidently needed to
establish the basis of commutation of : penalties, and
to make all verdicts against employers carry costs,
One would like to know if criminal proceedings
could not be instituted against the employers who
used the unfenced machinery.
_
Pills Fatal to Children.
An inquest held at Canning Town last week
upon the body of a child of thirteen has disclosed
some usually unsuspected dangers of home drugging
with chemists’ wares. The mother of deceased asked
a friend to get some magnesia, but instead of that
some pills were brought, and two of them were
administered to the child. A medical man was called
in later, but found deceased unconscious and
dying. He subsequently made a post mortem
examination of the body, and came to the con¬
clusion that death was due to collapse following
diarrhoea, caused by some irritant acting on
a delicate condition. The chemist from whom the
pills were purchased said that they contained capsi¬
cum and aloes, and were manufactured specially for
him. The jury returned a death from misadventure,
and added a rider requesting the coroner to call the
attention of the Chemists’ Society, or the proper
authorities, to this case, with the view of protecting
the public in the future. This attitude on the part
of the jury is somewhat unusual, for those bodies are
generally all on the side of the prescribing chemist.
At the same time, many rational men would feel
inclined to go a good deal further, and, after securing
a full analysis of the pills in question, to demand
legislative control over this reckless, irresponsible
vending of dangerous drugs by chemists all over the
United Kingdom. Not only do these tradesmen
encroach upon the ground that should be occupied
by legally qualified medical men, but by their illegal
prescribing they further constitute a standing
menace to the health and the lives of Her Majesty’s
lieges.
Medical Service in State at St. Paul’s.
On Thursday, October 19th, at 7.30 p.m., the
Bishop of Stepney will preach at St. Paul’s Cathedral
to the members of the medical profession. The Lord
Mayor of London will attend the service in state.
The service is the annual one organised by the Guild
of St. Luke, and is always a brilliant ceremony, as
many doctors who are graduates or Fellows of the
Royal College of Surgeons attend in academical
robes. The music will be rendered by a choir of over
two hundred voices provided by the London Gregorian
Association, so that the whole service is likely to be
most solemn, brilliant, and impressive. Admission
to the space under the dome will be by ticket only.
It is trusted that practitioners not wearing robes will
not be deterred from attending, as all are equally
welcome. On account of the great demand forseats
it has been found necessary to limit the number of
tickets issued for friends, and the executive committee
will be unable to grant more than one extra ticket to
those not wearing academical costume, and two to
those who have expressed the wish to wear robes and
join the procession. Application for tickets, with
information as to robes must be made on or before
the 8th inst., to the Registrar of the Executive
Committee, 24 Somerset Street, Portman Square,
London, W.
The Destruction of a Town for Sanitary
Reasons.
The Japanese are a go-a-head race, as everyone
knows, but they are about to achieve a record in
sanitation. The Government have just ordered the des¬
truction of a town, Teckcham, in Formosa, inasmuch
as sanitary experts have declared it to be unhealthy
and unsuitable for human habitation by reason of
having been built upon a swamp. The terms under
which the edict of the Government will be
carried out are somewhat interesting. A new
locality has been chosen for the town, and sites for
the houses will be presented to the citizens, occupy¬
ing as near as possible, the same relative position,
but the citizens will be called upon to bear the cost
of moving their belongings. Whether the community
in question are satisfied or not with the change
determined upon, the Government will cany it out.
The novelty, however, of the edict is somewhat
startling, and yet this record in sanitation is only
another instance of the enterprise and remarkable
progress shown by the Japanese nation.
The Remuneration of Public Vaccinators.
The old saying, “ 'Tis the number that pays ” has
been amply illustrated in the case of the public
vaccinator of Birmingham. For the half-year end¬
ing June last this official received for vaccinating
children no less a sum than £592 2s. 6d., which was
paid by the Birmingham Guardians. Pro rata this
means an income of £1,184 5s, per annum, quite a
princely amount to draw for public services of the kind
in'question. The payment was based upon the minimum
fee allowed by the Local Government Board for each
successful case of vaccination. But despite this fact,
the guardians think that the total amount
is excessive, and that the minimum fee should be
still further reduced. But Boards of Guardians are
very difficut to please. They appear to have over¬
looked the fact that it is far better to have paid their
public vaccinator yearly £600 for successful cases of
vaccination than for the people to remain unvacci¬
nated, and so expose the town to the risk of an
epidemic of small-pox, which might ultimately cost
the ratepayers £20,000.
Digitized by L^OOQle
MANCHESTER.
Oct. 4, 1899.
360 The Medical Press.
The Mill for Female Doctors.
It is evident that the chief centre for the manu¬
facture of female practitioners is Switzerland. Out
of a total of 1,153 students attending in the five Swiss
Universities, 344 were women, and of these only 24
were Swiss. Out of 247 students at Berbe 87 were
women; and out of 350 at Zurich 123 were females.
These figures have a serious bearing on the often
debated problem of the recognition of foreign medical
qualifications in Great Britain, for even the most
liberally minded educationalist must hesitate to admit
three hundred Swiss girl students annually to the
privilege of medical registration in this country, not
to speak of the crowd of those qualified in other
countries.
Typhoid and Dairies.
Thurles has been the scene of a serious outbreak
of typhoid which has been clearly traced to the milk
supplied from a local dairy, one of whose members
contracted the disease. Fifteen customers imme¬
diately showed symptoms of it, and some died, and
eventually, fifty other neighbours resident in the
immediate neighbourhood became infected. The
water consumed by these people was derived from
pumps within reach of infection, and it was ascer¬
tained to be polluted. At length the guardians
rose to the necessity of providing a safe water supply,
and the work has been put in hand.
PERSONAL.
M. Lacourt isthe first graduate to receive the newly
created degree of Doctor of Pharmacy of the University
of Paris. •
Mb. Harold L. Palmer, M.R.C.8.Eng., L.8.A., of
Newtown, North Wales, has been appointed a magistrate
for the county of Montgomery.
Dr. Francis Charlwood Turner, Physician to the
London Hospital, has had conferred upon him, honorit
causa, the degree of D.C.L. of the University of Durham.
Dr. Ricardo Joroe, the principal Medical Officer in
charge of the Plague Commission at Oporto, has asked to
be allowed to discontinue his work in connection with
the combatting of the plague, both on the ground of his
own state of health and of the hallucination of public
opinion.
Female practitioners cannot complain that they have
not fair play in Scotland. A few days since, the Hospitals
Board of Govan, a district of Glasgow, appointed Miss
Augusta Boyes, M.D., Ch.B., as resident physician to its
fever hospital, and the Edinburgh Victoria Hospital for
Consumptives appointed Dr. Anne Mercer Watson to be
resident physician.
Thebe are, doubtless, many among our readers who
have passed a portion of their time of study at the Uni¬
versity of Vienna, and will remember with kindly feelingB
the genial Professor of Medicine, Hofrath Dr. Theodor
Puschmann. The announcement of his sudden death at
the early age of fifty-six, will be received by them with
feelings of sincere regret. The deceased Professor wrote,
among other works, a " History of Medicine in Vienna,
during the last Hundred Years,” which was translated
into English.
gtoilmtD.
• [From Our Special Correspondent.]
“ Lord Kelvin, Professor of Natural Philosophy in the
Glasgow University, 1846-1899,” is the title of a volume
which Messrs. Maclehose, University printers, Glasgow,
announce will be issued shortly. The volume has been
in preparation for some time, and is to be published by
the desire of a number of Lord Kelvin’B friends. Pro¬
fessor Fitzgerald, of Trinity College, Dublin, has written
a biographical sketch of Lord Kelvin for it, with special
reference to hiB scientific work. It will also contain a
full account of what is of permanent interest in con¬
nection with Lord Kelvin’s jubilee, and appendices
giving the names of all those who were invited by the
University and the City to take part in these oelebrations.
There will be two editions, a special and an ordinary, and
the illustrations of the special edition will consist of
photogravures, including a portrait of Lord Kelvin, of
the old and the new college buildings, especially of those
g uidons of them more intimately associated with Lord
elvin’s name.
Death of Lachlan McPherson.— On Monday, Sep¬
tember 26th, Lachlan McPherson, Bedellus to the Glas-
w University, passed over to the majority, which will
regretted not only in Glasgow but throughout the
world where Glasgow students have made a home. At
the time of his death he had entered upon his 83rd year,
having been connected with the University for forty-six
years. During this long period he served under four
Chancellors, four Principals, sixteen Lord Rectors, and
more than two hundred professors. Four years
ago he celebrated bis golden wedding. A man of
fine presenoe, he bore himself with impressive stateli¬
ness in his publio appearance as bedellus. In his inter¬
course with students, he was the kindliest and most
encouraging of men ; most entertaining in his reminis¬
cences of olden timee in the old oollege in the High
Street, which made his listeners open wide their eyes
with pleasure and astonishment, and also of his more
recent experiences at Gilmore Hill. His funeral took
place on Friday last, at which the Principal and a large
assemblage of professors and the public were present.
A Windfall for Glasgow Charities. —By the will
of Mr. James Brown Thomson, of Glasgow, the charities
of that city have benefited to the extent of nearly
<£80,000. The University receives .£10,000, and the
Royal Infirmary .£6,000.
egftancht&tcr.
[from our own correspondent.]
St. Mary’s Hospital. —This old-established institu¬
tion for women and children is moving its home. The
foundation stone of the new hospital is to be laid by
the Countess of Derby on Monday, October 9th. It is
to consist of two portions, each distinct and furnished
with separate entrances. One will be devoted to
obstetric cases, the other to the treatment of diseases of
women and children. The hospital is intended to
accommodate 125 in-patients. Provision is to be made
for the training of medical students, nurses, mid wives,
and monthly nurses.
The Summer Mortality. —During the last fourteen
weeks 926 deaths have occurred in Manchester from
diarrhoea and English cholera, 713 being of infants who
had not completed their first year of life. The cooler
weather, however, is now having its effect, and last week
the deaths went down to 77, as compared with an average
Digitized by Google
Oct. 4, 1890.
CORRESPONDENCE. The Press. 361
of 114 for the sir preceding weeks. In addition to these
sixteen deaths were recorded with diarrhoea as a secon¬
dary cause.
Owens College.— The recently published calendar
shows the medical department to be in a flourishing con¬
dition. Of the 1,067 students of all departments, 428 are
“ medioos.” The medicine class numbers 115. As regards
examinations, 215 are working for the degrees of the
Victoria University, 47 for London, and 10 for other
universities. For the “ Conjoint ” there are 48 and 13 for
the “Triple.” In special departments there are 41
Dental, 11 Pharmaceutical, and 16 Publio Health.
The Introduction address of the winter session was
delivered on October 2nd by Sir Janies Crichton-Browne,
LL.D., M.D., F.B.S., on “ The Quest of the Ideal”
Royal Infirmary. —Various changes have recently
taken place in connection with the teaching staff. The
appointment of Dr. Reynolds will do much to strengthen
the medical side. Dr. Kelynack has been appointed
Medical Registrar in the place of Dr. R. T. Williamson,
who has resigned. Dr. Moore has been appointed to
succeed Dr. Kellynack as Pathologist. The new clinical
laboratory is in full work under Dr. Fothergill. The
discussion of the much vexed question of the new
infirmary site will shortly be reopened. A bust of the
late 8ir Joseph Heron has been presented to the
Infirmary Board. “James,” the head portei, will be
remembered by many generations of students, practi¬
tioners, and patients, for he has been a familiar figure
at the infirmary for forty-five years. He now retires on
a well-deserved pension.
Ctart&pmtflntcr
We do not hold ourselves responsible for the opinions of oar
correspondent*.
THE FORTHCOMING CONFERENCE ON
HOSPITAL REFORM.
To the Editor of The Medical Press and Circular.
Sir, —I feel some regret at the announcement
made in your last issue that Mr. Holmes is to take
the chair at one of the meetings of the association
interested in the Reform of Hospital Abuses. Some
years ago the Charity Organisation Society and the
British Medical Association combined and endeavoured
to supply what it was considered the working classes
most wanted—namely, some good system by which
medical and surgical advice and treatment could
be provided which would take the place of
the out-patient departments of our hospitals,
to which many resorted without any claim, and
by which much injury was done to the great body
of general practitioners. The relation between the
hospitals and the public through subscribers letters
was destroyed when the doors of out-patient de¬
partments were thrown open, and the fact that no
letters are required, was freely advertised. The greater
the number of out-patients, the greater was made the
claim of any hospital on the charitable public.
This abuse was not likely to be reformed by the
physicians and surgeons attached to them, and how far
Mr. Holmes and his friends succeeded by their
endeavours, they have not disclosed. If the great body
of medical practitioners throughout the country were
really suffering by the indiscriminate relief afforded by
hospitals, it will be well for them to act quite inde¬
pendently of those who are or have been con¬
nected with hospitals. It seems to me probable
that the want of funds will produce more effect on the
present defects of the out-patient system of hospitals than
anything else, and the best plan which practitioners can
adopt to assist in this is to use their influence with the
public by discouraging support to hospitals.
It is important that medical practitioners throughout
the country should be careful to avoid any charge that
may be brought against them of being influenced
chiefly by self-interest in their wish to
reform the abuses of hospitals. The question why
the public should prefer hospitals to practitioners is
to some extent due to the idea that specialism is pre¬
ferable in most maladies, and the general practitioners
have only been applied to when sudden illness or other
circumstances prevented patients from going to hospitals.
The very poor pay from clubs and the working class
generally has induced practitioners to look to the
middle and upper classes for remunerative practice, and
it seems now as if the reason why they are beginning
to attack the out-patient system is really because they
are losing this class of patient. Whether any system
can be organised to provide what hospitals supply at
reasonable rates, is the question of interest, and it would
be well to keep very clearly in view what are the publio
wants and how the profession must meet them.
I am, Sir, yours truly,
A Practical Reformer.
FEVER ACCOMMODATION IN DUBLIN.
To the Editor of The Medical Press and Circular.
Sir, —In an annotation on page 329, you speak of
Dublin having one special fever hospital of 120 beds (of
which about eighty are usually occupied). Cork Street
Fever Hospital—the only special fever hospital in
Dublin—has really 240 beds, and its convalescent home,
Benevin, has twenty-six beds. The average number of
beds occupied in Cork Street Hospital last year was
165*91, and during the present epidemics our numbers
have not fallen below 220. Your article alBO neglected
to mention that Sir Charles Cameron’s panacea was a
Corporation hospital of 80 beds !
I am, Sir, yours truly,
E. Macdowel Cosorave, M.D.,
Physician, Cork Street Hospital.
Gardiner’s Row, Dublin, September 27th, 1899.
[The number of beds available in Cork Street Hos¬
pital is stated in the latest edition of “ Burdett's Hospital
Annual ” as 220, and the average number occupied as 198
(seepage 201 of Annual). When writing, however, we
preferred to take the figures given in the report of the
Dublin Hospital Board published in the most recent
issue of the “ Irish Medical Directory,” and these state
the accommodation as we have given it— i.e., 120 avail¬
able beds, and 101 occupied on an average. The con¬
valescent home at Beneavin was not available at the
date of this report. It is scarcely necessary for us to
say that we never regarded the proposed isolation hos¬
pital as a substitute for, but rather as an auxiliary to,
Cork Street, the Hardwicke, and other existing fever
hospitals, and we think it is beyond question that such
additional accommodation is essential to meet the strain
of an epidemic. It appears to us that Sir Charles
Cameron’s estimate of .£250 per bed is excessive, but as
it appears that the Dublin Corporation is ready to throw
£28,000 of the citizens’ good money after the £91,000
already wasted in providing villas at £436 a piece for
well-to-do artisans we are not disposed to quarrel with
Sir C. Cameron’s scheme because it is somewhat extra¬
vagant.—E d.]
SANITARY REMOVAL BY FORCE.
To the Editor of The Medical Press and Circular.
Sir,—I see by this week’s Medical Press you take
exception to the way the law is set in force to carry out
the above Aot in London, but I think you do so under a
misconception.
I believe the Acts for England and Ireland are pre¬
cisely similar. In Dublin, when the Medical Officer of
Health for a district finds it necessary to put compulsory
removal in force, he fills up and signs a certificate setting
forth:—“-is suffering from a dangerous and infeo-
Digitized by CjOO^Ic
362 The Medical Press.
LITERATURE.
Oct. 4, 1899.
tious disease, and is without proper lodging and accom¬
modation,” which form he gives to the sanitary sub¬
official. The latter goes with this certificate to the
police court, and the presiding magistrate signs a
warrant for the removal. The sanitary sub-officer
without this certificate has no authority or power to act.
I am. Sir, yours truly,
Henry W. Oulton, M.D., M.O.H.
J7, Up. Fitzwilliam Street, Dublin,
September 30th, 1899.
(Dbituart).
SIE CHAS. ALEX. GORDON, K.C.B., M.D.
It is with sincere regret we have to announce the death
of Sir Chas. A. Gordon, at his London residence, West-
bourne Square, on Saturday last. Deceased was a
personal friend of the editorial staff of this journal, he
having contributed to its columns pretty regularly during
the past quarter of a century, and greatly attached him¬
self to all by his urbanity and great cordiality.
Immediately after qualification Sir Charles entered the
Army Medical Service, and probably saw as muoh
fighting as any officer during the present century. He
was engaged during the whole of the Indian Mutiny,
and had entire medical charge of the Army Medical
Service for many years before leaving India. On
his return to England he was sent on a special mission
by the British Government as medical representative
during the Franco-Prussian war, and was in Paris during
the whole of the siege and bombardment, at the
conclusion of which he published an exceedingly valu¬
able report in book form, entitled “ Lessons on Hygiene
and Military Surgery from the Franco-Prussian War”
(London: Bailliere, Tindall, and Cox), whioh created
considerable stir at the time, and is still referred to as
a standard authority on subjects with which it treats.
Sir Charles was a voluminous writer. He -wrote for the
love of it, and steadily declined payment for literary
work, the thought that he could impart useful know¬
ledge from his vast experience whioh might
benefit his fellow men was a sufficient incentive
to work, and throughout a long acquaintance
the writer of this brief notice can honestly affirm that
Sir Chas. Gordon was the most sincerely modest and
unobtrusive of men it has been his privilege to meet, a
gentleman in the truest acceptation. He was an officer
of the Legion of Honour of France, an Hon. Surgeon to
Her Majesty the Queen, held innumerable medals and
clasps, and was created a Knight Commander of the
Bath on the celebration of the Diamond Jubilee two
S ears ago. He was one of those to whom might have
een applied the epilogue to Horace, men who “ do
good by stealth, and blush to find it fame.”
5Caboratoi*!} Jlotrs.
INFANT AND INVALID’S FOOD.
We have received from the Infant and Invalid Food
Co., Ltd., Cereal Buildings, 54, City Road, London, a
sample of their “ I. and I. Food,” and find on analysis
that it has the following composition:—
Albuminoids 1181 per cent.
Moisture 8'08 „
Fat and Oil 3'19 „
Mineral matter 142 „
Fibre 1'12 „
Carbohydrates (by diff.) 74 37 „
A careful microscopic examination confirms the state¬
ment in the pamphlet accompanying the sample that
this food” is a carefully prepared mixture of various
oereals,” and also proved the absence of all moulds and
deleterious substances, and an undue proportion of
indigestible fibre or husk.
The analytical figures given above show that the food
contains a notable proportion of fatty matters, while the
nitrogenous or flesh forming constituents are present in
suitable proportions. The amount of moisture is by no
means excessive. The mineral matter consists almost
entirely of phosphates of calcium and potassium, which
are essential to normal nutrition, and are moreover valu¬
able as aiding the due formation of bone.
ARCHER’S COGNAC.
We have examined a sample of Eau de Vie Cognac,
imported by Messrs. Edward Archer and Co., Malvern,
and find on analysis that it gives the following
figures:—
Absolute alcohol (by weight) 40'o per cent, (or 83 - 9
per cent, proof spirit). The extractive matter is equal
to 0.64 grammes per hundred cubic centimetres. This
figure is consistent with the due maturing in a sherry
cask, which is part of the process in the preparation of
genuine brandy.
The acidity is "045 grammes per hundred cubic centi¬
metres calculated as tartaric acid.
The amount of ethers is equivalent to '04 grammes
per hundred cubic centimetres calculated as acetic ether.
This figure shows that the brandy has been duly
matured for a sufficient time to allow of the development
of thope volatile products on which the delicate flavour
and bouquet of the finished article depend.
We are satisfied that this brandy is of high quality,
thoroughly genuine, and worthy of commendation for
medical use.
TANNOFORM.
We have received from Merck’s London office samples
of Tannoform, a condensation product of tannin and
formaldehyde, which has come into use in the treatment
of hyperidrosis and bromidrosis, in virtue of its astrin¬
gent and antiseptic properties.
It is presented in two forms, the Tannoform Substance
and the Tannoform Dusting Powder. The latter is put
up in an ingeniously devised paper dredger, which facili¬
tates the dissemination of the powder evenly over the
affected surfaces.
Tannoform is not only a siccative antiseptic of the first
order, odourless and absolutely unirritating, but it
answers all the requirements of an intestinal antiseptio
for use in fermentative disturbance of the alimentary
canal associated with diarrhcea and gas formation. The
average dose for internal use is, in adult cases, eight
grains, and four grains in children’s cases, to be given in
the form of a cachet.
literature.
HOSPITAL REPORTS.
THE MIDDLESEX HOSPITAL REPORTS, (a)
The preface to this Report tells us that it is arranged
on the same plan as that of its predecessor. The plan
is all right, but we sincerely wish the volume had a stiff
binding that we might give it a place on our book-shelf,
and that it was not so closely printed. From time to
time we have to put the volume down, as we find a few
pageB of its closely printed statistics make our eyes ache.
We feel this all the more for the volume is rich in
information, weU arranged, and exceUently summarised,
but of what use is all this if the type is unreadable and
the paper back unfits the book for the book-shelf.
The work done during the year was large and creditable.
Such of the papers in the Report that we could read were
weU worthy of study, and yet for a small outlay this is
practically lost to the medical profession.
A severe headache and a series of coloured rings
before the eyes are too much to pay for the pleasure and
advantage derivable from reading the Report.
Of the latest of statistics the most interesting is the
P. M. Table with its abstract of 318 examinations. In¬
cluded in the last is an account of injury to the internal
mammary artery with wound of the pericardium and
(a) " Reports of the Medical, Surgical, and Pathological Regis-
1 trare for the Year 1897.’’ London: H. K. Lewis. 1898,
Digitized by
Google
Oct. 4, 1899
LITERATURE.
The Medical Press. 363
other by hydrochloric acid there were no excoriations
abont the mouth in either case.
From the Medical Registrar’s report we learn that
antitoxin was nsed in the treatment of diphtheria in nine
cases in 1894; in 29 cases in 1895 ; in 25 cases in 1896 ;
and in 17 casee in 1897. In two cases an erythematous
rash followed the administration of antitoxin, but other¬
wise no unpleasant results occurred.
ST. BARTHOLOMEW’S HOSPITAL REPORTS, (a)
The present volume of this great hospital’s reports is,
as a measure of the scientific advance of medicine, of
more than usual interest. These reports are really
the year-books of scientific medicine. They show the
prevailing type of sickness of the preceding year, they
give the effects of our social and domestic life on the
health; they show the influence of occupation, and they
give the most generally approved system of therapeusis.
The practitioner who reads the reports of the principal
era! hospitals is well prepared to successfully hold
own in these days of keen competition in the pro¬
fession.
Of the papers in the present volume the most inter¬
esting are Sir T. Smith’s “ Case of Abdominal Cysts ; ”
Mr. Walsham’s “X-Rays in Diseases of the Chest;"
“On Pneumonia and Pneumococcus,” by Mr. Turner;
“Stomachic Phenomena,” by Mr. R. Gitt; and Dr.
Andrewe’s article, “ The Growth and Work of the Patho¬
logical Department.” We may add, that for a pleasant,
chatty, well told record of a busy practitioner’s life, we
know none more enjoyable than that told in this volume
by Mr. H. S. Webb.
From the surgical report we learn that 3,746 surgical
cases were discharged, cured, or relieved during the year,
and that 219 cases died in hospital.
During 1897, anesthetics were administered 4,893
times, and it may interest those who, in season and out
of season, advocate ether, to know that only 201 cases of
etherisation are rf corded as against 1,969 chloroformisa-
tions. Ether, it thus appeals, was found suitable in no
more than 4 per cent, of the cases requiring an anesthetic,
whereas chloroform was used in almost 40 per cent, of the
casee, and this in London wher 3 ether is most zealously
advocated, to the exclusion, as far as possible, of
chloroform.
GUY’S HOSPITAL REPORTS. (6)
Th* present volume opens with a valuable article,
“Notes on Diagnosis," by Dr. Pye-Smith. It is a
practical contribution to clinical medicine, well worthy
of attention by practitioners and senior students. Indeed,
we should like to see it published in pamphlet form,
and in the hands of every senior medical student.
Mr. Jacobson and Dr. S. B. de Mesquita contribute a
joint paper on “ Epithelioma of the Neck,” probably aris¬
ing in a relic of the branchial clefts. “ Mediterranean
Fever,” by Mr. Gerald Sichel, goes over the familar ground
that for a century has been trodden by observer after
observer. In fairness to the author we must say
that he advances our knowledge of the disease by
showing that Widal’s serum method has materially
facilitated the diagnosis of the disease, and that a Mr.
Bruce has discovered its micrococcus. Needless to say,
an antitoxin has been prepared as a therapeutic remedy.
As we read of the continually occurring mention of
antitoxins we think we hear the emphatic pronounce¬
ment of Sangrado, “ medical reading is was to of time,
all treatment is but bleeding,” if for bleeding we substi¬
tute antitoxin injections we get much modern medical
practice.
The aggressive nature of surgery is well shown by Mr.
Gilford’s paper, “The Surgical Treatment of Unper¬
forated Gastric Ulcer.” He gives an account of three cases i
(a) “ Saint Bartholomew’* Hospital Beports.” Edited by Norman
Moore, M.D., and D’Arcy Power, F.B.C.S. Vol. XXXIV. London:
Smith, Elder and Co. 1869.
(1) “Gny'* Hospital Reports.” Edited by E. C. Perry, M.A.,
M. D., a nd W. H. A. Jacobson, M.D., M.Ch. Vol. LIII., being Vol.
XXXVill. of the Third Series. London, J. and A. Churchill.
1068.
in which operations were performed. As so many cases
of gastric ulcer get well under the ordinary treatment
of a regulated dietary and rest we cannot wholly
approve of this heroic method. We think the omission
of M. Dieulafoy’s name, and the ignoring the good work
he has done in this class of disease, is a mistake.
Dr. Poole’s account of the typhoid epidemic at Maid¬
stone occupies eighty pages, every one of which contains
instructive reading ; indeed, the article is one of per¬
manent value to medicine.
The functional activity of retained testicle is the sub¬
ject of a paper by Mr. G. Bellingham Smith. The author
arrives at much the same conclusion as the bath atten¬
dant in the “ Arabian Nights' Tales,” as told in
Burton’s edition.
ENCYCLOPAEDIA OF MEDICINE, (a)
This enormous undertaking by Hofrath Drasche has
now reached 183 parts, and is still far from being com¬
plete. The book is not a periodical, but a dictionary of
medicine, surgery, chemistry, Ac., comprehending all the
special departments recognised in the curative art. The
contributors exceed 200, engaged in the various special¬
ties, who are scattered over the two German
speaking empires of Austria and Germany proper. It
may be noted, by the way, that 46 of these authors, or
221 per cent., are located in Vienna itself. The other
representative towns and cities are Prague, Berlin, Halle,
Munich, Kbnigsberg, Buda Pesth, Warsaw, Frankfort,
Giessen, Ac. Each author confines himself to his own
specialty on which he professes to be an authority.
The views of other authorities from every quarter of the
globe are also added where a diversity of opinion exists,
so that this encyclopaedia of medicine, although written
by Germans, is not confined to views of the German
speaking race, but is a brief synopsis of the latest know¬
ledge for the specialist and busy practitioner who can
read the language.
Haug has among his “ Neoplasms of the Tympanum ”
a “ reflex neurosis ” associated with cough, sneezing,
Ac., that may be worth noticing as an example of the
exhaustive nature of the work and its practical utility.
This morbid condition is usually excited by the presenoe
of polypi in the recessus epitympanicus near the per¬
foration of the membrana Strapnelli. Troublesome
symptoms may be induced and much anxiety suffered
long before degeneration of the tympanum is manifested
and the real nature of the case diagnosed.
The prognosis, like all other cases of polypi, depends on
the nature, size, number, and duration of the growths, as
small, soft, rapidly growing polypi recur very frequently.
This recurrence has a tendency to produce caries or in¬
duce malignancy, which should be borne in mind during
treatment. In treating these, alcohol and sublimate
(01 of Bub. to 100 of alcohol), trichloride of acetum, and
chromic acid are the most potent.
Under “Prostitution” Jessner has a long history of
its rise and fall, and the application of hygienic measures
in the present age, as a means of modifying its ravages
on the present and future generation. He does not
coincide with Lombros’ opinion that all who follow
this calling, male and female, are irresponsible criminals,
although he believes there is something in heredity.
He agrees with penalising this trade and not legalising
it, as is too much the fashion at the present time. The
clinical histories of our hospitals are strong arguments
in favour of suppression.
These samples imperfectly illustrate the meritorious
utility of the work, and suggest how valuable such a
dictionary of medicine will be to the inquiring mind.
THE PENYCUIK EXPERIMENTS. (6)
The zebra stripes on the cover form a fitting introduc¬
tion to the contents, which deal with the author’s
experiments in crossing zebras, and with the literature
of the subject. Part II. consists of papers which have
( a) “ Bibliothek der gea&mmten Medicinitchen WisaenHchaften
fftr pracktische Aerzte und Specialaertae.” By Prof. A. Drasche,
Wien.
(b) "The Penycuik Experiments.” By J. C. Ewart, M.D., F.R.S.
Pp. xliii-177, Illustrated. London: Adam and Charles Black. I«!t9.
Digitized by G00gle
MEDICAL NEWS.
Oct. 4. 1890.
free bleeding from the artery into the pericardial sac.
In two cases of poisoning, one by carbolic, and in the
appeared in the Veterinarian, and the Zoologist, but part
I. gives a capital summary of the author's results and
beliefs. Many interesting questions are discussed, and
the author shows how far his experiments throw light
on them ; thus he only admits prepotency as occurring
by the parent of the purest descent having the greatest
influence. Telegony, according to the present state of
the author’s mind, occurs but seldom, if at alL The
many problems of Reversion are fully discussed, and
striking examples are given. The book is fully and well
illustrated, and will be found interesting reading.
To those who have opportunity of trying experiments
in crossing, it will have further interest, as it lays down
profitable lines of investigation, whioh, if pursued by
many, will lead in a few years to an accumulation of
collective experiment, which will finally clear up many
doubtful points.
THE NEW ENGLI8H DICTIONARY.
The double section of the New English Dictionary,
just to hand, finishes the letter H, and, with it, the first
half of Volume V. It contains 2,721 main words, 528
special combinations explained under these, and 467
subordinate entries, 3,716 in all.
Comparison with the corresponding pages of some
other lexicographical works shows the following
figures:—Words recorded, Johnson 403, Cassells 1,989,
Century 2,713, Funk 2,816, Here 4,371. Words illus¬
trated by quotations, Johnson 294, Cassells 459, Century
894, Funk 267, Here 3,290.
Number of illustrative quotations, Johnson 930,
Richardson 998, Cassells 656, Century 1,980, Funk 332,
Here 15,160. The total number of quotations in H
reach the enormous number of 69,776, for the letter the
“ Century ” Dictionary gives 8,349.
Among the substantives in this section are the names
of three important bodily members, hand, head, heart,
which, with their derivatives, occupy 109 columns, and
show how the designations of prominent parts of the
body lend them9elveB to all manner of figurative and
transferred applications, and to a luxuriant growth of
phrases.
^etos.
The Etymology of “ Drug.”
A contributor to the Chemist and Druggist discusses
the etymology,of the word drug. The generally ac¬
cepted derivation, we are told, is the Anglo-Saxon
“ dryge ” = dry. Dr. Murray cautiously states that the
ulterior origin is uncertain. The earliest quotation he
gives is from the Close Roll of Edward III., 1327:—
“ Novem balas de drogges de spiceiie.” In some
MSS. of Chaucer the word appears as “ dragges,” and
this has led some etymologists to the belief that
the words “drug” and “dragee” (a stomachic sweet¬
meat) are of similar origin. Professor Skeat, how¬
ever, says “ dragges ” and “ drogges ” cannot be
the Bame word. Littre, following most continental i
authorities, says that the French “drogue,” and the i
Spanish “ droga,” come from the Dutch “ droog ” or
“ drook,” which also means dry. Some authorities explain !
that this etymology i3 based on the fact that a drug was
generally a dried herb, while it has also been guessed that
a drug was so called because it dried up and cleansed the
body, affording no nourishment. A more plausible I
explanation is that the word “ drug ” is a descendant of j
Cymric “ drwg,” old Irfeh, “ droch,” signifying something |
that is bad. This idea is worked out in Larousse’B
“Grand Dictionnaire Universel.” The word would thus
be associated with the almost invariably nasty taste of
medicines. The Celtic “ drwg ” would probably, he
thinks, be related to the Sanscrit “ drub,” which is
applied in the Rigveda to a maleficient demon. Demons
under this or similar names are traceable in many
Eastern folklore tales, and the Irish had a dwarf evil
spirit, which was known as a “ droich.” The connection
of the word “ drug ” with this meaning, something nasty
and common, would go some way towards expl a in i ng
the very ancient use of the word as something not
wanted, as when we speak of “ a drug in the market,”
and it might probably help to understand its application
to a common sort of carpet, called a “ drugget,” which
some authorities with no sort of historical evidence have
associated with the town of Drogheda.
London Hospital Medical College.
The following entranoe scholarships have been
awarded :—Price Scholarship in Science, value .£120, Mr.
R. Milne. Prioe Scholarship in Anatomy and Physi¬
ology, for Oxford and Cambridge students only, value
.£60, Mr. A. W. S. Fisher. Entranoe Scholarships, value
■£47 10s. each, Mr. G. A. 8oltau and Mr. T. W. Smith
(equal).
8t Thomas’s Hospital Medical School.
The prizes were distributed at this hospital yester¬
day (Tuesday) by Dr. T. Clifford Allbutt, F R.S., at the
opening of the School for the winter session. The suc¬
cessful competitors for the past winter session:—
Entrance 8cience Scholarships.—C. M. Roberts, First
Scholarship, .£150, and C. H. Latham, Scholarship, ,£60.
First Year’s Students.—G. C. Adeney, the Wm. Tite
Scholarship, £27 10s.; C. M. Roberts, College Prize, £20 ;
C. H. Latham, College Prize, £10.
Second Year’s Students.—C. U. Ind, the Musgrove
Scholarship, £38 10s.; W. H. Harwood-Yarred, College
prize, £20 ; J. E. Adams, College prize, £10.
Third Year’s Students.—C. N. Sears, College prize,
£20, and 2nd tenure of Peacock Scholarship, and A. F.
Miskin, College prize, £16.
.The following were the prize winners for the past
summer session:—
First Year’s Students.—F. W. W. Smith, College
Prize, £15, and C. M. Roberts, College Prize, £10.
Second Year’s Students.—C. U. Ind, College Prize,
£15, and H. W. Sexton, College Prize, £10.
The following were medalists:—
R. J. Horton Smith, the Wainwright Prize in Practical
Medicine.
H. T. D. Acland, the Cheselden Medal, in Surgery and
Surgical Anatomy.
H. D. Singer, the Bristowe Medal, in Pathology and
Morbid Anatomy.
J. Gaff, the Treasurer’s Gold Medal, for General Pro¬
ficiency and Good Conduct.
In addition to the foregoing several students received
“ Certificates of Honour ” for excellent work done,
including those who had filled house appointments
during the past year.
Middlesex Hospital Medical School.
The Entrance Scholarships at the Middlesex Hospital
Medical School have been awarded as follows:—Freer
Lucas Scholarship (135 ga.), Leonard Herbert Henry
Bays, Epsom College; First Entrance Scholarship
(£100), F. Wood; Second Entrance Scholarship (£60),
W. Kingsbury; Entrance Exhibition (£25), Raoul
Felix, Mauritius; University Scholarship (£60), A. E.
Taylor, Downing College, Cambridge; proximo accessit,
Louis Courtauld, Trinity College, Cambridge.
Life Assurance Congress.
A congress of medical men interested in examinations
for life assurance was held last week at Brussels under
the presidency of the Minister of Agriculture, Mr. Van
der Bruggen. Recent legislation in respect of injuries
to workmen has given rise to a large number of interest¬
ing questions, and one of the results of the meeting will
be an endeavour to codify rules concerning the risks to
life and accident assuranoe companies for general use.
We hope to be able to give a synopsis of the transactions
at an early date.
The Mortality of Foreign Cities
The following are the latest official returns, and repre¬
sent the last weekly death-rate per 1,000 of several of the
populations:—Calcutta 25, Bombay 48, Madras 34, Paris
15, Brussels —, Amsterdam 13, Rotterdam 17, the Hague
Google
Oct. 4, 1899.
MEDICAL NEWS.
TrE MEDICAL PRK88. 365
21, Copenhagen 20, Stockholm 16, Christiania 16, Si,.
Petersburg 22, Moscow 25, Berlin —, Hamburg 18,
Dresden 20, Breslau 27, Munich 23, Vienna 15, Prague
22, Buda-Pesth 17, Trieste 28, Rome 1,2 Turin —, Venice
19, Cairo —, Alexandria —, New York 18, and Phila¬
delphia 13.
Surg.-Lixut. Anthony has command of a large force
of the Royal Army Medical Corps which is being concen¬
trated at Portsmouth in view of the probability of war
with the Transvaal. This corps will furnish the general
hospital in the field, and also a detachment for service on
the hospital ship.
Tropical Medicine.
The first winter session of the new School of Tropical
Medicine, recently established in connection with the
Seamen’s Hospital, was inaugurated on Monday last by
an ad dree a delivered by Dr. Patrick Man son. Instruc¬
tion in this special class of disease will be given both
in the lecture theatres and in the hospitals of the Sea¬
men's Hospital Society.
A Valuable Medical Appointment.
A recent recommendation of the Local Government
Board to the Glossop Guardians that they Bhould pay
for the more expensive medicines, and not throw the
cost on the Medical Officer, elicited the statement from
that officer that, out of a gross salary of .£50 he had to pay
out £25 to £30 for such medicines. The Glossop
Guardians are to be congratulated on the possession of
so conscientious an official. When paupers’ drugs for an
entire union, and for a year, have to be paid for oat of
such a pittance as £50, it seems probable that they
would not be of the rarest or most efficacious quality.
University Education in France.
The official report of the French Government states
that the total expenditure of the fifteen universities for
the year was 13,859,500 francs, for which sum they
educated 27,080 students—i.e., 511 francs, or nearly £20
per student. The united income of the universities is
about 3,600,000 francs, so that ten million and a half
francs have to be found by the State as a subsidy.
Vital Statistics.
The deaths registered last week in thirty-six great
towns of England and Wales corresponded to an
annual rate of 20 6 per 1,000 of their aggregate population,
which is estimated at 12,786,832 persons in the middle
of this year. The deaths registeren in each of the last
four weeks in the ceveral towns, alphabetically arranged,
correspndee to the following annual rates per 1,000:—
Birkenhead 25, Birmingham 22, Blackburn 21, Bolton
22, Bradford 17, Brighton 16, Bristol 14, Burnley 26,
Cardiff 16, Croydon 15, Derby 15, Dublin 29, Edin¬
burgh 19, Glasgow 21, Gateshead 26, Halifax 15,
Huddersfield 10, Hull 21, Leeds 21. Leicester 16, Liver¬
pool 27, London 18, Manchester 26, Newcastle-on-Tyne 27,
Norwich 17, Nottingham 22, Oldham 16, Plymouth 17,
Portsmouth 19, Preston 23, Salford 27, Sheffield 26,
Sunderland 28, Swansea 8, West Ham 21, Wolver- I
hampton 14. The highest annual death-rates per
1,000 living, as measured by last week’s mortality,
were :—From measles, 14 in Burnley; from fever,
1‘1 in Nottingham, 16 in Sheffield, and 2 5 in Ports¬
mouth ; from diarrhoea, 4 4 in Nottingham, 4‘7
in Birmingham, 6 0 in Hull, 6 4 in Bolton and in
Manchester, 6'8 in Sunderland, and 8 0 in Preston. In
none of the large towns did the death-rate from
scarlet fever or from whooping cough reach PO per
1,000. The 89 deaths from diphtheria included 42 in
London, 11 in Sheffield, 8 in Leicester, 5 in Liverpool,
3 in Leeds. Three deaths from small-pox were regis¬
tered in Hull, but not one in any other part of the
United Kingdom.
Adolescence and Longevity.
The Leisure Hour for October contains some interest¬
ing statistics regarding the duration of life, from which
we quote the following:—“ Dr. AinBlie Hollis has recently
directed attention to the connection between the times
which man and various animals take to arrive at
maturity and the duration of their natural life, assum¬
ing that death occurs by senile decay. It appears that
the period of adolescence is less in proportion to the full j
term of life in the case of short-lived mammals than it
is in those with longer lives. For instance, a mouse
arrives at maturity in about three months, and the
length of its subsequent life is four years, or about
fifteen times the period of adolescence ; a horse arrives
at maturity in eight years; its natural length of life
afterwards is about four times this period; man
completes his full growth at the age of twenty-
fife yeai8, and the expectation of life beyond this
is twice the period of adolescence. The length
of the period of man’s youth is thus greater in propor¬
tion to the whole length of life than that of animals
with shorter lives. The relation between adolescence
and longevity is so close that Mr. E. D. Bell has shown
that it can be expressed by a mathematical formula,
namely, ‘ The full term of life in a mammalian species
is equal to ten and a half times the period of maturity
divided by the cube root of the period of maturity.’
This statement, of course, simply represents an average,
and takes no account of death by accident or disease.”
PASS LISTS.
University of Durham.
The following candidates passed the third examina¬
tion for the degree of Bachelor in Medicine during
September:—
Honours—8 econd-c lass.
Thorne-Thome, Ricliard, St. Bartholomew’s Hospital.
Bodmnn, Christopher Osmond, University College, Bristol.
Hindmarch, Robert Simneon, College of Medicine, Newcastle.
Reah, Henry, College of Medicine, Newcastle.
Parkin, Alfred, College of Medicine, Newcastle.
Pass List.
Adeniyi-Jones, Curtis Crispin, College of Medicine, Newcastle.
Appleby, Ernest Bertram, College of Medicine, Newcastle.
Clarkson, Frederick. 8t. Thomas' Hospital.
Coates, Thomas Seymour, College of Medicine, Newcastle.
Gibson, Charles Henry, College of Medicine, Newcastle.
Hawes, Ivon Henry Skipwith, St. George's Hospital.
Hodge, Albert Ernest, College of Medicine, Newcastle.
Horan, Hubert Wolstenholme, College of Medicine, Newcastle.
Manson, Kenred, College of Medicine, Newcastle.
Scott, Frederick Riddle, College of Medicine, Newcastle.
Vanx, Ralph Thomas, College of Medicine, Newcastle.
Velenski, John Charles, College of Medicine, Newcastle.
The following Degrees were conferred on Septeml-er 33rd, 1809 :—
Doctor in Medicine -—John Charles Anderson, M.B.. Dur ; Arthur
James Dale, M.B., B.8., Dur.; J. Livingstone Frazer-Hurst, B.A.,
M.B., B.S., Dur.; Ralph Norman Lishman, M.B., B.S., Dur.;
Theodor Lund, M.B., B.S., Dur. (in absentia.): Norman
McCall-Smith. M.B., B.S., Dur.; William L. Wight Walker, M.B.,
B.S , Dur.; William Henry Whitehouse, M.B., B.S., Dur.
Doctor in Medicine I Practitioners of Fifteeen Years’ Standing).—
Oswald Baker, L.B.C.P. and S.; E.; Ralph Henry Browne, M.R.C.S.,
L. R.C.P.: William G. Dickinson, M.R.C.S., L.R.C.P., D.P.H. ;
Dennis Cawood Embleton, H.R.C.S., L.R.C.P.; Syea Hassan,
M. R.C.S., L.R.C.P., D.P H.; H. Nelson Halberton, M.R.C.8.,
L.R.C.P., D.P.H.; Joseph Stenson Hooker, L.R.C.P. and
S.; E., L.S.A.; John C. Radclyffe Husband. M.R.C.S., L.R.C.P.;
Heniy Knowles, L.R.C.P., L., L.R.C.S., E.: Henry Richard Leech.
L.R.C.P. and S.: E., L.S.A.; Gordon B. Willie Messum, M.R.C.S.,
L.R.C.P.; George Sinclair, L.R.C.P. and S : E.; Thomas Hanson
Smith, L.R.C.P. and S.; E.; Henry George Sworn, M.R.C.S.,
L R.C.P.: John Arthur Webster, M.R.C.S., L.S.A.; Neville"'horold
Wood, M.R.C.P., L.R.C.P., M.R.C.S.
Bachelor in Medicine (M.B.).—Norman Christian Bailes, Laurence
James Blandford; Mark Francis Cahill, L.R.C.P., L.R.C.S. ;
Solomon Cross ; Harold Ben Fawcus ; Richard Fisher, M.R.C.S.,
L. R.C.P.; Edward Gofton; Robert Bond Greaves, L.S.A.; John
Rutherford Halliday; William John Harrison: William Hayward,
M. R.C.S., L.R.C.P.; John Tyrer Johnson; Henry Herbert Mark¬
ham ; Richard Oswald Mather, L.R.C.P.; James Muirliead;
Edward Frederick Prutt, L.R.C.P.; Morgan Richards, L.S.A,;
Norcliffe Roberts ; Robert Lowis Routledge : Edward Norman
Threlfall; Carl Wahlgren Von Bergen ; David Henderson Weir.
Bachelor in Surgery (B S.). —Nonnau Christian Bailes, Laurence
James Blandford, Solomon Cross, Harold Ben Fawcus. Richard D.
Fisher, M.R.C 8., L.R.C.P., Leopold Fotliergill, M.B., Edward
Gofton, Robert Bond Greaves, L.S.A., William John Harrison,
William C. Hayward, M.R.C.S., L.R.C.P., John Tyrer Johnson,
Henry Herbert Markham, James Muirliead, Edward Frederick
Pratt, L.R.C.P., Morgan Richards, L.S.A , Norcliffe Roberts,
Robert Lowis Routledge, Edward Norman Threlfall, Carl Wahlgren
Von Bergen, David Henderson Weir.
^lotiae to
Corrcoponfcnttje, Short $etUro, &c.
«W CoaREBPOKDiMTR requiring a reply in this column are par¬
ticularly requested to make use of a distinctive signature or
Digitized by G00gle
366 The Medical Press.
NOTICES TO CORRESPONDENTS. Oct. 4,1899.
initialt, and avoid the practice of signing themselves " Header,”
"Subscriber,” "Old Subscriber," 4c. Much confusion will be
spared by attention to this rule.
HARD ON THE CHEMIST.
Bangs : " I’d give a good deal to know how it feels to be drugged
and rolil>ed.”
Benthere : “ Why don t you go and get a prescription made up at
Messrs. X and X ”
G. S. T.—We cannot toll without seeing our correspondent’s MS.
whether the article will be suitable for our columns or not.
POISONING BY MISADVENTURE.
The unfortunate mistake of Dr. Dick at Eastbourne, which a few
days ago cost him his life, has brought us more than one inquiry
about poison bottles and safety stoppers. It appears that the in¬
genuity of manufacturers is of no avail, and that the majority of
practitioners still store the most deadly poisons in ordinary bottle*, '
notwithstanding the frequent fatal accidents occasioned thereby.
For the information of our correspondents we may state that there
is no lack of protective material always at hand. But a few months
since we drew attention to an ingenious poison bottle made at
Hearn's Glass Works, Lea Bridge, London, N.E., costing but a few
pence, and of such a sliape that a mistake would be impossible in
the hurry of compounding or even in the dark. As an alternative
we have a sifety stopper, made by Messrs. Foster and Crowley,
which is provided with a prickly cap at the top of the cork, giving
a sharp reminder of danger. There are many other devices, but
these nappen to lie before us and may be pronounced absolute
safeguards.
. M. R. C. 8. (Leeds).—We cannot reoommend our correspondent
to ndopt the course which he proposes to take. We are writing to
him privately.
Da. S.—Application must be made direct to the Colonial Office.
Further information will be found in our “ Students’ ” number, pub¬
lished on the 13tli of last month. A copy can be obtained from the
publisher.
P. S. D. (Manchester).—From an ethical point of view our corres¬
pondent acted quite rightly.
L. R. C. S. Edin. (Bradford).—It is usual for a consultant to write
after seeing the patient sent for consultation, giving a detailed
account of the case to the practitioner.
M. D.—Our correspondent should write to the Dean, West London
Postgraduate College, West London Hospital, Hammersmith, W.
Surgeon.—T he subject has only recently been discussed in our
columns, but we will shortly again deal with it and draw attention
to the facts brought under notice by our correspondent.
THE VALUE OF PETROLEUM EMULSION IN THE
MORPHINE HABIT.
To the Editor of The Medical Press and Circular.
Dear Sir, —Incases of enforced administration of morphine there
is generally trouble with the bowels. In these cases I have almost
ceased the administration of powerful tonic drugs such as atropine
and mu vomica, and prescribed petroleum emulsion with much
success. Thinking this fact may be useful to otheni who have to
deal with similar cases, I should be glad if you will kindly draw
their attention to the points at issue through your valuable
columns.
I am, Sir, yours truly,
Percy G. Lodge.
100, Preston Street, Bradford, Oct. 2nd, 1899.
Erratum.— In the letter of Mr. Corbett upon the Lunacy
S uestion in our isBue of the 27th ult., the number of insane in the
ree kingdoms was, by a printer’s error, stated as 240,000 instead of
140,000. The nctnal figure was 139,700.
Omega. —The subject is referred to in our editorial columns.
Jfteetinge of the §otieties attb ^eotuves.
Wednesday, October 4tu.
Obstetrical Society of London.—8 p.m. Specimens will be
shown by the President, Dr. W. Duncan, and others. Papers :— Dr.
Williamson: The Pathology and Symptoms of Hydatidiform
Degeneration of the Chorion.—Dr. Herman: Two Cases in which
Life appeared to have been Saved by Anti-Streptococcic Serum.
Friday, October 6th.
West Kent Mki.ico-Chirurgical Societt (Royal Kent Dispen¬
sary, Greenwich Road. S.E.) 8.45 p.m. Annual Business Meeting.
Clinical Cases by Dr. Toogood, Dr. Dockrell, Mr. Clarke. Dr.
Sunderland, and Mr. Parke.
Uacanciefi.
Cumberland and Westmoreland Asylum, Garlands, Carlisle.—Junior
Assistant Medical Officer, unmarried. Salary £10u a year, with
l*oard and residence.
Durham County Asylum, Winterton, Ferryliill.—Assistant Medical
Officer, unmarried. Salary commencing at £14o, with board,
lodging, washing, and attendance.
Egyptian Government School of Medicine, Cuiro.—Professor of
’ Ophthalmology. Particulars from P. G. Hallett, Esq., Secretary,
Examination Hall, Victoria Embankment, Loudon.—(See
advert.)
Esse* and Colchester General Hospital, Colchester.—House Sur¬
geon. Salary t loo per annum, with board, washing aud residence
in the hospital.
Hospital for the Insane, the Coppice, Nottingham.—Assistant
Medical Officer, unmarried. Salary £150 per annum, with apart¬
ments, board, attendance, and washing.
Hospital for Women and Children, Leeds.—Non-resident House
Surgeon for six months. Salary at the rate of £125 per annum.
Leioeeterahire and Rutland Lunatic Asylum.—Assistant Medical
Offioer, unmarried. Salary commencing at £150, with board,
lodging, washing and attendance, Applications to the Clerk,
10, New Street, Leicester.
Loughborough and District General Hospital and Dispensaiy,
Loughborough.—Resident House Surgeon. Salary £100 per
annum, with furnished rooms, attendance, and board.
Parish of Fulham, London.—Medical Superintendent of the Infir¬
mary and Medical Officer of the Workhouse. Salary £300 per
annum, with residence, (partly furnished), fuel, lights, and
washing.—Applications to- the Clerk to the Guardians, 75,
Fulham Palace Rood, W.
Royal Infirmary, Hull —Senior House Surgeon for two years, un¬
married. Salary 100 guineas per annum, with board and fur¬
nished apartments.
West Riding Asylum, Wakefield.—Fifth Assistant Medical Officer,
Salary £100 per annum, rising £10 anually to £150, with fur¬
nished appartments, board washing, and attendance.
Worksop, Notts.—Medical Officer at the Worksop Dispensary, un¬
married. Salary £120 per annum, with house, coals, gas, and
attendance.
Baker, W. J. T., L.R.C.P., L H.C.8.Edin., L.F.P.S.Glasg., Medical
Officer for the South Sanitary District of the Sheffield Union.
Bovkt, Thos., W. W., L.R.C.P.Lond., M.R.C.S., Medical Officer
for the Abbotsbury District of the Weymouth Union.
Duke, J., M.D.Glasg., M.R.C.P.Lond., Medical Officer for the
Infectious Hospital, Chester.
Fpresuh, E. G., M.B., Ch.B.Edin., House Surgeon to the Royal
Alexandra Hospital, Brighton.
Jellett, J. C., L.K.C.P., L.R.C.S.Irel., Medical Officer pro tern, for
the Cranbrook and Frittenden Sanitary Districts of the
Cranbrosk Union.
Keltnack, T. N., M.D.Vict., M.R.C.P.Lond., Medical Registrar to-
the Manchester Royal Infirmary.
Loxton, Arthur. F.K.C.S.Edin., Honorary Surgeon to the Bir¬
mingham and Midland Hospital for Skin and Urinary Diseases.
Richmond, R. T., M.A.Gantnb., M.R.C.S., L.R.C.P.Lond., House
Physician to the Royal Hants County Hospital, Winchester.
Tatlob, G. G. S., M.D Durh., L.R.C.P.Irel., M.R.C.S., Honorary
Physician to the New Hospital for Cancer and Skin Diseases,.
Liv« rpool.
fiivths.
Gallowat. —On Oct. 1st, at 54 Harley Street, London, W., the wife
of James Galloway, M.D., F.R.C.P., of a daughter.
Layton.— On 8ept. 30th, at The Lawn, Walsall, Staffs., the wife of
Frank G. Layton, M.R.C.8., L.R.C.P., of n daughter.
Wallis.— On Sept 29th, at 237 Roman Road, Old Ford, Essex, the-
wife of Sidney 8. Wallis, L.R.C.P., M.R.C.S., of a son.
c |ftarriages.
Matburt—Wagner.— On Sept. 27th, at St. James's Church, Wey
bridge, Lysander Maybury, M.D , of Southsea, son of the late
N. A. Maybury, M.R.C.S., of Finchley, to Ethel, daughter of
O. H. Wagner, of Wimbledon.
Marsh - Crew. On 8ept. 27th, at Prestbury Church, John Hedley
Marsh, M.R.C.S., L.R.C.P.Lond., Medical Officer of Health for
Macclesfield, to Florence May, youngest daughter of Thomas
Crew, Macclesfield.
Rouse— Hawkins. - On Sept. 27th, at St. Paul's Church, Worthing,
Algernon Edward Rouse, M.R.C.S.Eng., L.R.C.P.Lond., of
Littleport, third son of the late Jnmes Bouse, F.B.C.S.. of
London, to Florence Edith Hawkins, third daughter of the late
Edward Hawkins, of Hampstead.
Stoner Hall.—O n Sept. 26th, at the Parish Church, Brighton,
Harold Stoner, M.R.C.S., L.B.C.P., L.D.S.Eng., of Regency
Square, Brighton, to Ethel Mary, second daughter of Edwin
Penfold Hall, of Grand Parade, Brighton.
Sutherland—-Gairdner. —On Sept 2*tli, at the University of
Glasgow, Lewis Robertson Sutherland, M.D., Professor of
Pathology in the University of St. Andrews, to Helen Cliristiau,
elder daughter of Sir William Gairdner, K.C.B., Professor of
Medicine in the University of Glasgow.
Thomas—Duncanson.— On Sept. 28th, at the Congregational
Church, Bromley, Kent, Harold Wynne Thomas. M.R.C.S.Eng.,.
L.R.C.P.Lond., of Bromley, to Madeline Forrester, twin
daughter of the late E. F. Duncanson, of Nutwood, Bickley.
deaths.
Jackson. —On Oct. 1st, at 94 Bronrdhurst Gardens, South Hamp¬
stead. Henry E. Jackson, M.R.C.S., aged 52 years.
King.— On Sept. 23rd, nt Chepstow, Edward Pendril King,
M.R.C.S., L.S.A., son of the late Thomas King, F.R.C.S., of
Chepstow, aged 64 years.
Shurloik On Sept. 27th, at Eldrilges, Chertsey, Man waring
Shurlock, M.R.C.S., L.S. A., aged 85
Wallace.— On Oct. 1st, at 1, St. John’s Terrace, Colchester,
Alexander Wallace, M.D.Oxon, M.K.C.P.Loud., aged 70 years..
Digitized by Google
the MUilical gtes and Circular.
4f BALU8 POPULI SUPREMA LEX."
Vol. CXIX. WEDNESDAY, OCTOBER 11, 1899. No. 15.
<S>rigin«l Communications.
THE QUEST OF THE IDEAL, (a)
By Sib JAMES CRICHTON BROWNE, F.R.S.
After comparing the Manchester of to-day with
the Manchester of a century ago. the city described
by de Quincy aa “ mud below and smoke above,” the
author reviewed the history of the institution, and
contrasted the sums, with difficulty raised to further
the cause of medical education with those so lavishly
bestowed on accommodation for lunatics.
Passing on to the oration proper, he said that in
considering how he could best achieve an introduc¬
tory address which would be stimulating rather than
instructive, that should stir one or two present to
more vigorous endeavour in the work before them, it
had occurred to him to warn them against certain
dangers which would assuredly beset their path,
dangers not generally realised, but real enough. The
dangers he referred to were not ethical, but mainly
intellectual. He desired to speak merely as one
who had gone before along the road they were about
to travel, who was familiar with its windings, and
able to caution them against certain tendencies which
were incidental to the route, and which sometimes
were lamentable and disastrous in their results. He
alluded to these modem tendencies to materialism,
which regarded mind as a mode of motion, or to
its congener, naturalism, which subordinated spirit
to mechanism and set up unchangeable law as
supreme, the agnosticism which ignored both
mind and matter and confined its attention to phe¬
nomena. tendencies the influence of which they were
certain to feel, and to which some of them were not
•unlikely to succumb. Their teachers could supply
them with no corrective to the materialising agencies
which would operate upon them in the laboratories
and the hospitals, but then they had no antidote to
the materialistic virus, the great catholic teachers to
whom all who are interested in medical and bio-
"logical science were obliged sooner or later to turn,
•would inject it into their veins with tenfold virulence.
Herbert Spencer was certainly responsible for the
widespread diffusion of materialism. The splendid
cogency of his arguments with regard to the whole
phenomena of the universe had obtained for his
theories as to the evolution of mind—which, notwith¬
standing his admission of an unknowable as a
necessary datum of consciousness, were pure and un¬
diluted materialism—such ready currency. Spencer
insisted that mind arose out of the molecular
vibrations of matter, just as do light, heat, and
electricity, and that the ortly difference between the
commonest sensation and the most transcendent
emotion lay in the number and complexity of the
m«lecular vibrations of nerve surface. He did this
with a subtlety and ingenuity that almost inevitably
(a) Introductory Address delivered at the Opening of the Winter
Session of Owen's College, Manchester, October, 191*9.
commanded the assent of those whose daily ex¬
periences impressed them with the constant and
intimate connection between brain states and mental
manifestations, and so his philosophy had dashed to
ieces the ideals of many medical postulants. If
pencer had done much to scatter broadcast ma¬
terialistic ideas in medical circles, Huxley had done
more, for in spite of his repudiation of the title
materialist as a reflection on his agnostic orthodoxy,
few recent writers better deserved the designation.
He had taught that molecular changes in the brain
were the causes of all states of consciousness,
voluntary acta being as purely mechanical as reflex
action. High thinking, in his alembic, turned out to
be merely increased resistance and friction in certain
nerve circuits. He had reduced our species to con¬
scious automata.
The ways by which materialism was avoided and
faith reconciled with science were many. Sometimes
it was not reconciliation, but cohabitation, that was
arrived at, as in the cases of Faraday and Cuvier.
The victory of science over faith was sometimes the
advent of peace. There were those again to whom
an expectant attitude afforded composure. The loss
of the ideal was apersonal calamity. “ That wav mad¬
ness lies,” as those engaged in his own special depart¬
ment of practice were not seldom made aware, and
the loss of the ideal was inevitable if no solution of
the world problem could be arrived at, or if the solu¬
tion were materialism. Materialism reduced all
things to the pull of opposing atoms. Under its
interpretation intellect was the activity of nerve
cells ; immortality a delusion ; virtue, honour, duty,
were forms of selfishness; and heroism a kind of
disease. When that glorious woman, the stewardess
of the Stella, took off her lifebelt and gave it to an
affrighted being beside her, and bravely sank, com¬
mending her soul to God, her act was not conducive to
the preservation of the individual or the special. It
was an expression, we were told, of the abnormal
overfunctioning of a certain portion of her brain.
Did not the heart sink and the gorge rise at such
revolting nonsense P
It was not for him in the time at his disposal to
combat those three formidable giants who were
always lying in wait to devour medical students—
materialism, naturalism, and agnosticism. What he
had to say was simply an exhortation to hold fast, as
their sure refuge, by idealism, which, in one shape
or another, and however smothered up, still dwelt in
each of them, and with this exhortation he
would associate a suggestion that the assumptions of
science which excluded an idealistic view of the world,
aa well as the prepossessions against anything beyond
solid facts and their material explanations, which their
studies might have engendered in their minds, were
still open to doubt and refutation. Wide as was the
sphere of science, it .vas still limited in all directions.
As Max Muller said :—“ Our minds are not so made
as to grasp either beginnings or ends,” The range of
the senses was a narrow one. Beyond the red and
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Digitized by
368 The Medical Pkkss.
ORIGINAL COMMUNICATIONS.
Oct. IT, 1899.
violet of the spectrum were rays of wave lengths to
which the retina did not respond. Hearing held good
only from thirty up to 40,000 vibrations a second, and
smell, taste ana touch, went but little way in reveal¬
ing the properties of matter. It was certain that
what we called our intellect rested on belief and not
upon knowledge. Physical science could do nothing
to demonstrate the existence of an outer material
world, which we believed in, nevertheless ; physical
science could never ^rove the existence of mind in
our fellow men, yet it was one of our most rooted
beliefs. He desired to draw attention to certain un¬
fathomable chasms that yawned well within the bounds
of recognised science, and the existence of which was
inconsistent with the materialistic hypothesis. First
there was the chasm between the organic and the in¬
organic. Secondly, there was the chasm between the
physical and the vital, for if the origin of life was
wrapped in obscurity, so was its maintenance. Thirdly,
there was the chasm—the widest of all and the most
fatal to materialism—between mind and matter. It
was just this chasm, which, as young medical
scientists, they were likely to overlook, for the
dependence of the mind upon the brain was a
pre-supposition of much of their work. No man had
seen thought at any time, and no man had seen
neural process. It was only in their effects that we
could follow them from point to point, i.e., in sensa¬
tion and movement. Thus it wa6 that Du Bois
Raymond had said it was hopeless to resolve thought
into a physiological process, and that Wundt had
delivered himselt to the effect that the action of mind
on matter, if it existed, would be in the nature of a
miracle. Thus it was that modern science had
repudiated crude materialism as regards the relations
of mind and brain, and had fallen back on an agnostic
theory called psycho-physical parallelism, which was
now in the ascendant. This theory avoided a shallow
materialism by propounding an enigma, but in spite
of its professions of the equality of the psychical
changes and their physical counterparts, it very soon
appeals that those who adopt it give precedence to
matter.
After a detailed dissertation on the structure of the
brain. Sir James said mind and character in health
and disease were to be appraised by the reactions
which a man's words and deeds had on our minds.
They could not be made visible or palpable to the
outer senses, but through their body mask they
might be discerned clearly enough by the light which
our own minds reflected on them. ■* Suppose,” Raid
Professor James, “ that the whole universe of material
things should prove a mere surface veil of pheno¬
mena, hiding and keeping Hack the world of genuine
realities. Suppose that our brains are thin or trans¬
parent places in the veil, through which gleams from
the outer sunlight of absolute light may shine ; is it
not clear that the light will break through our brains
in the restricted forms, and with all the imperfections
that characterise the medium of transmission? ”
“ Brain, like a dome of many coloured glass
Stains the white radiance of eternity.”
It was not any abstract psychological system - in¬
valuable though that may be in its own sphere—that
interested them as medical men, but the real life and
its ideal element ; and his firm belief was that their
professional success would largely depend on the
manner in which they combined realism with idealism.
About their realistic fidelity there could be no doubt;
it was for their adherence to the ideal that he pleaded.
How was the ideal, whether it was in the mind in¬
nately or had been won by sore travail, to be fostered
and nourished and kept alive? By all those observ¬
ances and ordinances that the wisdom of ages had
consecrated, and that in these hurried and luxurious
days we were apt to neglect. By the assumption of
an attitude of reverence and sympathy, which would
incline our ear to the whisperings of the infinite,'’.and'
afford us glimpses of the inner impulses by which
other men shaped their lives. By the practice of the
manly discipline of self-renunciation lor which their
profession afforded the finest scope; for in minister¬
ing to the wants of others, even at the sacrfice of
their own, they could mount to blessedness. He
could express no better wish for them than that
while immersed in the realities of life they might be
rewarded in their quest of the ideal, for it was a
talisman that, once seized and pressed to the breast,
would enable them to say to pessimism “ Avaunt! ”
and to beneficence “ Open Sesame! ” Negation was
a barren wilderness, belief a teeming garden. Lord
Byron said he would rather believe all the fables of
the Talmud or the Koran than deny the being of the
Universal Mind, and Newton concluded his Principia
with these words: “ The whole diversity of natural
things can have arisen from nothing but the ideas
and will of one necessarily existing being who is
always and everywhere, God. supreme, infinite, omni¬
potent, universal, absolutely perfect."
CHANGES IN THE MEDICAL PROFESSION
DURING THE PRESENT CENTURY.
Abstrict of Presidential Address delivered at the Inaugural
Meeting of the 127 th Session of the Medical Society of
London on Monday, October 9th, 1899.
By FREDERICK T. ROBERTS, M.D.,
F.R.C.P., Lond.,
ProfeBsor of Medicine in University College, London. Physician to
and Professor of Clinical Medicine in University College
Hospital, &c.
De. Roberts remarked at the outset that it would
be almost impossible for anyone who had to give an
address at the present time on an occasion such as
this to resist taking as his text, from some aspect or
other, the century now so rapidly drawing to a close.
As President of the Medical Society of London, it
would be inhuman to expect him, at the inaugural
meeting of the last session in the century, not to
take advantage of such an opportunity for selecting
a topic at hand, and he therefore proposed to indi¬
cate. on very general lines, the more striking changes
which had affected the medical profession during the
present century and the main results, in the direc¬
tion of progress, which had been achieved.
After a pereonal reference to the fact that he had
been associated with the profession for nearly the
latter half of the century, from the time when he
first started as an apprentice, the lecturer made some
observations on the apprenticeship system, the doing
away with which was a most important change. He
could not allow the century to close over its grave
without a parting word of kindly appreciation. He
had never regretted that it had fallen to his lot to pass
through this experience, and acknowledged with
ratitnde that the practical lessons impressed upon
is mind at that time not only helped him as a
student but had served him in good stead on many
and many an occasion.
Passing to the discussion of his special subjects.
Dr. Roberts assumed that he was echoing the senti¬
ments of his hearers when he affirmed that the
medical profession had made vast strides in the
direction of true progress during the past century,
especially its latter half, in spite of what carping and.
unfriendly critics might say to the contrary. He then
roceeded to indicate, briefly, the means or agencies
y which this had been brought about. He dealt, in
the first place, with the advance in general education-
Die
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Th* Medical Pbxbs. 369
Ocr. 11, 1890. ORIGINAL COMMUNICATIONS.
and culture, and the establishment of a
comprehensive and rational system of com¬
pulsory 1 professional education and training,
and its progressive development on scientific
and practical lines, including clinical teaching, in
accordance with the requirements of the age. He
laid special stress on the adoption of the scientific
spirit and of scientific methods in the study and
teaching of medical subjects, as well as the introduc¬
tion into the curriculum of allied subjects more
strictly scientific, and the promotion of their
methodical and deeper study. He also drew atten¬
tion to the great advantages derived from the separa¬
tion or unravelling of subjects which, though
essentially distinct, were formerly, if dealt with at all,
included under one term, and discussed in a single
course of lectures; and the addition of new subjects,
the outcome of increasing knowledge. Referring in
this connection to “ specialism,” Dr. Roberts expressed
his opinion “ that to this comparatively modem
development/the progress of medicine owes more than
can be imagined or expressed in words, and that when
carried out legitimately and rationally, it has proved,
and always will prove, of infinite advantage to the
profession and to humanity. It is its abuse which
works such serious mischief, and against which we
must ever protest.”
The lecturer next spoke about the influence of
examinations upon medical progress, and claimed
that though still unsatisfactory, they had certain
advantages, and had contributed materially io the
general advance. He referred at some length to the
institutions which have been concerned with and
responsible for the important departments of medical
education and examinations. In this connection he
drew attention to a significant change affecting the
profession during this century, namely, the admis¬
sion of “ lady doctors ” into its ranks, who had now
a ‘•school” of their own, where their students were
admirably trained. He also complimented the pro¬
vincial medical schools on the excellent work they
have done and are doing; and expressed his personal
satisfaction that more liberal ideas had at length
prevailed at the older English universities, and that
they now open their doors to allcomers, while joining
heartily in the promotion of medical education
and science. He then continued, “ Of all the
agencies which have contributed to the advance-
of medicine none have been more conspicuous
or potent than the general recognition of the essen¬
tial value and far-reaching importance of original
investigation and research, in a variety of directions,
especially by experimental methods, and the ever-
widening application of this principle as new fields
of inquiry have opened up.' In discussing this
point he insisted upon the great debt due to vivi¬
section in relation to practical advances in the
healing art. Finally, under this bead he mentioned
as factors contributing to the progress of medicine
during this century the remarkable increase in the
number and variety of hospitals and allied institu¬
tions, and their adaptation for clinical instruction
and research; the entraordinary development of
medical literature of all kinds : and the opportunities
for bringing liefore the profession the results of
personal observation, experience, and investigation,
and for the discussion of topics of interest or im¬
portance by the medical and kindred societies, as
well as by the larger associations, and in recent times
by congresses of all kinds.
Dr. Roberts then proceeded to discuss the practical
results upon the medical profession arising from the
changes just outlined, and the grounds upon which
he rested his c aim that medicine had made such
material progress during the 19th century.
1. He, in the first place, emphasised the fact that
he entire profession occupies an incomparably better
and higher position to-day than it has ever done
before, and that the general standard of knowledge
wd skill has steadily risen even within recent years,
BBtil it is now remarkably high, while the great
majority take a keen and intelligent interest in the
march of events, exhibiting an earnest desire to keep
abreast of the times and to take advantage of every
new discovery which can be utilised for the benefit of
their patients, whether in diagnosis or treatment.
2. He next dealt with the extraordinary advance which
had been made in dispelling ignorance and establish¬
ing knowledge on a positive foundation in relation to
morbid processes ana conditions, as well as to indi¬
vidual diseases and symptoms. Amongst other points
it was mentioned that complaints which were for¬
merly included under a particular name have been
shown to be distinct, ana are now duly discriminated
and classified; while affections which must have
stared the profession in the face from time imme¬
morial have only been definitely made out within a
recent period.
3. He then spoke about the causation of disease,
and insisted that one of the greatest benefits which
the nineteenth century has conferred upon humanity,
in relation to medicine, is the flood of light which it
has thrown upon the vast field of astiology, and the
striking practical results which have been worked
out in connection with this branch, not only in rela¬
tion to ordinary preventive treatment, but as laying
the foundation for that most important department
—hygiene, sanitary science, and public health. In
discussing this subject special reference was made
to micro-organisms.
4. Attention was next drawn to another striking
and most helpful advance, for which this century will
ever be memorable, namely, the remarkable addition
to, and development of, the methods of clinical
investigation applicable for a variety of purposes,
many of which are now regarded as so essential for
arriving at a positive and correct diagnosis. Dr.
Roberts remarked that the progressive development
of clinical methods is a highly interesting study,
culminating in that most startling revelation or out¬
come of modem science—the Rontgen rays—which
promises to supplant all other methods, and to enable
us actually to see what is going on within every part
of the human body, without taking any further
trouble.
Lastly, the lecturer discussed at some length the
advances in treatment, referring in the first instance
to his own recollections as an apprentice and sub
sequently, and pointing out the lines upon which pro¬
gress had been established. Standing out con¬
spicuously and pre-eminently above all others, two
achievements of this century must ever be regarded
with feelings of deep gratitude, wonder and admira¬
tion, namely (1) the introduction and development
of anasstheticB, general and local; (2) the working
out, on scientific lines, as well as on a rational and
intelligent practical basis, of the great principles of
antiseptic and aseptic treatment, for which we shall
ever be indebted to the patient investigations and
splendid work of Lister. The next line of progress
in treatment dealt with was the addition to our avail¬
able remedies of many genuinely useful and efficient
new drugs, as well as of excellent and valuable phar¬
maceutical preparations and combinations. The
profession cannot boast of having discovered many
“cures,” but not only have we at our command a far
larger and increasing number of really useful medi¬
cinal agents than formerly, but we undei'stund
better how to employ both the old and the new, and
for what purposes. Great improvements have also
taken place in the modes of administration of thera¬
peutic agents, the preparations and appliances
intended for local purposes, and the instruments or
byLjOOQle
y o
370 The Mmkcai. Press. ORIGINAL COMMUNICATIONS._ Oct. 11, 1899.
apparatus invented for making applications to, or
otherwise treating special parts. Particular attention
was drawn to the value of the hypodermic syringe
in this connection.
The next important advance referred to was the
recognition and adoption of the great principle of
hygienic treatment, diet and nursing being also
specially noted. Particular attention was then drawn
to a conspicuous development of modem therapeutics,
namely, the introduction or more systematic working
out of “ special methods,” or “ combinations of
methods,” intended either for producing some par¬
ticular effect, which might be beneficial in various
conditions, or for the treatment of some individual
disease or class of diseases. Finally Dr. Roberts, as
a physician, paid a tribute of respect and admiration
to modem surgery, which has acnieved such marvel¬
lous and brilliant results in a variety of directions,
and has made the nineteenth century memorable for
the splendid position to which it has been raised as
an art.
Dr. Roberts concluded his address as follows:—
•“I have thus endeavoured, however imperfectly, to
give some comprehensive sketch of what strikes me
as the most prominent and important changes which
bave guided the course of the medical profession
during the century which is now rapidly drawing
to its close, and the lines upon which pro¬
gress has taken place. I by no means wish
to make ourselves out better than we are,
and we must all recognise the fact, but too evident,
that there are many dangers and difficulties and
drawbacks in connection with our vocation, both in
its internal workings and its external relationships,
which cannot fail to rouse feelings of anxiety and
concern as to the future in any thoughtful mind.
But let us to-night be optimistic, and take a bright
and hopeful view of things. The Archbishop of
■Canterbury recently expressed his belief * that there
could not easily be found, all the world over, a body
of men who approached more nearly to the full dis¬
charge of their duty than the clergy of the Church of
England.’ That sentiment I unhesitatingly appro¬
priate for the great bulk of the medical profession.
And looking back upon the nineteenth century, I
venture to affirm, with a feeling of assurance and
pride, that their efforts during this period have con¬
tributed, in a degree which can never be adequately
realized or estimated, to the saving and prolonga¬
tion of life, to the cure and prevention of disease, to
the eradication or great amelioration of many grave
and formidable maladies, to the practical relief of
human suffering, and to the promotion of the health
and general well-being of the community at large.
THE PROGRESS OF RHINOLOGY. (a)
By JAMES B. BALL, M.D.,
Physician to, and Physician in charge of the Throat and Ear
Department at the West London Hospital.
I propose to devote the time which the custom of
the Society places at the disposal of its President at
this, the first meeting of the Session, to a brief retro¬
spect of the principal advances which have been
made in rhinology, or perhaps I should say, in
modern rhinology.
If we glance for a moment at the state of know¬
ledge of diseases of the nose, which existed about
the middle of the present century, we find that it was
by no means inconsiderable, but diseases of the nose
at this period were chiefly studied and dealt with as
a branch of surgery. General medicine took little
account of them. The influence of the integrity
a Abstract of Presidential Address delivered before the West
on Medico-Chirurgical Society on October 6, 1899.
of the nasal passages on the condition of the
lower air passages and the general health, though
not absolutely unknown, was scarcely ever considered.
Although the grosser lesions were fairly well known
there prevailed a certain amount of confusion, and a
want of exactness with reference to diseases of the
nasal passages, resulting from the fact that these
passages were not systematically inspected. Indeed
a proper inspection of them was not possible with the
methods then in use. Yet without such inspection
further progress was difficult. There was, however,
impending, a discovery which was to open up the way
for a proper inspection of the naBal cavities, and was
to unfold a more exact and complete knowledge of
diseases of the upper air passages than had hitherto
seemed possible.
The history of the discovery of the laryngoscope
has often been told, and it would be beyond my pur¬
pose to repeat it here at any length. The credit
thereof unquestionably belongs to Manuel Garcia,
the well-known professor of singing, who made the
discovery in 1854, but the discovery of the art of
inspecting the naso-pharynx and posterior nares, was
made by Czcrmak. Already in his first communica¬
tion on the laryngoscope he indicated its practicability
and subsequently, in 1859, he was able to publish a
full account of his method. From this date
modem rhinology may be said to have begun,
but it was not until 1868 that Thudichum
(a member and former president of this
Society) published some papers in the Lancet
entitled “ On some new methods of treating diseases
of the cavities of the nose,” in which he drew attention
to the prevailing neglect of inspection of the nasal
cavities through the nostrils. This he attributed
largely to the want of a proper speculum for dilating
the nares. He described the speculum which he had
devised, and he advocated the use of the oxyhydrogen
light for illuminating purposes, so that the author
was undoubtedly one of the pioneers of rhinology in
this country.
Still, the construction of a suitable speculum, or
dilator, for the anterior nares by no means overcame
the difficulties attending inspection of the nose from
the front. The turgid mucous membrane only
too often prevented a view of anything beyond the
vestibule and the anterior end of the inferior
turbinal. Zaufal, in 1875, introduced funnel-shaped
tubes for passing into the cavities and obtaining a
glimpse of deeper parts. In certain cases they
afforded some help,'but in 1884 a discovery was made
which rendered Zaufal’s funnels obsolete, and, while
affording unexpected facilities for x-hinoscopic exami¬
nation, was destined to give an impetus to rhinology
only second to that which was furnished by the intro¬
duction of the laryngoscope. This was the discovery
of the effects of cocaine, first described by Freud, and
utilised by Roller for the eye, and immediately after¬
wards by Jellinek for the nose and throat. Cocaine,
which in laryngology, has afforded such valuable
assistance to operative procedures, has proved of no
less service to rhinology as an aid to diagnosis. By
its constricting effects on the blood vessels of the
mucous membrane it opens up the passages to view,
rendering the deeper parts accessible to thorough
exploration with the eye and probe. Its value as
an anaesthetic in the performance of numerous intra¬
nasal operations is not to be under-rated, but still,
this must rank after its value as an aid to examina¬
tion of the nasal cavities. Since the introduction of
cocaine the diagnosis and treatment of nasal diseases
have made rapid advances, and rhinology has
acquired a precision and importance not previously
attainable.
With the introduction of improved methods of
examination, and the increasing attention given to
careful exploration of the nasal cavities, anteriorly
Dig
oogle
Oct. 11, 1890.
ORIGINAL COMMUNICATIONS.
Thb Medical Pbebs. 371
and posteriorly, more exact knowledge of pathological
conditions gradually replaced the vague ideas which
had hitherto prevailed. Morbid conditions were
carefully studied with the aid of the eye and the
probe. Symptoms were as far as possible traced to
their true pathological causes and, as each condition
was identified, an appropriate and rational treatment
was sought for. Many operations could be under¬
taken, under the guidance of the eye, and with
cocaine as an anaesthetic. New and more delicate
instruments were introduced, better suited to the
modern method of operating under the guidance of
the eye. Snares of various kinds superseded the
forceps, and the electric cautery, which Yoltolini had
long advocated, came into general use for many
operative procedures.
The first great step in the progress of modern
rhinology was the discovery of adenoid vegetations,
a discovery which conferred the greatest benefit on
otology and on general medicine. This important
affection was first described by Meyer, of Copenhagen,
in 1868. It is true that isolated instances of hyper¬
trophy of the pharyngeal tonsil, or adenoid vegeta¬
tions had been observed with the rhinoscopic mirror
by Czermak. and subsequently by Loewenberg and
Yoltolini, but nevertheless to Meyer alone must be
attributed the credit of discovering the disease. He
first drew a picture of its symptoms and effects,
pointed out its frequency and importance, and
demonstrated the excellent results of operative
treatment. The great frequency of this disease, its
injurious effects on the growth and physical and
mental development of children, its bearing on the
etiology of ear troubles, and the satisfactory results
of operation, all mark the recognition of this affec¬
tion as one of the greatest steps in rhinology that has
ever been made.
Although Meyer published hi6 first account
of adenoid vegetations in 1868, it took ten or
twelve years before the importance of his dis¬
covery began to receive anything approaching
widespread recognition. One of tne direct
results of this recognition was the increasing import¬
ance which became attached to free nasal respiration.
All forms of impeded nasal respiration were more
carefully studied, and operative methods for their
relief were improved and extended. From the
reiterated teachings of rhinologists, the profession
generally came to appreciate the fact that, side by
side with its olfactory function, the nose fulfilled still
more important functions ; that, in its passages, cold
air was warmed, dry air moistened, dusty particles
arrested, and germs of disease arrested and possibly
destroyed, and, further, that the fulfilment of these >
functions could not be thrown on other parts without
detriment. Mouth-breathing came at length to be
regarded in its proper light as a diseased condition
resulting from some impediment to nasal respiration,
and not as a mere habit. Its ill-effects at all ages,
but particularly in childhood, and the importance of
timely treatment, gradually gained a more general
acceptance.
Meanwhile rh'nologists were becoming cognisant
of the occurrence of certain disturbances in the nasal
passages, as well as in distant parts, which seemed to
arise in a reflex manner from nasal irritation. The
recognition of a relationship between certain disturb¬
ances, chiefly of a nervous character, and nasal affec¬
tions, was not altogether new, as occasional allusions
to. such a relationship are to be found in the older
writers. Among modern writers, Voltolini was the
first to point out, in 1871, the connection between
nasal polypi and asthma, and B. Fraenkel shortly
afterwards established a connection between other
nasal affections .and, asthma. The subject, however,
received no great attention until the publication of
Hack's observations between 1881 and 1884. It was
Hack’s enthusiasm, and perhaps we may now say, his
exaggerated views, which awoke the remarkable and
widespread interest in the so-called reflex nasal neu¬
roses, which manifested itself about this period. The
result was that by 1890 the subject had called forth
an extensive literature of its own. Besides asthma,
hay fever, and certain cases of migraine and epilepsy,
there was scarcely any disease the etiology oi which
was obscure, or the treatment unsatisfactory, that
some enthusiastic rhinologist did not claim to have
cured by the application of the galvano-cautery to the
inferior turbinals, or by some other intra-nasal opera¬
tion. Enthusiasm in anewfieldof treatment must be set
down as an excuse for the exaggerated views and the
loose reasoning which characterised many of the
publications of this period. A reaction, however,
soon set in, and at the present day, while rejecting
much that was put forward a few years ago, we retain
many solidly established facts, especially relating to
the etiology of paroxysmal sneezing and hay fever,
and of certain cases of cough, glottic spasm, and
asthma.
Suppurative affections of the accessory sinuses of
the nose, which at the present day form such an
integral part of rhinologieal practice, received for a
long time little attention at the hands of rhinologists.
The earlier rhinologieal treatises almost completely
ignored them, and the treatment of suppuration of
the sinuses continued in the hands of surgeons. Of
course, it was only the maxillary and frontal sinuses
that there was then any question of, and the great
frequency of suppurative affections of the sinuses
running their course without any gross external
signs was completely unknown. It was Ziem who
first led the way in this department. In 1880, and
subsequent years, he repeatedly demonstrated the
great frequency of suppuraton of the antrum, mani¬
festing itself by a purulent discharge from the nose,
and unattended by any of the classical signs which
were still enumerated in most surgical works as-
characteristic of the disease. Ziem’s observations
were quickly confirmed by others, and were sh own
to apply equally to the other sinuses. Thus a new
field of pathology, hitherto ignored, was opened up.
The ethmoidal cells and sphenoidal sinus were for
the first time brought within the range of diagnosis
and treatment, and the frequency with which suppura¬
tion simultaneously affected several sinuses was
demonstrated. In the year 1889 Heryng introduced
the method of electric transillumination, a method
which has proved of considerable service in the
diagnosis of diseases of the accessory sinuses.
Many cases of severe and intractable headache,
and neuralgia have been traced to a chronic, and
otherwise very latent, suppuration of one or more of
the accessory sinuses, and relief has been afforded by
operative measures. The pathology of nasal polypi
has received considerable elucidation from the dis¬
covery of the frequency with which these growths,
especially in the most intractable cases, are
symptomatic of sinus suppuration. Meanwhile, the
diagnosis of suppuration of the different sinuses has
attained greater precision, and great advances have
been made in treatment.
It must be admitted that for some time these new
branches of our art were by no means taken up warmly
by physicians and surgeons. For a considerable
time laryngology and rhinology were pretty generally
ignored. It is safe to say that fifteen years and
more after the introduction of the laryngoscope, there
was not a single person connected with many of the
large London teaching hospitals who could use the
laryngeal or rhinoscopic minor. It was left to the
energy of private individuals to start special hos¬
pitals, and to diffuse a knowledge of these arts. But
of course this state of things could not last. Gra¬
dually, but surely, the specialty asserted itself; and
D
372 The Medical Pbem>-
ORIGINAL COMMUNICATIONS.
Oct. 11, 1899.
departments for diseases of the throat were estab¬
lished first at one hospital and then at another. But
meanwhile rhinology was by no means keeping pace
with laryngology. Ignored by the rest of the pro¬
fession, it received, too often, nothing but neglect
from those who ought to have acted as its special
guardians in the throat and ear departments. Never¬
theless rhinology. as we have seen, has its devotees,
and it was steadily compelling the attention of its
sister branches. To-day its importance is generally
recognised. It has taken its place side by side with
laryngology and otology, indispensable to each of
them, and demanding and receiving from each an
equal share of attention. From them it can never be
dissociated. At the same time it presents problems
of its own in the fields of pathology, diagnosis, and
treatment, which will only be mastered by those who
devote to it the same time and attention as are given
to the sister branches.
THE RELATIVE VALUE OF ANTISEPSIS
AND IMPROVED TECHNIQUE, FOR
THE ACTUAL RESULTS OF OPERATIVE
GYNAECOLOGY, (a)
By L. GUSTAVE RICHELOT,
Paris.
[FROM OUR OWN CORRESPONDENT.]
It will be necessary before hazarding an opinion
on the relative value of these two important points,
to first examine operative results, and we have there¬
fore to discuss 1st, The evolution of antisepsis, the part
it has to play and its limitations. 2nd. The important
modifications undergone by the technique in use of
late years, and to point out how necessary it is to be
a thorough surgeon, in order to practise surgery with
success.
Operative Results.
The Development of Antisepsis. — With Lister’s
method began the revolution, which created the possi¬
bility for future perfection in technique, but ft was
not flawless, and is not so yet. In the beginning, all
danger was supposed to come from the air and from
the invasion of wounds by atmospheric germs. Car¬
bolic acid then reigned supreme, and this first period
has been termed “ empirical,”—not entirely without
reason. Afterwards came a time of more exact re¬
searches into the various causes of infection and the
preventive measures to be adopted. Morphological
investigation and experiments in vitro, became the
law. This was the era of scientific credulity, when
nothing more was aimed at, beyond making use of
the best laboratory-antiseptic for sickroom purposes.
It was not long, however, before the discovery was
made, that the very best antiseptic in vitro, does not
retain its value for clinical purposes, and that labora¬
tory prognoses were not always to be relied upon. It
was found that the use of antiseptics was not only
inefficient but at times dangerous. Hence, it gradually
became more or less discredited, whilst sterilisation
by heat has been duly gaining favour. This brings
us to the present time.
The utilisation of heat for the destruction of germs,
and for sterilising instruments and dressings, origi¬
nated with Pasteur, and has well nigh attained per¬
fection ; its assistance in the struggle against infec¬
tion is not to be denied.
Should it be considered as a new method ? It is
asserted to be so, by a class of surgeons who own that
antisepsis has been exchanged for asepsis. It strikes
me that here must have Deen confusion of ideas.
(a) Paper read before the International Congress of Gyn®c 'logy
at Amsterdam, August, 1899
Asepsis is the aim, antisepsis the way. Heat has
been substituted a s much as possible, for powders and
solutions, but heat, in itself, is only the most powerful
antiseptic. I will therefore continue speaking of
the “ antiseptic ’’ method. Moreover, heat is not capa¬
ble of being adapted to all purposes, and we cannot
do without other antiseptics as well. It cannot be
asserted that the utilisation of heat has simplified
matters. On the contrary; sterilisation can only be
obtained by a very complicated and expensive
apparatus, demanding the most careful manipulation.
It is a great mistake to suppose, as some do, that
so-called asepsis, is nothing more nor less, than
ordinary cleanliness; we oan safely aver that the
continual effort to attain asepsis by every means,
has brought forth the most admirable results.
The boundary line of antisepsis must now be traced.
We are enabled, to a certain extent, to prevent our¬
selves from carrying infection to our patients, but as
lersonal asepsis does not destroy the existence of
bacteria, we are fighting with unequal weapons
against pre-existent infection. For instance, if in the
course of abdominal salpingotomy, the purulent sac
should burst, “contaminating the peritoneum by its
contents.” if the matter be particularly infectious, the
patient will die, whatever may be done to avoid fatal
results. It can, however, also happen that when in
a similar case, the focus be carefully cleansed and
drained with gauze, the patient recovers, after a few
bad days. How are we to explain this ? It may be
that the pus was less virulent; or that the organism
defended itself, no share in the recovery being due
to ourselves.
This notion concerning the powers of self-defence
in the organism has rectified the absolutism of the
earlier ideas on the subject of micro organisms [the
specific gravity and degrees of virulency in microbes).
Bacteriologists have acknowledged its importance,
and shown its mechanism, by demonstrating phago¬
cytosis. The living organism is able to defend itself,
it beats off attack, when not in a debilitated condition,
and armed with all its resisting-power. If this is not
the case, hope is lost. We should not expect too
much from “ Nature medicatrix ”; and when in an
enfeebled condition should give it the support that is
wanted. Surgical art is now called upon, and the
importance of technique stands revealed. Antisepsis
is the same for everyone, and demands only passive
obedience to certain rules. On the contrary, techniques
vary, and are subject to personal aptitude.
The value of antisepsis is, within narrow limits,
absolute ; the value of the techniques is relative and
illimitable, it depends upon the operating hand and
the directing head.
Evolution of Technique.— The great technical im¬
provements have been rendered possible by the use
of anaesthetics, exact hmmostasis and antisepsis.
Instruments. — Among the numerous inventions
under this heading, that our time has produced, the
greater quantity can safely be consigned to oblivion.
We acknowledge the value of artery clamps and are
much indebted to the Trendelenburg position, but
as for the rest, we do not place too much reliance
on instrumental innovations. The best results are
obtained by the surgeon who knows how to use his
hands and his common sense.
ISurgical ability in the widest sense of the term is
comprised in the three chief qualifications : dexterity,
ingenuity, and judgment. Dexterity varies in its
nature—some possess the gift by birth, others never
acquire it, and most manage to do so, and to develop
it by practice. Anyone can observe this by himself.
An able surgeon operates quickly, so as to minimise
the dangers of a long operation, i.e , greater chances
of infection, haemorrhage, shock, &c., although quick¬
ness of execution, should never be allowed to en¬
croach on careful operating. The ingenuity of
oogle
Digitiz
Oct. 11, 1890.
TRANSACTIONS OP SOCIETIES.
The Medical Press. 373
gynecologists has opened several entrances to the
pelvic organs, and taught us various methods oi
procedure although it must always be remembered
that for methods, as for instruments, excess does not
mean riches.
The history of operative treatment of pelvic
diseases, fibroids, and uterine cancer, &c., shows how
important is the choice of the Operative Way. To
make sure of selecting well, we must have broad views
on the subject. “ Not one of us has the right to be
imperfectly educated.” Methods continue to become
more and more simplified, and in that way lies pro¬
gress. The successive extrnperitoneal and intra-
peri toneal treatment of the stump, and total extirpa¬
tions in the abdominal operations for fibroid, furnish
the example. Another is found in the application of
** pinces h demeure ” in vaginal hysterectomy. What¬
ever way may be followed, which ever may be the
method chosen, the details of execution will always
decide the point. The true surgeon shows himself,
who seems to be operating easily, and manages to
produce the impression that anyone else could do the
same.
Therapeutic Results.
Obviously the beet methods yield the most favour¬
able results, but it is not to demonstrate this I am
now addressing you, but to speak of the relative value
of antisepsis and technique—assigning to each its
share in the final results. I will not select my
examples among dangerous operations and merely
remark that, whilst in these many operators ascribe
their good results to antisepsis alone, it is the con¬
trary For minor operations where the importance of
method is greatly exaggerated. The question con¬
cerning abdominal suture and colporrhaphy points
to the conclusion that it matters less what is done,
than how.
To conclude, I wish to remark that the union of
antisepsis with improved technique paves the way
for conservative gynsecology. and that in this direc¬
tion lies the progressive improvement we hope to
attain.
Clinical JRccorbs.
ROTHERHAM HOSPITAL.
A Note on a Cass of Strangulated Hernia in a Child —
Death.
Under the care of Mr. Ltth.
[Reported by J. Sackville Martin, M.B., C.M.Ed,
M.R.C.8.Eng., House Surgeon.]
The occurrence of strangulated hernia in children under
10 years of age is sufficiently uncommon to make a brief
notice of such a case of interest when it occurs. In the
following case the hernia was of unusual size, consider¬
ing the age of the patient. The tightness of the con¬
striction was also very marked, and was in all probability
the cause of death.
A boy, rot. 5, was admitted to the Rotherham Hospital
on August 26th, at 3.30 p.m., with a strangulated hernia
in the right inguinal region. There was a history of its
descent on several previous occasions, but at 10 a.m. on
the morning of admission it had become strangulated
and could not be reduced. Its size was considerable,
being about four inches in length, from the neck to the
lowest part. The child had been sick several times in
the course of the morning. After a warm bath the
hernia returned spontaneously into the abdominal cavity.
The child was kept at rest until the 29th. During
this time he was quite well. At 1 p.m. on that date the
hernia returned and again became strangulated. A
warm bath, and very gentle taxis, under an anrosthetic,
having failed, Mr. Lyth performed herniotomy. The
sac was opened, and about eighteen inches of bowel were
found in it. The bowel was congested, but lustrous, and
was returned into the abdomen. There was some
omentum, which was ligatured and cut off. The whole
operation did not last above ten minutes, and there was
no undue handling of the intestine.
During the rest of the day the patient seemed comfort¬
able, ana the bowels moved freely on the following
morning. Serious symptoms then began to Bhow them¬
selves. The temperature rose steadily. It was 102 degs. at
3 p.m., and rose to 105 6 degs. at 6.30 p.m. At this time
the patient manifested extreme pallor and restlessness.
The pulse was feeble, rapid, and irregular, the
lips blanohed, and the pupils widely dilated.
It was thought that the condition was due
to Bhock produced by a hemorrhage from the
omentum, from which one of the ligatures was supposed
to have slipped. The patient’s condition precluded any
idea of further operative treatment, and in spite of the
administration of opiates and the infusion of saline solu¬
tion into the veins of the arm, he died at 12.30 a.m.
Post-mortem examination showed that the death was
due to no flaw in the operation. The congested portion
of the bowel was about one foot above the ilm crocal
valve. It was in a perfectly fit condition to justify its
return to the abdomen. In the layers of the mesentery
at this part, extensive extravasations of blood were
found. These were due to the nipping of the mesentery
at the constriction.
Death therefore was due to shock referable to the
severe injury sustained by the mesentery. The soft
tissues of young children do not often give rise to so
severe a constriction. In looking back upon the case, it
is difficult to see in what manner this particular danger
could have been guarded against.
I am indebted to the kindness of Mr. Lyth, under
whose care the patient was, for permission to publish
these notes.
^ransactionB of gortetteo.
OBSTETRICAL SOCIETY.
Meeting held Wednesday, October 4th, 1399.
Mr. Alban Doran, F.R.C.S., President, in the Chair.
rotation and impaction of a myomatous uterus.
Mr. J. Bland Sutton related the case of a woman,
rot. 35, who was seized with pain in the lower abdomen.
On examination a tumour was detected in connection
with the uterus, apparently a myoma, which rose above
the pelvic brim, and could be felt per vaginam, filling
the hollow of the sacrum, and occupying the left half of
the pelvic cavity. Pressure on the tumour provoked great
pain. A smaller tumour was felt on the right side of
the pelvic also connected with the uterus. The whole
mass was evidently impacted, but the cervix was free.
No vesical or rectal symptoms. He operated and found
the pelvis filled by a myomatous uterus, tbe left ovary
and tube lying under the sacral promontory, and the
right appendages just under the symphysis. There was
no utero-veeical fossa, the peritoneum being drawn
tightly over the tumour as a broad thick bamd. Ho
firmly impacted was the mass that it could be
withdrawn only with great difficulty. As soon as
this was done the parts righted themselves so that
evidently the uterus had rotated through half a circle,
from right to left. As the appendages on both sides
were closely adherent to the uterus he removed them
and the hysterectomy was then completed without
further difficulty. On section of the uterus myomata
were seen to occupy the anterior and posterior walls.
He suggested that as the tumours had increased in size
the slow growth led to passive rotation of the large
anterior tumour into the oblique diameter of the pelvis
ultimately leading to impaction, rotation and pain. He
remarked that it was unusual to find rotation and im¬
paction co-existing,
TUMOUR OF THE ME80METRIUM.
Mr. Bland Sutton next showed a tumour which,
when fresh, weighed 22 pounds removed from a woman,
Digitized by Google
TRANSACTION'S OF SOCIETIES. Ocr. n, 1899.
374 The Medical Press.
set. 43, who was admitted to the Middlesex Hospital
with an indefinite and untrustworthy history. The
belly was large and almost quadrilateral in shape, abso¬
lutely solid, and on auscultation a loud systolic hum was
heard. Per vaginam the cervix was drawn up out of
reaoh. On opening the abdomen a huge mass came into
view, covered with a plexus of very large veins, project¬
ing from the pelvis. He shelled it out of the pelvis,
clamped and then divided the uterine arteries. He
found the uterus so distorted as to be scarcely recognis¬
able, so he removed it along with the right ovary and
tube, having taken care to leave the pelvic portion of the
capsule intact, so that after tying the vessels he was
able to suture together the right and left wings thereof.
The central portion in relation with the stump of the
cervix and bladder was sutured to the lower angle of the
incision and lightly Btuffed with sterilised gauae. The
operation was a severe one, but the patient bore it well.
An hour later bleeding seemed to be going- on into the
peritoneum, so he reopened the wound, but this proved
to be unnecessary. Sne ultimately left with the wound
soundly healed in four weeks. The tumour measured
thirty centimetres in diameter, and the cervix was
Btretched over its right side. The whole-mass was hard,
and was made up of spindle cells with groups of oatshaped
cells presenting patches of softening. The appearances,
on the whole, suggested a slowly-growing spindle-celled
sarcoma. He discussed the nature of the group of
tumours classed as mesometric myomata, remarking that
many of them arose from the cervix and spread into the
mesometrium ; others grew from the uterus and pushed
their way between the layers of the me«ometrium.
There is, however, a distinct variety, to which this
tumour belongs, which may be described as a
roughly-globular, easily shelled out, yellowish-white-on-
section, and distinct from the uterus, histologically,
approaching rather a spindle-celled sarcoma than a
myoma or fibro-myoma. He remarked on the resem¬
blance of these tumours in size and shape to a football,
pointing Out that they occurred in other retro-peritoneal
situations, of which he mentioned an example in a
woman, set. 70.
MYOMATOUS UTERUS, WEIGHING TWENTY-8IX POUNDS,
REMOVED FROM PATIENT, .ST. 8EVENTY-FOUR.
Mr. Bland Sutton also showed a huge tumour
removed from a woman, set 71, admitted to the Middle¬
sex Hospital with some large and hard tumours, which,
though painless, were so cumbersome that she had
become bedridden. The existence of the tumours was
first recognised in 1871. Nothing of note could be made
out vaginally, and on September 6th he made an explo¬
ratory incision. The tumours were found to be partially
calcified uterine myomata, adherent only to the omen¬
tum. Their removal occupied 40 minutes. Very little
blood was lost, and the patient bore the operation well.
The subsequent p'ogress of the case was uneventful, and
she left the hospital convalescent on the 29th. The
tumour consisted of a number of partially pedunculated
and calcified myomata. He thought that this patient
was probably the oldest who had ever gone through so
severe an operation as hysterectomy.
The President supposed the author would not deny
that a myoma might form originally in the broad liga¬
ment, and he suggested that the existence of well-defined
muscular tissue in that situation might advantageously
engage the attention of pathologists. He mentioned
that the patient, let. 22, from whom he had last year re¬
moved a tumour weighing 44 lbs., was still in excellent
health.
Mr. Sutton, in reply, agreed that true myomata were
met 'with in the broad ligament, and also that true
muscle fibres were met with in that situation. He had
satisfied himself as to this in a case of large parovarian
cyst.
The Pati OLOtiY and symptoms ok hydatidiform
degeneration of the chorion.
Dr. Herbert Williamson first described the develop¬
ment of the chorionic villi, and the changes which occur
in them when undergoing myxomatous degeneration, the
changes as observed by himself agreeing almost entirely
with those previously described by other observers.
The “myxoma fibrosum” of Virchow was described,
and the author gave his reasons for regarding thi3 condi¬
tion as one closely allied with hydatidiform mole. He dis¬
cussed the question of the priority of the degeneration of
the chorion or the death of the embryo and arrived at the
conclusion that degeneration of the chorion usually
precedes the death of the embryo. He then discussed
relation of hydatid moles and deciduoma malignuin; he
gave reasons for doubting the doctrine of Spiegelberg
with regard to the fcetal origin of the hydatidiform
disease, and quoted cases of repeated hydatidiform
molar pregnanoies occurring in the same woman. He
then dealt with this abnormality from various points of
view (1) the frequency of the occurrence of the condi¬
tion, and (2) the effects of (a) age, ( b ) multiparity,
(c) rapid child-bearing upon its production ; concluding
that (1) Its approximate frequency may be once in 2,400-
pregnancies. (2) That hydatidiform pregnancy may
occur at any time during the child-bearing period, th»
age of the woman having very little influence. (3) That
the condition is more frequent in those who have borne
few children than in those who have borne many. (4)
That it is not the rule for previous pregnancies to
have followed upon one another with great rapidity-
The results of an inquiry which he had made into the
presence or absence of the usual signs and symptoms of
normal pregnancy under the following heads?—(I)
Amenorrhcea; (2) Vomiting; (3) Activity of breasts;
(4) Blue colouration of vaginal mucous membrane; (5)
Softening of cervix; (6) Uterine tumour; (7) Uterine
tumour and foetal heart-sounds, led him to the conclu¬
sion that all these symptoms and signs are usually
present excepting the uterine souffle and fcetal heart-
sounds, but sometimes even these have been heard - r
whilst, on the other hand, the only sign which is
constantly present is enlargement of the uterus. The
distinguishing features of the condition were then
described under the following heads:—(1) The size and
other physical characters of the uterus. Two classes of
cases are shown to exist: (1) those in which
the uterus is larger than would be expected from the
probable duration of the pregnancy; (2) those in which
the uterus is smaller. Another feature sometime* pre¬
sent, and of importance, is uterine tenderness. (2) Va¬
ginal discharges, with or without the cysts. (3) Haemor¬
rhage. The author then discussed the diagnosis of the
conditions likely to be mistaken for hydatidiform mole
being—(1) Concealed accidental haemorrhage and pla¬
centa prtevia; (2) the discharge of a pelvic hydatid
through the vagina; (3) hydramnion, especially if
combined with hydrorrhcea gravidarum. Among com¬
plications met with he mentioned—(1) Albuminuria,
a frequent complication. Two forms are to be dis¬
tinguished: (a) One form in which the prognosis
is good, in which blood and epithelial casts are not p e-
3ent in the urine. (6) One form in which the prognosis
is bad, and in which these structures are found in the
urine. (2) Haemorrhage, seldom fatal in itself. (3)
Sepsis; saprannia, septicaemia, and pysemia all being
frequent complications. Prognosis .—The mortality of the
whole 25 cases was 20 per cent. The moitality of the
ten consecutive cases from 8t. Bartholomew’s Hospital
was 30 per cent.
Dr. G. Herman expressed surprise at the relatively
high mortality given by the author, especially as nearly
all the cases he had met with had recovered without its
having been necessary to do more than give ergot and
introduce a tent. He commented on the large propor¬
tion of deaths from sepsis, which he thought might have
been prevented.
Dr. Griffith thought that the high septic mortality
might possibly be explained by many of the cases dating
back to pre-antiseptic days. He thought that myxoma
fibrosa was much commoner than was generally believed,
and was often overlooked or mistaken for an ordinary
carneous mole, of which two instances had accidentally
come under his observation. Moderate degrees of
degeneration, cystic of fibrous, <r the chorion, were, he
[ thought, by no means rare in otherwise healthy fcetus.
If, as suggested by the author, myxoma fibrosa was closely
associated with cystic mole he thought it must be difficult
Digitized by CjOCK^Ic
Oct. 11, 1899.
FRANCE.
The Medical Press. 375
to explain how it was that in the former the chorion stamps
were affected, while in cystic mole there were merely
isolated patches of bullous degeneration of the chorionic
tissue, with comparatively healthy chorionic stumps
between. If it were regards as a maternal disease,
how did the author explain the existence of
twins, one with a healthy placenta, while the
other placenta presented cystic degeneration ? He
recalled the suggestion that this might be due to
the fact of one fcetus having been implanted on a
degenerating spot of the uterine muooea. Personally he
held to the view that it was a disease of the ovum. He
asked whether anyone could boast of having diagnosed
a hydatilaform mole apart from the expulsion of a
vesicle. He had often diagnosed it, but it had always
turned out to be something else.
Dr. John Phillips alluded to the difficulty of the
differential diagnosis between this condition and con¬
cealed accidental haemorrhage. He mentioned that he
happened to have had a case of each kind on the same
day, and in respect of the mole even on passing the
finger into the cervix he obtained no indication of its
nature. The vesicles were very soft to the touch and
not unlike clotted blood. With regard to death from
sepsis he himself had hardly seen even a rise of tem¬
perature.
Dr. Hubert Roberts suggested that it might be that
it was in such cases with this tendency to degeneration
that one met with the condition described as dociduoma
malignutn.
Dr. Maclean related a case of a woman, a?t. 35, who
had previously borne two children, who came under
observation after four months’ amenorrhoea with a
tumour reaching above the umbilicus. There had been
slight loss of blood every two or three days, and while
under observation there was a sudden attack of profuse
hemorrhage, and then for the first time some vesicles
escaped. The uterus was rapidly cleared of its contents,
but in spite of saline injections she succumbed. He
mentioned this as an instance of death from hemorrhage
in a woman otherwise strong and healthy.
Dr. Blacker mentioned the case of a woman who
was admitted with a tumour of the anterior wall of the
vagina resembling a hiematoma which gave her much
pain. It was incised and was reported to be a fibro-
angioma of uncertain nature. The woman was appar¬
ently pregnant, and a few days later pass'd a hydati-
diform mole. He did not suppose that there was
any relation between the two things. He referred to the
curious case recently published by a surgeon of a girl
who had suffered from membranous dysmenorrhea, who
subsequently passed a bydatidiform mole, although it
was regarded as absolutely certain that there had been
no possibility of pregnancy.
Dr. Spencer pointed out that the statistics collected by
he author gave no clue to the relative frequency of such
cases. He observed that if one could obtain ballottement
that sign would argue greatly in favour of its being a
case of accidental concealed htemorrhage or placenta
pravia. He commented on the rarity of vesicles escaping
in the discharge. He only remembered one instance of
death from sepsis, and in that case infection had taken
{dace prior to admission.
Dr. Ludwig Frankel, of Bieslau, speaking in German
on the subject of deciduoma malingnum, said that Veit
was alone in Germany in supporting the English view
that this condition was due to sarcoma, existing inde¬
pendently of, and probably before, pregnancy. The
general view in Germany was that it was a fcetal neo¬
plasm arising from the chorionic villi and of the nature
of an epithelioma, and it appeared structurally analogous
to the cases of hydatidiform mole, which by analogy were
termed epithelioma benignum.
Dr. Williamson replied, and mentioned a case which
had since come under his observation, which was dia¬
gnosed as concealed accidental haemorrhage even after
the cervix had been dilated. He thought the change
was rather of the nature of a degeneration. He was
unable to accept the suggestion that a hydatidiform
mole could be present without impregnation.
dfrancc.
[from our own correspondent.]
Pabis, October 8th, 1896.
The Duration of Apparent Death.
At the Academie de Medecine, M. Laborde related
fourteen new cases of resuscitation of individuals in a
state of apparent death, thanks to rhythmical traction
on the tongue. Of these cases, the half was relative to
drowned persons who were brought back to life after a
time varying from twenty to sixty minutes of traction.
Up to the present, it was impossible to determine
exactly the time during which the functional pro¬
perties could persist in animals appaiently dead.
However, among the fourteen cases referred to
by the speaker, there was one, that of a
drowned man, who was called back to life after three
hours of rhythmical traction of the tongue. The vital
properties would seem then to persist in a latent state
during a lapse of time which might be estimated at
three hours as the extreme limit.
Another fact which deserved recognition was that with
old methods of recalling to life the respiratory move¬
ments were never established where the asphyxia had
exceeded five or six minutes. By means of the method of
M. Laborde, on the contrary, subjects who had sojourned
under water thirty or forty minutes had been very
frequently reanimated.
M. Colin asked if the examination of the blood and
of the heart had been practised on animals experi¬
mentally placed in a state of apparent death.
M Laborde answered that it was found that the blood
of such animals was very rich in carbonic acid, and con¬
tained only traces of oxygen, but remarked that it was
never coagulated, and that it always maintained a certain
temperature.
As to the heart, it was apparently stopped, and pre¬
sented only slight tremulations. As soon as the
respiratory movements became re-established, it began
to beat strongly. It was probable that the phenomena
occurred in drowned and asphyxiated persons.
Varicose Ulcer of the Leu.
For the treatment of indolent varicose ulcer of the
leg. Dr. Brunner highly recommends the application of
a two-and-a-half per cent, of carbonate of soda. Under
its influence the ulcer heals rapidly, but the same agent
is not superior to other means of treatment in recent
ulcers, or those covered with exuberant fungosities. His
modus operandx is: After having washed the ulcer with
a warm solution of sublimate, he applies a piece of anti¬
septic gauze, thinly coated with vaseline, and over this
hydrophile cotton soaked with the solution of carbo¬
nate of soda, and finally a bandage. The dressing is
renewed each day. Twenty-four hours after the first
application the ulcer assumes a more healthy aspect,
and at the end of a few days it granulates abundantly;
the callous edges become softer, and from that time the
ulcer cicatrises rapidly. The definice cure is obtained in
from ten to thirty days.
Certain persons cannot support the vaseline, which
provokes eczematous eruptions; in such cases he
replaces the vaseline by lanoline, or he applies simply
and directly on the ulcer compresses wet with the solu¬
tion of soda.
Digitized by Google
376 The Medical Press.
GERMANY.
Oct. II. 189ft
(Scrntattp.
[prom our own correspondent.]
Berlin, October 6th 1899.
At the seventy-first meeting of the 8ociety of German
Scientists and Physicians, after an address by Nansen,
Professor v. Bergmann addressed the meeting on
The Achievements of Radiography in the Treat¬
ment of Surgical Diseases.
No seer’s glance had penetrated boards and beams like
this dark light, no somnambulist with his clear vision
had discovered such secrets. Exaggerated hopes had
been placed on the curative power of the rays, and all
possible diseases had been submitted to their aotion.
But people soon became conscious that no wonder
cures would be wrought by it; it was not true that
other ways of curing had been discovered, but that
knowledge had been increased. It was not simply the
waves of the dark light, but the waves from the elec¬
trical discharges, heat waves, and a number of
waves possessing chemical powers. As a matter of
fact, the whole action of the waves was limited
to reddening and superficial inflammation of the skin,
and this effect was produoed much in the same way
as by a mustard plaster. The time of expectation
of mysterious powers was ’ passed. Medicine awaited
from it only a furtherance of the knowledge concerning
localised changes in the body. What it had done in
this direction was enough to prevent its exclusion from
the service of medicine. To anatomy, without an accu¬
rate knowledge of which therapeutics were useless, it
rendered useful service. For the diagnosis of diseases
of the internal organs it was comparatively valueless.
From the fleeting images afforded by the light on the
screen, for instance, it was not possible to determine com¬
mencing tuberculosis. Percussion was a more certain
guide as to cardiac area and pleuritic effusion than the
light, and never had any decided conclusion been
reached by it as to the position of gall-stones or vesical
calouli.
The importance of the new discovery was greater for
surgery. The rays had done the most service in the
discovery of foreign bodies and in fractures of bones.
The discovery of foreign bodies and the tracking of the
path they had taken in the system, and the treatment
resulting from this knowledge were the greatest achieve¬
ments for which medicine was indebted to the rays ; they
not only facilitated the removal of foreign bodies, but
they allowed of others being left in that would have been
sought for by operation before their employment, as
such foreign bodies could often be allowed to remain in
without fear of doing injury. Thus projectiles often
remained in the system without doing any harm. Their
removal would be more dangerous, as shown in many
cases of bullet and splinters healed up in the flesh, as
their removal would often necessitate dangerous and deep
operations. Thus the French surgeons in the attentat
upon Labori recognised that they would do better to
leave the ball alone. They made it possible for the dis¬
tinguished advocate to plead again a few dayB after being
wounded. There were cases in which bullets were in the
lungs, in the thorax, near to the heart, and even reaching
this; the persons implicated bore these foreign bodies
without being conscious of their presence.
The xepresentations of the bony system had been en¬
riched by the Rontgen rays. By a large number of
Rontgen piotures, the speaker showed normal and morbid
developments of the bones, particularly of the long bones,
and more especially those of the hand. From other
pictures not only could the age of children be
reoognised, but also the diseases that influenced growth.
Rachitic children could now, by means of the rayB, be
much more successfully treated, as the Rdntgen image
showed accurately the favourable point of time for
operation, which before could only be made out with
great trouble, and not with oertainty. It could now be
accurately determined from what basic diseases dwarfs
were developed, and French physicians had already
successfully employed thyroid preparations where by
Rontgen examination they had recognised the morbid
foundation for dwarf growth. The observations made by
the radiograph on the so-called Lilliputian troupe were
interesting. Through illumination had shown that
their bones, apart from their smallness, were quite
regularly formed, that they were furnished with well-
developed epiphyses. In faot, the people were still grow¬
ing. One of them,between his 26th and 36th year had grown
20 cm., and this at a time when, in the ordinary individual,
growth had entirely ceased. If this went on, and the
Rbntgen image showed a prospect of it, in his old age
he would have to leave the troupe through becoming
too tall.
The rays were also useful for the discovery of anoma¬
lies, such as absent joints or superfluous parts. The
occurrence of superfluous fingers was known to the Pro¬
phet 8amuel, as he mentioned a man of God who had
six fingers and six toes. At that time these deformities
were reckoned a sign of unoommon strength. Not less
interesting were the cases of hands with the middle
finger consisting of four, or, as in the thumb, two joints.
Nowadays Rbntgen illumination was sufficient to deter¬
mine the actual condition. This might under certain
circumstances have a surprisingly disagreeable effect on
the individual concerned, as the following very recent
case showed. A workman had been injured by a
machine. He complained of pains in the lower part of
the leg near the ankle. A bone was really felt there
that was not present in the normal skeleton. This bone
was supposed to have been split off by the accident, and
then healed in. As the man was supposed to be unfit
for work, he received considerable compensation. Then
came in the—in this case—bad rays. These showed
the like abnormality on the other leg also. It was,
therefore, proof that the peculiar condition oould not
have been caused by an injury. The incorreotness of
the professional opinion was brought to light by the
treacherous rays, and the man lost his compensation.
Protabgol as a Prophylactic—Crede’s
Instillation.
Hr. Fritz Engelmann has for some time been using
protargol in the place of silver nitrate as a prophylactic
in the case of new born infante. In the University
Franenklinik, at Bonn, he used it in 100 consecutive
labours without making any selections. The solution
was of a 20 per cent, strength. In almost 30 per cent, of
the cases there was no secretion, in about 60 a slight
one, only lasting a day. In 20 per cent, the secretion
became more profuse, but it lasted four days in four oasee
only. The opinion of the writer is that the prophylactic
Digitized by Cj oogle
AUSTRIA.
Thb Medical Press 377
Oct. 11. 189ft.
instillation of a 20 per oent. solution of protargol, which
scarcely irritates at all, is to be preferred to the 2 per
cent, solution of silver nitrate, which is a powerful
irritant. In opposition to Per gens, he shows that the
stains caused by the protargol can be removed.
Jlustria.
[from OCR OWN CORRESPONDENT.J
Vibnhi, October 7th, 189P.
Operative Treatment for Cancer or the Stomach.
Prof. Matdl has published the results of twenty-five
operations which he has performed for cancer of the
stomach. Since the days of Prof. Billroth these opera¬
tions have been subjected to severe criticism, condemna¬
tion and praise alternating. Prof. Maydl divides the
twenty-five cases into three classes for the sake of com¬
parison. The first comprises cases in which the patient
died from the effects of the operation either directly or
indirectly. These were four in number. The second
group includes those dismissed from hospital as cured*
but in which within a short period thereafter a recur¬
rence of the disease took place, and death ensued. These
were seven in number. The third group, whioh is the
most important, comprising fourteen cases, included those
cases in which the patients still live. This section he
divides into two sub-sections, (a) living upwards of two
years since operation; (b) those alive less than two years
after the operation.
Of the first group four died, one from a sudden attack
of gangrene in the right lower extremity, probably
embolic from the tying of a vein, but this could not be
confirmed, being a private patient and the friends
declining to consent to a post-mortem examination. The
other three died in two, three, and five days respectively
after the operation from peritoneal symptoms, collapse
with anaemia and exhaustion.
The second class left hospital in good health, and appar¬
ently cured, but ere long took ill with a recurrence some¬
where else and died. One of the seven may be looked upon
as doubtful. This patient lived fourteen months after the
operation and died of pleurisy with effusion, every other
organ being found healthy at the poBt-mortem. Even
the appetite was unimpaired up to the very end, and no
disease could be discovered in or near the stomach.
The other six cases lived 12 months, 8 months,
2 months, 20 months, 14 months, and 12 months respec¬
tively after the operation, or an average of irs months-
Of the third class fourteen are still alive. These were
operated on:—
August 27th. 1890.
June 7th, 1893.
January 27th, 1895.
March 1st, 1896
March 20th, 1896.
February 20th, 1897.
March 27th, 1897.
January 30th, 1898.
October 29th, 1898.
October 31st, 1898.
November 3rd, 1898.
December 21st, 1898.
January 4th, 1899.
March 25th, 1899.
If these be further sub-divided into two groups of over
two years and under we get the patient who may be
considered cured in the surgioal sense of the term.
Seven may be classed thus:—
8 years
5 „
* »
3
84 months
n „
34 „
2
3 years
2 „
2
14 months.
24 „
14 „
In considering the percentages of the different authors,
the above figures give 16 per cent, as the proportion of
those who die from the operation; in 28 per oent. the
disease recurs j while 66 per cent, still live. It may still
be remembered that C. Ewald, of Berlin, condemned this
operation on aocount of the mortality, he having had
73 3 per cent., which was certainly not encouraging ; but
these results far exoeeded those obtained by the pioneer
of the operation, Billroth, who had a mortality of only
45 per oent. Billroth’s pupil, Mikulicz, reduced this
mortality to 32 per oent., while other operators, Kronlein,
for example, had only 26 per cent., Carl and Fantino,
21-5 per cent., and now Maydl’s mortality stands at 16
per oent.
Naturforschkr Versammlung.
This year the German Science Association met on the
Isar, at Munich, which was well attended by represen¬
tatives from every Continental city, but more especially
from the German-speaking race. As advertised,
Frithjof Nansen, the North Pole explorer, gave the first
plenary lecture, which was mainly geographical. He
illustrated his remarks by a large diagram of the plum¬
bing of the North Polar sea, which reached 4,000 metres
(13,000 feet). The temperature of the water at the depth
of 200 metres was exactly at zero Centigrade; at a
depth of 800 metres it was 1 deg. Centigrade. The solid
matter (or salt) in the water at the surface was so small
that it could be used for drinking purposes, but when a
depth of 250 metres was reached the salt in the water
was normal. The lowest reading of the atmospheri 0
temperature was 53 degs. Centigrade, or 62 degs. Fahr
The summer temperature averaged 0 degs. Centigrade*
There were thirty-seven sections, but that dealing with
wireless telegraphy was by far the most popular.
Tubercle Bacillus Cultivation.
One of the distinguishing features of the tubercle
bacillus is its slow growth, but according to St. Hesse
thiB is purely on account of the nature of nutrient
media employed. With Hayden’s media in an incubator
he can obtain from a contact inoculation a culture in
five to six hours. In the sputum, whioh is rather more
difficult, he can determine in from half a day to one
day. The media, as prepared by Hayden, contains
common salt 5 grammes, glycerine 30 grammes, agar
agar 10 grammes, solution of soda (28*6 in 100) 5 cc,
distilled water 1,000 grammes. In experiments on
animals this is of great advantage.
Death of Prof. Puschmann.
Another of the professorial staff has passed away at
the comparatively early age of 45, after chronio
nephritis of long standing.
Born in Prussia, he was educated at Berlin, Marburg,
Munich, and Vienna. After qualifying, he went to
Tunis and Egypt, and settled in Cairo for two years as
a general practitioner. In 1878 he returned to Leipzig,
where he acted as Docent in Historical Medicine. He
was soon after this appointed Assistant Professor of
Historical Medicine in Vienna, and finally Professor
which post he has filled with dignity since 1888.
His twenty years’ residency in Vienna has endeared
him to the University as one of its most ardent
supporters, and one who will be greatly missed.
Digitized by LjOOQle
378 thb Medical Press.
LUNACY DEPARTMENT.
Oct. 11, 1899
§oitth Africa.
[from our own correspondent.]
Cape Town, Sept. 20th, 1869.
The War Scare and its Effects.
Medical matters are extremely quiescent, the perpetual
war tension absorbing every one’s attention. It is detri¬
mental to all work to a degree which English people can
hardly realise. One effect is the exodus of many of tne
best known local practitioners from Johannesburg.
Mr. Kendal Franks has been here for some weeks.
Having spoken at the great meeting which followed
the Petition, he was manifestly snspect, and
receiving information that a warrant for his arrest
bad been signed, he got away only with difficulty. Dr.
Harding and several others are also here. Dr.
Davies and some confreres in Natal. These gentlemen
state that it was not only the immediate prospect of
arrest that led them to leave, but the constant danger of
assassination, to which, of course, the necessary noc¬
turnal nature of a medical avocation exposed them par¬
ticularly. Numbers of the Boera openly threaten to kill
objectionable Uitlanders, and the police cannot be relied
upon for protection. Dr. Matthews, a very prominent
Uitlander, formerly a member of the Cape Parlia¬
ment, is, however, holding his ground most pluckily,
and lately gave evidence against a policeman who had
grievously maltreated an American coloured man. At
the moment of writing war iB regarded as certain, and
the Transvaal Government is making medical prepara¬
tions in a way. It has, of course, no properly organised
medical'military service, but the St. John’s Ambulance
centres in Pretoria and Johannesburg are organising
corps and being subsidised largely by the Government
so that, practically, the Red Cross will be a branch of the
burgher forces. The Johannesburg centre has just
applied to Cape Town for more material, and we have
sent all we can spare. On the British side nothing
has been done outside the R.A.M.C., but several medical
men have offered to join that corps as civil surgeons if
required, and the Cape Town St. John’s centre has
offered to supplement the military resources by fifty
bearers and corresponding equipment. It has already
cabled to England for more supplies.
The “ Anthony ” case, of which I gave you some
particulars before, has been investigated by a committee
of the local branch of the B.M. A., the result being a report
which, praotically, found him guilty of “ covering ” the
man Tate, and commented severely on looseness Bhown in
granting death certificates. The editor of the South Africa
Medical Journal also came in for censure. He had given
evidence in the case, and had recorded his opinion that
it was quite permissible to fill in death certificates on
the mere statements of friends of the deceased, without
any clear knowledge or record of having attended the
patient. This position, taken up by a representative
man, wsb roundly condemned by the C Dmmittee. The
report was adopted at a large meeting, with only two
dissentients, one being the editor of the South Africa
Medical Journal. Dr. Anthony has not resigned in
consequence, nor is he in the least likely to do so.
Whether any action will be taken to bring pressure
upon him is not clear.
The New Phakmact -Rilii and the Midwives.
Out Medical and Pharmacy Bill, which promised well.
has been grievously emasculated by the Dutch members
of the Houses, especially in the Legislative Council*
where a whole tirade of charges against the profession
as a whole was fired off. Tour average Dutch legislator
hates a doctor or a veterinary surgeon cordially. The
clause forbidding chemists to. practice was dropped
in the Assembly. Practically all we have got is
an additional member of the Medical Council, and
a little strengthening "of” the poisons enactment*
with an extension of the_ penal clause re puerperal
fever to unlicensed midwives. Under the old Aot a
npedical man or registered midwife could be baled before
a conrt for failing to take proper precautions, an
unlicensed woman went ecot free. But even this clause
had much ado in getting through. Only the interven-.
tion of the President of the Counoil, who, of course, very
rarely speaks, forced it through the Dutch members.
As an instance of the inconsequential way in which the
Boer argues, one sapient legislator gave, at an argument
agains1 the midwivee’ clause, an instance of a Cape Town
medical man having charged a patient A!65, then
accepted <620. What this had to do with the necessit y
of unlicensed midwives keeping themselves clean, good¬
ness only can say. In justioe, one must admit chat the
profession is worked on terribly commercial lines in this
country, and the field is so overcrowded that things are
becoming worse in this respect every day.
JEuitatg department.
SCOTCH LUNACY BLUE BOOK.
The Scotch Commissioners make their Annual Report
more interesting than that of the English Commissioners,
because the Blue Book contains, not merely a collec¬
tion of statistical tables, but an elaborate financial
statement, comparative in its character and enabling
one to see at a glance the relative economic posi¬
tion of different Scotch Asylums. In addition to this,
the Scotch Commissioners’ Report is interesting, be¬
cause of the important questions which are introduced
and discussed in it, and it certainly does more on
that account to bring itself in touch with the asylums
administered by its Commissioners, and to enable super¬
intendents to follow indications, and so organise and
develop these institutions. In the report just issued
many important questions are introduced, and the first
of these is, “ Changes among attendants and servants.”
They recommend that the administrators of asylums in
which changes among attendants occur frequently should
inquire carefully into the causes, and should endeavour
to remove them by offering increased inducements to
good attendants to remain, and to a better class to take
service. Their experience tends to show that, in the oase
of men, a high class of attendant, and security
for permanent service, are beet obtained by
increasing the number of married attendants.
There are, however, many questions which are not
settled by offering houses to married men, and there are
many assigned causes often unreliable, and reasons
which are difficult to reach and understand. The Com¬
missioners have laid a comforting unction to their souls
in that the Register, which they keep, of attendants and
servants dismissed for mis-conduct, is a safeguard
against these being taken on again in other asylums;
but it is doubtful if this system does much good, for
Digitized by Google
Ocr. 11, 1699.
THE OPERATING THEATRES.
the simple reason that it is not sufficiently thorough.
There are many who resign in order to anticipate dismissal,
and those are perh&pe even worse characters than those
who reoeive notice. A more elaborate register is required,
and the Commissioners might assist superintendents
considerably by the introduction of such a register, and
by insisting on fuller reports of attendants and servants
who resign, as well as those who are dismissed. The
reports of the Deputy Commissioners embodied in the
general report are as usual interesting, and contain much
useful information regarding the management of the
chronic insane in private dwellings. Dr. Sutherland is
very confident that real abuses scarcely occur without
coming to light, owing to the fact that patients are
visited seven times a year. We question, however, if
this system of visitation is as frequent as it ought to be.
Undoubtedly, boarding out patients in private dwellings is
a good idea, and the principle is a good one in theory, and
often in practice, but it has not been so popular with
inspectors of poor and parish councils as it ought to have
bees, and the visits made to patients boarded out are
not sufficiently frequent. It is interesting and satisfac¬
tory to know that Dr. Sutherland has had no complaint
of jruelty, neglect, harsh, or unfeeling treatment or of
overtaxing the strength of willing workers Dr. Charles
Macpherson reports that the insane poor in private dwel¬
lings are being well provided for, and that the arrange¬
ments for their oare are fully keeping pace with the
general improvement in home comforts which is observ¬
able throughout Scotland among the poorer classes.
Guardians are year by year more thoroughly realising
what the requirements of the Board are—what standard
of comfort must be reached— if they hope to retain the
patients in their care. He observes, “ The ideal in
boarding-out is to plaoe the patients as nearly as possible
in the same position as they would probably have
oooupied if they were not insane—to board them with
people who are willing to regard them as their social
equals, and to share with them a common sitting-room
and a common table.”
The Commissioners have of late had their attention
strongly directed to the advantages derived by a large
section of the insane from their being placed under the
constant care and supervision of nurses during the
night. They are strongly of opinion that the single
room idea in the construction of asylums must be
modified in the future. They must occupy a sub¬
ordinate place in asylums instead of being, as has
at one time been the case, the leading feature. The
better the arrangements for night nursing, the lees
necessity there is for the nse of single rooms, and
many patients are now kept under observation in
dormitories, who previously would be placed in
side rooms. The Commissioners have issued a return
to Superintendents of Asylums in order to ascertain what
their arrangements as regards night nursing are, and we
hope to find, as we likely will, the result of this
inquiry in their next report. Endeavours are
being made to obtain a more accurate state¬
ment as regards the prevalence of phthisis in
asylums. This is a step in the right direction. Some
interesting information is given as regards the oost per
patient in district asylums, of land, building, &c. The
cost of our asylums is a matter of very serious concern
to the ratepayer, and it is questionable whether there
Thi Medical Press. 379
iB not too much extravaganoe in the construction and fur¬
nishing of these buildings. The General Board of
Lunacy should be in a position to put a veto on un¬
necessary expense, for it is a public scandal that the
ratepayers are taxed so much, and without redress, at
the mercy of asylum authorities. When we think of
asylums costing .£400 a bed or more, and think that that
sum would build a commodious cottage for a work¬
ing man and his family, it seems nothing short
of scandalous. The tendency is more and more
to elaboration, while a refining system of manage¬
ment and the competition of one asylum with another
for pre-eminence is such that money requires to be spent
to keep it up. The whole tendency of local government
is always towards increased expense, and if we could see
any adequate results there would be nothing to say, but
the adequate results are sadly wanting. The statistics
of maintenance expense are very interesting and raise
many questions. In asylum finance one must be careful
not to draw too arbitrary conclusions, and suppose that
because the cost of food in one asylum is £2 a year more
than another, that the one with the highest cost feeds its
patients best. We have to consider the fact that one
asylum may be further from a good market than another,
or it may have a demand on it of a different kind. All
the food does not go to the patients. More or less ig
wasted and goes to the pigs, there may be extravagance
in the official consumption, or the local board may make
undue demands on the asylum cupboard.
Much more might be said regarding this report, but
we must leave its perusal in whole to its readers, as
space forbids our taking further notice of it. It is,
however, a more interesting, practical, and suitable
report than many of our Blue Books.
‘HLhz (Dperating theatres.
8T. PETER’S HOSPITAL FOR 8T0NE.
Litholapaxy followed by Supra-Pubic Lithotomy
for Encysted Calculus. —Mr. 8winford Edwards
operated on a man, tet. 65, who had suffered from sym¬
ptoms of stone in the bladder for the last two or three
years. On sounding the patient a stone was easily dis¬
covered. For purposes of demonstration cystoscopy was
undertaken, when a large white mass was seen projecting
from the bladder floor; so white And sharp were some
of the crystals that it reminded one of a range of snow¬
capped Alps. This was seen and verified by many
medical men present. Behind this white mass was a
dark-looking substance, which appeared to be a deeper
portion of the stone. A week subsequent to the cysto¬
scopy the patient was placed on the table for operation
and a good sized lithotrite was introduced. About 1 oz. of
deiris having been removed, which presented the appear¬
ance of ordinary washing soda, Mr. Edwards sounded
the bladder to make sure all had been taken away.
The sound came into contact with a large piece of stone,
which felt fixed, nor could thiB be dislodged. A finger
in the rectum showed at once that this was a stone
occupying a site between the bladder and the rectum
on the patient’s right side, and it was a question as to
whether thiB was a stone impacted in the veBical orifice
of the ureter or not. Supra-pubic cystotomy having
been performed in the usual method, the finger
Digitized by
380 Thb Medical PRESS.
LEADING ARTICLES.
was passed into the bladder, and there discovered
the remains of the stone projecting into the viscus
from a pouch with a small neck; it was with consider¬
able difficulty that the operator enlarged this neck with
his finger sufficiently to permit extraction of the stone,
whioh was ultimately done with lithotomy forceps.
The stone was of a dark colour, which contrasted in no
small degree with the white intra-vesicular portion.
Mr. Edwards pointed out that had he recognised that
this had been a pouched stone he would have proceeded
to do supra-pubic lithotomy at once instead of attempt¬
ing to remove it by litholapaxy. There are some
Burgeons, he said, who advise even in cases of pouched
stone that an endeavour should be made to grasp it
with the blades of the lithotrite in situ, and by
this means remove it into the general cavity
of the bladder, and there crush it. Mr. Edwards
disagreed with this procedure, believing that it
was fraught with considerable risk to the patient;
indeed, he quoted a fatal case in his own practice where
the patient died of acute peritonitis after an operation
of this kind, owing to damage done to the cystic wall in
crushing. Mr. Edwards, therefore, strongly advocated
lithotomy in all cases of true encysted calculi. It was
probable that the stone in this case was encysted in the
vesical end of the right ureter though this was not
proved. He said that the diagnosis of encysted stone is not
always an easy one for large stones, either lying in a post¬
prostatic pouch or in the bas fond of a contracted bladder
permit of very little movement by means of the sound,
but in stones of a more moderate size the sense which is
imparted by the sound t»the hand will often enable an
experienced surgeon to form a correct opinion as to
whether the stone is encysted or not. He pointed out
that if during many examinations the calculus is always
found in one definite spot it would cause one to suspect
a fixed stone. In the case under notice had he examined
per rectum carefully before operating he would doubt¬
less have discovered that owing to its clearly defined
outline part of the stone lay outside the true bladder
wall.
It is interesting to record the fact that the patient
has made an uninterruptedly good recovery; it is now
a month after the operation, and the man is getting
about the ward, and the pubic wound is healed ; there
is some atony of the bladder, for which catheterism is
necessary.
Vital Statistics.
The deaths registered last week in thirty-six great
towns of England and Wales corresponded to an
annual rate of 19' 1 per 1,000 of their aggregate population,
which is estimated at 12,786,832 persons in the middle
of this year: —
Birkenhead 18, Birmingham 23, Blackburn 14, Bolton
22, Bradford 12, Brighton 17, Bristol 14, Burnley 17,
Cardiff 16, Croydon 14, Derby 16, Dublin 33, Edin¬
burgh 18, Glasgow 18, Gateshead 22, Halifax 14,
Huddersfield 17, Hull 25, Leeds 20. Leicester 18, Liver¬
pool 26, London 16, Manchester 25, Newcastle-on-Tyne 23,
Norwich 13, Nottingham 21, Oldham 21, Plymouth 15,
Portsmouth 17, Preston 27, Salford 26, Sheffield 24,
Sunderland 24, Swansea 16, West Ham 16, Wolver¬
hampton 20. The highest annual death-rates per
1,000 living, as measured by last week’s mortality,
were :—Prom whooping-cough 1'2 in Leicester, and 1'6
in Portsmouth ; from fever, 11 in Sheffield, and 2 8
in Birkenhead ; and from diarrhoea, 3'1 in Liverpool, 3 3
in Nottingham, 3 6 in 8alford, 3 - 7 in Birmingham, and
6'3 in Preston.
Oor, 11, 1899-
Registered fob Tbabsmissiob Abroad.
Jftettcal Jrm mtb Circular.
Published every Wednesday morni ng, Price 5d. Pest fc 69 . Bid.
ADVERTISEMENTS.
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Small announcements of Practices, A Mis fancies, Vacancies, Books
fitc.—Seven lines or under, 4s. per insertion; 6d. per line
beyond.
Letters in this Department should be addressed to the Publishers.
^hc Jftebical Jrte* anil Circular.
“ SALU8 POPDLI SUPREMA LEX.”
WEDNESDAY, OCTOBER 11, 1899.
RECALCITRANT BOARDS OF GUARDIANS.
The position in which the Leicester Board of
Guardians now find themselves is strongly suggestive
of the unhappy state into whioh the obstinacy of the
Boers has precipitated the South African Republic.
So far as the Leioester Guardians are concerned
their refusal to appoint a vaccination officer in
accordance with the Vaccination Act of last year
has been treated from the first with leniency, never¬
theless firmly, by the Local Government Board.
Moreover, much official diplomacy was exercised in
order to bring about a peaceful solution to the diffi¬
culty. But the Guardians evidently interpreted this
action of the Board as indicative of a disinclination
to proceed to severe measures, and consequently the
obstinacy of the refusal was maintained. However, last
week an ultimatum was sent to the Guardians calling
upon them, by means of a peremptory mandamus of the
High Court, to appoint a vaccination officer. These
recalcitrant officials—forty-five in number—have the
matter under their consideration, and should they
determine to ignore the order of the High Court, for
this misdeed they will have to adjourn to gaol, where
abundant opportunity will no doubt be afforded them
of further pondering upon the folly of the course
which they have adopted. But they will have some¬
thing more to think about should they bring upon
themselves this penalty. If they decide to go to-
gaol rather than yield they will have the grim satis¬
faction of knowing that, while in durance vile, the
Local Government Board will undertake the duty of
appointing a vaccination officer for the Borough of
Leicester, and a correspondent in a local paper
has pointed out that the last state of the anti-vao.
' cination party in the town will thus have a good
Digitized by Google
Oct. 11, 1893.
LEADING ARTICLES.
chance of becoming worse than the first, inasmuch ,
as the officer whom the central authority are likely |
to appoint would be certain to be one chosen from I
the ranks of “ the enemy.” Thus it is plain that
some of the anti-vaccination party are by no means
satisfied with the attitude assumed by their local
guardians. The feeling is, in truth, beginning to
prevail that a huge blunder is being committed, and
that before worse happens the Guardians should
withdraw their opposition. The blunder, if carried
through, is described as one that would be irretriev¬
able, and altogether the situation is being regarded by
many with a good deal of conoern. In reflecting upon all
the points of the case it is impossible to deny that the
Board of Guardians, by their foolish obstinacy, have
played into the hands of the Local Government Board
in the same way as the Boers, by the same means,
have played into the hands of the Imperial Govern¬
ment. The Leicester Guardians, up to the present,
have foolishly determined to defy the law—a very
weak method for a public body to adopt under the
circumstances of the case, and one which can
scarcely be commended as setting a good example to
the townspeople, by whom they have been placed in
their position of responsibility. Furthermore, on
tactical grounds the Guardians do not stand to do
themselves any good, inasmuch as practically it is
useless for them to fight an authority like the Local
Government Board, who besides have the law on their
side. We agree, then, with the anti-vaccination
protestants in Leicester that the Board of Guardians
are acting very unwisely in the interests of the local
anti-vaccination party. It is quite conceivable that
the individual members of the Board are not particu¬
larly desirous of posing as martyrs in the gaol of
their town, and, perhaps, it may be that by now a
good many of them are reluctant to undergo this
extreme penalty for their obstinacy. However, a
graceful opportunity has been afforded them
by their party of withdrawing from the
position which they have assumed, and if
they are wise they will avail themselves
of it. But it iB no part of our duty to
point out what the Guardians should do
under the circumstances ; nevertheless, in no
case can they retrieve their position of being
sensible persons. In making a miserable effort to
defy the law they have simply afforded another
proof of the ohildish folly so commonly displayed by
members of the anti-vaccination party. Perhaps
when the next election for this Board takes place, the
townspeople of Leicester will see the necessity of
returning persons at the head of the poll prepared to
do their duty rather than to set a bad example of
refusing to obey the law of the land.
A LAY “CURE” FOR LEAD POISONING.
The hunger for specific cures is one of the most
characteristic mental features of the average citizen
of the United Kingdom. It is this amiable failing
that cozens him into supporting the vast industrial
organisation which supplies him with medicines
Thk Medical Phess : _ 381
warranted to cure any or all of his bodily ills, from
toothache to advanced Bright’s disease or locomotor
ataxy. Philosophers tell us that tbo typical Britisher
feels bound to have an opinion upon every subject,
as, for instance, whether a distant star is, or is not,
inhabited by highly organised animal beings, equiva¬
lent to mankind on our own terrestrial globe. It
is this stardy self-assertiveness of individual
belief, doubtless, that leads to a kind of national
assumption of capability to judge correctly of medical
matters, however complicated and technical. Indeed
there is reason to doubt whether any great reform of
preventive medicine could ever be earned out success¬
fully without the full assent and approval of the
general public. The crusade against consumption
has been skilfully conducted so as to take the laymen
into the confidence, as it were, of those medical men
who have educated the community at large through
the medium of the public press and of public meet¬
ings. Indeed, this whole movement savours of
the precise business handling that the medical
profession bewails the lack of in theory, but loses no
opportunity of exercising in practice. However, the
immediate object of the present article is not to dis¬
cuss the vexed question of what particular code of
ethics should regulate the conduct of the men of
light and leading in medicine, but to discuss a new
so-called “ cure ” that has lately been sprung upon an
astonished world of newspaper readers. All our
readers are, of course, familiar with the effects of
lead, both in its acute and its chronic phases, upon
the human system. In many respects the subject of
plumbismis one of the most fascinating in the long list
of maladies that are brought under the notice of the
physician. The blue line on the gums, the profound
anasmia, the colic, the constipation, the gout, the
organic changes, the epilepsy, the palsies, and various
nervous phenomena, together form a vivid and
peculiar picture. In its chronic form plumbism is
an intractable and well-nigh hopeless condition,
although, of course, many of its symptoms, such as
anaemia, constipation, and palsy are capable of great
relief under appropriate medical treatment. Now it
has been announced with a flourish of trumpets that
many cases of lead poisoning have been absolutely
cured by electric baths at Wolverhampton. That any
system of electro-therapeutics devised is able to cure
chronic lead poisoning we altogether doubt. That some
forms of electricity are of great value in treating the
paralysis of groups of muscles which is one of the
many peculiarities that stamp this strongly indi¬
vidualised condition, is known to every tyro of
medicine. It looks very much as if some enthusiast
unversed in medical matters had noted the recovery
of palsied muscles under the influence of electrical
baths, and from that observation had jumped to the
wide conclusion that the lead poisoning at the root of
the palsy had also been cured. As to slight recent cases
of lead poisoning there is little question that they
might get right under a course of electric baths, just
as they would under any other methodical living
under rational and healthy conditions away from any
Google
Digitized by
382 Th* Medical Pbxsb
NOTES ON CURRENT TOPICS.
Oct. 11. 1899.
fresh exposure to the poison. Having arrived at the I
conclusion as to the specific potency of the baths,
however, the Women’s Trade Union League have sent
as many patients to Wolverhampton for special
treatment as their means would allow. That body is
now appealing to the public for funds to enable them
to extend their sphere of operations, and their appeal
contains the following succinct statement: “The sum
of £5 is the average amount required for sufficient
treatment to restore power to a person suffering from
paralysis.” A less sum, it may be remarked, would
be required if the patient were sent for a course of
electric treatment to any well equipped public
hospital. At the same time it may be freely admitted
that the course recommended by the Women’s League
is calculated to cure the single symptom of palsy in
all but the most advanced cases. What we object to
is the assertion of the cure of lead poisoning by these
special baths, a claim that is not only misleading but
dangerous. The Women’s League, if we may ven¬
ture to give gratuitous advice, would do well to see
that trade regulations are carried out wherever lead
is used in factories. The compulsory use of leadless
glaze may be regarded as a simple first step on the
road towards efficient prevention. Meantime we
regret that we cannot endorse the announcement of
a new cure for lead poisoning, and, as a necessary
corollary that we are unable to urge the claims of the
subscription list for the purpose of using any special
electric baths for the “ cure ” of that condition.
THE INTRODUCTORY ADDRESSES.
The introductory addresses with which it is still
the custom in some medical schools to inaugurate
the winter session are always interesting reading to
those who take an interest in their profession,
although it is open to question whether the benefit
to the listener is always proportionate to the pains
which they must have cost to compose by those upon
whom the oratorical mantle has fallen. Nominally
intended for the guidance and edification of new
students, these addresses usually deal with scientific
or ethical problems as yet far beyond the ken of the
ex-schoolboy. The inconsistency of employing anti¬
pyretic drugs to reduce a high temperature which is
probably merely an indication of the intensity of the
reaction of the organism to the disturbing agent is
not a point in which he can as yet interest himself-
Even the importance of pathology as a guide to
etiology may leave him cold, while disserta¬
tions concerning overcrowding of the pro¬
fession and the increasing difficulty of gain¬
ing a livelihood therein can only have the
effect of discouraging his youthful ardour to acquire
the right to practise. The address delivered by Sir
James Crichton Browne, at Owens College, on “ The
Quest of the Ideal,” which we publish elsewhere,
represents a type of inaugural address which conforms
to one’s conception of what such an address ought to
be the moment it ceases to be a homily to students
on the importance of assiduity and the moral obliga¬
tion of sobriety and chastity. His resistance on the
importance of not falling victims to the prevailing
dogma of materialism and his eloquent pleading for
the cultivation of the ideal come very opportunely as
a reminder to those who are about to commence their
studies that there is something above and beyond the
mere acquisition of technical knowledge, however
useful that may be in its way. Medicine has been
defined as “ the experimental analysis of life in health
and disease,” but the analysis is only tentative and does
not assist us materially to unravel the fundamental
mystery of life. Anatomy enables us to form some
idea of the intricate mechanism whereby the prin¬
ciple of life finds utterance and physiology unfolds
to our astonished eyes a blurred glimpse of its
workings, but there is nothing “ telling us where life
has been, whence it issues.” The realm of science is
so vast and human knowledge is so limited that to
restrict one’s intellect to the finite is a process akin
to that of refusing to look at Nature except through
the objective of a microscope. A high ideal is a
necessary basis on which to rest a high character,
and a man who frankly and unreservedly gives
himself up to gross materialism thereby deprives
himself of the compass which should guide him
amid the temptations and trials of this exis¬
tence, and enable him to live a blameless life spent
in the service of humanity. Sir James Crichton
Browne’s address is a lay sermon adapted to present-
day requirements. The prelate who is to preach
at the annual gathering of medical men at St. Paul’s
could choose no worthier subject than this quest of
the ideal. Nothing more promptly dwarfs the
intellect and undermines the character than concen¬
trating one’s mind and energy too exclusively on the
material details of our daily existence. If we wish
to acquire and retain the esteem of our fellowmen,
if we wish to lay the foundation for a quiet conscience
and to prepare for a happier hereafter, let us follow the
orator’s injunction and cultivate the ideal.
on Current topics.
The Question of Dress.
“Honour peereth in the meanest habit,” and yet
the Royal College of Physicians, of London, is seeking
to glorify itself by dress. We can understand the
Lord Mayor and others in office, and those, too, of
the Royal Colleges who wear gowns, &c., when on
duty, appearing in public in their robes, but to ask
the graduates of various Universities, which have
nothing to do with the Medical and Surgical Cor¬
porations, to don gowns which they generally have to
borrow is rather absurd, and not likely to increase
the respect in which the profession should be held by
the public. After all, what is the object of gowns
being worn by men at Universities or by the
barrister when in court? It is certainly not to
add to personal and individual character. What
is the purpose of the footman’s livery or the soldier’s
uniform, except that it is to show there is something
more important and very different from the person
which is on duty, “ And thither walk on foot ” is
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Oct. 11, 1899.
part of tbe programme drawn np for one ceremony at
which the robes are to appear. Whether the great
anatomist in whose honour the oration was given
would have wished his colleagues and friends to
attend in robes is doubtful. W T e think he would have
agreed with the great dramatists of his own time,
“ ’tis the mind that makes the body rich.” Whether
the scarlet gown or the black silk of tbe M.D. of our
old Universities should be worn is left, we presume,
to choice; and if the square cap is a part of the
dress, the borrowing will not be an easy matter. When
the ceremony is over, and a little time passes after
the oration, we think that many will agree with
Petruchio, “It is now some seven o’clock, and well
may we come there by dinner time.”
Women Students and the Medical Jericho.
The Governors of Owens College have decided to
admit women students to cheir classes, an example
which will, sooner or later, we imagine, be followed
by many other medical teaching institutions. In
Edinburgh, if we understand aright, the School of
Medicine for Women has closed its doors because
female students were admitted to mixed classes, thus
rendering separate classes supererogatory. Some¬
thing may be said in favour of separating the sexes
during the firsttwo years of medical training, inasmuch
as this can be done without any difficulty, but when it
comes to clinical work the system becomes absurd,
and it is only in England that such an incongruous
idea has been received and acted upon. The curious
hypersensitiveness which takes alarm at the presence
of women students in the operating theatre, but sees
nothing objectionable in the presence of nurses, is so
ludicrously inconsistent that it must perforce die
out with the race of men who introduced it. The
walls of the medical Jericho are falling to pieces, and
we are getting within measurable distance of the time
when the principle that science has no sex will be
generally acted upon.
Medical Certificates in Law Courts.
His Honour Judge Emden, of the Lambeth County
( ourt, made the curious announcement the other
dsy, that he would never again pay any attention to
medical certificates handed to him which did not
specifically state the complaint from which the
patient suffered. This remark was a propos of
a medical certificate in which the practitioner
stated, “ I consider the plaintiff unfit to attend
tbe Court.” His Honour held that the question of
whether a person was or was not in a fit state to
attend was one for the Court itself to decide. We
must demur from this ruling. Why should the
nature of a person's illness be made the common
knowledge of the multitude ? Would the judge be
willing to apply this decision to his own case ?
Let us suppose that Judge Emden falls ill
and has to send notice to his Court of
his inability to attend. Would it appear
right to him that on the receipt of the
notice the clerk of the Court should rise and inform
those present that (say) “Judge Emden is suffering
The Medical Pbess. 383
from a bad attack of piles, and is consequently
unable to preside to-day ? ” What is sauce for the
goose is sauce for the gander. A hapless litigant
should not be called upon to have a public announce¬
ment made concerning the nature of his illness, merely
because the judge may, rightly or wrongly, have
some doubts as to the bona Jides of the medical corti¬
cate. Surely a better way would be to accept the
certificate conditionally up>on further evidence being
produced that the opinion therein expressed were
capable of confirmation. Judge Emden could easily
say, “ I accept the certificate, but I shall require it to
be endorsed by another medical man.” He states past
experience has taught him to regard some medical
certificates with grave misgiving. If this be the case,
the remedy which we suggest would be the right one
in order to arrive at the truth.
A Proposed Crematorium for Leeds.
The Leeds Cemeteries Committee have been dis¬
cussing anew the proposal of erecting a crema¬
torium for the town, and with that object
in view they are about to pay a visit of
inquiry to Manchester and Liverpool and several
other places for the purpose of ascertaining how the
system is practically carried on. There is no doubt
that a crematorium is a most useful adjunct to a
large town, and we believe that the promoters of the
one at Manchester have been abundantly satisfied
with the financial success of their enterprise.
Moreover, there can be no question that the senti¬
ment against cremation is gradually, but surely, dying
out. The lead, of course, in this direction is being
taken by the well-to-do classes, but there is no reason
why, in the future, the poorer classes should not
follow suit. At present, however, the cost of crema¬
tion is somewhat prohibitive, and the ceremonial of an
imposing funeral has such a hold upon popular
sentiment that some generations, perhaps, will be
required to depose it from that position. Neverthe¬
less, from a sanitary and hygienic point of view, there
is so much in cremation to recommend it that we
believe that tbe good sense of the people will gradually
lead them to adopt this method of the disposal of the
dead.
Notes on the Plague in Spain.
The Government Gazette of last Tuesday contains
a Royal Order instructing the provincial sanitary
inspectors to daily examine into the efficiency with
which the sanitary laws are carried out, ro that the
“ death-bearing ” plague may be shut out of the
country. Don Decis Carlan (El Sujlo Medico ) states
that, in all, ninety cases of plague have occurred in
Oporto, and that the plague is like a drop of oil
extending along its outer boundary to all the vil¬
lages in the neighbourhood. It is feared by the
populace that if God has not mercy on them by
sending cold weather to stay its progress the whole
country will be overrun by the epidemic. The Por¬
tuguese authorities, he writes, are responsible before
God and man. They have neither the wisdom nor the
thought fulenergy to contend with npestilence which iB
NOTES ON CURRENT TOPICS.
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384 The Medical Press. NOTES ON CURRENT TOPTCS.
Oct. 11, 1899.
causing now such calamities as humanity deeply
lamented in byegone ages. A correspondent of El
Liberal writes : “ In the evening we were in Oporto,
in the shoreward of the Douro, which includes Honte
Jaurina, the street in which the first case of the pest
was found, dead rats and even dead rabbits—in the
very focal point of the plague—the death threatener
of Europe. Should not the quarter be burnt down
and rebuilt.
The Dual Medical Offlcership at St. Olave’s.
The wealthy South London parish of St. Olave’s,
Southwark, continues to pay a salary to two Medical
Officers of Health. As readers remember, the Board
suspended Dr. Bond from office for failing to report to
them the removal of bodies from a church, and
appointed Dr. Dixon, the Medical Officer for Ber¬
mondsey, to discharge the duties of the post. The
Local Government Board refused to sanction either
the suspension or the appointment, and ordered Dr.
Bond’s reinstatement. Although some weeks have
elapsed since the receipt of the departmental com¬
munication, things are still in statu quo. There can
be no doubt that the Local Government Board
will shortly intervene to stop this scandal
of a two-headed sanitary offlcership. By the
way, we note that the newcomer. Dr. Dixon, has
presented a fortnightly report to the Board, which
presents a ro6e-coloured picture of the health of St.
Glare’s. The death-rate was returned at 14 per 1,000
as against 18'8 for London. When we take into con¬
sideration the mortality returns for neighbouring dis¬
tricts in South London, it is impossible to avoid a sus¬
picion that there is some fallacy in the correction of the
figures upon which the St. Olave’s rate is based. As
instance of the fallacies we have in mind are the
deaths of parishioners outside the parish, and those
of non-parishioners dying in the parish. The presence
of a large hospital like Guy’s in St. Olave’s introduces
a large possible element of error. It is to be regretted
that the death returns of the various districts are not
based compulsorily on a rational common plan.
Drug Adulteration.
At a prosecution at Market Harborough last w^t
it transpired that a seidlitz powder purchased for
analysis contained only nine grains of potassium
tart., when it ought to have contained 120 grains,
but it made up for the deficiency by contain¬
ing 127 grains of sodium bicarb, when it ought
to contain no more than forty. The usual plea
was put in— i.e., that the vendor obtained the
powders from a “ well-known firm ” of middlemen
who themselves got them from a London firm “ of
high standing’' in exactly the same condition in
which they were sold. This plea reminds us of the
spigrammatic charge delivered by a celebrated Judge
vho was trying a culprit for stealing a horse. Having
heal’d a mass of evidence as to the excellent character
and admirable qualities of the prisoner, his lordship
said, “ Gentlemen of the jury, after the irreproach¬
able testimony which you have just heard, no one can
entertain a doubt that the prisoner is a most respect¬
able man, but neither can there be a doubt that he
stole the horse, and you will, of course, find him
guilty.” The “ high-class ” and “ well known ” firms
were, of course, supremely respectable but equally
guilty.
Isolation Hospital for Dublin.
There is a good deal of controversy, especially in
medical circles, as to the proposals of the Public
Health Committee of the Corporation to build a
Municipal Hospital for the accommodation of
infectious cases, but the dispute l’esolves itself very
much into one as to whether it is best for the
Corporation to cater for itself or to spend the same
money as a subsidy to Cork Street and other fever
hospitals which have, heretofore, been attempting to
do the work. Obviously, the existing accommoda¬
tion for infective disease in Dublin is insufficient to
meet an epidemic emergency, and it would be well if
the Corporation could escape the risk of a big
hospital speculation by helping the existing hospitals
to make it sufficient, as to which, it may at
once be stated that schemes involving an
outlay of £250,000, such as were realised in Glasgow
and elsewhere, are totally out of the question in im¬
pecunious Dublin. Apart from this, there is the very
great objection to remitting to any combination of
private bodies the control of a system which ought to
reside in the municipality, and the efficiency of which
would depend, in great measure, upon central ad¬
ministration. The medical side of the controversy
may, we think, be put aside by the Corporation in
dealing with the matter, because their sole duty is to
ensure that each infected patient shall be safely iso¬
lated, and, in theory at all events, this cannot be done
in small wards attached to general hospitals, no matter
how well these may be managed. Fever, in our opinion,
is a speciality which the student ought to learn in a
special hospital, just as he now learns midwifery and
gynaecology and ophthalmology, and it is not to any
one’s eventual advantage that he should be supposed to
learn it over a few beds in the annexe of a general
hospital. It would be easy to make room in the
curriculum for such special study, by wiping out such
rubbish as lectures on insanity, which are now com¬
pulsory. On the whole, we trust that the Dublin
Corporation will not be deterred from forcing this
question of the infective disease hospital to the front,
and, by some means, providing sufficient accommoda¬
tion for the fevered poor when needed.
The Royal Orthopaedic Hospital.
It will be remembered that in the course of last
summer the policy of the then management of the
above well-known old-established medical charity
was called seriously into question. Without entering
into details it may be briefly stated that the insani¬
tary state of the building was proved beyond the
shadow of a doubt, while the unwisdom of the pro¬
posed sale of the Oxford Street site was effectually
demonstrated. The resignation of the President and
Council was followed by prompt and decisive action
on the part of the new management. The committee
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Oct. 11, 1809.
NOTES ON CURRENT TOPICS. iei Miwual Priss. 385
have been fortunate in securing the services of Mr.
Harry Marks, M.P., as their new president, and his
access to office has been the signal for the display of
some much-needed energy. The whole hospital
has been closed for some months, and extensive
sanitary and architectural improvements have been
carried out under the direction of Professor Corfield,
at a cost of £2.000. A special Court of Governors
will be held shortly for the purpose of remodelling the
rules of the institution, and it is announced that
while the Committee desire to bring the rules more
into line with modern hospital requirements, it is not
proposed in any way to interfere with the general
position either of Governors or of Committee. It is
sincerely to be hoped that this charity, which has
done so much good in the past, will enter upon a
fresh career of usefulness to suffering humanity
under the auspices of Mr. Marks and his fellow-
workers.
Quarantine for Tuberculous Persons.
It is quite possible to believe that in the process
of time tuberculous persons will be dealt with as
infected individuals, and restraint placed upon their
intercourse with the healthy members of the com¬
munity. A movement in this direction is actually
taking place in America. For example, in California
the State Board of Health have passed a resolution
to the effect that measures should be adopted pro¬
hibiting the entrance of tuberculous persons into the
State. The climate of California is regarded as
especially valuable for the cure of phthisical people,
so much so that it is stated no fewer than
20,000 of these enter the State in a year, of whom,
perhaps, about 1 in 50 recover. At the same time, it
is pointed out that such a huge accession of tuber¬
culous cases into the State can only result in dis¬
seminating the disease among many of those who
otherwise would remain uninfected. A medical man
in the State has also asserted that tuberculous
patients should be prevented from attending
churches, theatres, public or social gatherings, and
that they should not be allowed to occupy public
conveyances, such as railway carriages and omnibuses.
All this goes to show that the more the public comes
to learn regarding the infectivity of tuberculosis the
worse will the position become of those who
suffer from the disease. In the days of old the lot
of the lepers must have been an extremely unhappy
one, and the trend of opinion seems in the present
day to be in the direction of limiting the intercourse
of tuberculous persons to those who are similarly
infected. But, however this may be, it is neverthe¬
less certain that in the past a great deal of tubercu¬
lous disease has been disseminated by the unre¬
stricted co-mingling of healthy with diseased persons,
and there is no doubt that much good will result
from letting the public plainly understand the desira¬
bility of putting a stop to this promiscuous inter¬
course. Prevention, after all, is undoubtedly the
great thing in the case of a disease like tuberculosis:
for the less persons there are who suffer from it, the
less there must be by whom it can be disseminated
each case may become the focus of transmitting the
disease to a healthy person, and if means can be taken
to prevent such transmission, it is obvious that a
great point has been gained.
The Recent Health Congress at Blackpool.
The programme of the Health Congress that met
reoently at Blackpool was much like that of most of
these meetings. The question of the prevention of
tuberculosis was prominently raised, but nothing very
novel was advanced as a contribution to the practical
politics of the subject. This fact is somewhat to be
regretted when we consider the mixed nature of the
assembly brought together by the energies of the
Royal Institute of Public Health. What an oppor*
tunity was afforded in these discussions for educating
the minds of dilettante noblemen, mayors, vestry¬
men, sanitary inspectors, et id genus omne, who swarm
around the congress chambers as bees congregate
near honey pots! Not that we would infer there
can be a momentary doubt as to the value of
the diffusion of sanitary knowledge among the
people. At the same time it may be questioned
whether the papers and the speakers were not
at times a little above the heads of their lay audiences.
In some instances local authorities have sent, as their
representatives, subordinate inspectors and vestry¬
men, who, in their private capacity, are small trades¬
men, to cull the scientific fruits spread before visitors
at these gatherings. The composition of brandy was
discussed, factory and workshops legislation, the
sanitation of the Mosaic law, the medical inspection
of schools, the codification of sanitary laws, and
many other more or less recondite topics, so that
a wide and varied field of interest was opened
up to the zealous sanitarian. One speaker advocated
the necessity of fixing a standard of carbonic acid
impurity in factories, a point upon which future
efficient control of such places appears to us to hinge.
Among familiar names may be noted Sir Charles
Cameron, Dr. Ransome, Dr. Thresh, Dr. Cameron
(Leeds), Dr. Kenwood, Dr. Hope (Liverpool), and
many others.
The Art of Writing Medical Efnglish.
The average medical man has little power of
literary expression. Hence, when he rushes into print,
as often as not he bewilders his readers instead of
enlightening them with his particular views and
observations. Who is not familiar with the tangle
of reiteration, bombast, obscurity, and confusion of
utterance that marks the written effusions of the
ordinary medical man P Some there are who continue
through a long lifetime, with a perversity worthy of
a better cause, to pour forth long-winded communica¬
tions upon all kinds of topics. Bores of this type
are often mild monomaniacs, and their names are
known and carefully avoided by readers of the
medical journals. At times, no doubt, they are
able by their persistency to help forward desir¬
able change in the special section of the com¬
munity to which they belong. In much the same
way the political man of one idea now and then
386 The Medical Pbess.
NOTES ON CURRENT TOPICS.
Opt. 11, 1899
achieves some reform of value to the community : it
may be after years of patient waiting. On the other
hand the world of medicine can always boast of a few
particular stars who have literary faculties of the
first rank. Some of the most notable productions
have perhaps been those addressed to lay readers.
There are several scientific works of the present day
that may be termed classics as regards their purity
and felicity of style and diction. Fortunately, if a
man have his facts and his reasoning carefully pre¬
pared, good style is not an absolute essential to
successful publication. With the main mass of
the profession inability to write well simply means
that the art has never been cultivated.
A Remarkable Case of Nasal Obstruction.
Occasionally sensational incidents occur in
medical and surgical practice, and it may be
said of the following case, the notes of which
are published in the current number of the
Scottish Medical and Surgical Journal, that so
far it may be regarded as unique. A Japanese
workman in Singapore was brought to Dr. Keng
with the history that three months before he bathed
in a pond, and while doing so he suddenly felt some¬
thing slipping into one of his nostrils. He made an
effort to remove it, but failed to dislodge it. On
looking into the left nostril, which was a little
swollen, Dr. Keng could plainly see a black mass
projecting from the superior meatus. A cup of
water was accordingly held to the nostril, and in a
Bhort time the tail of a leech was seen projecting
from the nostril and wriggling about in the water.
The next question was, how to extract the leech.
The tail was seized with a pair of old fashioned
artery forceps, and the nostril was douched out with
a solution of permanganate of potash. But the
effect of this was only to cause the creature to con¬
tract more firmly, bo another method had to be tried.
The patient was, therefore, given some chloroform to
inhale, a procedure which proved effectual, for
in a few moments the leech, with the forceps
attached, dropped on to the floor. The man had,
in the course of the three months, during which the
leech had' located itself in his nose, lost a large
quantity of blood. His weakness was, indeed, such
that he was barely able to stagger into the author's
surgery, and there is no doubt that had the leech not
been extracted a fatal result might have ensued.
Motor Cars for Medical Men.
It would seem that practitioners in country dis¬
tricts are investing largely in motor care, and judg¬
ing from the number of letters published in a recent
number of the Autocar, in which high approval and
satisfaction are expressed by those who have adopted
them, this mode of locomotion is evidently becoming
more and more popular in the profession. Several
advantages are claimed for the motor care as
compared with horse traction. Generally it is
said that a car will go faster and further than
any horse, will negotiate any reasonable gra¬
dient. and is always ready for use, while the
doctor can dispense with the services of a man
to drive it, and the machine can be left un¬
guarded if necessary. These are certainly useful
points upon the question of expense. However
further time is still wanted in order to draw acorn-
pari son, but, so far, after the initial outlay of about
£165, a motor car, it would seem, can be kept in order
and regularly used at a much cheaper rate than
horses can be employed. The complaint that’cars
are objectionable from the smell and noise, which they
cause does not seem to have much foundation in fact.
Altogether, then, a good deal of enthusiasm is at
present being Bhown by those practitioners who have
adopted “ moting ”• as a mode of locomotion.
Public Analysis at Second Hand.
In a leading article on the above subject which
appeared in our Issue of September 27th, we com¬
mented on the undesirability of plurality in public
health appointments. Among public analysts we
mentioned by name two who each held appointments
to four vestries, and two more who acted in'that
capacity to three such authorities. In mentioning
these gentlemen our object was merely to show that
plurality existed by a simple statement of facts. It
is hardly necessary to add that nothing was further
from our intention than to insinuate that the
analysts referred to were not perfectly efficient and
conscientious in the discharge of their duties. Our
criticisms were addressed to the system, and
not to the officials who carry it into effect.
It is conceivable that an analytical chemist pure and
simple might hold more than one post as vestry
analyst with advantage to everyone concerned. At
the same time we see no reason to modify our general
conclusion that plurality has been the bane of
sanitary administration in the metropolis. A minute
and exacting analysis, whether chemical or bacterio-
ogical, demands the personal element, especially
when grave medico-legal issues are involved.
The Royal College of Physicians, Ireland.
The annual general meeting of the College will
take place on St. Luke’s Day, October 18th, on which
occasion the election of President and officers will
take place. Dr. J. W. Moore will, no doubt, continue
in occupation of the Presidential chair, and 'Dr.
Atthill and Dr. Craig will retain their positions
respectively as representative of the College in the
General Medical Council and as Registrar. The
examinere under the conjoint scheme with the
College of Surgeons will also be chosen, but in these
there will be changes. In the evening the college will
hold its annual dinner, and will entertain a number
of distinguished guests.
A New-Fangled Poison.
The first recorded case of poisoning by hydro¬
fluoric acid was the subject of an investigation
recently at New Cross. Our readers are aware that
the specialty of this acid is its erosive power on glais,
and the victim of this poisoning was a glass
enameller, who seems to have taken the poison out of
bravado. He died in a few hours, notwithstanding
all that could be done foi* him.
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NOTES ON CURRENT TOPICS.
Thk Medical Press. 387
Oct. 11, 1899.
The Hospital Matron Again!
The situation of the medical staff at institutions
where the matrons are placed on terms of equality
with them, to the detriment of harmony and disci¬
pline, is one that no body of self-respecting men ought
to tolerate. The matron is the head of the nursing
staff, and as such is the subordinate of the Medical
Officer. If an ill-advised code of regulations places
it in her power to balk her hierarchical superiors
with impunity, we may be sure that sooner or later, be it
whim, pique, or mere bad temper, she will fall foul of
that officer, leading to di ^organisation of the service, and
public discussions of the most deplorable futility.
Judging from the report of a meeting of the governors
of the Lowestoft Hospital, which is published in the
Eastern Daily Press, a situation of this sort appears
to have been brought about by the intolerable behaviour
of the matron in regard to Dr. Walker, an old-
standing member of the medical staff. The
report in question is devoted to an unusually pro¬
tracted wrangle, the upshot whereof was a resolution
in favour of a committee of inquiry, Dr. Walker in
the meantime holding over his resignation. So far
so good, but we venture to maintain that unless
allegations of positive misconduct are made against
the medical officer, the plain duty of the committee is
to call upon the matron to resign. We are aware
that it takes two to make a quarrel, but when¬
ever it becomes evident that there is a want of
harmony, the subordinate must give way. The
question is not one which can be discussed on its
merits. The matron “ cuts up rough ” at some
criticisms offered by the medical officer, and there¬
after loses no opportunity of scoring off him in the
wards and vid the nurses, who. poor things, thus find
themselves between the devil and the deep sea. We
trust the Governors will deal with the matter in
accordance with the dictates of robust common sense
and teach those who are in charge of nurses that
their first and indispensable duty is to keep in har¬
mony with their hierarchical superiors.
The Army Medical Department.
In our columns to-day the Director-General
advertises his readiness to engage a limited number
of civilian medical practitioners for temporary service
in the Transvaal. The engagement is for six months’
certain, and as much longer as may be found neces¬
sary, and the pay is to be £270, or at that rate per
annum. It is probable that many candidates will
offer themselves.
Fleas and the Transmission of Plague
Infection.
The rat, according to Hankin, is the animal by
which plague infection is conveyed. But the question
which has for some time exercised the minds of the
plague authorities is : How is the disease transmitted
from the rat to man ? A good deal of evidence has
lately been collected showing that the agent of in¬
fection is the flea. Fleas are said to infest rats
which are dying of plague, and bacilli, corresponding ,
to the plague bacillus, have been discovered in the I
intestinal contents of fleas obtained from such rats.
Again, fleas from plague-afflicted rats have been made
the means of communicating the disease to healthy
rats; all the experiments, then, undertaken to test
this flea hypothesis, have tended to show, almost
without doubt, that the flea plays a most important
role in the dissemination of plague.
The Irish Preliminary Examination.
The examinations of students who are desirous of
commencing medicine in the coming session was held
last week in Dublin. We understand that 64 can¬
didates offered themselves and that 32. or exactly
one-half, were rejected. Although this large “ mor¬
tality ” is by no means displeasing to us, because we
desire that no boy shall enter upon the study of
medicine without at least the rudiments of a gentle¬
man's education, we call attention to the large
percentage of rejections because it affords a complete
answer to the Committee of the General Medical
Council, which has devoted itself to throwing dirt on
the Irish examination on the ground that it is too
easy. We doubt that any university in the kingdom
could show as strict a severity of the examinations
required for commencing medicine as the Irish
colleges do.
A New Use for the Dispensary.
With reference to our annotation of last week in
which we protested against making the dispensary
rooms the centre for distributing charity relief to
miscellaneous paupers, the Council of the Dublin
Sanitary Association has adopted the following reso¬
lution .-—“ That the Council having read an article
which appeared in the Medical Press and
Circular, of October 4th, 1899, headed ‘ A New Use
for the Dispensary,’ hasten to express their opinion
that the proposal to distribute Poor-law relief from
the several city dispensaries is fraught with grave
danger to the public health, and should not for a
moment be entertained by any sanitary authority.”
Vaccination in Liverpool.
It is worthy of note that the general increase in
the number of vaccinations does not hold good in
Liverpool where the returns for the first half of the
year show a diminution equal to 22 per cent, on the
figures for last year. This is the more remarkable in
view of the fact that the “ concientious objector ” was
conspicuous by his rarity in that city. As the Liverpool
Mercury observes, in a paragraph on the subject, it
thus becomes appparent that even in the comparative
absence of the conscientious objector a community
may suffer from the adoption of a policy of mere
domiciliary visitation. The matter is serious enough
to merit the early attention of the Local Government
Board and of the Guardians.
Lord Rookwood last week handed over the
Cottage Hospital at Hatfield, Essex, as a gift to the
parish in memory of the late Lady Rookwood. Four
hundred pounds have been raised by subscription
among her ladyship’s personal friends, to be set aside
as an Endowment Fund.
Digitized by
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Oct. 11, 1839.
388 The Medical Prim. MEDICAL SOCIETY OF LONDON.
Return of the Liverpool Tropical Expedition.
Surgeon-Major Ross and the other members of
the Liverpool Medical Expedition on Tropical Dis¬
eases in "West Africa, returned to this country on
Monday. Although the Expedition had been at work
only six weeks the results have proved most en¬
couraging. The authorities at Sierra Leone have, on
the advice of the Expedition, decided to use every
means to exterminate the mosquito spreading malarial
fevers. Major Foss is of opinion that other conditions
are favourable to health in West Africa, there being a
good water supply, and that if Europeans are careful
both in their mode of living and house construction
the inhabitants would have every chance of health.
Despite the tropical climate, only one member of the
Expedition, Mr. Austin, had suffered from malaria.
He had slept for one night without mosquito cur¬
tains, and was thus infected, but was now convales¬
cent. Dr. Ould, of the party, had proceeded around
the West Coast in order to instruot medical officers
as to the best method of treating the scourge. The
opinion of the party was that the future of the West
Coast was assured as soon as the Colonial authorities
took steps to extirpate the virulent mosquito in the
neighbourhood of the principal towns. Of course,
years must elapse before the inland stations could be
cleared. -
St. George’s Medical School.
Curiosity has been somewhat aroused by the
announcement that St George’s is to have the
patronage of his Grace the Archbishop of Canterbury
on the prize-giving day. It is pleasant to see the
Church lending its hand to the profession, and there
has always been a kindly feeling between them since
the days of St. Luke; although now and then the
“ physician ” has been not altogether agreeable to
the “ Church.” The Archbishop probably knows
something of the history of the hospital of St. George-
Itdoes not owe its origin to the munificence of a liberal
patron like Guy, or to such religious bodies as those
to which St. Bartholomew’s and St. Thomas’s can be
traced. St. George's owes its character to its connection
with great surgeons and largely to the profession. The
School of the Hunters was a great school, and
rivalling it the School of Lane. They were indepen¬
dent of the Hospital in one way, but were rivals in
another. When the Lane School founded St. Mary’s
and the Kinnerton Street School moved up into the
present hospital, a different state of things arose, and
it must certainly be of interest to the present staff
of St. George’s to see that they stand worthy of the
reputation of their forefathers. It is well nigh im¬
possible in these days for anything to live on the
reputation of the past.
Dr. Telford Smith having been compelled to
resign the office of Medical Superintendent of the
Royal Albert Asylum. Lancaster, which he has held
for the last six years, on account of ill health, and
out of thirty-five applications, Mr. Archibald Douglas,
L.R.C.P., Deputy Medical Officer, H.M. Prison,
Portland, formerly Assistant Medical Officer, Royal
Albert Asylum, has been appointed in his stead.
Dr. Leslie Phillips, who has occupied the
position of honorary surgeon to the Birmingham and
Midland Hospital for Skin Diseases, has been presented
with an address on his relinquishing the poet.
JJartlanb.
[From Oue Special Correspondent.]
Professor Sir Thomas Grainger Stewart. —We
believe that Sir Thomas Grainger Stewart, although his
health, it is gratifying to learn, has very much improved
since Bummer, does not feel equal to the duties of his
double professorship, those of the Chair of Practioe of
Medic : ne, and of Clinical Medicine in the Infirmary.
No announcement of what arrangements have been made
as to the carrying on of his work in the Edinburgh
University and Royal Infirmary, but we suppose he will
be granted leave of absence for a considerable period,
and an outsider appointed as interim professor.
Typhoid Fever Outbreaks.— Several local outbreaks
of typhoid fever have this autumn occurred in various
districts round Edinburgh. Although the cases in some
of these epidemics were fairly numerous the attacks
have been up to the present of a mild character. As is
usual, each outbreak has been attributed by some to
infection through water, through milk by others, and
both theories supported by much, but vague, evidence.
The Edinburgh Royal Infirmary Contest. —The
contest for the vacant medical superintendentship of the
Edinburgh Royal Infirmary promises to be very keen.
It is too Boon as yet to say who will constitute the can¬
didates’ list, but all sorts and conditions of men would
appear to Tegard .£500 a year and a house as a desirable
prize, judging by what is rumoured as to those already
in the field.
Glasgow Southern Medical Society —The opening
meeting of the Glasgow Southern Medical Society ror the
session 1899-1900 was held on Thursday last, when the
following office-bearers were elected for the ensuing
year:—Hon. President—William M Ewan. M.D., LL.D.,
F.R.S. President—Hugh Kelly, M.D. Vice-presidents
—Thomas W. Jenkins. M.D.; William Watson, M.D.
Secretary — John Frazer Orr, M.D. Treasurer—
William M'Millan, M.B., C.M. Editorial secre¬
tary—Andrew Wauchope, M.B., C.M. Seal-keeper
—John Stewart, M.D. Extra members of council
—Robert Pollock, M.B., C M.; Alex. C. M'Arthur,
M.B., CM.; Duncan M'Gilvray, M.B., C.M. Court
medical—John Dougall, M.D.; Robert W. Forrest,
M.D.; Arch. Brown, M.D.; Edward M'Millan, L.R.C.S.-
Edin. Representative to Victoria Infirmary - Chas. E.
Robertson. M.D.
MEDICAL SOCIETY OF LONDON.
The Opening Meeting of the Session took plaoe on
Monday evening last, when the President, Dr. F. Roberts,
delivered the usual inaugural address, an abstract
whereof we publish elsewhere. This was followed by a
discussion on “ Serum Therapeutics and Anti-toxin
Treatment,” initiated by Dr. Heron, who referred to the
various experiences which he had published from time
to time on the tuberculin treatment of tuberculosis and
lupus by tuberculin, old and new. On the whole his
results were decidedly encouraging, and neither in
hospital nor in private practice had he ever seen any
untoward results follow the use of the old or the new
tuberculin. They had made upwards of 2,000 injections
at the hospital withoift even a superficial abscess.
Dr. Washbourn followed witn a disquisition on
diphtheria antitoxin, anti-streptococcic serum and anti-
pneumDCoccic serum. The former, he opined, had won
its spurs. He pointed out that there were two classes
of remedies, the antitoxin class which acted by anull-
ing the toxins and the sera which prevented the growth
of the living bacteria. In respect of the modus operandi
of anti-toxin he endorsed Ehrlich’s view that toxins and
poisons generally produced their ill-effects by entering
into a combination with certain molecules in the cells.
Digitized by Cj oogle
Oct. 11, 1899.
MFDTOA.L NEWS.
The Medical Press. 389
the antitoxin, by oombining with the toxins, prevent¬
ing the tissues entering into the combination, and so
averting the harmful results. Certain tissues, how¬
ever, bad a stronger affinity for the toxinB than had the
anti-toxin, and so might form the combination in spite
of the latter, and this explained why anti-toxin did not
save life in all cases. He pointed out that
patients who died in spite of the treatment
all succumbed to symptoms indicative of paralysis of the
vagus nerve. Admitting this explanation, he held out
the hope that it might be found possible to prepare
antitoxins from other animals than those at present
employed, which would display an affinity for the toxins
greater than that of the nervous system. With respect
to the antistreptoooccic serum, he insisted on the fact
that no specimen thereof could be relied upon to produce
beneficial results in all cases of streptococcic infection;
it exerted marked effects in some cases, and none at all
in others, and at present there were no means of
distinguishing between the two sets of case3. He spoke
leas confidently about the anti-pneumococcic serum,
which, though it was based on strong experimental
roofs, did not as yet yield results sufficiently sure for
im to express a decided opinion. He thought, however,
that it merited a more extended trial in this country.
Dr. Hubbard made some interesting remarks on his
experience with serum as a coagulating agent. He had
tried it in two cases of aneurysm with the result of afford¬
ing marked relief from pain, aud the coagulating property
had been very successful in arresting the loss in an
obstinate case of menorrhagia. Finally, in a case of
ha*mophilic epistaxis, the injections had arrested the
hsmonhage after surgical measures had failed.
,4Rebical ,iled)e.
Charing Cross Hospital Medical School.
The following entrance scholarships have been
awarded:—The Livingstone Scholarship (100 guineas)
to Mr. Philip Rees, the Huxley Scholarship (55 guineas)
to Mr R. Huxetable, and the Universities’ Scholarships
(each 60 guineas) to Mr. A. E. Taylor and H. F.
Skrimshire. Entrance scholarships have also been
awarded to Mr. L. Maitland (60 guineas), Mr Harold
Smith (40 guineas), and Mr. H. W. Farebrother
(30 guineas).
University College. London.
Medical scholarships and exhibitions have been
awarded as follows:—The Bucknill entrance scholarship
(for proficiency in science), value £30 a year for four
years, to Mr. G. Hall; two entrance scholarships (for
proficiency in science), value 55 guineas each, to Mi. A.
Ferriere and Mr. E. Mapother; two exhibitions (for
proficiency in anatomy and physiology), value 76 guineas
each, to Mr. C. S. Parker and Mr. T. L. Llewellyn.
Bt. Thomas's Hospital Medical School.
The University Scholarship (.£50) has been awarded
to Mr. Arthur Cyril Hudson, B.A., of Trinity College,
Cambridge; the Natural Science Schola ship (.£150) has
been awarded to Mr Lacey Bathurst; the Natural
Science Scholarship (.£60) has been awarded to Mr.
Leonard Craske. Messrs. E. H. Burnett Bailey and F A.
Broadribb earned marks qualifying for a Scholarship.
London School of Medicine for Women.
The following scholarships have been awarded at this
school in connection with the Royal Free Hospital: —
School Scholarship (value .£30). Miss Sommer; Bostock
Scholarship (JJ60 a year for four years), Miss Payne;
Mabel Webb Research Scholarship (value J530 a year for
two years), Miss Vaughan, M.D.B.S.
Guy's Hospital Medical Schools.
The following entrance scholarships and certificates
have been awarded :—Senior Science Scholarship, for
University' students, £50, Mr. P. N. Blake Odgers,
Lincoln College, Ox'ord ; and certificates to Mr. G. E.
Malcolmson, Owens College, Manchester; Mr. F. H.
Parker, Pembroke College, Cambridge; and Mr. H.
Robinson, Trinity College, Cambridge. Junior Scholar¬
ships in Science, .£150, Mr. H. F. Bell Walker; .£60, Mr.
J. H. Clatworthy ; and certificates to Messrs. G. Russell,
and H. H. Carter. Entrance Scholarships in Arts, .£100,
Mr. F. Hood, Roan School, Greenwich ; .£50, Mr. H. S.
Knight,Bancroft’s School, Woodford Wells; .£30 (Dental
School) Mr. A. Black, Foyle College, Londonderry; and
certificates to Mr, E. J. N. Aston, Jesus College,
Oxford ; and Mr. H. H. Watney, Trent College, Derby¬
shire.
Bt. George's Hospital Musenm.
We are requested to make known that the specimens
added to the Pathological Museum of this hospital
during the past year are, as usual, placed on view in ths
museum, and will remain on view during the month of
October. As this is the first occasion on which it
has been possible to show a large number of specimens
preserved in formalin solution, with the natural colours
preserved, members of other schools are invited to view
them. The Curator, Dr. Lazarus Barlow, attends from
one till four daily. The specimens number about 140,
and a description of each is attached.
All Saints’ Home.
The Sisterhood of All Saints’ Home, Margaret Street,
who have had charge of the nursing of University College
Hospital since 1862, having recently resigned, it was felt
by the Committee that the very valuable services
rendered by Sister Cecilia, who for twelve years had
worked as a ward SiBter, and for seventeen years had
occupied the responsible position of Lady Superintendent
of Nursing, should be recognised. The members of the
Hospital Committee and the members of the medical and
surgical staff accordingly assembled in the Board room
of the Hospital on the 4th inst. aud presented Sister
Cecilia, on behalf of the All Saints’ community with a
copy of one of Raphael’s “ Madonna,” to which was
attached the following inscription:—“The Sisters of All
Saints’ undertook the nursing of University College
Hospital in 1862, and for thirty-seven years devoted
themselves to this work of charity. In grateful remem¬
brance of their long association with the Sisterhood, the
Committee and staff of the Hospital present to Sister
Cecilia, who has been Sister Superior for seventeen years,
this copy of a well-known picture by Raphael.
The Medical 8lckness and Accident Society.
The usual monthly meeting of the executive commit¬
tee of the Medical Sickness, Annuity, and Life Assur¬
ance Society was held on the 29th nit., at 429, 8trand,
W.C. There were present: Dr. de Havilland Hall, in
the chair; Dr. J. B. Ball. Mr. Wm. J. Stephens, Dr. J.
Prikett, Mr. J. Brindley James, Dr. M. Greenwood, Dr.
Alfred S. Gubb, Dr. W. Knowsley Sibley, Dr. F. J. Allan,
and Dr. J. W. Hunt. The accounts showed the society
to be growing in numbers and financial strength. During
the summer a cash bonus of nearly .£5,000 has been dis¬
tributed, each member receiving his share, pro rata, of
the surplus found to exist when the business was valued
last year. The sickness during the summer had
been considerably under their expectation, and there is
little doubt that on the whole year the business will
show, as usual, a considerable profit. The Medical
Sickness and Accident Society makes a complete pro¬
vision for those of its members who are permanently
incapacitated, either by illness or accident. Under these
arrangements over a dozen members of this Society
whose affl iction leaves little hope that they will ever be able
to resume work are now drawing annuities averaging from
fifty to one hund<ed guineas a year. It is felt that this
is one of the most useful functions performed by the
Society. Prospectuses and all other particulars from
Mr. F. Addiscott, Sec., Medical Sickness and Accident
Society, 33, Chancery Lane, London, W.C.
West London Medico Chtrurgical Society.
The Society held the first meeting of its eighteenth
session at the West London Hospital on Friday,
October 6th, when the President, Dr. J. B. Ball, de¬
livered his inaugural address on “The Progress of
Rhinology.” The address was an interesting one, par¬
ticularly to specialisfs on the subject, and we give a full
risumi in another column under the heading of
“Original Communications.” After its delivery a vote
of thanks, proposed by Dr. J. W. L. Thudichum and
seconded by I)r. 8. D. Chippingdale, was carried by
acclamation. Dr. Ball briefly replied.
Digitized
Oct. 11, 1899.
NOTICES TO CORRESPOX DENTS.
390 Thk Medical Press.
Notices to
dorrefiponbcnlB. Short 'jCcttero, &t.
Correspondents requiring a reply in this column are par-
-ticnlarly requested to make use of a dixtinctiv* tignatw* or
initial*, and avoid the practice of signing themselves “ Reader,'
“Subscriber,” “Old Subscriber," &c. Much confusion will be
spared by attention to this rule.
Local Reports and News.—C orrespondents desirous of drawing
attention to these are requested kindly to mark the newspapers
when sending them to the Editor.
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 passed through
the post.
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.
Dr. Hayward.— We are unable to deal with your communication
in this number, but we hope to be able to do so in our next.
An Edinburgh Student. — Regret we cannot answer the
question; write to the publishers of the book, they will doubtless
be able to give you information not in our possession.
L. K. Q. C. P. (Belfast).—The information given you is un¬
doubtedly correct; it is the most up-to-date and sound “ manual of
surgery ” extant.
Mr. Hatton (Liverpool).—‘We think you have somewhat mis¬
understood the requirements; if you will re-read the advertisement
in another column you will see that “ civilian medical practitioners
for temporary service with the troops in the United Kingdon ” are
required by the Government.
Dr. T.—There is no reason whatever why our correspondent
should not charge for his visit.
General Practitioner. —Poludism in infante is well known in
certain parts of the world. It used to be very prevalent in Norway
and Sweden, but during the last ten years a great diminution in the
number of cases has occurred. The most marked symptom, noticed
by Cronquist, was an intense periodical frontal headache developing
in the early morning of each or every other day, lasting till
mid-day.
Dr. B. F. C.—Behring published as long ago as 1872 the results
of his experiments with the diphtheria antitoxin, showing its value
in immunising animals from and curing them of diphtheria. But it
was not till 1893 that, in his 11 History of Diphtheria,” he suggested
that the remedy could be used for children.
Dr. Dudgeon.— 8ee reply to Dr. Hayward.
of the godetieo anb Xectureo.
Wednesday, October 11th.
Hunterian Society.—8.30 p.m. Dr Sansom: The Effects of
Influenza on the Heart and Circulation, their Clinical History and
their Treatment. (First Hunterian Society Lecture.)
St. John's Hospital for Diseases ok the Skin (Leicester
Square, W.C.).—4.30 p.m. Dr. M. Dockrell: Bullous Eruptions.
(Post-giuduate Course.)
Thursday, October 12th.
BRITISH Gynecological Society (20 Hanover Square, W.)— 8 p.m.
Specimens will be shown by Dr. Macnaughton-Jones, Mr. Charles
Ryall, and others. Paper :—Mr. J. Furneaux Jordan (Birmingham):
On the After-results of Operations on the Uterus and Appendages.
Society for the Study ok Inebriety. —Quarterly meeting at 11,
Chandos Street, Cavendish Square, at 4 o’clock. Dr. Harry
Campbell, F.B.C.P., paper on The Craving for 8timulants.
Friday, October 13th.
W Clinical Society of London (20, Hanover Square, W.). - 8.30 p.m.
Papers Dr. Rolleston : A Case of Acute Streptococcal Meningitis
supervening in the course of Chronic Nephritis.—Dr. Churton:
Aneurysm of the First Part of the Arch of the Aorta projecting into
the Axilla.—Dr. F. J. Smith: A Case of Obstinate Anirmia in a
young Girl associated with peculiar Trophic Disturbances and with
doubtful Thrombosis of the Superior Longitudinal Sinus.—Mr. H. B.
Robertson : Acute Intestinal Obstruction due to an Intussusception
of Meckel’s Diverticulum.
Hospital Bekorm Association (St. Martin’s Town Hall). - 4 p.m.
Conference on Hospital Reform.
Uacattcice.
•County Asylum, Lancaster.—Assistant Medical Officer, unmarried.
Salary to commence at £125 per annum, with a prospect of in¬
creasing to £250 per annum, with board, See.
Hospital for the Insane, the Coppice, Nottingham.—Assistant
Medical Officer, unmarried. Salary £150 per annum, with apart¬
ments, board, attendance, and washing.
Leicestershire and Rutland Lunatic Asylum.—Assistant Medical
Officer, unmarried. Salary commencing at £150, with board,
lodging, washing and attendance, Applications to the Clerk,
10, New Street, Leicester.
Lincoln County Hospital, Lincoln.—House Surgeon, unmarried.
Salary £100 per annum, with board, lodging and washing.
Metropolitan Asylums Board.—Assistant Medical Officers at the
Fever and Small-pox Hospitals, unmarried. Salary commencing
at £160 per annum, with board, lodging, attendance, and wash¬
ing. Applications to the Clerk to the Board, Norfolk Street,
Strand, London. (Seeadvt.)
Parish of St. George-in-the-East, London. — Assistant Medical
Officer for the Infirmary and Workhouse. Salary £120 per
ennum, with rations and apartments. Apply to’the Clerk.
Guardians' Offices, Raine Street, Old Gravel Lane, E.
Royal Hospital for Diseases of the Chest, City Road, London.—
Resident Medical Officer for six months. Salary at the rate
of £100 per annum , with furnished apartments, board and
washing.
Royal Infirmary of Edinburgh. - Superintendent. Salary £500 per
annum, with free house, coals, and light.
St. Andrew's Hospital for Mental Diseases, Northampton.—Junior
Assistant Medical Officer, unmarried. Salary commencing at
£150 per annum, with board, apartments, and washing.
Victoria University, Manchester.—External Examinership in Ana¬
tomy for three years. Applications for terms and other neces-
sary particulars to be sent to the Registrar. (See advt.)
War Office, Army Medicsl Department.—Civilian Medical Practi¬
tioners, for temporary service with troops in the United Kingdom
for a period of six months. Remuneration at the rate of £270
per annum inclusive. Applications to the Director-General,
Army Medical Department, 18, Victoria Street. S.W. (See
advt.)
appointments.
Douglas, Arc hibald R., L.R.C.P., L.R.C.S.Edin., L.F.P.S.Glasg.
Resident Medical Officer to the Royal Albert Asylum for Idiots
and Imbeciles of the Northern Counties, Lancaster.
Evans, Daniel Edward, M.B.. B.S., M.R.C.P.Lond., M.R.C.S.,
Anaesthetist and Pathologist to the Swansea Hospital.
Hall ah, H., L.R.C.P.Lond„ M.R.C.S., Assistant Medical Officer
for the Workhouse of the Ecclesall Bierlow Union.
Halt., H. 8., L.R.C.P.Lond.,M.R.C.S., Medical Officer for the Leigh
Workhouse.
Hayes, A. Herbert. M.R C.S., L.R.C.P., House Surgeon to the
East London Hospital for Children and Dispensary for
Women.
Ingram, A.. M.B.Edin., L.R.C.P.Lond., M.R.C.S., Assistant Medical
Officer for the Workhouse of the Aston Union.
Jukes, G., L.B.C.P., L.R.C.S.Edin., Medical Officer of Health for
the Longndge Urban Sanitary District.
Pabr», Edward James, M.R.C.8., L.R.C.P.Lond., House Surgeon
to the Torbay Hospital and Eye Infirmary, Torquay.
Powell, C., L.R.C.P.Lond., M.R.C.S., Junior Assistant Medical
Officer for the Wandsworth and Clapham Union.
Baby, L. M.D Durh., M.R.C.S. Medical Offioer for the First Sanitary
District of the Devizes Union.
Shelley, P. W. G. L.R.C.P.Lond., M.R.C.S., Medical Officer
for the Cruwys Morchard Sanitary District of the Tiverton
Union.
Sutherland, D. Sage, M.B.,Ch.B.Glasg.,Reeeident House Surgeon
to the Cumberland Infirmary, Carlisle.
Tudd. G. D., L.R.C.P.Edin., M.R.C.S., Medical Officer to the Brook
Dispensnry, Selby.
#irths.
Bryce.- On Oct. 5th, at 54, Stroud Green Road, N„ the wife of John
R. Bryce, M.D.. D.P.H., Barrister-at-law. of a son.
Buttar. On Oct. 6th, at 20, Kensington Gardens' Square, London,
W., the wife of Chas. Buttar,-M.D., of a daughter.
Loxton.—O n Oct. 4th, at 45, Belgrave Road, Edgbaston, the wife of
Arthur Loxton, F.R.C.S., Edin., of a daughter.
Retell.— On Oct. 4th, at 11, Granville Road. Southflelds, S.W.,
the wife of Hugh Stanley Bevell, M.R.C.S., L.R.C.P., of a
daughter.
Sainsbury.—O n Oct. 3rd., at 63, Welbeck Street, London, W., the
wife of Harrington Sainsbury, M.D., of a son.
Southwell-Sander—Hatchard.— Oct. 5th, at St. John’s Church,
Sandown, I.W., Gerald Southwell-Sander, M.B., C.M., of
Wateringbury, Kent, to Emily Mary, eldest daughter of the late
Henry Hatchard, Esq., of Wnlsford, Wimbome.
Kingdon-Meadows.—B y special licence, at Saint Gabriel’s Church,
Willesden Green, Wilfred Robert Kingdon, M.B., B.S.,of 44,
Maitland Park Hoad, Haverstock Hill, N.W., to Florence
Matilda, eldest daughter of James Meadows, of Cricklewood.
$*aths.
Fenoulhet.— On Oct. 1st, at Blomfleld Terrace, Paddington, John
Henry Fenoulhet, M.A., M.R.C.S., L.R.C.P., aged 41.
Hodges. —On Oct. 3rd, at Addison House, Upper Edmonton, in his
42ud year, James Hodges, L.S.A., M.R.C.S.Eng., eldest son of
the late Rev. James Hodges, of Shippon, Berks.
Jackson. —On Oct. 1st, at Broadhurst Gardens, South Hampstead,
Henry Ensworth Jackson, M.R.C.S ,nged 52 years.
Kellett.— On Oct. 8th, at St. David’s Road, Southsea, Surgeon-
Major Ed. Young Kellett, A.M.D., aged 68.
Lawford. —On Oct 2nd, at Oriel House, Leighton Buzzard, Edward
Lawford, M.D., aged 79 years.
Lillies.—O n Oct. 3rd, at the Lawn, Shepherd's Bush, George
William Lillies, M.D., in his 77th year.
Wallace.— On Oct. 1st, at St. John s Terrace, Colchester, Alexander
Wallace, M.D., M.A. Oxon , M.R.C.P., aged 70. Foreign and
Colonial papers please copy.
Digitized by Google
“SALUB POPULI BUPREMA LEX."
Vol. CXIX. WEDNESDAY, OCTOBEE 18, 1899. No. 16.
Original Comm uni cations.
THE CAUSES AND TREATMENT OP
SCIATICA AND NEURALGIA.
Bj HERBERT W. G. MACLEOD, M.D., M.8 .Ed.,
Late Surgreon-Captain, H.M.I.M.8.
Sciatica and other forms of neuralgia are gener¬
ally believed to be due to a neuritis of the affected
nerve, its branches, or its cords of origin. The pain
of sciatica differs in character from that of supra¬
orbital neuralgia in being more constant, more easily
excited by pressure, and in shooting less rapidly
along the nerve. It is usually intense at the sciatic
notch, behind the upper half of the femur, about the
knee-joint, below tne head of the fibula, above the
outer side of the ankle, and on the dorsum of the foot.
When the pain is of a dull, gnawing character the
patient frequently thinks he is suffering from “ mus¬
cular rheumatism.” When the diagnosis is doubtful,
by flexing the leg on the hip and then pressing on
the external popliteal nerve as it lies under the tendon
of the biceps in the popliteal space, a sudden spasm
of pain in the course of the nerve is experienced by
the patient.
In doubtful cases I have been able to convince
myself (and the patient) that the case was one of
sciatica, by pressing deeply over the nerve below the
lower border of the gluteus maximus near the origin
of the long head of tne biceps.
By flexing the thigh on the pelvis, and extending
the leg, the characteristic shooting pain can be
elicited, and a doubtful diagnosis cleared up.
The causes of neuralgia and Bciatica are numerous,
and all of them point to irritation of the affected
nerve, either in its cords of origin, its course, or
in its branches.
Interstitial and peri-neuritis have been observed.
The nerve is swollen and reddened, and there may be
marked exudation in its sheath, or in the interstitial
connective tissue. Endarteritis has been noticed by
some observers in the nerve-sheath, but Horsley and
Rose detected changes in the nerve-elements—none
in the vessels.
Gont and rheumatism are stated to be predisposing
causes, but the late Dr. Fagge agreed with Ainslie in
thinking that “ the relation of sciatica to rheumatism
is altogether imaginary.” Gout and syphilis may
excite a neuritis, and so act as causes, and some
observers believe the latter not to be a common cause
of sciatica, unless spinal meningitis is present, or
there is a lesion of the cord.
Among existing causes exposure to cold (especially
when the body is heated), wet clothing, sitting on a
damp seat, &c., are foremost. I recently had a
patient under my care who got a severe attack of
sciatica (for the first time in his life), when travelling
on a cold and damp day in a tram-car.
Heavy muscular exercise may excite an attack, but
I am inclined to ascribe it more to a resulting en-
feeblement of the system than to the exertion
per »e. Deterioration of health, antmnia, nervous
depression, mental strain, overwork, &c., are all
exciting causes.
It is stated that neurotic subjects are not liable'to
neuralgia, and that in the clinical history of “ Neu¬
ralgia Major" strikingly few cases are found in
hereditary neuropaths. My experience has been
that neurotic people, especially nervous™ and
hysterical women, are particularly liable to suffer
from facial (supraorbital) neuralgia; and we know
that cases of neuralgia show a preponderance of the
female sex. It is the reverse in sciatica; and this is
explained by men, from the nature of their wort,
being more exposed than women to the exciting
causes of that affection. .
There is one exciting cause of facial neuralgia, and
of sciatica, which seems to be greatly under¬
estimated. It is malaria. I was somewhat surprised
to read in a well-known work on Medicine that,
“ although the distinct periodicity of neuralgia was
supposed to indicate a malarial origin, this viewjno
longer prevails ”; and later on in the same work,
“although malaria is considered to be a cause of
sciatica, such cases, however, do not yield to
quinine.”
I feel sure that there are many who, like myself,
have seen numerous cases of neuralgia (in Military
and Civil practice in and out of the Tropics)
due to malarial poison. I have noticed it in
f iatiente otherwise in excellent health. The only
ikely cause of their disease was exposure to malaria;
and further, their symptoms were relieved by arsenic
and quinine which are Known to be efficient in such
cases. I have in several instances been able to verify
the following points:—
1. That the first attack may come on some time
after the patient has left a malarial country or zone.
2. That in consequence, the cause of the disease
is likely to be misunderstood.
3. That, whether residing in a malarial or non-
malarial country, subsequent attacks are readily
brought on in damp weather, after a heavy rainfall,
and in a warm, moist, and enervating atmosphere.
Rank vegetation also is an important exciting factor.
4. That attacks are most common in spring and
autumn, and that a bracing climate and frosty and
fine weather do not as a rule excite a paroxysm.
Neuralgia is supposed to be caused by toxic sub-
stanoes circulating in the blood, and irritating the-
sensory neurons ; and one might suggest the malarial
parasite as the fone ei origo mali in persons who have
been exposed to infection.
With regard to treatment: Quinine is very mucl>
used in all forms of the disease. If given in
sufficiently large doses, and for a long period, it
e nerally has a beneficial effect. Cinchonism should
guarded against by giving hydrobromic acid or
sodium bromide. My experience of this drug in
neuralgia and sciatica has, however, been disappoint¬
ing ; the effect is slow and not always sure.
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Cinchonine has some effect, but in my limited trial
of that drug, the results have fallen short of those of
quinine. Ammonium chloride is much praised by
some authorities who have used it successfully in
facial neuralgia “ of. rheumatic character ” ; but Sir
Thomas Watson said that if four doses (of half a
drachm each) fail to give relief, the drug may be con¬
sidered unsuitable for the case. Dr. Ringer in his
classical work on “Therapeutics," states that eminently
practical men require no new remedy, for they con¬
sider this salt rarely fails to give relief in all forms of
neuralgia. Antipyrin, in my experience, has
temporarily relieved the pain, but has not cut short
the attack.
The drug on which I place most reliance is arsenic.
After a fair experience of it, both in neuralgia and
sciatica, I have come to the conclusion that it is the
most uniformly successful remedy.
It will not agree with all patients, and must be
commenced in small doses of about ll\_ij. of the
Liquor Arsenici Hydrochlor., for adults, given three
times a day after meals. I have not found Fowler’s '
solution so palatable as the former preparation, be¬
cause the Tr. Lavand Co. in it sometimes causes
nausea.
To prevent griping from the arsenic I have found
a preparation of opium useful, and prefer Nepenthe 1
to the Tincture, because it seems to cause little or no j
headache in persons who suffer from this distressing I
symptom when taking the tincture. With Nepenthe i
Liq. Arsenici Hydrochlor. can lie used (an alkali is ■
incompatible), and Sp. or Aqua Chloroformi. Tr.
Aconiti in IT^ij. doses may also be added ; the heart
must be watched. It has often succeeded in relieving
pain and shortening an attack. Liquor Soda;
Arsenicalis is also useful in sciatica.
Tr. Ferri Perchlor. has a great curative effect, espe¬
cially in anaemic cases, but I have often found that it
causes headache, dyspepsia, and a sensation of fulness
with throbbing of the carotids and temporals. I
therefore seldom employ it or other ferruginous
compounds, unless specially indicated, and rely on
arsenic.
Iron causes constipation when given as the tincture,
and I am quite certain that a severe attack of facial
neuralgia is markedly relieved after the bowels have
acted well.
Arsenic acts as a mild aperient or laxative, and
the dose of the Liquor should be gradually raised (if
well tolerated) from one or two minims to ten minims
two or three times a day after meals. At the first
indication of intestinal pain, irritation of the eye-lids,
Ac., the dose must be at once reduced or stopped
altogether for a few days, and then slowly recom¬
menced in much smaller quantities.
I can recall a severe case of sciatica in an officer of
a cavalry regiment, who was laid up for months, and
was finally cured after a prolonged course of arsenic,
when all other drugs had failed.
Heat locally applied and galvanism are useful
adjuvants. The constant current seems to be more
effective, or the two currents may be applied at the
same time by means of De Watteville’s key.
In severe cases acupuncture, Nelaton's cautery, or
stretching the sciatic nerve are useful.
Instead of cutting down on the nerve and then
stretching it, the same may be effected by flexing the
thigh on the abdomen and then forcibly extending
the leg. It is better to do this under an ana;sthetic.
Pressure on the supra-orbital nerve often relieves
neuralgia, and a 20 per cent, solution of cocaine in
Ol Month. Pip. or 01. Caryoph. is often effectual.
In severe and chronic cases of facial neuralgia
surgical treatment may afford relief. The operation
suggested by Professor Rose, of King's College Hos¬
pital, and the Krause Hartley operation on the
Gasserian ganglion have given satisfactory results.
In conclusion, I would suggest early employment
of arsenic in all cases of sciatica and of facial neural¬
gia. The symptoms must be carefully watched. If,
after a prolonged trial, the treatment fails, then other
drugs should be tried. In chromic and intractable
cases a surgical operation may be absolutely
necessary.
COFFEE-GROUND VOMITING
AFTER
ANAESTHESIA IN GYNAECOLOGICAL AND
OBSTETRICAL CASES
WHERE INSTRUMENTAL OR OPERATIVE
INTERFERENCE HAS BEEN RESORTED
TO. (a)
By Dr. OSCAR BEUTTNER,
Geneva.
During my term as assistant at the gyntecological
clinic at the University of Berne, I was fortunate
enough to observe six undoubted cases of vomiting
of coffee-ground coloured substances and a seventh
case presented itself to me in my practice at Geneva.
I have up to the present neither heard nor read of
references to this phenomenon ; but as I consider it
important with respect to the question of differential
diagnosis, I would claim your indulgence for a short
span of time by bringing this, to my mind, important,
phenomenon to your notice. .
In one case chloroform and ether were the
l anesthetics used; in five cases chloroform alone was
used, and in one case ether alone. The chloroform
was, as chemical analysis showed, of absolute purity;
and there was no reason to doubt the chemical purity
of the ether. In four of the seven cases the vomiting
of coffee-ground coloured substances followed opera¬
tive interference for difficult parturition, and in three
after gyna;cologicul operations. No abnormalities of
digestive tract or of the heart was diagnosed in any
of these cases.
I would like to dilate somewhat on the first of my
cases, so as to convince you of the importance of
recognising the phenomenon of vomiting of coffee-
ground coloured substances with reference to differ¬
ential diagnosis. The patient was a»t. 43, and the
operation performed was vaginal hysterectomy for
cancer of cervix uteri. The anaesthetic used was
chloroform, which was administered during thirty
minutes by aid of cotton wool by means of a mask
inhaler. On the patient becoming cyanosed ether
was resorted to. The operation lasted two hours.
During the same coffee-ground coloured substances
were brought up per os, but without the muscular
contractions induced in general by vomiting, the
brownish masses flowing out of the mouth in a con¬
tinuous stream.
After the conclusion of the operation ensued
very protracted and violent vomiting of coffee-ground
coloured substances, which consisted of altered red
blood corpuscles, detritus and mucous cells. Who
would not have thought that such symptoms were
caused by a cancerous state of the stomach, and that
in such a case the operation was entirely superfluous !
My colleague. Dr. Murat, from Lausanne, told me
that Professor Freund witnessed at the clinic in
Strasbourg a similar case to the one just cited; the
post-mortem examination revealed cancer of the
stomach, which von Recklinghausen looked upon as
primary (the cancer of uterus being also primary).
Happily in our case there was no cancer of
the stomach, as the period of convalescence and the
further sequel of the case clearly demonstrated.
(a) Paper read before the Amsterdnm Congress of Gynecology.
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ORIGINAL COMMUNICATIONS.
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In a case in which a post-mortem was made I could
verify that no coarse lesions are necessary for the
production of vomiting of coffee-ground coloured
substances; we only found numerous luemorrhagic
erosions in the neighbourhood of the pylorus. In
another case in which an autopsy was made nine
days after the operation we found very dark grey
coloured masses in the stomach, but could not discern
any pathological changes of the mucous membrane.
It would lead too far. to give in detail all the naked
eve and microscopical appearances which presented
themselves to me in each of the seven cases which
have come under my observation. I will only hint at
the most important ones, and shall publish detailed
accounts later on.
As regards the etiology of this kind of vomiting we
have not been able to arrive at a satisfactory con¬
clusion ; but it is evident that the stomach plays an
important part as a hollow viscus, and having a
peculiar arrangement of the endings of the smaller
arteries and veins. It seems to be pretty certain
that neither chloroform, nor ether, nor the manner
in which ana-sthetics are administered plays a direct
etiological part. Venous stagnation, on the other
hand, seems to be of great importance in this kind of
vomiting.
The haemorrhage into the stomach may attain con¬
siderable dimensions. This is easily proved by the
quantity of the spontaneous vomit, or what may be
brought out of tne viscus with the stomach tube.
The anremic condition of the liver and spleen found
at the post-mortem examination of the first case iR
thereby explained. The vomiting of coffee-ground
substances may take place during the operation or
immediately afterwards, or sometimes at a consider¬
able interval after the conclusion of operative inter¬
ference, after the application of an enema, or the
introduction of the stomach tube.
A peculiar phenomenon is the change the blood
undergoes after a very shoih time, as in a case I
observed, where, after anaesthesia had proceeded for
ten minutes, vomiting of coffee-ground coloured
matter occurred. (The vomited masses of all my
seven cases were microscopically examined and found
to consist of altered red blood corpuscles, detritus and
mucous bodies.)
In conclusion, if I am not able to give you a satis¬
factory result about my studies concerning the etiology
of coffee-ground coloured substances, l nave tried to
interest you in this phenomenon, so as to prevent
you from confounding the same with cases of cancer
of the stomach, and also to increase the number of
observers, who. by publishing details of cases under
their observation, may help to enlighten us on this
hitherto dark, but very interesting, symptom.
THE TECHNIQUE OF VACCINATION.
By COLIN CAMPBELL, L.R.C.P., M.RC.S.,
Sur>reon to the Workhouse anil Public Viiccimitor for
Saddleworth, Yorkshire.
That the recent Vaccination Act has enormously
increased the details of the work of public vaccinators
goes without saying—I should put it roughly that the
pay has been doubled, whilst the labour has been
quadrupled. The necessity of many of the new regu¬
lations may at first sight appear to be doubtful; but
it is our duty, as faithful servants of the State, to
carry them out to the utmost of our ability, to be
carefully watchful of results, to- discuss the subject
amongst ourselves—with a view of being able to for¬
mulate and suggest to the Local Government Board
such alterations and improvements as experience may
show to be desirable to secure the highest standard
of efficient vaccination.
To such an end I desire to offer a few observations
on some doubtful points of technique.
The amended rules under which public vaccinators
are now required to cany out vaccination are con¬
tained for the most part in Arts. 3, 4, 5, <> and 7 of
the third schedule of the General Order, and the first
question is, the particular sort of lymph to be
employed. Art. 3 says:—
“All public vaccinations are to be performed with
glycerinated calf lymph, or with such other lymph as
may be issued by the Local Government Board.”
This apparently means that public vaccinators are
restricted—in public vaccinations, of course—to the
use of N. V. E. lymph, and this interpretation is
borne out by the wording of Form I. (notice of in¬
tended visit):—
“.... I hereby give you notice that I shall visit
-, and shall offer to vaccinate it with glyceri¬
nated calf lymph, or such other lymph as may be
issued by the Local Government Board.”
On the other hand. Article 4 inferentially permits
the use of private supplies :—
“The Public Vaccinator . . . must not employ
lymph supplied by any person who does not keep an
exact record of its source.” Therefore he may employ
lymph supplied by those who do keep such record.
But many private producers of lymph supply tubes
containing, it is said, sufficient for two, three, or even
five vaccinations. The General Order condemns
this, but in somewhat ambiguous language. “ When
once he has unsealed a tube of lymph he must never
attempt to keep any part of its contents for vaccina¬
tion on a future occasion.” (Article •*>.) The exact
meaning of the word “ future ” appears to be open to
doubt.
As regards the method of using lymph directed by
Article •">. no one will cavil at a word. Most of the
directions have long been carried out by public
vaccinators—with perhaps the exception of the
aitificial blower”—•*blowing” being rarely needed
when we used points, and had a regular succession of
children.
The necessity for sterilisation and aseptic vaccin¬
ations. often in the midst of suspiciously septic
surroundings, has necessitated a reconstruction on
an elaborate scale of our armamentarium. Hitherto
a lancet (or one of its substitutes), a basin of hot
water, and a clean towel were all that was required.
Even now we might sterilise and cleanse with¬
out heat, but for the blower. It is a great improve¬
ment, an obvious necessity, and if you have a nice one,
much spillingof lymph is prevented. But it has a nasty
trick of “ sucking back.’’ and for its re-cleansing,
nothing short of cold washing, followed by boiling,
can l^e thoroughly sufficient. But as we cannot put
our fingers into boiling fluid, we require a forceps;
and we also want scissors to cut the lint or other
material required for cleansing the 3kin and dry¬
ing our instruments. As there is no real cleansing
without soap, that is also required. So that our
new “ case ” must include vaccinators blower,
forceps, scis8oi*8, spirit-lamp basin, aseptic soap
(some may desire antiseptic tabloids), lint, or
gauze, and some means for protecting “ the
vaccinated surface against extraneous infection, both
on the performance of the operation, and on inspec¬
tion ot results.” (Art. t».)
This is a rule to which I desire to draw attention,
for personally I am unable to conceive a way in
which the italicised part of it can be scientifically
carried out, unless we have some means of deter¬
mining the atmospheric purity of the apartment in
which the operation is to Ire performed. We make
four abrasions, four doors through which potentially
possible septic germs may enter. How can we
scientifically keep them out—-protect “ the vaccinated
surface against extraneous infection ” ?
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394 The Medical- Press.
ORIGINAL COMMUNICATIONS.
Oct. 18, 1899.
The addition of glycerine to lymph adds a new
difficulty. Fresh lymph dries as quickly as it is
introduced, whereas the glycerinated lymph takes
half an hom- to dry, and so seal the abrasion.
Fortunately the dangers which the rule is designed
to meet cannot be so real as an out-and-out advocate
in the germ theory would have us believe. During
17 years’ work as public vaccinator, I have not known
a single case in which any troublesome symptoms
followed on the initial operation, that is to say, in
which symptoms of sepsis developed within three or
four days.
And from my own experience, again, I would assert
that in 99 cases out of 100 the unpleasant results
which occasionally follow vaccination are caused
either by the irritation of the vesicle after it has
begun to form (by clothing), or by a premature dislo¬
cation of the scab, subsequent to “ inspection.”
To guard against these more real dangers the
general order gives us very little assistance, except
by directing that “ Advice as to the precautions to be
taken . . . shall always be given.” It is easy to
give advice, but difficult to ensure its being carried
out.
The two objects which the public vaccinator aims
at are: (1) Thoroughly efficient vaccination, and (2)
the prevention of those unpleasant consequences
which may cause suffering to the patient and also
tend to bring the operation into disrepute.
The Vaccination Department of the Local Govern¬
ment Board lias provided us with a lymph capable of
giving the most perfect results. I believe that when
failure follows its use a careful reconsideration of any
individual case would reveal some slight error of
procedure on the part of the vaccinator.
As to its reliability, my own statistics are perhaps
worth recording. From January to April last I
vaccinated 258 cases, with 256 perfect results. In
four cases only was there any inflammation present
at the time of inspection—almost invariably the
eighth day. There were nine cases in which I was
asked to see them after inspection, and found in all
that the cause of trouble was premature rubbing off
the scabs. Without troubling the section with sta¬
tistics I may say that these 258 cases included 194
children, whose age varied from 1 to 14 years, and
the worst arms were those of children between 1 and
6 years old.
But there is still a small percentage of “ bad arms ”
even among children between four and six months.
They are usually found in the dirty homes of the
ignorant, thriftless classes. As regards the “ one
mark ” question, the position in which public
vaccinators and the better class of general practi¬
tioners generally are placed, is not only illogical, but
utterly unreasonable. The law, in its wisdom,
acknowledges as “successful ” vaccination a “mark”of
any size,howevermicroscopic; whilst the Local Govern¬
ment Board directs—and probably every teacher of
vaccination inculcates—the necessity of four marks!
What is the position of a man trying to explain
that four marks are necessary, when his listener knows
that a certificate of “ successful ” vaccination under
the Vaccination Acts can be obtained, perhaps,
fifty yards off for the modest sum of sixpence—and
one pimple ?
But toe difficulty does not end there. A large
number of people regal’d a vaccination as good or
bad, not by measuring the size of the vesicles pro¬
duced, but by the presence or absence of all irritation,
inflammation, or subsequent trouble of any sort.
Well, if the efficient vaccinator must produce four
pocks aggregating half a square inch, whilst the one
mark man can also certify successful with one
mark of (J ths of a’squareinch x -j* ff ), it would be
an interesting calculation to estimate how many
times more frequently efficient vaccination is
likely to produce what is regarded as unfavourable
results than “ successful ” vaccination.
The consequences of this condition of things are
far-reaching. It makes the position of the efficient
vaccinator logically untenable, and is piling up
future evidence against the utility of the vaccina¬
tion laws.
The initial difficulty is the glycerinated lymph: it
takes forty minutes to dry ! Well, one cannot wait
so long at every house. If you apply a pad of wood¬
wool or gauze immediately, I am satisfied that is
Bucks-up the lymph, and so spoils the vaccination
If you leave the application of the pad to others, it is
applied awry, or too tightly, or too loosely, and so
the vesicle is endangered.
Alternative applications for immediate use—discs
prepared with gelatine or other non-absorbent
material may be applied ; but it is far from easy to
secure their uniform adhesion. If a large disc,
sufficient to cover four marks, be used, it usually
wrinkles at its circumference and so becomes readily
displaced; whilst smaller discs, designed to cover
each separate mark, fail to adhere to the glycerinated
surface and are usually on the day of inspection
found far away from where they were placed.
Occasionally a very pretty result is secured with both
large and small discs, when the intelligent co-opera¬
tion of the mother is secured.
Recently I have tried the application of flexile
collodion—not exactly immediately. I have vac¬
cinated, then packed up my case and filled up
certificate, and at the last moment applied it.
Nothing further has been applied till the day of
inspection, when a gauze or woodwool pad has been
personally applied. I have examined several cases so
treated, on the fourteenth day, and the results have
been remarkably good.
In conclusion, i would say that in the perfection of
our technique lies the surest hopes of perfecting our
results. A box of vaccinator’s instruments has been
prepared at my suggestions by Messrs. J. Weiss and
Son. In a large number of dwellings there is abso¬
lutely no space on which to lay out our instruments.
My first object was to make the box or case, complete
in itself, and no other space is required by the
vaccinator, who has this box with him, than that
which it stands on, and no other material than cold
water.
ON EARLY DECAY OF THE TEETH, (a)
By J. KINGSTON BARTON, M.R.C.P.Lond.
Seeing that the enamel and dentine of the per¬
manent teeth are formed so early in life, it is evident
the factors concerned in the sound development of
these parts of the teeth must produce their effects
during the infancy of the individual.
The six-year old molars, or first permanent molars,
are far on their way of formation even before birth,
but the incisors and canines do not begin to consoli¬
date until a few weeks after the child has been born.
At three years of age most of the permanent teeth
are well advanced. In the jaw of a six-year old
child all the permanent teeth, excepting the wisdoms
(third molars), are fully formed, saving the fangs.
Hence, whether the child’s constitution, or its infan¬
tile diseases, or the nature of its food, be the cause
of good or bad teeth, in any case the effect is pro¬
duced long before the seventh year.
This subject comes well within the scope of the
Department of State Medicine, prevention being
the guiding principle of this section.
It has been urged that School Boards should take
(a) Abstract of Paper read at the 8ection of State Medicine,
Portsmouth Meeting of British Medieal Association.
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The Medical Press. 395
Oct. IS, 1899.
the matter up. But the expense of treating diseased
teeth would he very great, and seems entirely for the
well-to-do. The State can alone touch the subject
by attending to the question of prevention. It would
be far better and cheaper for the State to provide
good cow*8 milk for all infants who could not get
breast-feeding than to deal with bad teeth in children
and young adults.
If bad teeth could be prevented the gain to the
State and individual would be of enormous value, as
it is wonderful how many diseases can l>e traced in¬
directly to bad teeth. The one condition that is
chiefly responsible for bad teeth is rickets. The rich
who are hand-fed all have rickets in a mild degree,
and the poor almost all have it more or less severely.
In the well to-do the one common symptom of mild
rickets is delay in the appearance of the milk teeth,and
very few children cut their milk teeth at the proper time.
Among the poor delayed teething and convulsions,
bronchitis, diarrhoea oow-legs, and other well known
manifestations show how numerous and prevalent
are its symptoms.
Rickets is not a disease, but rather a diet disorder,
almost entirely due to improper feeding, and the
early use of starch, especially if insufficiently cooked,
is nearly always the prime cause.
In India, and other warm climates where children
live so much in the air, it is said they suffer but little
from rickets. On the other hand, it is among these
people that children are kept at the breast nearly
two years, it being well recognised by the natives
the deadly danger of infantile diarrhoea in a hot
climate, and its associations with the use of animal
milk. So it is the breast rather than the sun which
prevents rickets.
For twenty years I have been observing the history
of milk, and permanent teeth in infants and children
developing under one's care. Also, inquiring carefully
into the early feeding and health of growing children,
young adults, and old people. Three facts come out
very strongly as a result of these inquiries —:
1. Breast-fed children always have the best milk
and pei-manent teeth.
2. Those fed from the beginning with cow's milk,
asses or goat's milk, come off second best.
3. Directly starch or any patent food comes to be
added to, or given in place of, cow's milk, then
almost for certain will the milk and permanent teeth
turn out badly.
When a person between 20 and 30 years has excel¬
lent teeth, it wi‘1 nearly always be found he or she
had a good period of suckling followed by very simple
feeding in the first few years of life.
If the first permanent molars are the only bad
teeth, it is possible that the mother's health at the
end of pregnancy was at fault, but errors in diet or
disease in the very first months after birth will
usually be found to have been the cause of such
teeth being bad.
' If the second or third molars are chiefly affected
then errors of health and diet between five and twelve
yeuis will have been noted. In every case where,
after fifteen years, the teeth »re bad, then it is
invariably found the child had neither breast nor
s'onple cow’s milk, but one or other of the patent
foods came on the scene. Of these artificial foods,
some are less injurious in their effects than others,
but none are good. In the earlier years of condensed
milk, I have notes which show that in a few cases it
did not produce such bad teeth as one would have
expected, but this does not hold good with most of the
modern preparations. In the Westminster Hospital
Reports of this year, appears an excellent article by
Dr. W. A. Wills on the composition of modern Swiss
milk, and other infant foods ; also certain statements
in Parliament of late, exposed tl e poverty of nnd?rn
Swiss milk as a food substitute.
Many a modern child child owes its life to one or
other of the humanised foods, but I am sorry to say
that the teeth of these children do not bear testimony
to its being a perfect food. So there is some flaw in
its composition the chemists have not yet satis¬
factorily overcome. Good as breast feeding is, yet it
is not everything. For after weaning at nine months,
until about three years of age comes the critical
time when rickets is so rife. Hence, if after weaning
injudicious feeding is adopted, then the last pre-molars-
suffer as also the bicuspids, with second and third
molars of the permanent set ; early breast feed¬
ing having generally ensured the success of tho
permanent incisors and canines.
In Scotland teeth are destroyed by too early use of
oatmeal, some of the worst cases I have ever seen
occurring in children who were given oatmeal from
birth. In Ireland teeth are spoiled by too early use
of potatoes, and in England by the early use of
badly cooked flour and of bread. Until some teeth
are cut the child should have nothing but breast or
some animal's milk, the cow’s for preference. By wait¬
ing for the appearance of teeth the pernicious system
of pap foods can be avoided.
As each set of teeth (incisors, pre-molars, canines,
and secoDdpre-molais) appears, then further additions
of egg, fish, vegetables, and selected fruits should be
given until the milk set are complete, when meat
may be added.
To bear out the above statements 100 consecutive
cases of all ages have been taken from the note-books.
A further separate account was taken of 100 cases
over the age of 12. In these, 75 per cent, of good
teeth had some form of breast-feeding. Of hand-fed
cases, 75 per cent, had bad teeth, the remainder
being good, or fairly good. In only one case was
there loss of enamel, where the history showed good
breast-feeding, followed by fresh country cow’s milk,
and no known severe infantile disease. However, in
this case the teeth lasted very well in spite of the loss
of enamel, showing the value of the early breast¬
feeding.
MEDICINE AND ITS STUDY, (a)
By J. W. MOORE, M.D.,
President of the Royal College of Physicians in Ireland.
After some introductory remarks on the “ nobleness
of medicine,” Dr. Moore passed on to
The “ Mens Medica ”
of our profession, which on account of its dignity and
responsibility should bn approached with bated breath
and reverent mien. I do not urge, he continued, that
the physician should be an ascetic; the very solemnity
of our work forbids this, and councils reaction as a foil
to the stern realities of our daily life. The best physician
is the man who, daily witnessing the havoc
wrought around him by the hand of Death, from
h : 8 experience forms the habit of acting with a
constant view to death, and develops the earnest
desire to shield from its stroke the sick entrusted
to his care. “ Perception of distress in others,” writes
Bishop Butler in “ The Analogy of Religion,” is a natural
excitement passively to pity, and actively to relieve it ;
but let a man set himself to attend, inquire out, and
relieve distressed persons, and be cannot but grow less
and less sensibly affected with the various miseries of
life, with which he must become acquainted ; when yet,
at the same time, benevolence, considered not as a
passion, but as a practical principle of action, will
strengthen, and whilst he passively compassionates the
distressed less, he will acquire a greater aptitude
actively to assist and befriend them.” This is the “ mens
medica.” which endows the true physician with the God¬
like power of healing. His compassion, observation,
(a) Abstract of AddresB delivered at the inauguration of tli*
Session of the Meath Hospital, Dublin, October, 189J>
V
396 The Medical PsEsb. ORIGINAL COMMUNICATIONS. Ccr. 18, 189J.
experience, reason, and learning are all enlisted in a self-
denying and supreme effort to combat disease and to
ward off death.
Clinical Casb-takino.
With much concern the physicians of the hospital
have observed that for some years back—especially since
the institution of a fifth year of medical study—students
have been inclined to pay less attention to their olinical
work than was hitherto their custom. They still “ walk ”
the hospitals, but their attitude has become less actively
attentive than of old. When it was not compulsory to
“ take cases,” cases were taken as they should be taken
—that is, the patients were visited twice a day, and
every symptom and turn of their illness were noted.
Now, I do not for one moment wish to belittle the
teaching in our schools of medicine. A liberal general
education and a sound knowledge of the auxilary
sciences are essential elements in the evolution of the
physician or the surgeon. But the paramount use
of these aids to a professional training is to
enable the medical student rightly to observe and
study disease -and this crowning work of medical edu¬
cation can be pursued only at the bedside of the sick—
there alone can “ the ways of the sick ” be learned. In
my first address, delivered in 1875, I quoted Robert
James Graves on this point. With your permission I
shall quote him again. In his first introductory lecture
after his appointment as physician to this hospital in
1821, he wrote:—“From the very commencement the
student ought to witness the progress and the effects
of sickness, and ought to persevere in the daily obser¬
vation of disease during the whole period of bis
studies.” He continues“ A great number of students
seem little, if at all, impressed with the difficulty of
becoming good practitioners; and not a few appear to
be wholly destitute of any prospective anticipation of
the heavy, the awful responsibility they must incur
when, embarking in practice, the lives of their fellow,
creatures are committed to their charge. It is by
perso s of this description that the earnest attention
and permanent decorum which ought to pervade a class
employed in visiting the sick are so frequently inter¬
rupted. Young men of the character to which I allude
attend, or, as it is quaintly enough termed, walk the
hospitals very regularly, but they make their appear¬
ance among us rather as critics than ss learners - they
come, not to listen, but to speak—they consider the
hospital a place of amusement rather than of instruc¬
tion. Students should aim not at seeing many diseases
every day; no, their object should be constantly to
study a few cases with diligence and attention; they
should anxiously cultivate the habit of making accurate
observations. This cannot be done at once; this habit
can be only gradually acquired. It is never the result
of ability alone; it never fails to reward the labours of
patient industry. You should also endeavour to render
your observations not only accurate, but complete; you
should follow, when it is possible, every case from its
commencement to its termination, for the latter often
affords the best explanation of previous symptoms, and
the best commentary on the treatment.”
In some degree, the languid case-taking of the present
day is due to the active training of nurses and proba¬
tioners which goes on in our wards. Our neat clinical
charts are filled in by the probationers who are trained to
take observations on the temperature, the pulse rate, and
the rate of breathing. But this should not interfere with
the case-taker’s records—quite the reverse, for a second
series of observations would control the first. Speaking
with more than thirty years’ experience as both student
and practitioner, 1 assert wi>h all the emphasis at my
command that the student who neglects his clinical
work, or carries it out in a half-hearted and perfunctory
manner, will bitterly regret his lost opportunities in
after life. Sooner or later, with much searching of heart
and with many a misgiving, weighed down by a full
sense of undivided responsibility, he will have to strive
after that ripe experience which was within his grasp
while yet a student, when he could share all responsi¬
bility with his teachers, and was sheltered beneath the
iegis of their position.
After a brief reference to the advances made in
medicine and surgery during the past quarter of a
century, the lecturer alluded to
The Fever Process.
The nature of the fever process is now far better
understood than it was even a few years ago, and we
have learned that “ fever,” or elevation of bodily tem¬
perature above the standard of health, or “normal,”
serves a useful purpose, provided that it is properly
controlled. There is, in fact, what the Germans aptly
cill “das Heil-Fieber”—“the fever which brings back
health.” At the close of an able address on “ Antipy-
rosio" before the Tenth International Medical Congress
at Berlin, in 1890, Professor Arnaldo Cantani, of Naples,
used the memorable words, " Das Fieber, das in so
vielen Krankheiten der lieste Verbundete des Arztes
ist ”—“ the Fever, which in so many diseases is the
best ally of the physician.” Fever, in a word, purges
the system. In an excellent article on “ Typhoid
Fever,” written in the present year, Drs. Affleck and
Ker, of Edinburgh, say:—“ The ordinary fever of a
typhoid case runs such a fixed and definite course that
it is hard to believe that the pyrexia is not nature’s
cure for the disease.”
In this mixed assembly of laymen and members—
actual or presumptive—of the medical profession, I
would raise a warning voice against the pernicious doc¬
trine that in fevers the temperature must be reduced ns
quickly as possible to what is popularly called “ normal ”
It cannot be too often or too emphatically and
authoritatively declared that such a procedure is very
likely to destroy life. The so-called antipyretic inedi-
cines, or heat-reducers, should never be used by un¬
skilled hands. The employment of such remedies, even
by the skilled physician, calls for the utmost caution
and the most anxious consideration. The danger lie?
in an interference with the production of body-beat,
while the escape of heat from the system is increased.
In this way collapse is likely to be induced. F->r
many years I have taught that the only safe antipyretic,
or assuager of fever-heat, is water, and especially cold
water. It helps the escape of heat from the body in
many wayB, while it does not interfere with heat produc¬
tion, rather, indeed, does the use of cold water internally
and externally encourage the evolution of heat in the
body.
Alcoholic Stimulants in Disease.
Another popular eror, rife among medical students
also, is that alcoholic stimulants are a sheet-anchor in
Berious disease. Such a notion may be fraught with
grave consequences—immediate and remote. A patient,
already suffering from the effect of a specific poison, may
be doubly poisoned by alcohol, itself an intoxicant, or
poison. And - a still greater disaster—a habit of
alcoholism may be engendered through the carelets
administration of alcoholic stimulants Childten and
women, as a rule, bear stimulants badly, and in their
case especially their use should be but temporary: In
so-called “ nervousness,” nervous depression and sleep¬
lessness, stimulants are much more likely t. do harm
than to do good. If they are given at all, it should be
under the watchful supervision of the physician, tLe
effect of each dose being carefully noted and weighed.
The question of the administration in fever of these
powerful drugs—for such they are—isan anxious one. The
chief indications for their use are derived from the state nf
the pulse, the heart, the tongue, and the brain and from the
presence of complications, particularly of the “typhoid
state,” or that Btate which betokens profound depression
of the nervous and muscular systems. Stimulants are
most urgently required during the night and in the
early morning, when the life-tide is at the ebb and the
vital powers are wont to flag. In the forenoon they are
much less needed. A comparatively safe way of exhibiting
stimulants is in combination with food, in the form of
egg-flip, wine-whey, sillabub, and bo on.
Diet of the Sick.
This leads me to remark that, if you wish to be a good
physician, it is necessary that you should also be a good
cook. At all events, you should be a good theoretical
TRANSACTIONS OF SOCIETIES. The Medical Press. 397
Oct. 18, 1899.
cook, effect being given to your theory by a good prac¬
tical cook. There is scarcely a disease in which diet
does not play a more important part than mere medi¬
cines. Again, there are no two patients whom precisely
the Bame dietary will suit. We might say: Quot homines,
tot epulae. The skill of the physician will at times be
severely tested in the attempt to draw up a suitable bill
of fare for a fastidious patient. We should always re¬
member that “ what is one man’s food is another man’s
poison.” Dr. T. King Chambers, in his excellent
Manual of Diet in Health and Disease ” (published in
1H75), reminds us that when the tailor in Laputa sternly
refused to take the usual measurements, and insisted on
constructing Captain Gulliver's coat, waistcoat, and
bieeches on absurd principles, the customer voted it was
the worst suit of clothes he ever had in his life. Dr.
Chambers adds: “ We should certainly fail in the same
way if we did not take the measure of numberless con¬
tingencies in the daily life, and numberless peculiarities
in the persons of those who consult us about their diet
and regimen.”
Pulmonary Tuberculosis.
The hospital treatment of consumption—by which is
commonly understood pulmonary tuberculosis—is an
anxious question, and one that iB difficult of solution.
Year by year the conviction grows stronger that in
Treating this fell disease in the wards of a general
hospital we are committing a grave hygienic error.
In an address on the ** Prevention and Cure of Tuber
calosis," delivered before the Section of Medicine at the
Carlisle meeting of the British Medical Association in
1896, I pointed out that, theoretically, the air of a
hospital ward, however clean and well-ventilated that
ward may be, is unsuited for a consumptive. In it his
surroundings are calculated to depress. The dietary
may not coax his appetite. And then to look at the
question from the point of the other patients, the
presence of the consumptive may be no more than
tolerated. He keeps them awake at night with his
hacking and racking cough ; he resents open windows,
yet may pollute the air in the ward to an extreme degree..
If his expectoration is not destroyed or disinfected, he
may even infect his fellow-sufferers with his own
disease, (a) He occupies month aftei month a bed
which otherwise would accommodate many generations
of patients labouring under less chronic and more
curable maladies. Lastly, the hospital treatment of
tuberculosis breaks down because of its utter in¬
adequacy to cope with so universal and so tedious a
disease. In a week every bed in every hospital in the
United Kingdom might be filled with consumptives,
and even then thousands upon thousands of cases would
be left without hospital accommodation, so widespread
is the plague of phthisis.
The hospital treatment of tuberculosis should resolve
itself into providing of—
1. Consumption hospitals, or sanatoria, in which the
disease could be treated in its earlier and more hopeful
stages.
2. Speeial consumption wards in general hospitals,
into which tuberculosis, and that disease alone, should
be received.
3. Refuges for those far advanced in, or dying of, con¬
sumption. The German name for Buch an institution is
very expressive—” Friedensheim," or “ Home of Peace.”
The providing of speeial wards in, or adjacent to, our
general hospitals would meet to a certain extent some of
the objections I have advanced to the treatment of con¬
sumption in hospitals. In such wards eomsumptives in
a more advanced stage of the disease could be treated,
the separate principle being carried out wherever
possible, a ward in any case being planned to con¬
tain never more than three or four patients, and
provision being made for inhalations of osonised oxygen,
as suggested and carried out by Dr. Ransome.
Medical Etiquette.
I do not wish to weary you with a long address, but
there is one fact which, if once pressed home, may save
' (a) Geo. Allan Heron. The Belatioa nl Dust in Hospitals to
Tuberculous Infection. Lat.cf, Jan. 6ih, 1894.
you and others from many a heart-burning in your pro¬
fessional life. A physician or a surgeon has no vested
right or property in a patient. To put it in another way,
the public have the most absolute right to choose their
own medical attendants, and to change them ns often as
they please. Therefore, do not pick a quarrel with a
professional brother on the ground that he has super¬
seded you, and do not judge him harshly, or at all,
until you have heard both sides of the question.
Do not misunderstand me, While the public must be
left free-handed in this matter a serious responsibility
rests upon every member of our profession who does not
act toward* his professional brethren with consummate
tact, consideration, and forbearance. Never take advan¬
tage of a brother. If you are called in to visit a patient
hitherto under his care, acquaint him of the fact with
the least possible delay. Come to an honourable under¬
standing with him. Do unto him as you would he
should do unto you. If he then takes umbrage the fault
lies at his door, not at yours. Such is “ Medical Eti¬
quette.” William Stokes concluded one of his eloquent
addressee on our conduct towards other men with the
words of Hamlet, “ Use them after your own honour and
dignity ; the less they deserve the more merit is in vour
bounty.”
^vanfiactionB of §orietiee.
CLINICAL SOCIETY OF LONDON.
Meeting held Friday, October 13th, 1899.
Sir R. Douglas Powell, Bt., President, in the chair.
acute streptococcal meningitis supervening in the
COURSE OF CHRONIC I’ARENCHYMATOU8 NEPHRITIS.
Dr. Rolleston described the case of a man, a-t. 22,
admitted on the eighth day of his illness with a tempe¬
rature of 103 degs., but without any definite evidence
as to the nature of his illness, which had begun with
tonsillitis. He was quite free from headache on admis¬
sion, but the next day had two fits, passed into a condi¬
tion of cerebral irritation, and died within 24 hours.
The autopsy showed extensive purulent meningitis, due
to streptococci infection, and an acute nephritis
on the top of chronic parenchymatous nephritis.
No streptococci were visible in microscopic sections
of the kidney, so the acute renal changes may have
been toxic. But, inasmuch as cultures wore not
made from the spleen or heart’s blood, it could not be
certainly said that the streptococcal infection was con¬
fined to the meninges of the brain. Terminal infections in
renal disease were known to be common in the lungs,
pleura, and pericardium, but not in the meninges. In
Flexner’s statistical study of terminal infections in
chronic heart or kidney disease, the few cases of menin¬
gitis that occurred were almost always due to pneu¬
mococci. Flexner had shown that in chronic renal
disease the bactericidal power of the bl lod was diminished
and that terminal infections were therefore very liable
to ocour. This case was remarkable for the uuusual site
of the terminal infection, and for the latency of the
meningitis. The tonsils were possibly the source of
infection.
Dr. F. J. Smith commented on the rarity of such cases
of which he had not met with an example in the post¬
mortem room. He remarked as curious that purulent
meningitis so rartLy followed renal disease, though
pericarditis and pleurisy were common. He was sur¬
prised that the streptococcal infection could not be traced
seeing that iu tuberculous meningitis injection had been
known to take place through the tonsils of which he
mentioned an example.
ANEURISM OF THE FIR8T PART OF THE ARCH OF THE
AORTA PROJECTING INTO THE RIGHT AXILLA.
Dr. T. Churton (Leeds) related the case of a man. set
53, admitted June 15th, 1898, with a painful swelling on
the right side of the chest, extendiug from the mid-
axillary line to the nipple line, half the size of a c>coa-
nut, the seat of well-marked expansile pulsation. Fiist
Digitized by G00gle
398 Ta* Medical Press.
TRANSACTIONS OF SOCIETIES.
Oct. 18, 1899.
noted two years ago, he only left off work three
months ago on account of pain in the right arm. Had
been confined to bed for a fortnight, he was feeble, and
had anginal attacks. Aneurism was diagnosed. An
aortic regurgitant murmur was heard over the ffturth
costal cartilage. Syphilis was denied. It had
been thought by a surgeon to be of axillary
origin, but a resident believed it to be aortic,
the diagnosis turning upon the effect of pressure upon
the subclavian artery. On palpation, however, a slight
heaving could be felt from the tumour to the sternum
and this area was dull. The hearths impulse was felt in
the sixth space. If. in external to the left nipple line.
The bruit was fine and whiffing, not suggesting a large
regurgitation. No other marked pressure signs. The
patient died on July 5th with symptoms of internal
haemorrhage. Post-mortem—the heart was enlarged,
chiefly the left ventricle, the mitral valve was normal,
the aortic cusps were rather thick, but presented no
marked deformity. Ihe cavity was not much enlarged,
but the muscle was thick. The first inch of the aorta
was fairly good, but beyond, it was greatly dilated, even
within the pericardium. Beyond the pericardial attach¬
ment the first part bulged outwards and downwards. Just
outside the pericardium on its outer aspect was a long
narrow slit leading into a sac measuring 6i x 4i x 3J
inches, having a thick lining of solid clot. At the upper
and inner part of the sac was a small opening J in. in
length, from which blood had escaped into the pleura at
the upper and posterior part of the thorax. The third
and fourth ribs appeared to have been broken in the
anterior axillary region, and the remains of the broken
and separated parts are apparently contained in the
wall of the sac. The ribs were intact as to their outer
surfaces for two or three inches. The aneurism lay
wholly in front of the lung, the inner face of
the upper lobe being closely adherent thereto. He
pointed out as an unusual feature the point of pro¬
jection of the aneurism into the right axilla, of which
he had been unable to find another example.
Dr. F. J. Smith raised the question whether a bruit
afforded any estimate whatever of the amount of regur¬
gitation. As the result of combined clinical and post¬
mortem work he thought it was quite impossible to tell
the amount of freedom of regurgitation by other than
clinical symptoms. He asked what was the weight of
the heart, and pointed out that unless the valves were
affected an aneurism of the arch or descending aorta
had no effect in producing hypertrophy. The position
of the aneurism, he opined, was merely an anatomical
accident.
Dr. Chapman referred to Gross’s diotum that as
regards an aortic regurgitant bruit, if the second sound
far exceeded the first in length this would indicate
extensive regurgitation, but this did not hold good as
regards the mitral valve.
Dr. Rolleston, in respect of the significance of such
murmurs, observed that there was a difference between
a mitral and a regurgitant aortic murmur. In the
former there was little relation between the loudness of
the murmur and the extent of the lesion, but with an
aortic regurgitant murmur, though there were note¬
worthy exceptions, there was a very fair relation between
the distinctness of the murmur and the character of the
lesion. He agreed that in the absence of heart or
kidney disease aortic aneurism did not lead to hyper¬
trophy of the heart.
Dr. Percy Kidd agreed as to the unimportance of a mur¬
mur qu‘\ the amount of regurgitation, but this could be
estimated by reference to the pulse and to the presence
or absence of the second sound over the aorta and the
carotids. Perforation in this site was uncommon, but he
had in his wa-ds a case in which the perforation seemed
to be posterior, the patient presenting a pulsating
tumour over the scapula. In this case there was granu¬
lar kidney.
The President said it was remarkable what an
amount of absorption of ribs and other bones could take
place without entai'ing suffering. He recalled the case
of a patient who had an aneurism pulsating th'ough
the back of the scapula, who had complained of no par¬
ticular suffering. He agreed that a bruit gave com¬
paratively little information unless taken in association
with the valve function. He asked whether the tracheal
tug had been noted.
Dr. Churton, in reply, said it had been definitely
settled in a discussion last year that hypertrophy of the
heart was not a necessary consequence of aneurism, He
referred to the case of a boy with a severe aortic regurgi¬
tation murmur, who presented two special signs which
he considered indicative of grave regurgitation, viz.,
obvious enlargement of the heart downward and to the
left, and instead of its being best heard over the fourth
left costal cartilage it was loudest over the fifth and
even the sixth, and a needle passed in through the fifth
cartilage, went through the base of the conical channel
which leads to the pulmonary valve in front and to the
aortic valves behind. The kidneys in this case were
reported to be slightly affected.
Dr. Fred J. Smith showed a case of apparently
8IMPLE AN.EMIA
in a young girl, a>t. 19. First under observation in
1895, improved under iron. In 1896, while taking large
numbers of Bland’s pills, developed features of peri-
heral neuritis. In 1898 she suffered from warts on one
and, which showed peculiar phenomena of growth and
decay. In 1899 she became much worse, and was ad¬
mitted with a grave degree of anaemia, and while in
hospital developed most peculiar nervous symptoms con-.
Bisting of (1) a prolonged condition of serious inter¬
ference with the respiratory mechanism, with periods of
hours of rapid breathing (66 or more per minute),
alternating with hours of very slow breathing; (2)
intermittent fits of unconsciousness with convulsive
movements of face and right arm and leg. No treatment
seemed of any avail, but the patient gradually improved
until headaohe and pain in the legs were her only com¬
plaints. Incisions down to the bone of both tibiae
relieved the latter; nothing has touched the former. Dr.
Smith summarised the points of interest in the case as
follow :—(1) its extreme intractability; (2) nervous
phenomena, apparently peripheral; (3) nervous
phenomena, apparently of central origin.
Dr. Kidd, who had seen the case in hospital, said t
was a very puzzling case, and he had been inclined to
fall in with the original diagnosis
Dr. Norman Dalton said that until this year he would
have been inclined to think that thrombosis was lare in
anaemia, but in December last he made the post-mortem
of a young woman who had been suffering from anaemia,
and had (Bed with cerebral symptoms. He found exten¬
sive thrombosis of all the sinuses extending into the
venae galeni. Some months later a young woman with
marked anaemia complained of pain in the arm and they
found the veins of the arm thrombosed right up. During
the present week he had seen a case very much like the
one related by the author, but at an earlier stage. The
patient, a woman, a?t. 23, complained of persistent head¬
ache, which was entirely localised to the longitudinal
sinus. There was numbness of, and movements in, the
left arm. He pointed out that in this case, as in so
many other cases of anaemia which did not yield readily
to treatment, there was a suspicion of inherited syphilis.
Dr. Rolleston asked what was the tension of the
pulse during these attacks ? He thought that in some
ways this remarkable case read something like Stokes-
Adams’ disease. He asked whether there was much
constipation P
Dr. Savill recalled the case of a boy, set. 15. who
was extremely aniemic, and had a little oedema around
the ankles, and a persistent loud double murmur over
the heart with intermitting temperature. He died of
asthenia and post-mortem nothing was found until
they opened the head, when at each corner of the
longitudinal sinus an unmistakable gumma was found.
They then examined the eyes and found stria; in the
cornea?. On examining all the bones they were
rewarded by finding gummatous masses, so that un¬
doubtedly it was a case of congenital •■yphilis.
Dr. C. Box referred to a case under Dr. Payne, sup¬
posed to be suffering from pernicious anosmia. The red
corpuscles were reduced to considerably under a million,
but there was also a great increase in the eosinophile
Oct. in 1899.
GERMANY.
celli. Subsequently a small serpiginous ulcer was seen
on the palate, and the patient improved at once under
iodide of potassium. Another case was examined for
signs of syphilis, and some thickening of the tibiae was
made out. Examination of the blood showed no increase
in the eosmophile cells. The patient died, and the ordi¬
nary signs of pernicious anaemia were found post-mortem.
Dr. 8mith, in reply, admitted that the possibility of
syphilis had not occurred to him, but that he would
take care that it was now inquired into. When she was
at her worst the pulse was very small—asphyxial. Her
temperature averaged about 97, though she had two
days of unexplained pyrexia.
prance.
[from oub own correspondent.]
Paris, Octol>cr 15th, 1880.
Adenoma of the Intestine.
Independently of adenoma of the rectum described
under the title of polypus, there exists an affection, very
rare, it is true, in which the adenomata are not localised
in the rectum but extend to all the surface of the
large intestine called by M. Quenu, who made a
study of the disease, polyadenoma. According to the
author the neoplasm appears first on a relatively
healthy portion of the mucous membrane, contrary
to the opinion of Rokitansky, who pretended that
it took its origin from ulcerations caused by chronic
dysentery. The co-existence of polyadenoma and
cancer is relatively frequent, since out of 42 cases
observed by M. Qu£nu 20 were found to have been the
seat of both diseases. Polyadenoma would seem to be
rare in children. Statistics show that more than one
half of these cases were observed between 16 and 31 years
of age, and twice more frequently in man than in woman.
The malady presents three principal symptoms, diar¬
rhoea, hwmorrhage, and painful phenomena; later on the
general health suffers. The diarrhoea is very abundant,
from fifteen to twenty evacuations in the twenty-four
hours, and resists all medical treatment.
Sometimes the evacuations are mixed with blood and
mucus, at others they are exclusively composed of
mucus more or less • stained with blood. At times no
pain is complained of, but in general the patients suffer
from violent pain in the abdomen and along the sides.
The diagnosis is difficult as it is necessary to bring
the intestine to view by laparotomy as performed more
than once by Czerny.
If, however, the finger iB passed into the rectum it
will generally perceive a series of polypi soft and
pediculated, varying in volume between the size of a pea
and that of a cherry along the walls of that portion of
the intestine.
As to the treatment, it is necessarily unsatisfactory.
Surgeons have ablated all the polypi within their reach
through the anus with considerable benefit, especially
as regards the haemorrhage, but resections of the
intestine were prevented by the anaemic conditions of
the patients.
Yellow Fever in America.
There have been twenty-seven fresh cases of yellow
fever, with two deaths, at Key West; one case (fatal)
at Jackson; and five cases, with one death, at New
Orleans.
The Medic al Press. 399
(Sermantj.
[from odr own correspondent.]
Berlin, October 14th, 1899.
Tuberculin Soap.
At the Miinchenei Naturforsche Versammlung, Hr.
P. G. Uima read a paper on this new form of soap. The
strain and stress period of tuberculin had, it was to be
hoped, so long passed that when the speaker proposed
a new form of it it would meet with a cool reception, but
one free from prejudice. Scarcely any remedy had ever
been used so lavishly, to be, in a short time, so com¬
pletely neglected as tuberculin. Both the lavish use
and the neglect wero equally undeserved, and it appeared
to him time that the experimental therapeutist, as well
as the practitioner, should become masters of this wonder¬
ful specific, without expecting from it more than it
could do.
Under the personal influence of Koch himself the
administration of the drug had never ceased in the
Infective Institute in Berlin, but elsewhere it was
scarcely used except in veterinary medicine. This was
not because physicians had not seen good effects from
it; the reason probably was that people had not found
the absolute radical effect that had been hoped for, and
also partly that people believed that its benefits must
be paid for by dangers to other organs, and to the life
of the patient, and that the use of it was always to be
associated with subcutaneous injections, general effects
and fever.
As regarded the first prejudice, the remedy could not
be allowed to fall out, because Koch, in the first joys of
discovery, did not at once recognise its limits. The
speaker could not name a single powerful remedy from
morphia and chloroform to quinine and mercury, the
sphere of action of which had not at first been over¬
estimated.
It was the general body of the profession that expected
more of tuberculin than it could do, for Koch had from
the first emphasised the fact that tuberculin could not
kill the tubercle bacillus. From this the practised
dermatologist had taken the conclusion that neither
lupus nor any other disease produced by tubercle could
be cured by tuberculin alone. The chief reason for
the neglect was, however, the danger of tuberculin.
He, like many other physicians, had soon gone back
to very small doses of tuberculin, and he held gradual
cautious tuberculinisation with the smallest possible
doses when it was only one factor used along with other
well tried means, to be a comparatively safe method of
treatment, at least for external tuberculosis, so long as
its limits were kept in mind, and the period of time not
put off in which the other remedies should be made use
of. The use up to now [of tuberculin injections involved
a general action that, in the case of external tubercu¬
losis, was quite unnecessary, and this could be replaced
with advantage by a local tuberculin treatment. By
such local use the dosage could be varied from place to
place, corresponding to the degree of disease without
the need, or thought for, any unnecessary or troublesome
constitutional effect.
There were in general two ways by which medicaments
that did not attack the skin could be made to find
entrance through the cutis. They were mixed with
either salicylic acid, resorcin, or other similarly active
Digitized by
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400 The Medical .Press.
AUSTRIA.
Oct. 18, 1899.
phenol in the form of ointment, or with strongly alkaline
soap. In both cases the skin was so opened up by these
adjuvants that the remedy could act on the changed
papillary body, and even on the deeper lying layers of
the skin. The first experiments with tuberculin Bhowed
that salicylic acid oaused precipitation, but an alkaline
soap did not. The direction of his investigation was
therefore decided, and after half-a-year’s use on over
thirty patients he had seen no reason to depart from the
first selected form:—
Sapon. unguinosi, 10 0;
Tuberculini, 0 - 6—1 - 0—2 0 M. ft. ointment soap.
Here, as in all similar cases, the sapo unguinosus had
shown itself the mildest yet the most energetic of all
kinds of soap medication. The method of use was that
used for all ointment soaps. A small quantity of soap
(about 0,025 gm.) was used for the square centimetre
rubbed in with the finger, which could be covered with
a glove ot protection, until its dryness prevents any i
further rubbing. Then the finger was wet with water,
and with farther rubbing it froths until it becomes
dry again. Then the finger was wet again, and so on
for four or five times until the whole had found its way j
out of sight below the horny layer.
As the ointment soap had a decided effect on diseased
surfaces it seemed proper in the first experiments to
treat a symmetrically lying spot in a similar manner
with simple ointment soap instead of tuberculin soap.
The difference of action between the two was as marked
as could have been wished. With the tuberculin soap
after 6, 12, 24 hours a slight prickling began, then an
inflammatory hypenemia with cedema that sometimes
went on to formation of thick scales and crusts, and
after a few days went back, but more quickly under the
use of drying material, such as zinc sulphate paste
Then the lupu3 surface showed paler, softer, smoother
than before; a portion of the plasmom had disappeared,
and, more striking still, a portion of the fibrous growth
which reacted to tuberculin like cellular lupus
tissue, and which should not be confounded with
lupus iccatrix. It was just this lupus fibroma that
caused the disfiguration of long treated lupus of the
face, it caused the ectropium of the eyes and lips,
closure of the nose and mouth, Ac., in short, which caused
the greater part of the hateful residua that so pitiably
disfigured cases of half-cured lupus. If he then said,
“ Koch’s treatment had, in the first place, a highly satis¬
factory cosmetic effect, and that through its specific
absorbent action on lupus fibroma,” he could now add
that the same satisfactory cosmetic result could be
obtained in a .much simpler way, by the application of
tuberculin soap. If the remedy did no more it deserved
to keep a place in the dermatological armamentarium.
But tuberculin soap did more. What was to be expected
of it was the removal of diffuse lupus tissue, not that of
the bacilli-containing lupus centres. The number of
lupus centres after treatment with tuberculin soap was
greater than with tuberculin itself, the recurrences more
promp and energetic. Surgical treatment must there¬
fore be promptly applied where a radical cure was
wished for.
On the other hand the tuberculin soap treatment had
two essential advantages over all other—it acted quickly
and almost painlessly. The quickness depended in the
first place on the thickness and dryness of the upper
layer ; if this was considerable, it was well to apply
moist heat over the soap application, and to leave it on.
It was less depeodent on the mass of lupus, as the re¬
action was in proportion to the amount of tubercle, and
in the same way on the disappearance of it, so that
hypertrophied forms of lupus did not require a much
longer time than the smooth and partially healed cases.
More important for a rapid result was the percentage of
tuberculin in the soap. In order to keep the reaction
within bounds it was well to reserve the 20 per cent,
strength for circumscribed cases, and more extensive
cases to treat with the weaker 10 per cent, strength. In
the latter case, it was well to divide the diseased areas
intodivisions the size of a shilling, which could be treated
uninterruptedly and alternately with the soap and some
drying material. This mosaic way was specially suitable
for ambulatory practice. The period of treatment de¬
pended on the conditions named, and varied accordingly
to extent and situation between two and three weeks.
(To be continued.)
Austria.
[from odr own correspondent.]
Vienna, October 14tli, 18W>.
Pneumococcal Sepsis without Pneumonia.
Mant cases have been recorded in literature where
pneumonia has been present without pneumococci being
found. Pelnar, in Prof. Hlava’s clinic, produces the
antithisis in that the pneumococcus and its product were
present without concomitant pneumonia; in proof
whereof he gives the results of the post-mortem examina¬
tions. The first case was in December of last year, and
on admission the patient had a high temperature, but
died in a few days from eclampsia.
Post-mortem: purulent cerebral meningitis; partial
atelectis; enlarged spleen ; follicular enteritis with
thickening; calculi in right ureter; purulent rhino¬
pharyngitis, herpes labii with general sepsis.
Microscopic preparations of the cerebral effusion
yielded diplococci lanceolati, from the spleen diplococci
of an atypical form were met with. Cultivations from
the meninges and spleen yielded the typical diplococci
of Frankel-Weichselbaum. Sections of the brain and
spleen, after hardening, revealed the same micro¬
organism.
The second case was that of a woman, set. 22, in the
puerperium Suffering from scarlatina. The post-mortem
gave somewhat similar results, purulent cerebral
meningitis, laryngo-tracheo bronchitis, hypenemia of
the lung, enlarged spleen, parenchymatous degeneration
of the liver and spleen, the uterus non-involuted with
residual shreds of placenta on its walls. General sepsis
was originally diagnosed.
The placenta was normal as well as all the serous
membranes, sections of the uterus and parametria gave
negative results; and nothing abnormal could be dis¬
covered in the peritoneum.
Microscopic preparations of the tonsils yielded diplo¬
cocci, both lanceolate and capsuled forms, the latter in
chains. The same forms were found in the brain and
splenic pulp. In the tracheal mucous membrane a few
were found. Cultivations from the membranes of the
brain, spleen, Ac., yielded the diplococci of FrAnkel-
1 Weichselbaum, which formed chains best in glycerine
Digitized by
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Oct. 18. 1899.
lunacy department.
The Medical Press. 401
bouillon. When inoculated into dogs, the sairo diplo-
cocci were obtained from the cedema. In both of these
cases clinically and experimentally no trace of pneumonia
could be demonstrated. The probability ia that the
micro-organism gained admission to the body by infect¬
ing the mucous membrane of the mouth and nose (which
is the usual channel for the diplococcus lanceolatus),
and thence was carried to more remote organs, such as
the brain and spleen, while the lungs escaped.
Tetanus and Behring's Antitoxin.
Dorner records a oase of tetanus in which recovery
was attributed to injections of Behring’s antitoxin.
On January 19th a farmer had his hand injured by
the bursting of a rifle. On the 21st he came to hospital
with the injured hand wrapped up in wet clothe. No
blackening from powder was observed, but a yellow
viscid matter was everywhere present. The middle and
terminal phalanges of the middle finger had been carried
away, together with the soft parts of the fourth and
fifth fingers as well as the index finger and thumb.
After removing a number of the phalanges and dressing
with antiseptic solutions all went well till March 3rd,
when stiffness of the jaws was complained of. On the
5th spasms of the muscles appeared; on the 11th the
spasms invaded the neck and shoulders ; on the
15th the entire body was involved, with opisthotonos ;
pulse, 110; temperature, 37‘4 degs. = 99 32 degs. Fahr.
Uric acid was in the proportion of 1 to 26.28 of urea.
On March 16th he had 66 attacks of the spasms in
twenty-four hours, 14 of which were very severe, not¬
withstanding the adminstration of six grammes of
chloral hydrate. On the 17th he bad 89 attacks, 33 of
which were very severe. On the 18th, at mid-day, 25
grammes (each representing 250 units) of Behring’s
tetanus antitoxin were injected. The attacks numbered
202, temperature, 37 9 degs. On the following day
another 25 grammes were injected and the dose of chloral
hydrate repeated, and there were only 44 attacks. On
the 20th, temperature, 36 9 degs., attacks, 50: two hours
at a time quite free ; no sleep, but the mouth could be
opened; no stiffness in neck, and the proportion of uric
acid fell to 1 as against 6174 urea. On the 25th there
were only two attacks in the twenty-four hours, and
these were but slight. The following night he slept from
twelve to eight o'clock; during the day a few faints.
On the 2Kth he was able to open the mouth freely. On
the 30th the chloral was stopped. On April 27th all the
muscular groups were normal. The wound on the
middle finger had a small granulating surface, while
the others had cicatrised. On May 1st he was dismissed.
From the very first appearance of tetanuB to the
time of dismissal repeated microscopic examinations
were made of blood, discharges, &c., but the tetanus
bacillus of Nikolaier could not be found. Experiments
on animals as well as anaerobic cultures were also nega¬
tive It should also be noted that the incubation period
in this case was six weeks, with consequently a favour¬
able prognosis. Richter’s recoveries were 45 per cent,
for fifteen days’ incubation; Poland had 50 per cent
after twenty days.
Among the many congresses which are to meet in
Paris during the Exhibition year is the second Inter¬
national Congress on Hypnotism. Nine subjects
which seem to exhaust the whole subjects connected
with hypnotism and its applications, are proposed for
discussion.
JCuuaci) .department.
TENTH ANNUAL REPORT OF THE ASYLUMS
OF THE COUNTY OF LONDON.
The progressive increase of pauper lunacy in London
still continues to attract considerable attention, and is
relatively in excess of the increase of the popu¬
lation. The actual increase for which accommodation
has to be provided by the county is 639. A graphic
statement is furnished which shows the relation of the
increase of London pauper lunacy to the increase of the
population during the ten years, 1889 to 1898. The
ratio per thousand of all pauper lunatics chargeable to
unions and parishes in the county of London to the esti¬
mated population on January 1st, 1899, was as follows:
—Mean ratio, 4 7; parish of Hampstead being lowest
with a ratio of 19, and the Strand Union highest with a
ratio of 10T. The inference is that lunacy is increasing
at a faster rate than the population. We have frequently
pointed out that while technically this is so, it is an
exaggeration to say that lunacy is actually increasing.
The fact is, that many broken-down creatures are sent
to asylums who would not be regarded as insane under
the old conception of lunacy. They are incapable
mentally, often because they are incapable physically, and
they are real cases for the workhouse rather than the
asylum, in a large proportion. Every care is exercised
to limit the admissions to the asylums as much as pos¬
sible, and many certified lunatics have to be detained
for a considerable time in the workhouse infirmaries,
and they have sometimes been certified several times
because of the scarcity of proper accommodation. It is
worthy of note that some of these cases have sufficiently
recovered to enable them to be discharged without
necessitating their removal to an asylum. It is, and
has been for some years, recognised, that additional
accommodation must be made to meet an increase of
about 600 patients per annum, and the delay which has
occurred in keeping up to these requirements has meant
considerable additional cost for accommodation else¬
where. The medical statistics as regards recoveries and
deaths for all the asjlums are: recoveries on total ad¬
missions, 30'49 per cent.; on the total number under
treatment, 6 70 per cent. ; deaths on the total number
under treatment, 7'15 per cent. Dr. Claye Shaw, in his
report to the sub-committee of the Banstead Asylum
says, “ It is worth noting that whilst the tendency of
medical opinion is to treat private cases of insanity in
uncertified houses, or to place them in the houses of
medical men without certification, there seems to be an
increasing desire to rush pauper patients into asylums.
Many of the patients sent here might just as well be
treated in infirmaries or hospitals, but there seems to be
no great object on the score of economy for so dealing
with them, inasmuch as pauper asylums are very,
economically worked, whilst the fuss that is made if by
chance an untoward event occurs to a person mentally
affected, and treated in any other place than an
asylum, makes responsible persons send the patients
to an asylum whenever a vacancy can be got
and the probability is that the larger the amount
of available accommodation, the greater will be
the number of candidates for admission, in other
words, che amount of * official,’ i.e., registered
lunacy increases with the accommodation provided. It
Digitized by CjOO^Ic
402 Th b Medica l Pres s. THE OPERATING THEATRES. _Oct. 18, 1699^
is difficult to see how thi> can be prevented by any other of a very large rabbit into the interval securing it as
means than by some direct supervision over the cases armly as he could by wire to the upper frapient. An
proposed to be sent to the asylums. There appear, to interval of about three-quarters of au inch renmmed
be no donbt that parish authorities show an increased between the lower end of the rabbit s emur
readiness to demand asylum accommodation, and that and the lower tibud fragment. The absence of soft
the persons sent are often unnecessarily certified.
parts rendered it impossible to introduce another
Hanwell there seems to have been some trouble with portion of rabbits bone into the interval without
typhoid and erysipelas. Dr. Alexander, speaking of the endangering the safety of the larger graft. The
latter says:-"The current opinion among medical limb was put up in plaster after this operation
men, that this disease is the result of overcrowding does any subsequent interference being postponed for at
not receive much support from our experience of it in least six months. In performing the operation every
1898, for the cubic space in that part of the asylum is precaution was taken to keep the wound and the graft
according to the authorised standard.’* sterile > the eternity of the rabbits femur being
trimmed to accommodate it to parts about, and the
Report op the Pathologist. medulla was cleared of its contents. The chief difficulty
Dr. Mott’s report is as usual very interesting and experienced in the operation was due to the tension of
valuable. He tells us that the signs of syphilis and the
history of it is proportionally very much greater in
the soft parts and skin, which resulted from the absence
of the tibial shaft, they resting on and covering the inner
general paralysis than in other forms of insanity, ex- surface of the fibula. The conditions presented by the tibial
eluding brain syphilis. Atheroma of the aorta was fragments in the child were small spikes of bone which
found to be extremely common, but the severe forms extended upwards and downwards from the epiphyses,
were met with in general paralysis. Of ninety-one these were buried in the soft parts; the upper one was
females who have died at Claybury forty-one had ulcera- exposed and cleared and was perforated for the wire
tion of the intestines, six of these were tuberculous, one loops which connected it to the graft. When this had
was typhoid, and thirty-four were dysenteric. From the been done the rabbit was killed and its femur removed
statistics of the weight of different hemispheres of the and prepared for insertion as already described. Mr.
hrain in persons dying insane he finds a marked Lane pointed out that the mechanical conditions pre-
-contrast between the weights of the hemispheres sented by this case were such as only offered to the
in the general paralytic brains, as compared with
other forms of insanity, and with the normal brain,
in which the two halves balance each other. One
surgeon the possibility of restoring to the child the capa¬
city of transmitting through an already much shortened
limb the superjacent weight of the body; he hoped, how-
of the most constant and the earliest symptoms of ever that the child would be very materially benefited by
general paralysis is the affection of verbal and written the operation of introducing a rabbit's bone, which he had
language which progresses steadily with the dementia found of the greatest service in previous cases (reports
and paresis. He attributes the marked loss of weight of these have already appeared in the Operating Theatres),
of the left hemisphere as compared with the right in He said that in six mouths he proposed to expose the
about 70 per cent, of the cases of general paralysis to lower tibial fragment, and to connect it by a rabbit’s bone
the fact that we use the left hemisphere much more to the graft just introduced. He hoped that as the
than the right; in consequence it is more liable to result of the first operations the soft parts in the
undergo degeneration earlier than the right. The vicinity would beome looser, and offer less resistance to
corollary is that stress is an important factor in causing the introduction of more bone. The wound healed in
degeneration, and that structures which are used most a m08t satisfactory manner,
are, if previously subjected to the devitalising influences .
of toxic agencies, such as syphilis and alcohol, the most
prone to undergo premature decay. Vital Statli
^The (Dperatittg theatres.
GUY’S HOSPITAL.
Vital Statistics.
The deaths registered last week in thirty-six great
towns of England and Wales corresponded to an
annual rate of 18 - 8 per 1,000 of their aggregate population,
which is estimated at 12,786,832 persons in the middle
of this year:—
Birkenhead 18, Birmingham 20, Blackburn 19, Bolton
15, Bradford 16, Brighton 15, Bristol 14, Burnley 16,
itr » t 4 - j Cardiff 16, Croydon 16, Derby 16, Dublin 29, Edin-
BoNEGRAFTiNo.-Mr.AaBUTHNOT Lane operated on a . 18 / Gla I ow 17 [ Gateshead 17, Halifax 13,
:hild, ait. about 12, who had suffered from necrosis of the Huddersfield 12, Hull 19, Leeds 19. Leicester 17, Liver-
tibia, the bone having been removed at the epiphysial
lines. This had occurred'some years previous, and very
little lengthening of the leg had taken place since, so
that the right leg was much shorter than the lelt. The
pool 24. London 17, Manchester 24, Newcastle-on-Tyne 24,
Norwich 14, Nottingham 17, Oldham 13, Plymouth 17,
Portsmouth 16, Preston 22, Salford 25, Sheffield 22,
Sunderland 23, Swansea 12, West Ham 15, Wolver¬
hampton 20. The highest annual death-rates per
fibula had accommodated itself to the shortening, and 1,000 living, as measured by last week’s mortality,
was quite straight. She was unable to sustain her were :—From measles l'l in Nottingham; from fever,
. • , x. . d11 .s , Tj , , , 1-2 in Sheffield, and 16 in Bolton ; and from diarrhoea,
weight at all upon the shortened limb. He determined to w . , ’_,__ K . 0 ■ A T „ „„„„
® m , , ,, .... , 29 in Wolverhampton anu 5 8 in rreston. In none of
make an effort to replace the shaft of the tibia by ^e large towns did the death-rate from scarlet fever
means of a graft, but found that the interval or from
reach l'O per 1,000. The 117
between the tibial fragments was too great to deaths from diphtheria included 55 in London, 10 in
P-* * "V «■« W by any single JSSt
bone, 80 he determined to do the operation in death from small-pox was registered in any part of the
two stages. He therefore introduced the femur United Kingdom.
Digitized by Google
Oct. 18. 1899 LEADING
Bxqistered roR Trasskissiox Abroad.
€hc Jttcbical J)re£* attb (Eircular.
Published every Wednesday morning:. Price 5d. Put fr a. 511.
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Letters in this Department should be addressed to the Publishers.
Jttebicd fkess attb Circular.
'* 8ALU8 POPCLI SCPREMA LEX.”
WEDNESDAY, OCTOBER 18, 1899.
NEW LIGHTS ON THE PLAGUE AT OPORTO
When tbe plague broke out at Alexandra, its
occurrence sooner or later in European ports became
a matter almost of certainty. It was our fortune to
be able to announce tbe almost certain invasion of
Oporto towards the end of July, several weeks before
the discovery was made by the lay newspapers. The
attitude of English journalism, both medical and
otherwise, as regards this serious European invas : on,
is not a little curious and interesting. There can be
no doubt whatever that the only accurate and trust¬
worthy reports that have yet been made
of the plague in Oporto have come from
the Special Correspondent of the Times. His
description of the facts of the case as regards, not
only the extent and progress of the disease
but also the conditions of i acial and physical environ¬
ment are worthy of the best traditions of the Local
Government Board reports - that is to say, it is the
work of a skilled observer who is versed in the
principles of modern preventive medicine and is able
to couch his tale in clear and vigorous English. As
a result, after reading his special article, one has a
clear view of the natural filth, sloth and ignorance,
the official corruption, the bad sanitation, the foolish
attempts at isolation and disinfection, and the farce
of cordons and quarantine that together make the
outlook for the future of plague in Oporto of a nature
that may fairly be styled dubious and alarming.
As a contrast with the energy and outlay of capital
by means of which the Times has secured sound
first-hand information let us turn for a moment to
some of the statements with regard to the outbreak
at Oporto that have appeared in representative
medical journals at home. In its issue of October
ARTICLES. The Medical Press. 403
7th the Lancet says that during the month of Sep¬
tember there were seventeen cases of plague in that
city, with four deaths. Now, if that were true, it
would tend to persuade eveiyone that the disease
had experienced a considerable check. What are the
facts ? We are in a position to state on authoritative
and direct information that there were thirteen cases
from the 1st to the 10th of September, while there were
upwards of fifty cases in Oporto during the month
of September. A similar inaccuracy of statement
appears in the British Medical Journal for October
7th, which stereotypes the September return at
seventeen cases and four deaths. TheTast mentioned
journal, in its next issue on October 14th. stated that
the plague bulletin for “ last ” week was the worst yet
issued, and that twenty-eight cases of plague with
three deaths bad occurred during the week end¬
ing October 3rd. The number given, twenty-
eight, agrees with our own figures, but there
is the trifling error that the week should have
been recorded as that ending on the Mth and
not on the 3rd October. Inaccuracies of this kind
are to be deplored when dealing with a subject of
such current interest and importance as the invasion
of Europe by the plague. Then there is another matter
about which we feel it to be simply a matter of duty
to speak out clearly and emphatically. A great deal
has been said about Calmette’s visit to Oporto and
his persuading the Portuguese to be inoculated. Asa
matter of fact, he did nothing of the kind. During
bis fortnight’s visit to the town he did not
in any sense persuade the population to try
protective vaccination, but it is true on the other
hand that he induced a number of foreigners
to adopt that measure and also a small propor¬
tion of native officials engaged in the hospital
and sanitary services. The whole visit of Calmette
appears to us to savour of of a commercial rather
than of a scientific element. The report on his
serum was said to have been signed by an Inter¬
national Committee at Oporto. If our information
be correct, the document in question was franked by
a certain number of signatures obtained haphazard
from foreigners in the neighbourhood, and we
believe we are correct in asserting that there is not
a single German to be found among the list of
signatories. What scientific conclusion could a fort¬
night’s trial of this remedy be imagined to establish,
and why should it require the support of an
“ international ” document ? Is not Calmette content
to leave his plague serum to stand or fall on its own
merits ? But we claim a right to demand from M
Calmette the exact nature of his remedy, with which
he proposes to replace Haffkine’s serum, a prepara¬
tion that may be regarded as being fairly, if not abso¬
lutely, established from a scientific point of view.
Calmette’s serum, we believe, is commonly described
as the Yersin serum, that is to say, it has the
synonym applied to Pasteur’s serum. Now, the
scientific evidence yet obtainable is all against the
Yersin serum, und if M. Calmette has found
it necessary to push the Yersin serum by
such methods as those indicated, our readers will
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404 Thb Medical Press.
LEADING ARTICLES.
Per. 18, 1899.
agree that the sooner commerce and scientific medi¬
cine are divorced the better. Of course, it is possible
M. Calmette may have adequate explanations and
justification for his conduct of the Oporto serum
mission. We trust that he will at least favour.the
world with a clear statement as to the identity, or
otherwise, of his serum with that of Yersin. The
bare suspicion that so terrible a scourge of mankind
as the Oriental plague is being handled by way of
commercial catspaw might well make the veriest
cynic shudder, and we trust M. Calmette will at once
take steps to clear the ground of anything that might,
however remotely, suggest such a rock of offence. In
future articles we shall hope to keep readers ac¬
quainted with the progress of the plague in Oporto.
THE NOTIFICATION OF MEASLES.
The wisdom of providing for the notification of
infectious diseases is now generally recognised, and
the example set by this country is being followed in
many others in a more or less perfunctory way-
There may be differences of opinion as to the proper
person or persons upon whom the duty of conveying
the information to the authorities ought to be im¬
posed, but as to the principle itself no such diver¬
gence of opinion can well exist. This being so, is it
not somewhat inconsistent that measles should not
be included in the schedule of notifiable diseases ?
This disease has a higher death-rate than any other
zymotic disease except perhaps diarrhoea and whoop¬
ing cough, yet practically nothing is done to check
its ravages. The opposition which the proposal to
notify measles has hitherto encountered has, in the
main, been based on too narrow a view of the value
of the system. It has been assumed that it is idle to
notify a disease unless steps lie taken to provide
accommodation in isolation hospitals for the victims.
This is a fundamental error, because compulsory se.
quest-ration is the ultima thule, and not the primary ob¬
ject of notification. As matters stand at present by no
means every case of notifiable infectious disease is
removed to the hospital, and in measles it is not indeed
absolutely necessary. In the first place, an intimation
of the existence of measles in a family would afford the
medical officer of health an opportunity of educating
the people on the importance of isolation and the
propriety of removing the other youthful members of
the family. Then, too, the knowledge would enable
rigorous measures to be taken to prevent the con¬
veyance of infection the from home to the school, and
to other aggregations of the young. At present no
concerted measures of the kind are possible, and the
public are left in the lazy belief that measles is a
disease which every child must have almost of neces¬
sity, and which consequently calls for no special pre¬
cautions. The very fact that it is excluded from the
list of notifiable infectious diseases tends to reinforce
this view for it may logically be argued that if the sani¬
tary authorities treat it as a negligible quantity it
cannot possess much importance. The only way to
prevent an outbreak developing into an epidemic is
to have early intimation of the first cases, and to
enforce the usual precautions. No one pretends that
notification is likely to stamp out the disease, but if
we can only lengthen the period of time which elapse^
between the widespread epidemics which now devas¬
tate whole districts at frequent intervals, and if we
can in some part ensure that each outbreak shall
burn itself out in its own particular locality some'
thing will have been accomplished in the direction
of lessening the present high rate of mortality from
this source. Of course even these moderate measures
of repression cannot be adopted without some increase
in expense, but the cost of prevention is neces¬
sarily vastly less than that of treatment, and it might
be minimised, as suggested by Dr. Berry, the ener¬
getic Medical Officer of Health for Wigan, by limit¬
ing notification to the first case in a given household-
Thisisan economical idea which might advantageously
be extended to other diseases than measles. The
important detail from an administrative point of view
is the knowledge of the existence of infectious disease
in a given locality. The occurrence of subsequent
cases is information of second-rate importance, which
could easily be obtained by the sanitary inspector in
the ordinary course of his duties. No better defini¬
tion of notification could be given than that with
which Dr. Berry wound up his recent address before
the conference of medical officers of health. “ Noti¬
fication,” he observed, “ is to sanitary officials what
intelligence of the enemy’s movements is to military
officers.” Without such knowledge, scientific war¬
fare is an impossibility, especially the warfare
against disease in which positions can, under no
circumstances, be carried by assault.
SERUM THERAPEUTICS AND ANTITOXIN
TREATMENT.
We hear a good deal about the advances made in
the domain of serum-therapy, but as a matter of
fact the average practitioner must be at a loss to
know exactly what this vaunted progress signifies.
A glimpse of the actual state of the question was
afforded by the necessarily brief discussion on the
subject which took place at the first meeting of the
Medical Society of London, though curiously enough,
no one came forward with any observations bearing
on the serum treatment of plague, a subject which
i6, however, very much the order of the day. For
scientific purposes it is necessary to distinguish
clearly between the different classes of serums, some
of which, as antitoxins, act by neutralising or other¬
wise rendering inert the toxins secreted by the
specific organism, while others act by inhibiting the
development of the living microbe. Speaking
generally, the latter are more useful for the purpose
of affording protection, that is to say, prior to infec¬
tion, while the antitoxins, as in diphtheria, render
signal service, even after the disease has declared
itself. There are, clinically speaking, two great
classes of serums, the antitoxin or curative class,
and the anti-bacterial or the protective class, though
there are some which appear to possess, to
a greater or less extent, both qualities. It
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Ihk Medical Pbesb. 405
Oct. IS, 1899.
is hardly necessary at this time of day to insist on
the unquestionable value of the diphtheria antitoxin,
the efficacy whereof has been confirmed by statistics
from all parte of the world. The cordial reception
which this remedy has received at the hands of the
medical profession everywhere must have a substantial
basis of fact or we should have had a repetition of
the criticisms which soon followed the introduction
of Koch’s first tuberculin, from which much was
hoped, but which, in practice, soon belied the
sanguine expectations which the name and
authority of its inventor seemed to warrant.
Even tuberculin, however, has its partisans, and Dr.
Heron spoke in very favourable terms of the results
which he has obtained with the new tuberculin. It
must, however, be laid down as a primary condition,
that the disease must be strictly localised to a small
part of the lung, and must not be complicated
by infection with other microbes. All cases in
which the temperature exceeds 100 degs. F.*
at most, must be regarded as cases of mixed
infection in which tuberculin can do no good.
Curiouslyenough .it does not appear to have occurred
to anyone to try and stem the current of infection
by a combined treatment of tuberculin and anti¬
streptococcic serum. This may be due to the fact that 1
the therapeutical results of anti-streptococcic serum
are somewhat dubious. It seems to exert a marked
effect in certain cases and none whatever in others,
and this failure to relieve drives us to the conclusion
that there must be several varieties of streptococcus,
all of which are not amenable to the same remedy.
As there are at present no means of distinguishing the
remediable cases from the others we must await more
complete bacteriological knowledge of the natural
history of this group of microbes. Another problem
which awaits solution is that of preparing an anti¬
toxin which shall be powerful enough to neutralise
the toxin of diphtheria completely. At present it
would seem that nervous tissue has such a marked
affinity for the toxin that it can wrest it from the
antitoxin in some cases, that at least is the explana¬
tion suggested by Dr. Washbourn, on Ehrlich’s
lines, of the fact that antitoxin does not save
life in all cases. Probably, however, we have
once again to do with mixed infections, and a?
this seems to be the rule rather than the exception,
it behoves bacteriologists to devote themselves to the
preparations of grapeshot antitoxins for use in our
* therapeutical artillery. Of the anti-pneumococcic
serum Dr. Washbourn, though he was the first to
prepare it on anything like a large scale, cannot
speak in definite terms of approbation, but there
Beems to be no reason why it should not be tried on a
more extensive scale in this country than has hitherto
been the case. An altogether novel departure in
serum-therapy has been inaugurated by Dr. Hubbard
who makes use of the serums, not in view of their
antitoxic or anti-bacterial properties, but as coagula¬
ting agents. He claims to have obtained tangible
relief in certain cases of aneurysm of the aorta, and to
have arrested the haemorrhage in menorrhagia and
in haemophilia. If these results are confirmed
by other observers there is reason to hope that an
agent of considerable power has been added to the
resources at our disposal in dealing with haemor¬
rhagic conditions. Haemophilia, indeed, is a con¬
dition which one might have thought would long
since have tempted the serum-therapist, seeing that,
theoretically, it ought to be possible to supply
artificially the coagulating agent which is wanting.
Instances of death from haemorrhage in the subjects
of this abnormality, though not of everyday occur¬
rence, are still sufficiently numerous to ma re it worth
while to study its prevention, but in view of what
precedes it may be that the task has already been
accomplished by Dr. Hubbard.
on torrent ‘topic*.
Vapours.
There seems to be a tendency now to study
somewhat carefully the influence of the atmosphere
in a certain class of maladies of the respiratory
organs, which are difficult to treat by remedies
administered through the stomach. The last edition
of the British Pharmacopoeia excludes the six vapours
which were contained in former editions, for the good
reason probably that they were of nr* practical use.
There is no doubt but that the health of a people
depends largely on the air they breathe, and
certainly the subject is one of great interest to those
who appear to inherit tendencies of serious character,
which are likely to assume under certain circum¬
stances a fatal form. The question of the causes
which influence the atmosphere is beginning to be
inquired into. The nature of the soil certainly has a
great influence. The difference between clay, sand,
and chalk is fully appreciated by those who live in
London or its suburbs; and if we go further afield
we cannot but notice very great differences in the
various parts of our coast as well us in the interior
of our island. The pathological aspects of geology
might well in some form or another constitute part
of the education of those entering the profession, for
without this they cannot understand why the climate
in vaiious parts differs as it does. If now there are
good reasons for resorting to inhalations in the treat¬
ment of lung diseases, we have to consider the quali¬
ties of vapours and the agents we employ. The
subject has not baen studied as it deserves,
and there is yet a great deal to ibe learned,
l.efore we can decide upon the best methods to be
employed for utilising many agents, when we endea¬
vour to administer them not as solids or liquids, but
in the form of vapours. When we see what use has
been made of chloroform, ether, or nitrous oxide gas,
it is suggested that various volatile substances, such
as phenol, menthol, the turpentines, benzoic acid,
camphor, and others might prove of great value
when we change them from the solid or liquid form
into that of vapour. We hope that it will not be
long before we have more accurate knowledge on
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06 The Medical Press. NOTES ON CURRENT TOPICS.
Oct. 18, 1899.
this matter than was evidently possessed by those
who introduced the vapours into the British
Pharmacopceia, or even by those who struck them
out. .,
The Plague in England.
While the general newspapers contain sheets of
war news they can spare no more than an obscure
paragraph to announce the fact that a case of plague
has been brought into Plymouth. Yet not so long
ago that announcement might have heralded in an
invasion more terrible and costly both in life and in
treasure than that of any human foe. The facts are
that on the 14th instant the P. and O. Company’s
steamer Peninsula arrived at Plymouth from
Bombay. The day after leaving Marseilles, on the
9th instant, a Leedi boy, employed as a coal
trimmer, was taken ill with the plague. As the
incubation stage of plague is not more than five days
it will be interesting to learn whence the Leedi boy
brought the infection. Possibly this case is the first
intimation of the invasion of France. In our own
country, with its fairly good general standard of port
and inland sanitation, and its rational system of super*
visory quarantine, we need have no fear that this
scourge will find any real foothold upon our shores-
It is interesting to compare the present attitude of
dilettante interest and curiosity in the advent of the
plague with the panic it would have caused even a
generation ago.
Hospitals and Rates.
Growth appears to be a necessary complement of
health, and though this may not hold good of animal
Organisms at all periods of their healthy existence it
certainly seems to apply to public institutions. In
accordance with this impulse of expansive vitality
the Sheffield Royal Infirmary is preparing to stretch
its limbs, swathed in brickwork, but to do this with
ease the bagatelle of £30,000 is required, and the
means of raising this sum was discussed last week at
the annual meeting of the governors. The Lord
Mayor of Sheffield, in the course of his remarks, held
out the hope that if proper application were made to
the City Council it might be possible to induce that
body to forego the payment of rates from such a
deserving institution. Inasmuch as the amount at
present paid exceeds £200 per annum, and after
the proposed extension may reach £500, the sugges¬
tion is one of considerable importance. It is hardly
necessary to add that before the meeting came to an
end a resolution was passed inviting the attention of
the City Council to this subject. This conduct
offers a somewhat invidious contrast with that of
the rating authorities of London towards the
magnificent institutions which minister to the
medical wants of the metropolis. In times gone by
exception might reasonably have been taken to
exemption from rates on the ground that it would be
unfair to tax the inhabitants of particular parishes
for the maintenance of several hospitals, the benefits
whereof were not by any meanB limited to the dis¬
trict, but with an Equalisation of Rates Act this
objection ceases to have any bearing. Why a place
of worship should be exempted while a hospital is
taxed it is not easy to understand, but for the matter
of that this is only one of many things in the social
edifice which defy explanation.
Medical Appointments for the War.
The following were gazetted on Friday last :—
8urgeon-General W. D. Wilson, M.B., to be Prin¬
cipal Medical Officer. Major W. G. A. Bedford,
M.B , Royal Army Medical Corps, and Captain M. L.
Hughes, Royal Army Medical Corps, to be Medical
Officers on the staff. Colonel E. Townsend, M.D.,
C.B., Royal Army Medical Corps, to be Principal
Medical Officer, and Major C. H. Burtchaell, M.B.,
Royal Army Medical Corps, to be Medical Officer of
the First Division. Colonel T. J. Gallwey, M.D.,
C.B., Royal Army Medical Corps, to be Principal
Medical Officer, and Major W. Babtie, M.B.,
C.M.G., Royal Army Medical Corps, to be Medical
Officer of the Second Division. Lieutenant Colonel
J. D. Edge, M.D., Royal Army Medical Corps,
to be Principal Medical Officer, and Major G.
E. Twiss, Royal Army Medical Corps, to be
Medical Officer of the Third Division. Lieutenant-
Colonel W. Donovan, Royal Army Medical Corps,
to be Principal Medical Officer, and Major
H. G. Hathaway, Royal Army Medical Corps,
to be Medical Officer to the Cavalry Corps. A draft
of the Royal Army Medical Corps left Portsmouth
on Monday for Southampton, where they went
aboard the hospital ship Trojan, for duty. Most of
the nursing sisters and doctors in the Corps have been,
warned to hold themselves in readiness for South
Africa.
Food Poisonings.
Ip the frequency of cases of food poisoning were
to be depended upon as an index it would hardly be
possible to escape the conclusion that such occur¬
rences were vastly on the increase. Beyond the
introduction of tinned meats within the memory of
the present generation, however, there has been no
marked alteration in the food of the people. After
all the percentage of poisoning cases from tinned
food must be small. What really happens is that
general attention has been drawn to the subject of
ptomaine poisoning. There is hardly a general
newspaper writer in the length and breadth
of the country who has not something to
say about the matter. The consequence is
that if a family (say in the North of
Scotland) eats cold veal pie on Sunday, and gets
purging and vomiting during the night the fact is
reported in the London evening papers on the
Monday. In other words the number of cases is not
so much increased as the quickness and certainty
with which they are recounted in general journalism.
By the way, it is somewhat curious that although
the matter has been before the world of scientific
medicine for more than a few years yet little is
really known about the matter. Ptomaine poisoning
is an acute and well-defined symptomatic malady, yet
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Oct. 18 1899. NOTES ON CURRENT TOPICS. The Medical Press. 407
we are curiously at fault as to the recognition of the
toxic matter, either in the tainted food or in the
patient’s corpus. The only practical lesson of any
value yet gathered appears to be to enforce the need
of absolute wholesomeness in all that we eat or drink.
Succour to the Sick and Wounded in the
War.
The outbreak of war with the South African
Republic has again afforded the philanthropic British
public the opportunity of doing something to relieve
the sufferings of the sons of the Empire who will be
engaged in fighting their country’s battles. During
the Franco-German war a British Red Cross fund
was started which resulted in subscriptions amount¬
ing to £500,000 being collected for the sick and
suffering in that great contest. From time to time
the surplus which remained has been drawn upon
and employed in our recent wars in Egypt and the
Soudan, but the sum still unspent is regarded as in¬
sufficient for the needs of the war which has just
broken out in South Afrjca. Accordingly, in the
name of the Central British Red Cross Committee,
Lord Wantage makes an earnest appeal for con¬
tributions in order to enable the societies which
he represents to carry on their excellent humane
work among the British troops. It is proposed
to provide in South Africa two hospital railway
trains for the transport of the sick and wounded,
and to fully equip a hospital ship, thus supplement¬
ing the transports now being prepared by the War
Office for the conveyance of the sick and wounded
from Natal to the Cape and home. Thus it is evident
that the scheme of succour now being organised by
the Red Cross Committee is destined to prove of
immense service in the cause of humanity, and ire,
therefore, do not doubt that the public will see that
ample funds will be forthcoming for the purpose.
Professional Etiquette from a Legal Aspect.
What is known as “ professional etiquette ” in the
medical profession has often been made the subject
of unfriendly criticism by laymen. Indeed, the
latter have frequently expressed themselves to the
effect that they cannot understand why medical men
should be bound by the unwritten laws of ethical
procedure. Of course, the profession cannot be
responsible for supplying the intelligence necessary
to the understanding of these or any other matters
with which laymen may be concerned. Nevertheless,
mention may be made of the fact tbut if there
were no such thing as professional etiquette,
regulating the intercourse between medical men,
the public would very soon find that all sorts
of difficulties and unpleasantnesses would occur
between their medical men and themselves. Bear¬
ing, then, these facts in mind, we trust that the
result of a trial which took place last week in the
Market Drayton County Court will not be lost upon
the cavilling section of the public who profess to see
in professional etiquette nothing but nonsense.
The facts of the case are as follows. A medical man
named Dr. Yates, sued a cheese factor for half a-
guinea fee on behalf of an employe of the latter, to
whom he had been summoned. The practitioner
responded at once to the call, and travelled a distance
of six miles for the purpose. On arriving at the
house, however, he found that the'patient had already
been seen by a confrere, and that the accident, a
fractured leg, had occurred about three days
previously. Dr. Yates having ascertained these
facts, refused to Bee the patient professionally,
and returned home. However, a fee of half-a-
guinea was charged for the abortive visit, which
the cheese factor declined to pay. The defence was
advanced that the practitioner had not fulfilled his
contract by undertaking the treatment of the case.
But the judge held that Dr. Yates could not have
done other than he did on finding that another prac¬
titioner was in attendance. He further added, sig¬
nificantly, that professional etiquette was part and
parcel of a doctor’s profession, and ultimately gave
judgment for the plaintiff with costs. The decision
is really an important one, for it establishes the fact
that professional etiquette possesses a legal value.
Medicine in Decadent Nations.
In an interesting article by M. Gaston Deschamps
on “ La Fin d’un Monde,” there is an interesting
passage which touches on a phase of medical history
which savours of original observation. When, he
says, nations are declining, man, no longer having
the consciousness of a great task to be accomplished
and no longer being sustained by an ideal, readily
falls into the habit of regarding death as a thing to
be dreaded and develops an exaggerated regard for
his perishable body. The citizens of the Asiatic
cities, he observes, thought more about their health
than anything else. They had, so to speak, ‘‘the
religion of their skins.” A noteworthy phenomenon,
one which invariably presents itself among decadent
peoples, is the apotheosis of the physician. The de¬
generate Greeks could not well escape the application
of this general law. If we read the honorific registers
of the Asiatic province we see numerous examples of
the fulsome praise of physicians such as might have
fallen from the pen of a frightened sufferer. Menopliile,
son of Dosithea, a physician of Cadyanda, received as
a recompense for his services a golden crown and his
bust in bronze. Elsewhere a certain Heraclitus, who
rejoiced in a purely local fame, is proclaimed to be
“ the foremost physician of the century ” and “ the
Homer of Medicine.”
The Malarial Mosquito.
The return from the Gold Coast of the Malarial
Expedition organised by the Liverpool School of
Tropical Diseases was warmly heralded by the press
throughout the country last week, and there is no
doubt the welcome extended to the Commission was
thoroughly deserved. In less than three months
they have accomplished much in a scientific sense.
Major Ross, I.M.S., has now placed beyond a ques¬
tion the direct relation between malarial fever and
a certain species of mosquito. His object in taking
part in the expedition was to ascertain the
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408 The Medical Press
NOTES ON CURRENT TOPICS.
Oct. 18 1899.
special insect concerned in the transmission of
the disease, and this he has attained with a
success which can only be regarded as most
gratifying. Dr. Fielding Ould, of Liverpool, who
was recently sent out, and joined the expedition at
Sierra Leone, has been left there in order to continue
the duty of instructing the medical men in the
district concerning the mosquito and the method of
exterminating the dangerous species. It is needless
to add that the members in the profession upon the
Gold Coast have shown a keen interest in the import
ant investigations which the expedition have brought
to such a successful close. Major Ross lias asserted
that in his opinion it would be an easy matter
to exterminate the mosquito responsible for the
dissemination of the malarial micro • organism,
and that the work could be carried out at a
trifling expense, so far as the principal towns are
concerned. But whatever the cost may be, every
effort should be made in the localities concerned
to give effect to the measures of prevention
which Major Ross has shown to be necessary. More¬
over, now that the cause of the dissemination of
malarial disease has been proved, the Government
should take the matter in hand, and encourage the
carrying out of Major Ross’s instructions in all other
parts of Greater Britain where malaria prevails.
The Royal Army Medical Corps on its Trial.
The address descriptive of the shortcomings of
the Royal Army Medical Corps, given by Professor
Ogston at the Portsmouth meeting of the British
Medical Association, has now been endowed with an
additional interest, for it is certain that with the
outbreak of war the opportunity has now come of
showing whether Dr. Ogston was justified or not in
his criticisms. The Journal of the American
Medical Association, when discussing this subject a
week or two ago, said :—“ The English people, while
comparatively pachydermatous as regards criticism
from without, do not take kindly to public acknow¬
ledgments of their faults from home sources, even
in a modified and comparatively harmless way.
Dr. Ogston s recent address on the faults of the
British Army and Navy Medical Services has there¬
fore stirred up something of a wasp's nest sort
of turmoil. . . . We wonder what the British
public would have to say to such rampant criticism
of all kinds as everything in our late unpleasantness
with Spain received from responsible and irrespon¬
sible writers last year. It would be a new experience to
them, but we can dismiss it from our imaginations as
an impossibility in any country but our own.” The
war in South Africa, however, has now placed the
medical service of the army on its trial, and we doubt
not that keen interest will be generally taken in the
manner with which the Department acquits itself of
its duties. We have persistently contended that if
faults are to be found with its equipment and
organisation these cannot be attributed to
the medical officers. The stumbling block in the
way of much needed reforms is the War Office. ‘ My
military advisers,” instead of affording encourage¬
ment to the officers of the Royal Medical Corps to
bring their department up to date are apparently
jealous of the efforts of the latter to improve the
service. But we shall see what this war brings forth
in the test to which the Army Medical Service is
about to submit. We are not too hopeful of its being
able to establish its efficiency; nevertheless, we
earnestly trust that no breakdown will occur, or any
untoward contretemps, to prove the truth of the mis¬
givings to which currency was given by Dr. Ogston
in bis address.
The Bacteriology of Plague.
The facts connected with the life, history, and
methods of detection and destruction of the plague
bacillus have an unusual interest at the present
moment, when this disease is within two or three
days’ voyage of our own shores. The small specific
black rod, somewhat shorter than the typhoid
organism, was discovered independently by Kitasato
and Yersin during the Hong Kong epidemic in 1894.
They possess flagella which stain with difficulty, and
a central portion of the bacillus often remains
uncoloured, forming the so-called “ pole-staining.”
In cultures, the bacilli often run into chains of
"strepto-bacilli.” On dry agar, with a slightly
alkaline reaction, involution forms are rapidly found
at body temperature, while another characteristic
of growth is seen in powdery “ stalactite ” flakes
seen on the surface of bouillon cultures when
kept at rest. Rats, mice, guinea pigs, rabbits,
monkeys, and other animals are susceptible to
inoculation, and are supposed in some instances to
convey the infection. Yersin, Calmette, and Borrel
injected cultures killed by heat into rabbits, and
procured a certain amoimt of immunity. They also
obtained a serum from a horse immunised by intra¬
venous injection of living bacilli, but this serum has
not established its scientific reputation in India.
Haffkine’s method, on the other hand, is a bouillon
culture killed by an exposure to 70 degs. C. for one
hour. Preventive inoculation by Haffkine’s plan
has been systematically and extensively tested in
India with results that are most encouraging and
full of promise, although they still full short of com¬
plete scientific demonstration.
Mr. Chamberlain and Tropical Diseases.
Mr. Chamberlain has now the opportunity, with
the return of the Liverpool * chool of Tropical Diseases
Malarial Expedition, of doing something to show the
official appreciation of the work which has bee a
accomplished. We refer to this matter in another
column. Up to the present the Colonial Secretary
has practically done nothing for the Liverpool School,
which has so justly proved itself deserving of support.
But where official assistance has been withheld local
enterprise has been abundantly shown, as the result
of which it can be said that the Liverpool School
of Tropical Diseases is bound to take a leading
position.
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Oct. 18. 1899.
NOTES ON CURRENT TOPICS.
The Midical Prbs8. 401*
A Russian University for Women.
It has apparently fallen upon Russia to lead the
way in founding a university for women. A wealthy
Russian died recently and left the magnificent sum
of £100.000 towards the foundation of a university
for women in Moscow, to comprise a mathematical,
scientific, and medical faculty. The Municipal
Council of Moscow, inspired no doubt by this
generosity, have agreed to supplement it by an
annual grant of £300. Thus the land of the Czar
may be backward in granting emancipation to
the serfs, but from the above announcement one
may conclude that no objection is raised to the
emancipation of women. That there is no woman's
university in this country is somewhat a blot upon
our national character. The increased freedom
which, owing to the advancement of the times, and
the bursting of many bubbles of antiquated customs,
is now being enjoyed by British women, has not been
abused, nor can it l)e said that the nation has failed
to benefit from the change. As, therefore, women
have eminently proved themselves worthily capable of
profiting by a greater freedom, facilities should be
afforded them of developing their mental and physical
resources. A woman’s university must certainly be
regarded as a desideratum in this country, in view of
the difficulties placed in the way of the academic
advancement of the sex.
Vaccination Law in Japan.
The Japanese have repeatedly shown their wisdom
by their adoption of Western civilised customs. The
Government of the country have now decreed that
vaccination shall be compulsory throughout Japan,
and that all children shall be vaccinated before
reaching the age of ten months, also that re¬
vaccination shall take place when they are six
and twelve years of age respectively. It will
be interesting to note the effects of this in after
years, and to compare the results of its opera¬
tion with those now obtainable. We wonder if any
anti-vaccination societies will be started in Japan
with a view to opposing the law. Possibly not, for
although Japan is in many respects a highly-civilised
nation, it probab'y is still not advanced enough to
allow “ cranks,” “ faddists,” and others to make
fools of themselves and the public without summarily
interfering with their programme. In this respect
Japan has distinctly the advantage of us.
A Criminal’s Brain.
Some months since was executed in France a
certain nomad who had committed a long series of
execrable crimes, more particularly in violating and
afterwards killing and mutilating young girls.
Although he simulated madness, the medical experts
refused to endorse that line of defence, and he duly
expiated his crimes on the scaffold. His brain was
deposited at the Musee Dupuytren, and has since been
carefully examined, microscopically and otherwise,
by several psychologists of experience, who hoped to
find, or thought they might find, something in the
cerebral conformation or intimate structure to
account for the subject’s well-marked criminal
propensities. Not without a vague regret we learn
that the results of the investigation were altogether
negative. No abnormality was discovered nor anything
that could throw light upon the mental tendencies of
the one-time owner of the brain. There is, of course,
nothing surprising in this. The same absence of
obvious abnormality has been observed in numerous
instances of notorious madness, and when we reflect
that, after all. morbid mental tendencies are the out¬
come of want of equilibrium between the functional
areas and not of any essential vice of conformation
it is evident that the discovery of a physical basis for
criminal instincts is never likely to be achieved.
Until, however, that shall have been accomplished it
will be difficult to educate public opinion to the l>elief
that crime, like inebriety, is a symptom of disease.
Atropine Poisoning Case at Kendal.
A curious case of poisoning occurred last week
at Kendal. A family consisting of a man, his wife,
and four children were ta-en seriously ill after
dinner with symptoms of acute poisoning. The
father and three of the children were removed to
hospital, where the children have been detained for
several days. Investigation showed the presence of
atropine in a dish of beetroot of which the family
had partaken at the dinner table. It was next ascer¬
tained that one of the children had been using an
eye lotion obtained from the Liverpool Ophthalmic
Hospital, and one of the ingredients of the applica¬
tion was atropine. How the contents of the
physic bottle were mixed with the 'vinegar is un¬
known. but the accident seems to have been con¬
nected with a recent house removal. The compara¬
tive frequency of this accidental atropine poisoning
by means of eye “ drops ” or lotions renders it
desirable that every medical practitioner should be
familiar with symptoms and with antidotes. Fortu¬
nately, the action of the drug is characteristic. The
dry mouth, the dilated pupils, the disturbed vision,
the excitement, the delirium, the dry skin, the
muscular weakness, and the ineffectual desire to pass
water form an unmistakable clinical picture. The
treatment is to empty the stomach with mustard
or other emetic and copious draughts of hot water,
or by the subcutaneous injection of apomorphia.
Half a grain of pilocarpine should then l>e given
hypodermically (10 minims of the 1 in 20 solution).
Two grains of atopine have proved fatal. The liquor
atropime contains 1 grain in 101 minims.
Register! Register!
The General Medical Council has issued, through
our columns, its annual appeal to the members of the
profession throughout the kingdom to supply, each
for himself, the information necessary for a correct
entry in the Medical Register of 19(H). We should
have supposed that having regard to the slight
trouble which it costs, every medical man would take
care to be accurately gazetted in the Register. Apart
from the consideration that he may be tripped up in
the giving of certain certificates if his entry is wrong.
Digitized by LjOOQle
410 The Medical Press.
it certainly cannot be to the advantage of any prac¬
titioner that magistrates and other persons who refer
to the Register for official information should be led
astray respecting the qualifications and residence of
the practitioner. Newly-qualified men should, if
possible, effect their registration in order that they
may appear in due and correct form in the forth¬
coming Register for the first year of the new century.
Terms of Comparison.
We have more than once animadverted on the
vagueness and incongruity of the terms of comparison
so commonly employed by physicians, surgeons, and
pathologists, in attempting to give a picture estimate
of size. There is the conventional millet seed, but it
is open to question whether the botanical knowledge
of the average reader enables him to identify this
particular agricultural product. Though better known
the size of a filbert is equally uncertain, for its dimen¬
sions vary within fully as wide limits as the orange.
We are all familiar with the tumour which is
described as the size of the fist, but every pugnacious
schoolboy is aware that there are fists and fists, some
of comparatively little import from an offensive
point of view, while others inspire respect if
not awe. The foetal head is possibly less
variable in size than some of the objects just
referred to, but even then the observer ought at
east to take the precaution to state whether he
means the head of the foetus at term or at some
earlier period of piegnoncy. It would be much more
scientific to give the dimensions in inches or centi¬
metres using fruits and seeds foot-balls and foetal
heads merely to indicate the approximate shape.
It may be permissible to describe the terrestrial
globe as having the shape of an orange, but it
would be grotesque to explain that it was so
many times larger than this fruit. For all practical
purposes those who make use of these terms of com¬
parison might as well say right out that the growth
was “ about the size of a lump of chalk.”
Anaemia and Syphilis.
At last Friday's meeting of the Clinical Society, a
discussion arose on an obscure case of antemia which
had resisted all the usual methods of treat¬
ment, and incidentally an interesting fact was
alluded to which embodies a useful hint to practi¬
tioners, viz., that in many cases of refractory ana*mia
the cause may be inherited syphilis. In all such
cases, therefore, it behoves one to institute close
inquiry into family and personal history with the
object of eliciting the possibility of this etiological j
factor ; indeed, when other remedies have failed, it
would be well to try the effect of a mercurial or |
iodide treatment before classing and abandoning the :
case as one of pernicious antemia. It was noted by I
one speaker that an excess of eosinopbile cells had I
been noted in a case of this kind which proved post- \
mortem to have been syphilitic, such excess being
absent in a very similar case, which post-mortem
Oct. 18, 1899.
presented only the lesions usually associated with
pernicious ana;mia.
The Pathological Society of London.
The Pathological Society of London, desirous of
moving with the times, have determined to strike out
a new departure, and it is announced that in future
four of the fifteen meetings will be held elsewhere
than at the usual meeting place of the Society, 20,
Hanover Square. The object of these four “ Labora¬
tory Meetings ” is to enable experimental work to be
demonstrated before the Society, on the lines laid
down by the younger and highly successful sister
Society, the Physiological, in that the proceedings
will be less public, and it is hoped on this account
more productive of frank discussion and exchange
of opinion. It is felt that the publication of dis¬
cussions sometimes tends to hamper criticism, and
with the view of obviating this the Council of the
Pathological Society have passed a resolution that
at the Laboratory meetings the discussions shall be
private and that the papers read shall only be pub¬
lished in abstract in the medical journals if the
authors so desire. The object of this last clause is
to enable men engaged in research to bring forward
for discuseion and criticism work as yet immature,
and not ready for formal publication. In this way
many communications of interest will be brought
forward, and workers will gain much in the
progress of their work from friendly and confidential
criticisms of their audience. The first of the
“ Laboratory Meetings ” will be held at the Jenner
Institute on Tuesday, November 7th, at 8.30p.m. After
Christmas similar meetings will be held at University
College. King’s College, and the Laboratories of
the Royal Colleges of Physicians and Surgeons.
A special evening will also be set apart for the
discussion of papers on pathological chemistry. In
thus exerting itself to hear all sides of pathological
work, and to include research work in the newer and
rapidly developing subjects of bacteriology, experi¬
mental pathology, and pathological chemisty; the
Society is to be congratulated, while it is of course
intended that the Society should continue to be the
means of making public advances in the important
subjects of morbid anatomy and histology, for which
it has done so much in the past.
Tetanus.
The statement is published that M. Nocard lias
distributed a large quantity of anti-tetanic serum
which has been used for injection into various animals
as a prophylactic against tetanus. He asserts that
out of 2,300 beasts so injected not one suffered lock¬
jaw after operation. So far, good, but we should like
to be told how many of them would, probably, have
so Buffered if they had never been injected.
Dr. W. J. Collins is to be presented with his
portrait, painted by Mr. Hugh Herkomer, as a
memento of his chairmanship of the London County
Council in the Diamond Jubilee year.
NOTES ON CURRENT TOPICS.
Digitized by Google
Oct. 16. 1899.
MANCHESTER.
The Medical Press. 411
Dr. G. Vivian Poore will deliver the annual
Harveian oration at the Royal College of Physicians.
London, to-day (Wednesday), at 4 p.m.
Mr. Tho8.E. Flitcroft, L.R.C P.Edin., L.FP.S.
Glasg., of Parkhurst, Bolton, has been appointed a
magistrate for that borough by the Chancellor of the
Duchy of Lancaster, Lord James of Hereford.
8ir Thomas Grainger Stewart, Physician to
the Queen in Scotland, who has lately been residing
at Dunbar on account of ill-health, has now returned
to Edinburgh. He is in improved health, but has
been advised not to deliver lectures in the University
during the ensuing session.
It is perhaps not generally known that the late
Right Rev. John Wale Hicks, Bishop of Bloem¬
fontein, was a doctor of medicine of the University of
London as well as doctor of divinity of the University
of Cambridge. The deceased prelate had even
carried off the gold medal in obstetric medicine,
which must be a rare achievement in the annals of
the bishops. He must have been just the man for a
colonial post, and this assumption is more than borne
out by the popularity he enjoyed while alive, and by
the expressions of regret which his death has called
forth.
Jtartlatii).
[From Our Special Correspondent.]
The Late Dr. William Menzies Hutton,
F.R.C.S.Ed.—D r. Hutton, the surgical registrar to the
Royal Edinburgh Infirmary, an appointment he succeeded
to only la9t winter, succumbed last week to a tuber¬
culous affection of the throat and lungs at the early age
of 29. Gold medallist for his M D. Thesis, 8yme Surgical
Fellow of the Edinburgh University in 1893, F.R.C.S.Ed.
in 1895, his career promised well, and death has intervened
all too soon. Dr. Hutton had been for some years past
one of the most successful coacheB in medical and surgi¬
cal subjects in Edinburgh. He became ill not very long
after appointment to the surgical registrarehip at the
Royal Infirmary, and since last spring was unable to
undertake any of his duties.
A Batch of New Professors for Glasgow. —The
coming session will find the University of Glasgow with
three new professors, viz.. Dr. Andrew Gray, formerly
assistant to Lord Kelvin, has been appointed to succeed
his lordship in the chair of Natural Philosophy ; Mr.
Dudley Julius Medley, M.A., Oxon., has been appointed
to fill the chair of English Literature, rendered vacant
by the resignation of Professor Lodge, who has gone to
Edinburgh ; and Mr. Phillimore, who succeeds Professor
Murray to the chair of Greek. Certainly the session
will open with fresh blood, and the new professors are
men who are certain to do justice both to the University
and to themselves.
Glasgow University Rectorial Election. —At
present there is a great squabbling going on, both in
print and orally between the two sections of students
as to the most suitable candidate for the position of
Lord Rector. One section is highly indignant that Lord
Kelvin should be brought forward in opposition to Lord
Rosebery, and suggests that the latter should be
unanimously returned just now, with the under¬
standing that Lord Kelvin be also unanimously returned
when the time next arrives for the appointment of a
new Lord Rector. The opposite side contends that Lord
Kelvin being the older man, who for fifty-three years
shed lustre on the university, a general favourite, one
who would not be merely an ornamental Lord Rector
should be at the present time returned, and after
his term of office has expired. Lord Rosebery should
Buooeed to the position. We think the latter proposal a
good one and feasible, but it will be difficult to decide-
where party feeling runs high. In any case, there will
be a great deal of ink spilled and much jostling before
the affair is finally settled.
Glasgow Medico-Chiruroical Society. — The
following gentlemen have been appointed offioe-bearers-
for the ensuing session.—President—Mr. H. E. Clark.
Section of Medicine—Vioe-President, Dr. W. G. Dim.
Councillor, Dr. J. W. Allan. Secretary, Dr. Jas.
Hinshelwood. Section of Surgery—Vioe-President, Dr.
John Barlow. Councillors, Dr. Rutherford and Mr.
Maylard. Secretary—Dr. J. H. NicolL 8ection of
Pathology—Vice-President, Dr. Lindsay 8teven. Coun¬
cillors—Drs. Workman and Teacher. Secretary—Dr.
R. M. Buchanan Section of Obstetrics—Vioe-President,
Dr. John Edgar. Councillors—Drs. J. K. Kelly and
Gibson. Secretary—Dr. Balfour Marshall. Treasurer
—Dr. Barclay Ness. Editorial Secretary—Dr. W. R.
Jack. General Secretary—Dr. W. K. Hunter.
iftanduster.
Tfrom oub own correspondent.]
Women Medical Students.— At last the authorities
of Owens College havo bowed to the inevitable. The
charter of the Victoria University permits the admission
of females as graduates in the faculty of medicine.
Hitherto the leading college has, however, made no pro¬
vision for their training. Now sex will be no bar, and
before long it is hoped that adequate arrangements will
be made for the thorough instruction of women in the
clinical as well as the scientific work of a full medical
curriculum in Manchester.
St. Mary’s Hospital.— The foundation stone of the
new building of this old and much valued institution
for the treatment of women and children was recently
laid by the Countess of Derby. In spite of its anything
but ideal site the building promises to be a thoroughly
modern and suitable hospital. It is to accommodate
125 patients, the main portion being reserved for diseases
of women and children, and with a separate department
for maternity cases. Adequate arrangements are being
made for the training of medical students, nurses, mid¬
wives, and monthly nurses.
Dental Hospital.— The Manchester Dental School,
a department of the Owens College, has its clinical
centre at the Victoria Dental Hospital. The opening
address was this year delivered by Professor Leech, who
expressed the view that it might be possible to establish
a degree in dentistry. Since the founding of the Dental
Hospital aid has been given to over 160,000 patients.
Pathological Socizty.— This, the largest medical
society in Manchester, numbering over 400 members,
held its annual meeting on Wednesday last, when the
following officers were elected for the ensuing session:—
President—W. Thorburn, B.S. Vice-presidents—E. S.
Reynolds, M.D., A. Brown, M.D. Treasurer—T. A.
Helme, M.D. Secretary — T. N. Kelynack, M.D.
Research Secretary—F. C. Moore, M.D. Committee—
J. G. Clegg, M.D., W. F. Fothergill, M.D., J. E. Platt,
M.S., A. W. W. Lea, M.D., F. C. Moore, M.D., W. A.
Fenshaw, E. J. Sidebotham, M.B., J. W. Smith, F.R.C.8.
The following gentlemen were elected honorary mem¬
bers:—R. W. Boyce, M.B, Professor of Pathology,
University College, Liverpool. H. B. Dixon, M.A.,
F.R.S., Professor of Chemistry, The Owens College,
Manchester. S. J. Hickson, M.A., D.Sc., F.R.S., Pro¬
fessor of Zoology, The Owens College, Manchester.
W. E. Hoyle, M.A., F.R.S.E., M.R.CS., Keeper of the
Manchester Museum, The Owens College, Manchester.
W. H. Perkin, Ph.D., F.R.S., Professor of Organio
Chemistry, The Owens College, Manchester. E. F.
Trevelyan, M.D. B.Sc., ProfesEor of Pathology, The York¬
shire College, Leeds. F. E. Weiss, B.Sc., Professor of
Botany, The Owens College, Manchester.
Dig itized by
412 The Medical Press.
CORRESPONDENCE.
Oct. 18, 1899.
Clinical Society of Manchester.— The following
have been elected office-bearers for the session 1899-
1900 : - President—Judson Bury, M.D. Vice-Presidents
—T. A. Helme, M.D., E. S. Reynolds, M.D. Hon. Trea¬
surer—C. H. Braddon, M.D. Hon. Secretary—J. E.
Platt, M.S. Hon Librarian—J. W. Smith, M.B. Com¬
mittee—Alfred Brown, M.D., J. G. Clegg, M.D., R.
Crean, M.D., J. Daniel, M.D., J. W. Hamill, M.D., J.
Holmes, M.D., C. F. H. Kitchen, M. P. Ledward, M.D.,
C. T. B Maisey, R. T. Parkinson, M.D., T. Porter. M.B.,
J. Rust, Graham Steele, M.D., F. H. Westmacott, J. P.
Williams, M.D.
QtmrrespouOcna
We do nor hold ourselves responsible for the opinions of our
correspondents.
THE PROGRESS OF RHINOLOGY.
To the Editor of The Medical Press and Circular.
Sir, —Dr. Ball, in his admirably concise and lucid
Address on “ The Progress of Rhinology ” (Medical
Press and Circular, October 11th), has given so much
oi edit to Englishmen that I am sure he will excuse me
saying that another Englishman, Spencer Watson, pre¬
ceded Ziem of Danzig by five years in drawing attention
to the fact that in empyema of the maxillary antrum
the classical signs of pain, heat, redness, and swelling
laid down in all manuals of surgery up to, and long after
that date, as diagnostic of the condition, are, in the
majority of instances, conspicuously absent. Also that
although during the seven or eight years ending 1873, that
I was associated with Sir Morell Mackenzie, I never saw
a case of empyema of any of the accessory cavities
diagnosed, either in his private or hospital practice—a
proof that such maladies were at that time practically
unknown, but in February, 1879, fully a year preceding
the publication of Ziem’s observations, I was able to
report three cases of maxillary empyema at the Harveian
Society ; they are recorded in the British Medical Journal
Of March 8th, 1879.
I am, Sir, yours truly,
Lennox Browne.
Mansfield Street, W., October 14th, 1899.
CHLOROFORM r. ETHER.—St. BARTHOLOMEW’S
HOSPITAL REPORTS.—A CORRECTION.
To the Editor of The Medical Press and Circular.
Sir,—In the number for October 4th, 1899, p. 3(53,
there is a review of the St. Bartholomew’s Hospital
Reports in which your reviewer has fallen into a slight
error. He says: “ During 1897 anaesthetics were ad¬
ministered 4,893 times, and it may interest those who,
in season and out of season, advocate ether, to know
that 201 cases of etherisation are recorded as against
1,959 chloroformisations. Ether, it thus appears was
found suitable in no more than 4 per cent of the cases
requiring an anesthetic, whereas chloroform was used
in almost 40 per cent, of the cases, and this in London
where ether is most zealously advocated, to the exclusion,
as far as possible, of chloroform.”
On turning to the volume under review, there is seen,
on p. 172 of the Statistical Tables (which are bound up at
the end of the Reports), as follows: —
“The Statistics of Aniesthetics—During the year
1897 aniesthetics were administered 4,893 times.
Chloroform.
1,959 times
Gas and ether .
1,261 „
GR8.
965 „
Gas and oxygen
477 „
Ether .
201 „
Mixture of chloroform and ether
30 „
Total.
4,893
As one of the administrators of anesthetics to the
hospital I should like to explain this table and to
point out the error into which your reviewer has fallen.
For some years it has been the almost universal rule, in
these cases to which it is thought advisable to administer
ether, to commence the administration with nitrous oxide
gas, gradually to turn on the ether, and to continue ita
use alone until the operation is completed. Thus it
will be seen that out of 1,462 cases in which ether was
the chief anaesthetic used in 1,261 cases, the administra¬
tion was begun with nitrous oxide gas, ether alone
being given in 201 cases; indeed, I am surprised that
the gas, as a preliminary, was omitted so often. This
quite alters the ratio of ether to chloroform as pointed
out by your reviewer, 1,462 out of 4,893, being nearly
33 per cent., instead of 4 per cent.
I am. Sir, yours truly,
Edgar Willett, M.B., F.R.C.S.
25, Welbeck Street, London, W., October 12th.
HOMOEOPATHIC ASSURANCE.
To the Editor of The Medical Press and Circular.
Sir,—U nder this title you have last week a leaderette,
in which you refuse credence to Dr. Hayward’s statistics
of the comparatfve mortality under hoaueopathio, and
ordinary, treatment of such diseases as jellow fever,
cholera, and typhoid fever. With respect to yellow fever
you “ imagine that the number of patients suffering
from this fell disease who underwent homoeopathic
treatment must be far too small for it to be possible to
base any trustworthy conclusions thereupon.” I have
before me two pamphlets relating to the homoeopathic
treatment of yellow fever in New Orleans. The first
is by a well-known homoeopathic practitioner, Dr. William
Holcombe, of New Orleans, entitled" Yellow Fever and
its Homoeopathic Treatment,” published by Rodde.of New
Y'ork, in 1856. It relates to the treatment of this disease
in the epidemic of 1853, which “ decimated the popula¬
tions of New Orleans, Mobile, Vicksburgh, and Natchez,
and some of the smaller towns and villages,” by him¬
self and Dr. F. A. W. Davis. Dr. Holcombe says:—“ I
treated 140 cases of yellow fever between the 13th of
August and the 15th of December, 1853. None of them
were cases of ephemeral Bickness—nothing but un¬
equivocal, strongly marked yellow fever was admitted
into the list. Of this number 71 were white and
69 coloured, of the coloured 39 were blacks and 30
mulattoes. The adults were 93, children 47 ; cases in
town 111, cases in the country 29 ; males 60, females 80.
At least one-half of the cases were very severe, the
patients being for several days in a critical and dan¬
gerous situation. Of the 140 cases, 9 died. Of these
6 were treated homu-opathically by me from the
beginning ; 3 came into my hands on the fourth or fifth
day of the disease, 2 of them having employed allo¬
pathic measures. Of the (5 treated with pure homoeopathy
from the beginning, one case was complicated with
abortion and profuse haemorrhage; another, a cachectic
negro, died 6 weeks after the day of attack, in a typhoid
condition—the sequel of yellow fever. Dr. Davis treated
415 cases, with 24 deaths. The combined result of our
treatment was, therefore, 555 cases and 33 deaths, a
mortality of 1 in 16 87, or 5.94 per cent.”
The second pamphlet is entitled “ Special Report of
the Homeopathic Yellow Fever Commission, Ordered by
the American Institute of Homoeopathy for Presentation
to Congress,” published at New Orleans in 1879. This
gives the report s of 24 homoeopathic physicians hailing from
9 different localities; the total number of cases of yellow
fever treated by them was 3,914, with a loss of 261
patients, a mortality of 6 6 per cent. The mortality
under allopathic treatment could not be so accurately
ascertained, but it was certainly not less than between
20 and 30 per cent.
I th'nk you will allow that the nuinberof cases treated
hommopathically in these two epidemics was sufficiently
large to base trustworthy conclusions upon.
With regard to cholera I will only mention two in¬
stances of the comparative results of the honucopathic
and allopathic treatment of this disease. In the epi¬
demic of 1836 the Homeopathic Hospital of Vienna,
under the care of Dr. FleiBchmann, was ordered by
Government to be devoted to the reception of cholera
patients, the disease being especially prevalent in
Digitized by GoOglC
Oct. 18, 1899.
CORRESPONDENCE.
The Medical Press. 413
“the suburb of Qumpendorp, where the hospital
-was situated. Here is what Sir William Wilde,
in his^book on Austria, says (p. 275): “ Upon comparing
the report of the treatment in this hospital with that
of the same disease in the other hospitals in Vienna
during the same period, it appeared that while two-
thirds of the cases treated by Dr. Fleischmann, recovered,
two-thirds of those treated by the ordinary methods in
the other hospitals, died.” I may mention that this
striking testimony to the superiority of the homieo-
pathic over the ordinary methods, led the Government
to repeal the ordinances prohibiting the practice of
homceopathy in the Austrian States, which had hitherto
disgraced—or, perhaps, you would say adorned—its
statute books.
The other instance of a comparative trial of the two
systems in the treatment of cholera occurred in
London in connection the with epidemic of 1854. The
London Homoeopathic Hospital, then in Golden Square,
devoted to the reception of cholera cases by order of the
Government, and a treatment committee appointed by
the Royal College of Physicians, sent Dr. Macloughlin
to inspect and report on the cases treated, which
amounted to 61, of whom 10 died, giving a mortality of
164 per cent. The mortality in the other hospitals,
under allopathic treatment, averaged 51 - 8 per cent. The
inspector said, in a letter to Mr. Cameron :—“ All I saw
were true cases of cholera in the various stages of the
disease, and I saw several cases which did well under
your treatment, which I have no hesitation in saying,
would have sunk under any other.”
1 am unable to give any comparative trials of hoimi'o-
pathic and allopathic treatment in typhoid fever, but
the experience of Dr. Kidd, who was sent by the English
Homoeopathic Association to Bantry in 1847 to treat the
sufferers from famine fever, which may be considered as
a kind of typhoid, may be mentioned. In 67 days he
treated 111 cases, of whom only two died. During the
same time 264 cases were treated allopathically in the
Bantry Union Hospital, of whom 35 died. Thus, while
the mortality under homoeopathic treatment was only
18 per cent., that under allopathic treatment was 13 7
per cent,
The foregoing statistics relative to the three diseases
you have mentioned will, I think, show that homeo¬
pathists do not deserve your censure that they resort
to “ the arts of the mountebank to bolster up their
system.”
I am, Sir, yours truly,
R. E. Dudoeon, M.D.
63, Upper Berkeley Street,
October 6th, 1899.
To the Editor of The Medical Press and Circular.
Sir, —You are quite right to insist on having the
actual figures when statistics are quoted, whether
homoeopathic or otherwise, but before condemning Dr.
Hayward and all his brethren for want of candour, it
might have been better to have ascertained if the
published report of his lecture contained all he
had said on this matter. As you wish for the actual
figures I will, with your leave, supply them. You
are mistaken in supposing that homoeopathy is not
largely used in the treatment of yellow fever, in both
North and South America. The epidemic to which I
presume Dr. Hayward referred was that which occurred
in Rio de Janiero in 1851. Dr. Martins and three other
homoeopaths treated among them 3,256 cases, with 227
deaths—under 7 per cent. In the terrible epidemic of
1853, which occurred in New Orleans, Drs. Holcombe and
Davies, homoeopaths, treated between them 555 cases,
with 33 deaths—under 0 per cent. During the epidemic
which occurred between 1853 and 1878, the honueopathio
practioners, whose number was being constantly added
to, treated altogether 6,569 cases, with 360 deaths—under
5i per cent. During the same period there were treated
allopathically 23,540 cases with 4,050 deaths—over 17
per cent.
The cholera statistics of homceopathy are the best
advertisement that homceopathy ever had, and luckily
they are vouched for by allopathic authorities. Sir
William Wilde, the well-known oculist of Dublin, in
his work on Austria says (p. 275) : —
“ Upon comparing the report of the treatment of
cholera in this hospital [the hospital placed by the
Government of Austria under the control of Fleisch¬
mann, the homoeopath] with that of the same disease
in the other hospitals in Vienna during the same
period, it appeared that while about two-thirds of
the cases treated by Dr. Fleischmann recovered,
two-thirds of those treated by the ordinary methods
in the other hospitals died.” These results had the
effect of causing the Government to repeal the laws
which had previously been in force against homceopathy
in Auatria. The statistics of the London Homoeopathic
Hospital, then in Golden 8quare, in the epidemic of
1854, were no less striking. The mortality was 16 4 per
cent., as against 518 per cent, in the other hospitals.
These figures were vouched for by the Government
inspector, Dr. Macloughlin, who wrote to one of the
medical officers: “All I saw were true cases of cholera
in the various stages of the disease, and I saw several
cases which did well under your treatment, which I have
no hesitation in saying would have sunk under any
other.”
I am. Sir, yours truly.
John H. Clarke.
Clarges Street, W., October 12th, 1899.
To the Editor of The Medical Press and Circular.
Sir,—I am hot displeased with your editorial com¬
ments on some of the assertions made in my lectures at
the Hahneman Hospital, except the snarl as to ad¬
dressing the uncritical laity. As a fair-minded editor
you will, of course, allow me to explain the points you
complain of.
I am not surprised that the statement that “ while the
average mortality from yellow fever is 27 7 per cent.,
the mortality under homeopathic treatment is only
7,” should appear “ very remarkable ” to the editor
of an ordinary medical journal; still, it is possible it
may be quite true for all that. Nor am I surprised that
you should imagine the numbers of yellow fever patients
treated homoeopath ically are too small to draw conclu¬
sions from, because the work and writings of those
members of the profession who practice honuvopathically
are so studiously ignored that you do not know what is
being done by them. It may, perhaps, be news to both
yourself and your readers to be told that in sub-tropical
and tropical America, where yellow fever abounds,
there are scores of homoeopathic practitioners; and
that they have gone through epidemic after epi¬
demic, and treated thousands of cases of “ this
fell disease,” of which reports have been furnished at the
request of the Government; and that the statistics have
been collected and compared times out of number, not
by taking one epidemic but several, and making averages
honestly and fairly. These statistics arc given in the
“North American Quarterly Homoeopathic Journal”
and the “ British Quarterly,” where they are compared
with those furnished in the ordinary medical journals,
as to the same epidemics and under the same circum¬
stances. It is true the comparisons are not made in
the latter journals, and for good reasons. By these
statistics it will be seen that 7 per cent, is quite
a high percentage under homoeopathic treatment.
And as to ordinary treatment, let Mr. Manson he
heard; he is one of the highest and most recent
authorities on the subject On page 130 of his most ex¬
cellent treatise on “ Tropical Diseases,” writing on yellow
fever, he says ;—“ The mean mortality in the whole 209
cases was 27'7 per cent. This may be taken as a fairly
representative mortality in yellow fever among the
unacclimatised, something between 25 and 30 per cent.,
although in some epiolemics it has risen as high as 50,
or even 80 per cent, of those attacked.” So my state¬
ment is not at all wrong.
As to cholera, you yourself know quite well that the
average mortality under ordinary treatment is not less
than 50 per cent. And in his address on cholera, as
president of the National Health Society, the late Mr.
Digitized by Google
414 This Medical Press. LITERARY NOTES. Oct. 18. 1899.
Ernest Hart, as reported in the British Medical Journal,
said:—“ Onoe established, and in well-marked cases of
Asiatic cholera, drugs will do little to cure. The
mortality of cholera all over the world, and in all
epidemics, had defied drugs, and varied according to
the intensity and the age of the patient, from 46 to
64 per cent.” Contrast this with the following result of
the treatment in the London Homoeopathic Hospital .—
“ From these it appears that the number of cases
treated in this hospital was 61, of whom 10 died,
giving a mortality of 16 4 per cent. From the report
issued by the Treatment Committee it was seen that the
mortality in the other metropolitan hospitals averaged
51*8 per cent. The Government inspector of the London
Homoeopathic Hospital, Dr. Macloughlin, wrote to Mr
Cameron, one of the medical officers of the hospital.
“ All I saw were true cases of cholera in the various stages
of the disease, and I saw several cases which did well
under your treatment, which I have no hesitation in
saying would have sunk under any other ? ” So here,
too, I am within the mark.
As to typhoid, why should the statement that “ horn > o-
pathic treatment can do much to modify the course and
shorten the duration,” excite contempt, as you say, when
the present boast of the profession is that “ simple open-
air treatment ” can, and does, cut short and cure such a
germ diseas® as tuberculosis; and“ snnshine” treatment
can do the same for some skin diseases of germ origin,
as is now being put forth in orthodox medical journals ?
And whilst another great boast is that of the rapid
cure of diphtheria, cholera, plague, tetanus, and
other germ diseases by ordinary practitioners with
antitoxins, and even of typhoid with anti-typhoid
serum ? These boasted cures of germ diseases by
ordinary practitioners with antitoxins and animal
extracts are orthodox, and therefore admissible; but to
make a similar claim for ordinary medicines is only “ to
excite contempt.” Could prejudice further go ? Surely
the shiboleth that “ germ diseases must run their
course ” is an acknowledgement of impotence disgrace¬
ful to the profession; and the sooner the better it is
allowed to follow into the limbo of discarded heresies
the fiction of the “ change of type in disease.”
As to appealing to the laity, that is the fault of the
members of the profession. They were invited, and several
by “ complimentary ticket,” the course being addressed
to “medical men takingcharge of steamers visiting Africa,
or taking charge of trading stations out there,” as well
as to “missionaries and nurses.” But only four non-
homceopathic practitioners were sufficiently open-minded
to put in an appearance. We would much prefer to
appeal to our professional brethren, but we are not
allowed, professional societies and journals being c'osed
against us ! I am, Sir, yours truly,
John W. Hayward, M.D.
Birkenhead, October 6th, 1899.
[We cannot deny the right of explanation to a corres¬
pondent whose statements as to comparative mortality
are called in question, however widely we may differ
from him. We prefer to leave his figures to the judg¬
ment of our readers, and it is hardly to be supposed that
any of them will be prepared to accept without further
inquiry the assertion relating to the “ scores of homoeo¬
pathic practitioners” whose experiences are published
in the North American Quarterly Homoeopathic Journal.
We are asked to believe that a normal mortality of 27'7
per cent, has fallen to 7'0 per cent, under treatment by
homoeopathy, but before doing 30 we should require to
know how much confidence the statements of these
ransatlantic authorities are entitled to inspire, and
whether the methods of treatment which they employed
were really those associated with the name of Hahne¬
mann. We are, however, indisposed to lend our columns
to the discussion of the merits or demerits of homceo-
pathy, for at this time of day such discussion could serve
o useful purpose.—E d.]
ICiterarg Jtotes anb Gkrssip.
Mesbr8. Wright and Co., of Britol, publishers of the
“ Medical Annual ” announce a “ Synoptical Index to
Drugs and Treatment,” for the twelve years 1887 to
1898, during which the Annual has appeared, for the
purpose of gathering up in concise form all the references
to treatment, Ac., from the world’s literature which are
to be found there.
• •
•
W■ understand that the Scottish Medical and Surgical
Journal, which was started some two years since as an
opponent to the Edinburgh Medical Journal, will be
taken over by a company on January 1st, 1900, with a
view to improving and extending same. Dr. Wm.
Bussell will remain editor as heretofore, and Dr. Norman
Walker has been appointed subeditor and business
manager. Two or three medical journals are now run
on company lines, but so far we have not heard of any
big dividends.
V
There has not been a great rush of new books in
medicine or surgery this season so far, and we congratu¬
late authors ana publishers alike. At times books and
their producers appear to vie with each other in the
plenitude of excessive redundancy, and one wonders
how many, or rather how few, of the new ventures will
be rescued from the waste-paper market.
The present Season, however, appears to be an excep¬
tion to the plethoric rule of October, as but two large
books have reached us, and only two i r three smaller
ones. The two larger works are manuals of surgery,
one, a new edition by Messrs. Bose and Carless, wnich
has already made a distinct mark, and is perhaps to-day
the most popular “ surgery ” extant; the other, on
similar lines and of similar dimensions, by Mr. T.
Pickering Pick. The latter we merely announce, not
having yet had time to examine into its merits.
% #
Of the smaller tomes, we have “ An Introduction to
Diseases of the Nervous System.” by Dr. H. Campbell
Thomson •, ” Difficult Digestion due to Displacements,”
by Mr. A. Symons Eccles, M.B.; “ Differential Dia¬
gnosis,” by Dr. Fred J. Smith ; “ Raynaud’s Disease,”
translated from the French by Dr. T. K. Monro ; and a
manual of “ Modern Gastric Methods,” by A. Lockhart
Gillespie, M.D., F.R.CP., F.R.S.Ed., with a chapter on
mechanical methods for young Chrildren, by John
Thomson, M.D., F.B.C P.,Ed.
• #
•
Nor are the announcements of new editions so numer¬
ous as usual. A third edition of Sir Wm. Broadbent’s
“ Diseases of the Heart ” is expected this month. A
fourth edition of Mr. Hy. Sewill’s “ Manual of Dental
Surgery; ” a second edition of Prof. Mayo Robson’s
“ Diseases of the Gall-Bladder; ” and an eighth edition
of Dr. Macnaughton-Jones’ “ Diseases of Women,” are
in the press; and a new edition of “ Intestinal Obstruc¬
tion,” by Mr. Frederick Treves, F.R.C.S., is just ready.
% #
A new quartertly journal of “Climate” issued under
the auspices of the Council of Livingstone College, and
edited by Dr. C. Harford-Battersby, has just made its
appearance. The object of the college is the instruction of
missionaries in the elements of practical medicine, for the
care of i heir own health, and to render simple help to native
races far removed from medical aid The object of the
Journal is to afford an opportunity for an interchange
of opinions on health questions by those who have had
experience in various parts of the world. Both are
excellent ideas, and we wish them an unqualified
success.
V
“ A Guide to Urine Testing for Nurses and Others, *
by Mark Robinson, L.R.C.P., Ac., published by John
Wright and Co., of Bristol, may prove useful to nurses
“ and others ” employed in provincial hospitals and
Poor-law infirmaries where the services of no clinical
clerk are available. It is very difficult to draw the line
at which to stop when initiating “ nurses and others ”
GoogI
e
Oct. 18, 1800.
MEDICAL NEWS.
THK MkDICAL FrKSS. 415
in the details of urinary analysis, and the author has
been wise in limiting the chapter on the microscopical
examination of urine to the bald statement that it is not
within the nurses’ province, though in truth this makes
rather a short chapter. For the rest, the instructions
are given in simple language, and will adequately fulfil
the purpose for which they are intended.
Thk “Handbook to South African Health Resorts,”
published by Messrs. Donald Currie and Co., has surely
been issued at a singularly inopportune moment. It
would require more vivid word painting that even the
author can command to induoe invalids to hie to the
Cape under existing circumstances. The effect of the
charming little views which solicit our admiration here
and there throughout the book is stultified by the know¬
ledge that many thousands of men are now on their way
thither for purposes far removed from the pursuit of
health. We would not advise any one either to rely too
much on the details gi^en in the chapter on the railway
system, for “ circumstances alter cases,” and the most
carefully prepared time tables are apt to be dislocated
by warlike operations. So long as the traveller sticks
to one of Messrs. Donald Currie and Co.’s magnificent
steamers he may have no cause for anxiety or regret,
but as to landing—that is quite another matter. On the
whole we prefer to place the book on one side until the
clouds have rolled by.
4ttcbical $etos.
King’s College, London.
Thk following Entrance Scholarships have been
awarded Medical Entrance Scholarship—70 guineas,
A. J. Wigmore. Two Sambrooke Medical Exhibitions—
£60, E. L. Holland ; and £40, T. H. Jones and J. James,
aeq. Two Clothworkers’ Company Science Exhibitions—
£30 for two years. V. E. Kingsbury ; and £20 for two
years, F. C. McCombie. Engineering Entrance Exhibi¬
tions—£15, W. J. Marlow; £10, A. H. Imber; £10,
W. A. Sad grove.
The Mortality of Foreign Cities
Thk following are the latest official returns, and i epn •
sent the last weekly death-rate per 1,000 of several of the
populations:—Calcutta42,Bombay 32, Madras 37, Paris
15, Brussels 16, Amsterdam 14. Rotterdam 15, the Hague
12, Copenhagen 14, Stockholm 17, Christiana 16, St.
Petersburg 21, Moscow 23, Berlin 19, Hamburg 13,
Munich 23. Vienna 10, Prague 19, Buda-Pesth 15, Rome
15, Turin 15, Venice 14, Cairo 43, Alexandria 32.
Deaths from Chloroform.
A death from chloroform asphyxia was the subject of
an inquest at Stamford last week, the victim being a
child who was about to undergo an operation for strangu¬
lated hernia. As is usually the case, no details were
elicited as to the method in which che chloroform was
administered, or the amount that had been employed,
and the medical evidence favoured the view that the
amount of chloroform used and the strength of the
patient were factors of no importance. It is distressing
to witness this unscientific attitude towards fatalities
which are in large proportion, strictly speaking, avoid¬
able. The mechanism of the production of death from
chloroform narcosis is well understood at present, and
there is no longer any mystery surrounding it. In
this instance the existence of a strangulated hernia
goes far to explain the untoward result, but we could
nave wished for evidenoe of the use of a suitable
apparatus.
Another death from chloroform was inquired into by
the St. Pancras coroner on Friday. The victim was a
child, set. 4, who had suffered from diphtheria upon
whom Dr. Cremin was about to perform tracheotomy,
but the child promptly succumbed to chloroform narcosis.
No information was forthcoming either as to the method
employed, or the amount used, and a usual verdict was
returned.—At Matlock, a young woman, set. 24, appears
to have succumbed to the effects of lees than two-penny¬
worth of chloroform, obtained for the purpose of allevia¬
ting toothache. 8he appears to have wrapped her head
up closely, and to this is attributed the fact that death
resulted, though the quantity inhaled probably did not
exceed 25 minims.
University College, Liverpool.
It is announced that Mrs. George Holt and her
daughter. Miss Emma Holt, have each contributed
£5,000 towards the Physical Laboratory. With the
generosity which does them honour these ladies had
already subscribed £2,000 to the Medical School and
£3,000 to the Anatomical School.
A Needle la the Heart.
At an inquest held on Saturday last on the body of
an elderly lady who was known to be addicted to the
hypodermic use of morphia, it was stated at the post¬
mortem examination a needle was found embedded in
the heart which had determined hemorrhage severe
enough to cause death. No trustworthy history could
be obtained of the way in which the needle had found
its way thither, but her son stated that about four
months ago the deceased thought a needle which she was
using had entered her ear. Whether there was any
connection between these two things is a matter which
must remain in doubt, though the tendency of pointed
bodies of small dimensions to travel considerable
distances inside the body is well known and has often
been recorded. A verdict of accidental death was
returned.
Irish Medical Schools' and Graduates' Association.
Thk Autumn General Meeting of this Association
will be held in London at the Hotel Cecil on Wednesday,
Nov. 29th, at 6.30 p.m. The dinner of the Association
will be held on the same evening at 7.15 in the same
building, the President, Sir William Thomson, in the
chair. Later on, at 9.30 o’clock, the coming of age of
the Association will be celebrated by an “ at home.” The
cost of dinner tickets for members and their guests,
exclusive of wine, but including subsequent admission to
the " at home,” will be 10s. 6d. each. The cost of tickets
for admission to the “ at home ” only will be 4s. each.
This being an unique occasion in the history of the
Association, it is hoped that members and their guests
will muster in large numbers. Applications for tickets,
accompanied by remittance to cover coat thereof,
together with the names of guests, should be forwarded
as early as possible to Mr. P. J. Freyer, Hon. Sec., 46,
Harley Street, W.
Society for Relist of Widows and Orphans of
Medical Men.
At a quarterly court, held on Wednesday last,
Mr. Christopher Heath, V.P., in the chair, six new
members were elected, and the death of Mr. Mould,
a vioe-president, and at one time a very active member
of the society, was reported. The death of a widow was
announced, who had received £50 per annum since July,
1894. A first application for a grant was read from a
widow, and a grant at the rate of £40 per annum made.
Applications for renewal of grants were received from 48
widows, 12 orphans, and six recipients from the Copeland
Fund, and it was resolved to distribute at the next court
among them the sum of £1,201 10s. The directors were
pleased, on the report of the acting treasurer, to be
enabled to vote a sum of £541 to be given as a Christmas
present to the widows and orphans on the funds of the
Society, viz., £10 to each widow, £3 to each orphan, and
£5 to five recipients from the Copeland Fund. The
expenses of the quarter were £62 10s.
University of Glasgow.
At the recent professional examinations for the
degrees of M.B., Ch.B., the following candidates passed
with distinction in the subjects indicated:—
First Examination.— In Botany. -HenrvCraeme Anderson, John
Baird Morton, William Templeton. In Zoology.—James Glover,
Anna Pollock Martin, Berkeley Hope Roliertson. In Physics.—
Curl Hamilton Browning. John Muir Kelly. David Robertson
Mitchell, John Murdock, Robert Tait Wells, M.A. In Chemistry.—
Isabel Deane Mitchell.
Second Examination.— In Materia Medica and Therapeutics.—
Robert Wellwood Auld, Samuel Jnmes Cameron. James Bertie
Wylie Cook, William Dick. James Grant Millar. John Paton. John
Walker Benton, Elizabeth Ness MacBeon Ross, Donald Steel, Joseph
Goodwin Tomkinson, John U ns worth
Third Examination. —In Medical Jurisprudence and Public
Health.—Lizzie Thomson Frazer, James Dunlop Lickley, William
Barr Inglis Pollock, Alexander Dey Thompson.
Google
416 The Medical Pbess.
NOTICES TO CORRESPONDENTS.
Oct. 18,189ft.
Notices to
Correspondents, Short 'fetters, &c.
•9* Correspondents requiring a reply in this column are par¬
ticularly requested to make use of a dixtinctivi lignature or
ini Halt, and avoid the practice of signing themselves “ Header,"
"Subscriber,” “Old Subscriber,” Ax. Much confusion will be
spared by attention to this rule.
A QUESTION OF ETIQUETTE.
To the Editor of the Medical Press and Circular.
Sir,— I was called in a few days since by the landlady of the house
to an inmate who had tnkeu a poisonous dose of Inuiauiun. On my
arrival I was confronted by a confrere, who promptly told me the
case was his, as he had been there an hour. I nsled him what lie
had done, and finding that he had done nothing beyond injecting
Btrychuiue, I took upon myself there and then to wnsh out the
stomach with n solution of permanganate, and to secure the services
of two nurses to keep the patient moving. She ultimately re¬
covered, but I am charged with a breach of etiquette in that I
interfered in another man's case. I must admit that I did so, but
it was bv reason of the extreme urgency of the case, and the appa¬
rent inability of the mnu in charge to "do the necessary,” he having
neither stomach-pump nor antidote case at hand.
Ought I to forego my fees and tender an apology, or am I at
liberty to claim that the case was one in which the combined efforts
of two practitioners weie not de trop ? I nm anxious to do the
proper thing, and shall l e glnd of your opinion.
I am, Sir, yours truly,
Antidote.
*,* It would probably have been best to suggest the necessary
steps to the “ man in possession," instead of carrying them out
independently, but in such an urgent case, it must be admitted, too
strict a regard to etiquette would be out of place. It ought not to be
difficult to “ square " matters on a friendly footing, l>ecanse there is
nothing to prevent both practitioners from claiming their respec¬
tive fees. A friendly assurance of respect and esteem to the
medical man originally called might advantageously take the place
of an apology.
Dr. J. Lamond Lackie (Edinburgh).—An engraving, is being
made, aud space will be given to your interesting case in an early
number.
THE IMMUNITY OF BIRDS TO SEWBR GAS.
To the Editor of The Medical Press and Circular.
Sir, — I have had opportunities of studying the development of
sundry families ,.f sparrows whose parents had selected the patn-
lous ends of soil pipes and sewer ventilators for their homes. In
view of the lethal properties with which sewer and drain air is
credited, it occurred to me to watch them in order to ascertain
what effect, if any, the habitual breathing of this contaminated air
would have on their health and growth. So far as my observations
went the young birds seemed to thrive admirably, and I was never
able to detect any sign of ill-health or retarded development. They
were plump and quitted home at the usual period
I do not advance these observations as an argument for admitting
sewer gas to our dwellings, but either animals, or some of them,
are immune against such sources of infection, or we greatly over¬
rate their virulence.
I am, Sir, yours truly.
Meetings of the Societies anb lectures.
Wednesday, October 18th.
Royal College of Physicians ok London.— 4 ji.m. Dr. G.
Vivian Poore: Harveiau Oration.
St. John’s Hospital for Diseases ok the Skin (Leicester
Square, W.C. 1—4.30 p.m. Dr. T. D. Savill: Ringworm Favus and
Pityriasis Versicolor. (Post-graduate course.)
Thursday, October 19th.
OPHTHALMOLOiilCAL SOCIETT OK THE UNITED KlNflDOM —8 p.m-
Cases and Card Specimens. 8.30 p.m. Mr. A. Critchett (President) :
Introductory Address. Papers Mr. R. W. Doyne : (1) Notes on
the Value of Rnlinut Heat in Eye Disease: (2) Notes on Recurrent
Superficial Necrosis of the Cornea.—Mr. J. B. Lawford: Keratitis in
Acquired Syphillis.
Harveun S', iety of London (Stafford Booms, Ticliborne
Street. Edgware Road).—Clinical Evening.
Fridat, October 20th.
Society of Anesthetists (Cafe Mouico).-<>.30 p.m. Annual
Meeting. 7-15 p.m. Annual Dinner.
ftecanties.
Bethlehem Hospital, London.—Two Resident House Physicians for
six months. Apartments, complete board, and washing pro¬
vided, and an honorarium at the rate of *12 12 s. each per
quarter will be paid. (See advt.)
Brighton, Hove, and Preston Dispensary (Northern Branch).—
House Surgeon. Salary, *160 per annum, with furnished
apartment-, coals, gas, washing, ami attendance.
County Asylum, Prestwich, Manchester. Assistant Medical
Officer, unmarried. Salary commencing at 4:125, with board,
apartments, and washing.
County of Loudon Manor Asylum, Horton. Epsom, Surrey. —A Dis¬
penser. Salary, til" per annum, rising CIO a year to *150, with
dinner daily. Apply to the Clerk of the Asylum Committee,
Office, ti, Waterloo Place, London, S.W.
Glamorgan County Council and Cardiff Cor]>omtlon.—Bacterio
logist to the Joint Committee and Lecturer on Baoteriology in
the University of Cardiff. Salary as Bacteriologist and
Lecturer, *300 a veer. Apply to the Clerk, Glamorgan County-
Offices, Cardiff.
Hospital for the Insane, the Coppice, Nottingham.—Assistant
Medical Officer, unmarried. Salary *150 per annum, with apart¬
ments, board, attendance, and washing.
Lincoln County Hospital, Lincoln.—House Surgeon, unmarried.
Salary *100 per annum, with board, lodging nnd washing.
Nottingham General Dispensary.—Senior Resident Surgeon, un¬
married. Salary £190 a year, increasing by *10 annually to *200.
Special arrangement for board, Ac.
Parish of Ham in ersmith.—Medical Officers and Public Vaccinators
for tlie Tirst and Fourth Districts of the Parish. Apply to the
Clerk, 75. Fulham Palace Road, Hammersmith, W.
Royal Infirmary of Edinburgh. Superintendent. Salary *500 per
annum, with free house, coals, and light.
St. Andrew’s Hospitnl for Mentnl Diseases, Northampton. —Junior
Assistant Medical Officer, unmarried. Salary commencing at
*150 per annum, with board, apartments, and washing. Salary-
increasing *25 per annum to *20".
Sussex County Hospital, Brighton.—House Physician, unmarried
Salary commencing at *50 per annum, and 'board, residence
in the hospital, and washing. Application to the Secretary.
Victoria University, Manchester.—External Exauiinerehip in Ana¬
tomy for three years. (See advt.)
appointments.
Buxton, Edward, M.D., F.R.C.S., M.R.C.P.,Ed., D.P.H. Medical
Officer of Health for the Little Crosby and Hightown Districts.
Dixon, W. E.. B.Sc.Lond,. M.B., L.R.C.P., M.R.C.S., Assistant to
the Downing Professor of Medicine, University of Cambridge.
Faulkner, Hush, M.B., Cli.B.Ediu. House Physician to the
General Hospital, Birmingham.
Forbes, W. J., M B., C.Cli., B.A.O., R.U.I. Medical Officer of
Health for the Knarosborougli Rural District.
Huey, John J., L.8.A.Lond. Medical Officer of Health to the
Mexlioro’ Urban District.
Huxphrt, L.. M.A., M.D.Camb., M.R.C.S. Assessor to the Regius
Professor of Physic, University of Cambridge.
Hutton, Eustace, M.R.C.S., L.R.C.P.Lond. Visiting Surgeon to
the Stockport Infirmary.
Mitchell, ArthukM., M.A., M.D., B.C.Cantab. Honorary Assis¬
tant Medical Officer to the Royal Surrey County Hospital,
Guildford.
Ratthat, P W., M.B., C.M. Aberd., F.R.C.S.Eng. Pro tern. Medical
Superintendent of the Workhouse of the Parish of Islington.
Reed, John Arthur, M.B., Ch.B.Viet. House Surgeon to the
StockjHirt Infirmary.
Stephen, Southall, M.B., Cli.B.Ediu. House Surgeon to the
General Hospital, Birmingham.
Thorp, Harold, M.R.C.S., L.R.C.P.Lond. Junior House Surgeon
to the Warrington Infirmary and Dispensary.
fifths.
Neill.-O n Oct. 12th, at Ranagliat Melical Mission, the wife of
Charles Neill. M.A..M.B., Comb., of a son.
Pinkerton.— On Oct. 1.1th, at Trevaruo, South Norwood Hill, the
wife of Robert L. Pinkerton, M.A., M.D., of a daughter.
South.— Ou Oct. loth, at Church Close. Boston. Lines., the wife
of Richard E. South. J P., L.R.C P , M R.C.S., of a daughter
Williams.— On Oct. i3th, at 1, Somerset Place, Stoke, Devonport,
the wife of Dr. J. O. B. Williams, R.N., of a son.
Carriages.
Ehrke-Castle. —On Oct. 10th, at Claines Church, Worcester,
Frank Ehrke, M.D., of Kempsey, to Emmeline Dora, daughter
of the late Charles Castle. Esq,, D.L., J.P.
Lander-Slihos. —On Oct. 12th, at St. Mark’s Church, Dulston,
Harry, eldest son of H. Longley Lauder, of Clnpham Common,
to Liesel Jean, eldest daughter of George C. Simon, M.D.,
C.H.M.. of Hackney.
Macpherson-Nash.- On Oct. 14th, at St. Peter’R Church, Bays-
water, William Hugh Mocplieraon, M.A Cantab. M.R.C.S., of
Henley.on-Thames, son of Sir Arthur George Maoplierson,
K.C.I.E., to Maud Hollick, fourth daughter of Edmund Nosh,
M.D., of 125, Lansdowue Rood. Not ting Hill.
Polehampton-Davie.— On Oct. 9th, at Victoria, British Columbia,
Frederick W. Polehampton, second sou of the late Rev. Edward
T. W. Polehampton, Rector of Hartfield, Sussex, to Kathleen
Eunice, youngest daughter of John Chapman Davie, Esq., M.D.,
of Victoria, British Columbia.
deaths.
Banks.- On Oct. llth, at Golagli House, Monaghan, Alice, dearly
lieloved wife of Sir John Banks, K.C.B., M.D., of 45, Merrion
Square, Dublin.
Barnes.— On Oct. 12th, John Wiekliam Barnes, F.R.C.S., of Bolt
Court and Stunwell Moor, Hon. Sec. Poor Law Medical Officers’
Association, lute Secretary Medical Society of London.
Flower.— On Oct. 7th, at Beaufort West, Bath, Thomas Bruges
Flower, F.R.C.S.Eng., aged St years.
Hokton-Smith. On Oct. Sth, R. J. Horton-Smith, M.A., H.B.-
Cantnb., youngest surviving sou oi R. HortOn-SuiUli, Q.C.,
aged 26.
Mould.— Ou Oct. 10th. at 1, Onslow Cresceut. London, S.W., John
Thomas Mould, F.K.C.S.. in his 92nd yenr.
Rtan.—O u Oct. 1st, at his residence, LI, Idrone Terrace, Blnckrock,
co. Dublin, Michaud Ryan, M.D., F.R.C.S.E., in bis 86tli year.
Digitized by Google
®ht Redial %tm and (L'irtular.
“SALUS POPDU 8UPREMA LEX."
Vol. CXIX. WEDNESDAY, OCTOBER 25, 1899. No. 17.
(Original (Communications.
THE NERVOUS LESIONS <>F
CONGO SICKNESS («)
By F. W. MOTT, M.D., F.R.C.P.Lond.,
Pathologist to th* London County Council.
The author related the results of the investigation
of the central nervous system in two cases of
Congo sickness, and he showed a number of lantern
slides and microscopical specimens. The brain and
spinal cord, pituitary body and spinal ganglia were
examined. To the naked eye the tissues in Case 1
presented but little change beyond some slight
thickening of the pia-arachnoid. The convolutions of
the brain were complex and not atrophied. The
organ weighed ~>± ozs. The two hemispheres were
of equal weight, and there was no excess of
fluid. In Cuse 2. the younger patient, the dura
mater was found adherent to the skull cap. There
was a considerable quantity of cerebro-spinal fluid.
The pia-arachnoid was somewhat thickened and
opaque over the convolutions. The base of the
brain likewise showed thickening and opacities of the
pia-arachnoid : weight of the brain, 3ti ozs. Neither
of the brains showed flattening of the convolutions,
erosions on stripping the membranes, or dilated
ventricles with granular ependyma. The nervous
tissues before mentioned were removed so soon after
death as to avoid post-mortem infallaci s. Portions
of different parts of hemispheres, cerebellum, pons,
medulla and cord, also spinal ganglia, were stained
by Nissi method, Marchi and Marchi-Pal methods,
after suitable hardening and fixation. The micro¬
scopical examination of these sections exhibited in
both instances similar conditions. There was a lepto¬
meningitis and encephalo-myelitis throughout the
whole central nervous system, but especially in the
medulla and base of the brain, sections showed all the
K rivascular lymphatics distended with more nucleur
icocytes. The left cerebral hemisphere in case 2
showed this condition in an especially marked
manner, very probably accounting for the right-sided
fits from which this patient st ffjixd towards the end
of life. Sections were also stained by Gram method,
Pfeiffer, and other methods, but with negative results,
thus agreeing with the negative evidence obtained by
Dr. Bullock, who examined the blood and lymphatic
glands removed from Case 2 during life. Some of tlip
cerebro-spinal fluid removed from Case 2 after death
yielded by culture various organisms, but this
evidence is of no value, because rigid precautions
were not taken in obtaining the same; moreover a
large bedsore existed over the sacrum.
General and Special Appearance of the Nerve
Cells In Case 1 the outline of the nerve cells and
their arrangement appeared fairly normal, neither
was it considered tnat the neuroglia cells were
(a) Delivered before tlie Patholojricnl Society of London, Tuesday'
October 17th, ltW.
markedly increased. The columns of Mynhert in the
cortex cerebri were distinctly evident, thus contrast¬
ing with the appearances of the brain in general
paralysis. The cells themselves throughout the
whole nervous system showed a uniformly dull diffuse
staining reaction, and in none of the cells were the
Nissi granules evident. This change was certainly
due to the hypopyrexia. In Case 2 the cells for the
most part presented a normal outline and exhibited
Nissi granules on the dendrons and in the body of
the cell. In the medulla, however, a considerable
number of cells showed chromolytic changes, and to
a less degree changes were found in the motor cells
of the anterior cornua. The cells in the left hemis¬
phere showed degenerative changes in sections of the
motor area. Meynhert's columns were not distinctly
visible, and many of the cells seemed atrophied und
broken up.
Fibres:—Sections of the brain and cord were
stained by Marchi, and Marchi-Pal methods.
Nothing abnormal was found in Case 1, except per¬
haps the tangential fibres were not so numerous as
in the normal cortex cerebri. In Case 2 there was
obvious wasting of the tangential fibres in both
hemispheres but especially of the left. There
was slight sclerosis of the crossed pyra¬
midal tracts of the cord, more marked on the right
side, and also a number of recently degenerated
fibres were exhibited by the Marchi method. The
arteries of the central nervous system exhibited no
trace of endarteritis. In the choroid plexus there
were numerous microscopical psammomata. The
central canal of the spinal cord was filled up by
proliferated glia tissue. The posterior spinal
ganglia showed the same appearances around the
vessels, but the ganglion cells in case 1 only showed tlie
diffuse staining of hypopyrexia, and in Case 2 exhibited
a fairly normal appearance. Can the changes above re¬
ferred to account for the symptoms ? The changes in
the left cerebral hemisphere of Case 2, together with
the evidence of degeneration in the opposite crossed
pyramidal tracts agrees with tbe convulsions of the
right side observed during life. No doubt these con¬
vulsions were the expression of the increased irrita¬
bility prior to death of the cortical motor neurons.
The symptoms, which were, however, present in both
patients, and characteristic of the disease, viz., pro¬
gressive drowsiness and lethargy, which eventually
led to most of the lives of the patients being passed
in sleep; and the progressive weakness in
body and mind without, however, any distinct
paralysis or mental disability, can best lie
accounted for by supposing that the metabolism or
functional activity of the neurons as a whole is
affected injuriously either by some toxic product
circulating in the blood or existing in tbe cerebro¬
spinal fluid, that this toxic agent, whatever it
may be, has occasioned an enormous pro-lifera-
tion of mononuclear leucocytes beneath the
pia-arachnoid membrane and in the perivascular
lymphatics. It might, however, be considered that
Google
Digitized by
418 The Mxdical Prebb.
ORIGINAL COMMUNICATIONS.
Oct. 25, 1899.
the functions of the nervous system were affected by
an interference with their nutrient supply owing to
the perivascular lymphatics boing filled with leuco¬
cytes and thus interfering with the circulation of
the lymph of the brain.
The liver, kidneys, lungs, pituitary body, spleen,
lymphatic glands, and duodenum were also examined.
The results were for the most part and with the
exception of the duodonum and lymphatic glands,
negative. The lymphatic glands were greatly en¬
larged owing to lymphocytes great increase. Sec¬
tions of the duodenum showed a large number of
lymphocytes and a proliferation of the same in the
lymphoid noduleB. It is a pity seeing that the
French authorities have considered this disease to be
due to the pneumococcus that lumbar puncture was
not performed during life, and the cerebro spinal
fluid examined for organisms* The negative evidence
as to the disease being due to a micro-organism is in¬
conclusive, but it must be remembered that in rabies
no micro-organism has been found. The faots
mentioned may perhaps help towards elucidating
the pathology of this disease.
They are also of interest in contrasting this affec¬
tion with general paralysis, which by many autho¬
rities is still considered to be a primary meningo¬
encephalitis, yet although the appearances of inflam¬
mation in this disease are as intense and certainly
more widespread than any case of general paralysis
which I have seen, yet the cellular changes are in
comparison with general paralysis slight; an argu¬
ment, I think, in favour of the view that progressive
paralysis of the insane is a primary disease of the
neuron with secondary inflammatory changes.
•Annales de l’Institut Pasteur, March, 1899. Role
du Pneumocoque dans la Path, et dans la Pathogenie
de la Maladie du Sommeil. Par le Dr. E. Marchand.
Regis et Gaide have published (Prease Medicate,
October 1st, 1896,) case observed in the region of
Timbuctoo. They consider it to be a diffuse meningo
encephalitis of diffuse infective origin.
PHAGEDENA
OF SIMPLE (OR SO-CALLED SOFT) SORES
AND OP
SYPHILITIC (OR SO-CALLED, HARD)
CHANCRE.
By H. De MERIC, M.R.C.S.
Surgeon to the French Hospital.
The two following cases which came under my
care simultaneously at the French Hospital illustrate
very clearly the difference in the phagedeenic action
affecting simple sores, and phagedsena when taken on
by the syphilitic chancre.
Case 1. —E. B., set. 27, came to my out-patient room
with a sore at the edge of the prepuce, just in front of
the frsenum. There was a history of three connections
with different women during the preceding three
weeks; after the first two connections he noticed
what he described as small blisters on the glans penis,
which disappeared in three or four days after the
application of Yin aromatique. The patient stated
that he tore himself slightly at the second connection,
and bleeding took place from the tear; this solution of
continuity had very nearly healed at the time of the
last connection which took place eight days before he
came to the hospital; the day after this last con¬
nection the tear became very painful, and on the day
after, from the man's description, began to ulcerate;
he applied vin aromatique, but as the ulceration
continued to extend, he came to the hospital.
There was then one unhealthy looking sore with
rounded edges having a tendency to excavation of
the centre and to spreading at the bordere, bathed in
an abundant thick pustular discharge; the sore gave
to the fingers a feeling of doughy hardness but no
induration; nothing whatever could be felt in the
groins. Taking into consideration the shortness of
the incubation (barely two days) the appearance and
feel of the sore and the absence of any glandular
enlargement in the groins I regarded the sore (though
single) as a simple or so-called “ soft ” sore, therefore
I merely lightly brushed it over with nitrate of silver
and gave the patient some lot. nigra to apply. After
a few days another sore appeared posteriorly to the
first one; this second sore had at first the appear¬
ance of a small punched-out hole, from which pus
was oozing, this soon, however, became a definite
sore similar to, though of course much smaller than,
the first; the next time the patient was seen a third
sore had appeared the other side of the framum, this
ran the same course as the second, both being evi¬
dently caused by direct inoculation from the first. In
spite of treatment in the out-patient room all these
sores got rapidly larger and larger, and eventually
joining together formed one large ulcerating
surface, which became phagedenic; the exten¬
sion of the sore thus formed was towards the
mucous membrane of the glans penis, not on the
skin of the prepuce, but another sore had by this
time made its appearance on the interior of the aorsal
part of the prepuce; this was long and narrow and
only extended laterally on the skin of the prepuce,
not on the mucous membrane ; it became phagedoenic
also, but the phagedsenic action here was not nearly
as intense as in the original sores. I now took the
patient into the hospital (I wished to admit him
before but he had refused to come in). During the
first three days of his stay the sores continued to
extend, the original sore both deeply and laterally,
the one on the skin of the prepuce only laterally at
each extremity, and this in spite of every care as to
cleanliness, in spite of the application of nitrate of
silver, in spite of the constant soaking of the part in
lot. nigra, and in spite of the internal administration
of $ gr. of proto-iodide of mercury (this I gave as
a precautionary measure in view of the appearance
of the last sore on the skin of the prepuce, although
I.ordered it a contre ceur, as I felt certain all the
sores were simple and not syphilitic). On the fourth
day I applied fuming nitric acid freely to the
original sore, lightly to the other; at the same time
I stopped the internal administration of mercury
which I was convinced was useless for such a case.
The effect was magical. The phagedenic action was
at once arrested over nearly the whole extent of both
sores and they gradually began to heal by granula-
tipn. In a week I had to apply the acid again to the
centre of the original sore and to tbe ends of the pre¬
putial sore ; twice more at intervals of three days the
centre of the original sore had to be touched lightly
with the acid. Both the sores were, during the
whole time, dressed at short intervals, at first, with
lot. nigra, and later, with lot. sod. chlorinatse. During
the next three weeks the sores healed up gradually;
as cicatrisation proceeded, more and more difficulty
was experienced in getting the foreskin forward
after each dressing; this, perhaps, retarded the
healing. During the whole time the patient was in
the hospital, and during the subsequent three or four
months of his reporting himself to me in the out¬
patient room, there never was the slightest enlarge¬
ment of the glands in the groin, nor a tiace of any
eruption or of any other syphilitic symptom, con¬
firming, if confirmation was necessary, the diagnosis.
I may also mention that the man had never suffered
in his life from any venereal complaint whatever.
Case 2.—A. P., set. 26, a weak anremic-looking man,
came to my out-patient room having contracted a
gonorrhoea which came on four days after connection
Oct. 25, 1899.
ORIGINAL COMMUNICATIONS. The Medical Press . 419
be had never had a venereal sore in his life, but had
suffered from gonorrhoea five years ago ; he had a very
long foreskin which he had never been able to get
back.
The case was treated with antiphlogistic internal
remedies, and a weak lotion to inject, not. only into
the urethra, but also under the prepuce in conjunction
with warm water. Twelve days afterwards the resident
medical officer admitted the patient to my ward; the
man was then suffering from very great pain on
micturition, and the whole of the penis and foreskin
was very red and inflamed. On the day after admis¬
sion, the resident medical officer freely slit up the
foreskin. As expected, theie was a great deal of
balanitis, together with a profuse discharge from the
urethra. Ordinary remedies were applied, and the
swelling and discharge diminished. A very small
“ ecorchure ” was noticed by the fnenum a few days
after admission, but this did not develop into a sore
until eight days afterwards. During the subsequent
four or five days this sore extended rapidly, develop¬
ing great induration at the base, and becoming
phagedsenic, not, however, in the same manner as in
Case 1, there not being the same tendency to excava¬
tion by loss of tissue, but the morbid action going on
over the whole surface of the chancre with a tendency
to extension at the edges, there being but little discharge
as compared with that occurring in Case 1; the in¬
duration was essentially basic, and had none of the
doughy feel remarked in Case 1; in fact, but for the
phagechena the whole chancre would have been
raised above the surface, there being no rounded
edges with a tendency to excavation at the centre of
the sore as in Case 1. Specific treatment was com¬
menced the instant the “ Ecorchure ” developed into
a chancre; I had felt venr much inclined to oegin it
on the first appearance of the “ Ecorchure,’’ especially
as the glands in both groins were indolently en¬
larged, but taking into consideration the presence of
the balanitis, which by irritation sometimes gives
rise to quite innocent little sores, and the gonorrhoea
which I have often found in weakly subjects to pro¬
duce an enlargement of the inguinal glands, I con¬
sidered it better to wait; I am also very much against
giving mercury to a patient unless the diagnosis of
syphilis be almost or absolutely certain. Black
wash was locally applied. At first it seemed as if
the application of fuming nitric acid would be neces¬
sary as in Case 1, but I refrained, for I felt certain
the chancre was a syphilitic chancre, which would,
even when phagedsenic, be acted on by specific
treatment, and, although for three or four days the
chancre still extended, it never showed any tendency
to excavate ; on the fifth day the phagedamic action
had evidently lessened, and from that time it
gradually disappeared, the chancre, however, taking
nearly two months to completely heal, leaving
behind an enormous amount of induration. In the
meanwhile the secondary eruption had come out with
sore-throat, &c. I may mention that the extension in
this chancre was never by inoculation as in Case 1;
there were no little sores formed near the original one
that gradually merged into it; on the contrary, all
the extension was from the edges of the chancre,
although sloughs formed over its whole surface, there
was never any tendency to excavation of the centre.
The points of interest in these two cases may be
considered under the heads of Diagnosis, Treatment,
and Prognosis. With regard to the diagnosis of
venereal sores it has been over and over laid down that
simple sores are always multiple, and that the syphi¬
litic chancre is, as a rule, single. This is perfectly
true, but it must be borne in mind that the multiplicity
of simple sores may not date from the beginning of
the disease as there may have been only one portal of
entry, in which case there will only be one sore until
others form round it by inoculation, as happened in
Case 1; therefore we must not rush to the conclusion
that a sore is syphilitic because it is single, if seen a
short time after it has been acquired, but we must
carefully sift the two most important points for our
diagnosis, viz., length of incubation and glands in
the groin. In Case 1 the incubation was about
24 hours (a little shorter than usual because at the
time of contamination a tear existed on the penis
giving an easy point for inoculation during connec¬
tion), and there was not the slightest glandular
enlargement: with simple sores there is either
nothing at all in the groin or else an intense inflam¬
mation of the inguinal glands rapidly forming an
abscess, there is never the indolent enlargement of
these glands which accompanies syphilitic chancre.
On the other band we must not fall into the error of
regarding the presence of two or three chancres to
indicate the absolute fact of their being simple
sores; it must be remembered that the syphilitic
virus may find several portals of entry during
a connection, in each of which a chancre will
form, but no more chancres will subsequently
be produced by inoculation as is the case with
simple sores. The diagnosis of phagedama attacking
a venereal sore presents no difficulty, but the perusal
of my two cases will show that the phagedsenic
action affecting the syphilitic chancre was not nearly
so intense as that affecting the sore produced by the
coalescence of several simple sores. In my experi¬
ence, this is invariably the case, and I believe the
reason phagedaena of a syphilitic chancre has been
described as very acute, is that a tertiary gumma of
the penis has been mistaken for a primary sore.
When phagedena attacks a venereal sore the
importance of diagnosing, whether we have to deal
witn a simple or a syphilitic lesion, cannot be over¬
rated, as the treatment is absolutely different, in the
one being local, in the other almost entirely constitu¬
tional. as shown in my two cases. It is rarely
necessary to apply strong nitric acid to arrest the
phagedamic action in a syphilitic chancre, for the
internal administration of mercury will do all that
is necessary. A case in point I have recently had in
private. A gentleman came to me with a primary
syphilitic chancre which had just taken on
phagedsenic action. He could not lie up as he had
to go abroad on business. I ordered mercurial pills
internally, and black wash locally, but thinking I
might hasten the disappearance of the phagedsena, I
brushed over the chancre with dilute nitric acid on
the two consecutive days before his departure : this
did not produce any immediate improvement, but as
I was certain the chancre was syphilitic, I felt he
was quite safe if he took his pills regularly. In a
fortnight he came back; the chancre was then
nearly entirely healed, and he had a well-marked
secondary eruption all over him.
With regard to the prognosis in my two hospital
cases, it is evident that it is only serious in Case 2,
from whom the poison of syphilis will have to be
eradicated; whilst Case 1 is none the worse, except¬
ing for some loss of substance of the penis.
1HE SURGICAL TREATMENT OF
FIBRO-MYOMA.TA.
By FREDERIC BOWREMAN JESSETT,
F.R.C.S., '
Surgeon to the Cancer Hospital, Brompton.
Mb. Boweeman Jessett alluded to the import¬
ance of the subject as shown by the great improve¬
ments of the technique in late years.
He then alluded briefly to the history of the opera¬
tion for the removal of the uterus with its myomata
attached, pointing out that Langenbeck was tne first
Digitized byLjOOglC
4-0 The Medical Press. ORIGINAL COMMUNICATIONS. Oct. 25, 1899.
to actually perform these operations, the results of
his operations were, however, not satisfactory.
Kceberle, in 1863, introduced the extra-peritomal
operation, and the use of the “ Berre-nceud,” which was
adopted in England until he (Mr. Bowreman Jeesett)
introduced his operation of pan-hysterectomy at
about the same time as Dr. Heywood Smith reported
some cases of the sub-peritoneal method of dealing
with the stumps.
The question of morcellement and the removal of
the adnexa was briefly touched upon, but neither of
these operations met with his support. In discussing
the treatment, Mr. Jessett considered the question
under the following heads : viz., the subserous, intra¬
mural, submucous, combined subserous, and intra¬
mural. Polypoid fibro-myomata becoming malignant
either sarcomatous or carcinomatous, and lastly tibro-
myomata complicated with pregnancy.
The subserous might be met with with long slender
f >edicle. in which case it could readily be removed by
igaturing the pedicle and not interfering with the
uterus, or they might have a broad sessile base when
the peritoneum could be divided and the tumour
enucleated, the uterus still being left. In cases of intra¬
mural or combined subserous and intra-mueral myo¬
mata in which operation was indicated, he recom mended
either complete hysterectomy, or the sub-peritoneal
operation by the abdominal route; he, however, pre¬
ferred the major operation, unless the patient were i
in an enfeebled condition and it was desirable to
complete the operation quickly. In all cases of
submucous fibro-myomata and polypoid growths the
vaginal route was recommended; the cervical canal
being dilated and the tumours enucleated; in case of
haemorrhage the uterus to be packed with iodoform
gauze.
Complete hysterectomy by the abdominal route or
by the combined vaginal and abdominal route was
strongly advised for all cases in which the fibro-
myomata had taken a malignant action. The result in
such cases in his hands had been most encouraging.
In cases in which doubt existed it was recommended
that the cervical canal should be dilated and the
cavity curetted, the debris being examined micro¬
scopically. The consideration of myomata compli¬
cated with pregnancy was of very great importance,
and great discretion was required to decide when to
operate or not, as in many cases gestation proceeded
normally and the foetus was bom naturally, whereas
in others the foetus was destroyed by pressure of the
tumour, when, if prompt operative measures were
not adopted the patient’s life might be lost or
seriously jeopardised. The question of producing
abortion was touched upon, but on account of the
great mortality attending this operation it was not
recommended.
Vaginal hysterectomy for these cases could only
be practised when the tumour was small, and the
uterus easily drawn into the lower pelvis; in some
cases the relation of the intestines to the tumours
might be such that, by adopting this operation
disastrous results may follow.
The method of performing the operation was
alluded to, and the use of the forceps and angiotribe
discussed, but he (the author) preferred the use of
ligatures of properly prepared catgut or silk.
A very valuable contribution to the botanical
department of the Dublin Museum has been made by
Lady Leighton, sister of the late Lord De Tabley,
consisting of 20,000 sheets of dried botanical speci¬
mens collected by his Lordship.
OBSERVATIONS UPON A NEW"
FISH FOOD.
By A. LOCKHART GILLESPIE, MD.,
F.R.C.P.E., F.RS.E.,
Medical Registrar to the Edinburgh Royal Infirmary; Lecturer
on Materia Medica and Therapeutics, Edinburgh School of
Medicine.
Through the courtesy of a professional brother,
aware that such matters were of interest to me, I
received some little time ago a quantity of a new
food preparation, almost entirely derived from the
flesh of white fish. As upon examination of the food
its composition, theoretical food and nutritive values,
both actual and in relation to its pecuniary aspect - r
its digestibility and the pleasant nature of its-
culinary preparations, were so striking, that I thought
a note about them might prove useful.
Marvis, as the food is named—“warts” "vis”
strength of the sea—is a white, or very slightly
yellow, powder, scarcely distinguishable from flour to
the eye, with a slight odour such as is common to all
fish. The powder is dry. does not adhere in lumps,
and mixes easily with water, hot or cold. It consists
of the flesh of fresh white fish, newly caught, treed
from skin, large bones, and viscera, thoroughly cooked,
and finally minutely powdered by special machinery,
the finer bones of the fish being similarly treated
along with the muscle.
A small proportion of flour is added to the fish pro¬
duct to facilitate a proper mechanical suspension of
the powdered muscle and bone, on being mixed
with fluids. The resulting compound is, as stated
above, a homogeneous powder closely resembling
flour, with a high nutritive value, and a food-stuff
which can be kept practically for any length of time
unaltered.
Marvis is manufactured at a northern seaport
town, where the fishing industry is of prime import¬
ance. The fish used can thus be and are procured on
the spot, fresh from the sea ; a point of much weight
when the liability for fish flesh to undergo rapid
post-mortem changes is considered. The Marivis
powder, as I have seen it, has undoubtedly been pre¬
pared from fresh material, and as the muscle juice
or serum is largely removed during manufacture—
the juice is the first part of the fish to decompose,
and the part with the strongest fishy odour—the
powder is not liable to go wrong, nor has it nearly
such a pronounced fishy smell, owing to the absence
of its chief source, the serum.
The novel characteristics presented by this food-
preparation led me to examine it more closely.
Analysis of the powder gives the following results
expressed in percentages :—
Moisture driven Total Inorganic Organic
off nt 110 degs. C. Solids. Ash. Solids.
11-9 8.H 1 335 8475
The ash, therefore, forms 3 8 per cent, of the dried
solids.
The nitrogen, estimated by Kjeldalil’s method, is
8'6 per cent., or equal to 54*25 per cent, of proteids,
if it be regarded as being present entirely in proteid
bodies. Compared with the dried total 6olids the
proteids amount to 61*5 per cent, or 64 per cent,
of the total organic material.
Organic Solids.
P. c. to Total.
Total p. c. to
Organic Solids.
Total 84'73 p. c.
Proteid 54-25 „
Fats 2-5 „
Carbohydrates 150 „
Undetermined 130 „
64 p. c.
298 „
(circa) 17'69 „
(of which phosphorus
0-31 p.c.) ... 15-33 „
Digitized by CjOO^Ic
Oct. 25. 1899
ORIGINAL COMMUNICATIONS.
The Medical Presi 421
Inorganic Abb.
P. c. to Total.
P. c. to Total
Ash.
Total 3 - 35 p. c.
Chlorides (as NaCI) 0 217 „ 6 47 p. c.
Phosphates (as Na. H P 0 4 ) 1*50 „ 44 7 „
(asP.'Oj) 075
Organic Phosphorus.
0 73 p. c. (as P., 0.0
107 „ (as H : , P0 4 )
Total Phosphorus (as P. 0,).
1-48 p. C.
77 9 per cent, of the organic solids were dissolved
and acted upon by pepsin and hydrochloric acid in
artificial digestion experiments, practically the whole
of the nitrogenous substances undergoing digestive
changes.
Cold water dissolved 6 43 per cent., boiling water
3 33 per cent, of the total from the residue left.
Both extracts contained native and derivative proteids
among other substances.
The percentage of total phosphorus is high. Katz
(Pfliig. Arch., Bd. 63) obtained 1*035 per cent, from
the muscle of pike, as P g 0 8 , 0'83 per cent, in
inorganic form, 0*195 per cent, in organic combina¬
tions. Noel Paton’s (Fishery Board for Scotland
Report on Salmon, 1898. p. 143), found a mean of only
0*2l5 per cent., as P, 0 8 in the muscle of salmon.
The phosphorus of Marvis. therefore, is present in
considerably larger proportion than in the muscle of
pike, and enormously over that of salmon, Of course,
the water percentage is very much more in the
case of the salmon, where the proportions are given
in relation to the fresh muscle, salmon muscle con¬
taining about 66 per cent, of moisture, Marvis only
12 per cent. In the dried total solids the total
phosphorus of the salmon muscle represents 0 632 per
cent., of Marvis 168 per cent, as P, 0 8 .
A noteworthy difference also appears between
the proportions of inorganic phosphorus shown by
Katz’s analyses, and those of Marvis ; for although
the total phosphorus is greater in Marvis, the
inorganic moiety is less than in the pike muscle, the
organic portion, therefore, is markedly in excess.
While preparing the various data for incorporation
into the chapter on Foods, which forms a part of my
volume upon digestion in the Contemporary Science
Series, and calculating out the food and money values
of different common articles of diet. I remember
being impressed by the high relative value of dried
cod, both for nutrition and as regards value for money
paid, when compared with other food stuffs. Though
unexpressed in the text the thought occurred to me
that any one who should apply this fact towards the
preparation of a food-stuff from white fish flesh in a
palatable and digestible form would be doing a
service to the unhealthy among mankind, and also
to many of the normal members of the species.
Although ordinary dried white fish is possessed of so
high a nutritive value, without doubt it loses much of
it owing to its being rather indigestible, when con¬
sumed in bulk, perhaps when of uncertain age, how¬
ever prepared for the table. But the muscular tissues
of white fish so often sold at nominal prices, or if
harvested too plenteouslv frequently applied as
manure to enrich the soil, if bought and treated on the
spot, cheap because the material is cheap, nutritious
because its basis is nutritious, digestible and assimil¬
able by reason of the method of preparation em¬
ployed, offer a most valuable source from which to
obtain a rich concentrated supply of food, costing less
than the similar preparations from mammalian flesh,
and giving as good value in return.
A dry preparation, such as Marvis, consisting in
arge proportion of the powdered muscular tissues
and fine bones of fresh white fish, together with a
small amount of cereal flour, will yield in nutritive
value, using Konig’s well-known factors in its deter¬
mination', of about 353*5 per cent, by weight; while,
still following Konig, if four ounoee cost a shilling,
the nutritive value in return for every penny spent
is represented by 33 38 units.
Dried ood or ling, as usually placed on the market,
is so cheap that the value of a pennyworth reaches
732 units, compared with the 432 units of a penny¬
worth of dried peas, and 49 7 units afforded by lean
beef for the same coin, at lOd. the pound.
Thus, lean beef possesses an average nutritive
value of 109*5 per cent.; at lOd. a pound each penny¬
worth bought will equal 49*7 units, at Is. a pound
41*4 units for each penny, or if in the form of the
best rump steak 31*0 units for the same expenditure.
Marivis, therefore, per unit of weight is three times
more nutritious than lean beef, while if its selling
price be taken at Is. for four ounces its money value
as a food is theoretically 70 per cent, of that of
cheap beef, a value, however, which is, in practice
rendered higher owing to the ease with which the
food elements of Marivis can be utilised, and the
small proportion of its constituents wasted.
Few of the fluid or semi-fluid meat extracts in the
market afford more than 5*35 units in nutritive value
per penny spent on them, or six times less than
Marvis, while in nutritive value per cent, of their bulk
they fail to exceed a proportion higher than one-
third of this fish food’s theoretical estimate.
Referring again to the book already mentioned, it
will be seen from a table on page 393, that 2*7 ounces
of dried cod are equivalent in nutritive value to ten
ounces of lean beef, and that this dried fish-food has
even more nourishment in it than dry powdered meat
of which 2*9 ounces equal the value of ten ounces, of
lean beef, and therefore 2*7 ounces of the dried fish.
In addition, it is stated that 274 ounces of beef-tea
would be required to be taken before the same amount
of food - elements, serving to maintain metabolic
processes, as in ten ounces of beef, or 2*7 ounoes of
dried fish would be obtained. Marvis, principally
composed of this dried fish in a powdered form, with
an approximate nutritive value per unit of 353*5, would
only require 3*1 ounces to equal the nourishingelements
of ten ounces of lean beef. The 3*1 ounces would
cost 9*3 pence, the ten ounces 6*25d.; at 3d. and
0*625d. the ounce respectively. The food value of the
one per penny being 33*38, of the other, 49*7.
A number of the food preparations in the market
in a fluid or gelatinous form are little more than
high-prioed solutions of meat extractives, with some
power of stimulating the various tissues and organs,
especially the heart; but this power is but transient,
not sustaining, though it often proves of great value
at the time.
The dried food-preparations have of late grown in
number, and multiplied exceedingly. The many
excellent examples of infants' foods manufactured
from cereals, milk, &c., now available can often be
usefully employed by adults. The more technical,
dried derivatives of proteid digestion typified by
somatose, sanose, and their congeners, are even
more than the members of the meat extract class,
medicinal aids to nutrition, not foods in the proper
sense of the word. Indeed, if given in the amounts
proper for the total metabolic needs, they frequently
cause symptoms more akin to poisoning than to
correct alimentation. They again, however, may
prove very beneficial under appropriate circum¬
stances.
A word as to beef powders. Theoretically, these
are of great nutritive value, easy to digest, and
quickly incorporated with the body. Practically,
they are of less value, their physical properties, by
causing feelings of repulsion often after but a com-
Digitized by GoOglC
Oct. 25, 1899.
422 The Medical Pbess. ORIGINAL COMMUNICATIONS.
paratively brief experience of them, chiefly, I suppose,
because of the strong flavour conferred on them by
the sapid meat extractives present, prevent their
employment in bulk or for a length of time, while
their money value for nutrition is low by reason
of the price charged for them.
I have found that made into fish soups, simply or
variously strengthened, fish soufflees, custards, and
cooked in other ways, Marvis yields most appe¬
tising dishes, proves very palatable to patients, and
supplies a very valuable addition to our stock of
nutritive foods, which is at the same time rich, sus¬
taining, and easily disposed of.
I have been led to write these few lines about this
new food because I believe that physicians will find
in it a scientific means towards enriching the diet of
dyspeptics, and of patients who require to supple¬
ment their stores of proteids without digestive em¬
barrassment or induction of nausea.
PROFESSIONAL BEHAVIOUR.
Abstract of an Inaugural Address delivered in St. Vincent’*
Hospital, Dublin, Oct. 1899.
By R. F. TOBIN, M.R.C.P., F.E.C.S.I.,
Surgeon to the Hospital.
After some introductory remarks, Mr. Tobin said:—
If there is one man more than another who has my sym¬
pathetic good-will, it is he who, fresh from the schools,
fall of enthusiasm and first principles, is boldly joining
the battle of life. He has yet to learn how little mere
enthusiasm will avail him in the struggle, and how
many are the exceptions to every rule that has been
given him for his guidance. The complexity of life,
with its difficulties and interests, is yet a distant cloud
about which he does not materially concern himself.
It.is of this cloud as it affects the practice of medicine
that I purpose speaking to you; and since money may
be said to be its electricity, I shall, at the outset, ask
you to consider some of the social and economic questions
that influence the payment of the profession. First,
why should we not have free trade in medicine? Free
trade I will define as unrestrained competition—in other i
words, as regards our relations with one another and [
our patients, each man for himself, and the Devil take
the hindmost. It will take very little consideration to
show that it will be an evil day for the public when this i
rule prevails. For, in the first place, the public have no
means of estimating the value of the goods we offer them.
On matters medical their ignorance is only equalled
by their gullibility. You will not ask me to prove this
proposition. Times and times again you have heard
your unoles, aunts, and cousins lay down the law on
difficult points in physiology, a subject in which, per¬
haps, you, after much study, have been plucked two or
three times. You have seen Sequah, on a prairie horse,
ride into public favour; you have known men of intelli¬
gence pin their faith and their lives to the teachings
of honceopathists and Christian scientists. The dif¬
ference between the knowledge which the man ia the
street has of the inside of his watch and his own inside
is this—he knows nothing of the inside of his watch;
he knows a great deal of nis own inside, but all that he
knows of the latter is wrong. I may, therefore, take
this proposition for granted, and pass to my second,
which is equally clear. It is that the patient, who in
this matter represents the public, is not in a position,
when he is most a patient, to test experimentally the
quality of what we offer him.
What I have now to submit to you makes our pecuniary
relations with the public unique. To preserve our
status and attract suitable men to the profession, we
have to put a high price on our services, but (here
comes in the difficulty) these services are required as
much by the poor as by the rich. This difficulty has
been met, and I think properly met, by giving gratuitous
service to all whose ability to pay does not reach a
certain standard. You must either do this, or you
must in some cases take a copper for your services.
The wisdom of our professional ancestors is embodied
in the etiquette of the profession, and although they may
not have known much of science, they knew a great deal
of the world, for conjointly they lived in it a long time.
I would therefore advise you in being slow in departing
from it. Their usage, as regards fees, a'; far as I know it,
was this—they fixed on what they considered a suitable
fee, and they rarely deviated from it, meeting the require¬
ments of those who were not wealthy by gratuitous
visits. Against a graduated scale of fees there is much
to be said. First, there is the tendency of all patients
to gravitate to the lowest scale ; secondly, there is the
fact, which, however we may explain, your experience
will, I believe, confirm, that men educated as doctors
do, as a rule, better work for no fee at all than for one
disproportioned to the occasion. The graduated fee
somehow introduces into the profession an element of
trade that is disastrous alike to doctor and to patient.
But the first difficulty that you will meet—you, the
youth full of enthusiasm and first principles whom I
am addressing—is not the fixation of the amount of
your fees, but the earning of any fees at all. Now in
this connection the bit of advice I have to give you is,
before entering for any event take stock of your own capa¬
bilities and qualities. It is well known that to be success¬
ful on the turf a horse must not only be a good one, but he
must be properly placed. It is better to be first in small
events than second in big ones. Therefore, don’t enter
for a race in which you will be outclassed, or which calls
for qualities other than you possess. To work hard is
the great pleasure of life, but the work muse be con-
S nial and not beyond one’s powers. One man will be
ppiest in the routine life of military service; another
in country practice where the strain is rather physical
than mental; a third will delight in the keen contest of
the metropolis, and in its difficulties find wholesome
stimulation. Having selected the line you mean to take,
get under weigh at once. It is often fatal to interrupt a
habit of work by a lengthened dawdling at home or at
sea, or on any road that leads nowhere.
The lazy drifting I have warned you against is usually
done by men in search of what they call a vacancy.
Now let me tell you there are no vacancies in the
medical profession. It abhors a vacuum. You cannoc
book a place in it. Having selected your theatre you
must join the crowd that is waiting, and with a steady
pressure hold your own, or perhaps a little more —when
a door is opened you must put forth all that’s in you,
and try and gain a front place. This you may then
occupy with complacency, and perhaps after a while
turn round and ask, “ "Who are these fellows that are
crushing behind ? ”
I now propose to say a few words on the difficulties you
will find in your way. The first is the necessity of keeping
up appearances. We have already seen that the public
can gauge in only a very uncertain way our professional
skill, and consequently we have to make ourselves loom
as large as possible in their eyes. The painter, the
musician, the litterateur, even the pure scientist may live
and dress very much as he likes—his work goes forth
and speak for itself; the shop-keeper has to advertise,
but he cries up, as a rule, goods that are the work of
other hands than his own; for the medical practitioner
is reserved the temptation—I was about to say the
necessity—of crying up himself.
You may advertise yourself by your hat, by the play
of your facial muscles, by titles, equipages, mansions in
fashionable squares, reports of cases, inaugural addresses
—in a word, by every action which a man may play.
Advertisement with us may be described as a keeping
up of appearances, for, of course, it is by appearances the
public are mainly guided in their estimation of us. I
am not going to run full tilt against advertisement. On
the contrary, I hold that a doctor often cannot do better
than put his money into his own business—first, by
making himself as efficient as possible; secondly, in pro¬
perly setting forth such efficiency. But, at the same
time, I would like to warn you against overstepping the
limits outlined by the experience and good sense of the
wise men who have gone before us.
Before beginning let me ask you to consider the
following pointsFirst, that it is often contrary to a
Die
oogle
Oct. 25, 1899.
CLINICAL RECORDS.
The Medical Pre«3. 423
man’s interests, his pecuniary interest, to be forced too
rapidly into practice. It is one thing to make the public
think highly of you while yon are still behind the scenes,
it is another thing to act up to that opinion. The
proper practice of the profession is a thing slowly
acquired, and although you may have much medical
knowledge and skill yonr reputation in a district may
be irrecoverably ruined by your ignorance of the world
and its ways.
Secondly, success so attained is not like success
honestly won, it leads seldom to happiness. Thirdly,
success may not be reached as early as you calculated
on, and thus, by the necessity of keeping up appearances
that you have made for yourself, you may be landed in
monetary difficulties that will darken your whole life.
The second of the difficulties I have referred to arises
from the impossibility of steering a bee-line in your
dealings with your patients. “ Life,” it has been said,
“ is one of compromise, and what we chiefly compromise
is the truth.”
Now, unhappily in the practice of medicine the truth
at times requires careful handling. I have known a
patient’s pulse intermit one beat on every five on being
told the truth, and I have also known a rash use of that
virtue cause a doctor’s fees to intermit in an even
greater degree.
You must see that this constitutes a most dangerous
situation. The patient gains by our economy of the
truth we also gain, and it is quite possible that what
one began in the patient's interest one may almost un¬
wittingly continue in one’s own. But lest I should be
misunderstood, perhaps I ought here remark that I am
not now in any way reflecting on the general veracity of
the profession to which we belong. That you and I can
hold our heads high is due to the fact that the great
majority of the men who have gone before us have
steered their way safely through the dangers I am
pointing out to you. They were helped in doing so, no
doubt, by a cognisance of them. If you value truth,
be particularly on your guard on those occasions when
you feel yourself called upon to win a patient’s con¬
fidence. If you do not you will find yourself in time
doing, under the cloak of this supposed necessity,
what would be amaziog things to your present eye. In
the first case you are called to you will, perhaps, meet
the following situation: You will find your patient in
his trouble expecting of you two things—a definite
diagnosis and active treatment. I need not point out
to you that the latter of these should wait upon the
former. Now the lamp of science, much as it has been
trimmed of late, does not burn brightly, and as you are
anxiously and slowly trying to find your way by its
light, the only thing you clearly discern is an expression
of doubt on the face of yovr patient and his friends as
to your competence.
In concluding this address I am not sorry at having
to omit reference to professional shortcomings, that
being the way one usually teaches professional be¬
haviour. For a man not to be envied or imitated is he
who takes pleasure in cavilling at the conduct of his
neighbours, and constituting himself the unofficial
guardian of the honour of the profession. When you
feel yourself in that mood ask yourself what would be
your true feelings if the rival practitioner you are
abusing was seen drunk about the streets. If such news
would be, excuse the word, “ nuts ” for you, it will help
ou to gauge how much you have really at heart the
onour of the profession.
(Elimcal Jlccorbs.
TWO CASES OF ABDOMINAL HYSTERECTOMY
FOR CHRONIC FIBROID THICKENING OF
THE UTERUS.
By Chableb Rtall, F.R.C.S.,
Suiveon to the Cencer Hospital, Brompton ; Surgeon to the Gordon
Hospital for Diseases of the Bectum; Surgeon to the Out-patients,
London Lock Hospital.
A.B., tet. 37, governess, unmarried, was sent to me by
Dr. Ch&s. Heaton on August 14th, 1899, and complained
of the following symptoms:—
For the last two years she has suffered from dys¬
menorrhea and menorrhagia, and of such a grave nature
that she is periodically quite incapacitated from following
her vocation. The menorrhagia persisted usually from
about seven to ten days, and during that time the
amount lost was excessive, with the frequent passage of
clots. She also suffered from severe sacral and abdominal
pain.
The catamenia has always been copious, and with a
considerable amount of pain, but two years ago she
suddenly became worse, and since then has been con¬
tinually under treatment. Drugs, rest, and repeated
curetting had been tried but without affording her any
relief. She was, therefore, not only willing but most
anxious to undergo any surgical treatment which would
make her sufficiently well to earn her living.
On examination there was a good deal of tenderness
in the hypogastrium, the uterus was found to be en¬
larged, and reaching just above the pubes, and a small
myoma could be distinguished in its anterior wall. The
length of the uterine cavity was four inches, and the
organ was movable but tender to the touch. I
Hysterectomy was recommended, and met with the
patient's approval.
Operation, September 5th, 1899.—On opening the
abdomen the enlarged organ was drawn out of the
wound, and on examination proved to be very hard and
paler than normal, which was due to an excess of fibrous
tissue, which could be distinctly seen beneath its peri¬
toneal investment. Hysterectomy was performed, leav¬
ing a cervical stump, and the operation was finished in
the ordinary way.
The patient made an uneventful recovery.
E. B., tet. 50, married, was sent to me by Dr. R. H.
King, and admitted to the Cancer Hospital on Sept.
11, 1899, and was said to be suffering from a uterine
tumour.
Two years ago she had a miscarriage, and since then
she has not been well. She complains of constant
sacral pain and pain of a throbbing nature, which she
refers to the rectum, and which is worse on defalca¬
tion. There is a thick vaginal discharge, usually yellow
in colour, but occasionally brown, and sometimes foetid.
Menorrhagia of a severe nature is a great source of
trouble to her; it lasts usually a week, and the loss is
very excessive. Drugs, rest, and repeated curetting had
also been tried in this case, and with a negative
result.
On examination the uterus was found to be retro-
flexed and fixed in Douglas’ pouch, and the fundus
enlarged to about the sire of a cricket ball, and
apparently the site of a small myoma. The os uteri
was patulous, but no tumour could be felt within.
Operation, September 12th, 1899.—On opening the
abdomen the uterus was found firmly adherent in
the pouch of Douglas from which it was liberated, and
also from some adhesions of the sigmoid. On exposing
it to view no tumour could be detected, and the
enlargement was the result of a process of fibroid
thickening which was found in the previous case.
Hysterectomy was performed in a way similar to the
other case. The patient made an uneventful
recovery.
Remarks .—These two cases were brought forward to
show what the operator considered the proper treatment
for trouble of such a nature. The patients were chronic
sufferers, and drugs and repeated curetting had been
tried to relieve them but in vain, and needless to say the
patients were therefore only too anxious to have any¬
thing done that would restore them to health. The
disease was a fairly common one, was inflammatory in
origin, and was frequently traced to septic endometritis.
The pathology of the affection consisted in a thickening
of the uterine wall by fibrous tissue and a partial dis¬
appearance of the muscle elements. A marked thicken¬
ing of the endometrium was also a feature of the disease
He considered hysterectomy as the proper treatment
for these two cases and as the only means that would
effectually restore the patients to health.
by Google
Die
TRANSACTIONS OF SOCIETIES.
Ocr. 25, 1899.
424 The Medical P bebb.
^ransactimts of §actetus.
BRITISH GYNECOLOGICAL SOCIETY.
Meeting held Thursday, October 12th, 1899.
The President, Dr. Macnaughton-Jones, in the chair.
Specimens.
Dr. Macnaughton-Jones showed: —
TWO UTERI REMOVED BY VAGINAL HYSTERECTOMY FOB
INTRACTABLE PROLAPSE.
Case 1.—The patient was set. 38, 6-para. The uterus,
with a fibroid in the fundus, was removed for procidentia
of 15 years’ standing. The bladder was firmly adherent
to within half an inch of the os uteri, and there was
extensive ulceration of the cervix. The operation was
a difficult one. The patient made an excellent recovery
and is now more than a year after the operation, in
perfect health and comfort.
Case 2.— The uterus was removed recently from a
patient, set. 74, for a large procidentia of over 25 years’
standing. There was disease of the cervical endo¬
metrium and attendant ulceration of the sac externally,
bhe had had both pain and great discomfort. Both
bladder and rectum were in the sac. The former viscus
was firmly adherent to the entire sac-wall, reaching to the
os uteri. Hysterectomy was performed, the adhesions
were slowly cleared, and the ureters, being exposed,
were avoided. The rectum had also to be freed pos¬
teriorly from the sac-wall. The vagina was subsequently
curtailed by circular incisions, the bladder and bowel
were returned into the pelvis, and the wound closed by
the union of the peritoneal edges and adaptation of
the vaginal flaps. The patient was making an excellent
recovery.
FIBRO-MYOMA REMOVED BY SUPRA-VAGINAL
HYSTERECTOMY.
This was a large, stony, hard fibroid tumour that filled
the pelvis and reached to the umbilicus. The difficulty
in removing consisted in the pelvic adhesions, reaching
posteriorly to a level with the coccyx. The patient was
anemic, emaciated, and extremely nervous. Myo-
hysterectomy was performed. The delivery of the tumour
was a matter of considerable difficulty, but was even¬
tually safely accomplished, and the patient made a
perfectly satisfactory recovery.
Dr. Heywood Smith observed that in one of the first
two cases the uterus was myomatous, and so could not
be considered as a case simply of prolapse; and he
thought that the term should be restricted to cases of
prolapse pure and simple. For cases of simple prolapse
he thought that ventrofixation was better than h)-sterec-
tomy. In the second case it appeared to him that it
would have been sufficient to amputate the cervix.
Dr. Mansell-Moullin recalled the fact that not long
ago a case was reported at the Society in which hyste¬
rectomy was done for prolapse, and the procedure was
somewhat severely criticised ; but the question of justi¬
fiability need not now be dwelt upon. As to method,
there had been suggested a plan which he thought
would have done well in these cases, viz , extraperitoneal
hysterectomy by means of the serre-noeud. This had the
advantage of conserving the pelvic floor; and in Dr.
Macnaughton Jones’ cases would have avoided the diffi¬
culties attendant on the operation. He had adopted
this plan in several cases with very good results.
Mr. Furneaux Jordan (Birmingham) stated that he
had done vaginal hysterectomy twice for prolapse, which
could not be relieved by pessaries. Both operations were
done about ten months ago ; and both patients had since
returned to hospital with inversion of the vaginal walls, for
which he had to perform plastic operations. Consequently
he did not feel inclined to try this treal ment again. He
hoped that Dr. Macnaughton-Jones’ results would be
more satisfactory. The question arose. What were they
to do in such cases ? In the case of the first specimen
shown it appeared to him that the best plan would have
been removal of the appendages and ventrofixation ; but
he would not advocate ventrofixation in a patient who
might yet bear children. As to the most satisfactory
treatment of Dr. Macnaughton-Jones’ second case, he
thought it was a very difficult question to decide.
Mr. Bowreman Jessett said that in the second case
he would have preferred ventrofixation because of the
difficulty in getting the uterus away; and now that the
uterus was away, the patient had lost some of the support
of her pelvic floor, and prolapse of the rectum or vagina
might follow. Such risks would be avoided by ventro¬
fixation.
Mr. Charles Ryall remarked that prolapse of the
vaginal walls was very rare after vaginal hysterectomy
for tumours; but it was rather more common after
hysterectomy for prolapse. He did not agree with Mr.
Furneaux Jordan’s view that the appendages should
have been removed in the first case; in his opinion the
best plan would have been amputation of the cervix and
ventrofixation.
Dr. Macnaughton-Jones, in reply, said that one of
the chief reasons for not doing a simple hysterectomy in
the first case was the fact that the cervix was unhealthy.
He might have amputated the cervix, but this would
have had the disadvantage of leaving an unhealthy
body of the uterus, which would probably have resulted
in a return of the patienf s trouble to its original condi¬
tion. With regard to the second case, lie hesitated
between ventrofixation and hysterectomy, but decided on
the latter as likely to be the less severe. If the bladder
had not been so adherent it would have been a very
simple operation, but he was deceived as to the bladder
attachments. Nevertheless, he did not think that the
patient would suffer later on from prolapse, either of
the rectum or of the bladder.
Mr. Charles Ryall showed uteri with fibroid
thickening removed by abdominal hysterectomy, which
will be found under the heading of “ Clinical Records.”
Mr. Bowreman Jessett said that these cases raised
two or three questions(a) Was it desirable to do any
serious operation for this condition ? (6) If so, should the
uterus be removed or the appendages? (e) If the
uterus required removal would not vaginal hyste¬
rectomy be better than abdtminal ? (a) With regard
to the first point he had himself adopted with
good results in such cases a milder plan of treat¬
ment—viz., curettage followed by burning out the
endometrium with strong mtric acid, plugging with
iodoform gauze and washing out with bicarbonate of
soda to counteract excess of acid. He would always try
this plan before resorting to hysterectomy. (6) Removal
of the appendages was a less severe procedure than
hysterectomy, and would probably be followed by cessa¬
tion of hffimorrhage. On the other hand he recognised
that after such treatment the nervous system of the
patient might be affected, (r) He would like to know
why Mr. Ryall did not operate by the vagina in pre¬
ference to the abdominal route.
Dr. Walker Smtthe asked whether, if the uterus
had been left in these cases, any great harm would
have resulted to the patient. Not long ago, he had
a case of a woman with a myomatous uterus larger
than those shown by Mr. Ryall; she was anxious to
be operated on, but he persuaded her to wait; and the
fibroid had now got decidedly smaller. It did not
appear to him that there was any great necessity for
the removal of the uterus in such cases.
The President said that the question in these cases
had been admirably summarised by Mr. Jessett. The
most common cause of this condition was hyperplasia of
the connective tissue of the uterus followed by forma¬
tion of fibroid tissue therein. He should not himself
remove the uterus for such a condition, unless there
were also some indication of malignant changes; he
concurred in what Mr. Jessett had said about removal of
the appendages, but this was the course which he would
have been disposed to adopt in the present case. He
would recall to Mr. Jessetrs recollections the fact that
it was over 30 years since Dr. Lombe Atthill advocated
the use of strong nitric acid for this very condition.
This was the only treatment which he himself carried
out for many years, until curetting became more fre¬
quent, and he doubted whether they had gained much
by giving up the use of nitric acid in favour of curetting
in every case, in view of the arrest of htemorrhage
Die
GoogI
e
Oct. 25, 1899.
GERMANY.
Thr Medical Press. 425
and the reduction in the size of the uterus which the
nitric acid brought about. He had heard the treat*
ment adversely criticised, but this was because it was
not carried ont in the manner prescribed by Lombe
Atthill.
Mr. Ryall, in reply, said that he adopted the abdo¬
minal route because he preferred it for two reasons: in
the first place it enabled them to deal much more readily
with adhesions; and in the second place they could see
much better what they were doing. He bad not used
nitric acid in these cases because he did not regard the
condition as a disease of the endometrium, but as a
fibroid thickening of the uterine wall. He did not wait
before operating, as Dr. Walker 8ymthe suggested, be¬
cause the patients were anxious to be put into a condition
in which they could earn their living; and from this they
were debarred by their complaint. Everything had been
previously tried, in the way of palliative measures, but
without result. As regards removal of the appendages,
he thought it was always better to remove the diseased
organ and leave the healthy ones; and hence he considered
it preferable in such cases to remove the uterus.
Mr. J. Furneaux Jordan (Birmingham) read a paper
" On the after results of operations for the removal of
the uterus and appendages,’’ which we hope to publish in
full, with the discussion thereon in our next.
[FROM ODR OWN CORR18PONDRNT.]
Paris, October 22ml, 1899
Essential H.ematuria.
At the Fourth Session of the French Association of
Urology, M. M. Malherte and Leguen read a very
interesting report on Essential Hrematuria.
Up to late years, the papers read on hrematuria were
divided into two classes, essential and symptomatic.
This latter, the more frequent and the better knowD,
depended on some well-defined cause •, while the
former teemed independent of any lesion of the
urinary apparatus and appears to constitute simul¬
taneously symptom and malady. To distinguish that
affection from the other the term, “ essential
hrematuria ” was invented. But could hrematuria
really exist independently of a lesion of the renal
organ or of a more or less established disease? Such
was the question the authors proposed to treat, after
passing in review the different causes of symptomatic
hrematuria, which were of two orders—general and
local.
Infectious Maladies — Hrematuria was frequently
observed in the course of infectious maladies, and more
especially in those cases where the fever ran high; it
constituted, generally the ultimate period of the affection
and rendered the prognosis very grave. The blood
could come from any position of the urinary tract, but
it was probable that the seat of the hremorrhage was
the kidney. Where the cause was local the hrematuria
could derive from the urethra, the prostate, the
bladder, the ureter, or the kidney. Abundant
hrematuria had its cause exclusively in the bladder
or the kidney, and was provoked habitually by
calculi, tuberculosis, neoplasms, or retention, more
rarely by traumatism, inflammation (nephritis) or para¬
sites (hot climates). Such were the principal causes of
hrematuria resulting from a manifest lesion of urinary
apparatus and notably of the renal organ. Whether it
were a case of traumatism (calculus), of inflammation
{nephritis), or of a neoplasm there was a factor which
in the pathological physiology of hrematuria intervened
at each stage ; it was congestion. Congestion played in
urinary pathology a very effective role. M. Guyon had
frequently insisted on that point. It was it which
determined frequently the hrematuria modifying the
clinical aspect of the symptom, and troubling the
practitioner by a disconcerting paradox.
jEssential Hematuria .—After having passed in review
the great causes of symptomatic hematuria, the authors
treated of essential hrematuria, which, in its clinical
characters they said did not present any particular
sign. It was frequently very abundant, so as to produce
anremia, and was rebellions to all treatment. What was
in reality essential hematuria ? In pathology every
phenomenon had a cause, and although the cause could
not be determined, it did not follow that it did not exist.
When hrematuria occurred it should in some way have
its raison d’etre. If it was not found it was because the
insignificant lesion had passed unperceived, and that
lesion was almost in every case to be found in the
kidney, consequently essential hxmaturia did not exist i*
fact.
The predominating character of pseudo-essential
hrematuria was that it did not resemble any of the forms
habitual to that of calculus, neoplasm, or tubercles.
! Abundant and continual, it was not influenced by rest
, or motion, and appeared at first as renal hrematuria,
but other symptoms were sought for in vain.
The treatment of that kind of hrematuria depended on
the cause, but the cause was unknown; therefore an
exploratory incision became necessary to complete an
imperfect diagnosis. It was only in the course of that
incision that nephrotomy or nephrectomy could be
best decided upon.
Total Abdominal Hysterectomy.
At the first meeting of the Surgical Congress held in
Paris last week the subject of abdominal hysterectomy
was discussed. M. Ricard, in a review of the question,
said that abdominal hysterectomy for fibroma was prac¬
tised there last year according to very different methods,
but it might be said that there were only in reality two
principle methods according as the operation was done
with or without previous ligature of the arteries. The
latter method of operating belonged exclusively to
M. Doyen, who removed fibroma from the abdomen
without paying any attention to possible hremorrhage.
Ligature of the vessels, on the other hand, had the
advantage of being applicable to every kind of tumour.
As to the operation itself, surgeons were divided as to
the method. Some maintained that total hysterectomy
gave most successful results, while others, and the speaker
was one of them, considered that a great'point was gained
in not opening the vagina and leaving a stump of the os
behind. To this operation they gave the name of sub¬
total supra-vaginal hysterectomy. The advantages of
the method were considerable; the operation was more
quickly and more easily done, less hremorrhage took
place, and antisepsy was easier to effect. The mortality
was also one-half less than that of total hysterectomy.
Germans.
[from our own correspondent.]
Bbrliit, October Jlst, 1899.
Tuberculin Soap.
(Continued from page 400.)
Another important advantage of treatment by
Digitized by v^ooQle
426 The Medical Press.
GERMANY
Oct. 25. 1899.
tuberculin soap was the painlessness, especially as con¬
trasted with salicylic creosote gauze plaster and caustic
paste. There were some very sensitive lupus patients,
in whom the first parts of the treatment were, on account
of their sensitiveness, very prolonged, and for whom an
entirely painless application was very desirable. There
were also regions of the body that in all patients were
exceedingly sensitive; among these he reckoned the
internal ear. In these parts the acquisition of the
tuberculin soap was a true gain.
The new preparation had proved its value in those
parts where, under certain circumstances, no application
could be made, the mucous passages. For here gauze,
plasters, caustic vapours, green salve, and caustic paste
were very difficult to apply. For the auditory passages,
the nasal openings, the eyelids, lips, and angles of the
mouth the tuberculin soap was better than the other
remedies during the first stage.
It was a natural step to extend this treatment that
had answered for the mucous entrances to lupus of the
mucous surfaces, first to the mucous surface over the
gums, the cheek, the palate, and nasal cavities. The
daily application was less painful than in the case of 1
other remedies. If other applications were not rendered
altogether unnecessary, the field for their employment
was much restricted. In the mucous surfaces the re¬
sorption of remedies was much easier than in the
external skin, and under the simultaneous action of the
soap was still further facilitated. Here, as in the skin>
the most striking results were obtained where a fibrous
new growth was present, as in snout-like projections of
the lips, narrowing of the mouth-opening, and the nasal
entrance.
Finally, he would mention as suitable for tuberculin
soap treatment those oases where heuling was nigh at
hand, where a small remnant of lupus remained, but
which resisted treatment. These were mostly small
circumscribed reddenings, with scale formation, and
which diascopically did not allow any distinct lupus
centres to be recognised. In many cases there was only
a post-lupus eczema-like skin affection, which healed
rapidly under zinc sulphate paste. In other cases these
punctiform remnants were present. Here, it was more
agreeable to the patient, and instructive to the atten¬
dant, to make use of the tuberculin soap. A positive
reaction, as well as a rapid healing, both pronounced in
favour of the tuberculous nature of the affection. But
occasionally a distinct brown lupus centre first appeared,
which could be quickly needled out.
No surprising new fact was brought to light by this
treatment. He had, however, gathered the impression,
in seven of the cases treated, that the tuberculin soap
had achieved more under certain circumstances than a
simple tuberculin vehicle should achieve, and than he
had expected. When following the analogy of the
tuberculin injection treatment, he had expected an
unusually large number of lupus centres for needling
out; he was surpriseed to find that the number was
unusually small. A case of symmetrical lupus of the
nose and cheek showed this fact in a striking manner.
One side was treated with green salve, the other with
tuberculin soap. 8hould it be shown by further
observation that tuberculin soap did more than
tuberculin itself in the treatment of lupus, it would
not be surprising, as the potash soap, forced in along
with the tuberculin, doubtless had a destructive influ¬
ence on the tubercle bacillus, and the more so as the
tuberculin at the same time removed the reaction wall
set up by it. In that case they had indeed in the
combination of tuberculin and potash soap a happily
selected antilupous remedy.
Although at first tuberculin soap was only intended
for tuberculous affections of the skin, after itB success
the limits of its application were naturally extended.
That it exerted a rapid and favourable action in two
cases of scrofuloderma he only mentioned as something
that might be expected.
It was more interesting to him to use it in various
leprous affections. Up to the present he had used it in
six cases of leprosy, with the noticeable result that a
direct therapeutical result was obtained by subcutaneous
infiltration in neuroleprous cases only (2), and not in
the cutis lepromata (4 cases). In the two neuroleprous
cases by the due application of the tuberculin soap
alone he had obtained a striking improvement, until the
whole spur had gradually taken on the appearance of a
thin white atrophied Bkin free from leprosy. In cutis-
lepromata it only hastened complete resorption after
previous destruction of the surface with caustic paste;
but for this subordinate rdle we possessed so many other
good remedies, that the tuberculin soap need not be
considered. A good result was, however, obtained in
the fibromata and cheloids of lepromata, that had been
burned with caustics.
After lepra the behaviour of tuberculin soap in the
treatment of ulerythema Antrifugum (improperly so-
called lupus erythematosus) interested him. Up to the
present he only had the opportunity of employing it in
two cases. The result was not so favourable as in lupus,
a severe acute inflammation took place with swelling,
and to some extent profuse serous exudation, but after
its disappearance the ulerythema showed itself no better.
The remarkable effect of tuberculin soap on fibrous
sclerotic lupus, and the healing of cauterised lepromata
led the speaker to use it on the firm sclerotic patches of
tertiary syphilitic origin. Here also the result corre¬
sponded to the expectation (three cases). One was a
case of extensive gummatous swelling near the knee, in
a woman who could not bear iodide, and on whom
mercury, long continued, had no effect.
The local application of mercurial gauze plaster had a
decidedly good effect, but a rapid and permanent cure
was only obtained when this treatment was combined
with the tuberculin soap applied twice daily. The
extremely firm tissue mass melted away, or became
absorbed. Particularly striking was the effect of the
tuberculin soap on the firm sclerotic cords passing
through the skin, and attached to the fascia and
periosteum. In another case of obstinate periosteal
gumma of the tibia, sudden softening and rapid absorp¬
tion took place.
After those experiences, he had recently tried the
tuberculin soap on cicatricial cheloid (two oases; burns
and surgical operations). The result was a slow, but an
unmistakable improvement. First of all softening of the
cords took place, and then resorption.
He had also tried it in. lichen and glandular tumours,
but without special result; but he had never seen any
harm result, event when the 20 per oent. strength had
been used for months. He could, therefore, recommend
the tubereulin soap to specialists and practitioners for
the dermatoses mentioned as a form of tuberculin as
agreeable as it was active.
Digitized by Cj ooole
THE OPERATING THEATRES. The Medical Press. 427
Oct. 25, 1899. _
Austria.
[from our own correspondent.J
Vienna, October 21st, 1899.
Acute Ltuph^mia.
At the Medical Club, Pineles recorded a case of
lymphsemia of Borne interest owing to the great age (73)
of the patient; she had never been ill and confined
to bed at any time before, and could do her house-work
actively up to three months ago, wheu she was suddenly
attacked with headache and high fever. She recovered
in a week or fourteen days, but was not strong enough for
her domestic duties, and finally had to return to bed with
pain in head, breast, &c., when she was removed to
hospital complaining also of a “discharge of matter from
her chest,” dulnesa in the head and general confusion
On her reception the musoles were observed to be lax,
and the adipose tissue fairly retained, with pain over ster¬
num when pressed, as well as in both legs. Temperature
37'2 deg8., pulse 100. The radial artery had a serpen¬
tine movement: vesicular sounds in upper part of lung;
cardiac sounds dull; liver enlarged downwards with
rounded edges. The spleen extended three fingers’ length
below the ribs, and was not painful on pressure. The
glands of the throat, axilla, and groin were all enlarged-
The flexor Bide of the forearms had small hiemorrhages’
ranging from the size of a linseed to a sixpence, gums
swollen and bleeding, ai well as lower surface of the
tongue, fundus of the eye normal, urine much nucleo
albumin, but no serum-albumin.
The next day consciousness became dulled with tetanic
spasms in both arms. On the lower extremities several
small haemorrhages; highest temperature, 33 7 degs.
After this the weakness and delirium increased, and she
died nineteen days later.
The enlargement of the liver and spleen with
haemorrhage from the teeth and skin pointed to leucaemia.
Examination of the blood gave 3,550,000 erythrocytes and
560,000 leucocytes in the millimetre of blood. The pro¬
portion of white to red being 1 to 0J. The red blood
corpuscles had nothing special in size or form; rouleaux
in small masses, and the fibrin slightly netted. White
corpuscles somewhat small; preparations with eosin
hiematoxylin and Ehrlich’s tri-acid mixture gave 92 per
cent, of large leucocytes ungranulated and Rmall
lymphocytes, 3 3 per cent, common neutrophile poly¬
nuclear leucocytes,0-0 percent, polynuclear eosinophile
cells; poikilocytosis was not present, nor were there
any nucleated red cells. When coloured with fusch-
ine none of the cells showed basophile granulation.
The post-mortem revealed skin white, no oedema,
lymph glands of neck enlarged, as well as those of
axilla and groin, but nowhore adherent to the
skin. In the left pleura slight fibrinous deposits,
lungs full of blood, both upper lobes lobular pneumonia
Pericardium slight fibrinous deposit, heart en¬
larged containing blood of light colour. Liver
one and half times normal size, of a yellow,
brown colour, friable, numerous white spots with inter¬
lobular division. The spleen was eight times its normal
size, and had a reddish grey colour, in section and
lymphatic glands, white patches. The kidneys
were bleached and soft; retro-peritoneal glands
swollen while the marrow of the bones was red and
almost free of fat. Microscopically the lymph glands
were hyperplastic but normal in structure. The lymphoid
cells had nothing peculiar, and nowhere were there any
abnormal conditions except a deposit of lymphocytes from
the blood. A similar condition was present in the spleen
The most prominent changes were in the bone marrow,
which was largely composed of lymphatic tissue, with great
and small granulated lymphocytes in the form of nests.
The common granulated polynuclear leucocytes and the
eosinophile cells were quite separate. It was therefore
concluded that the structure of the marrow and the
lymphatic apparatus of the blood were the cause of the
disease which might be termed acute lymphromia. It is
usual to designate chronic leucaemia as myelogenic
leucaemia when the myeloid changes of the lymphatic
glands and blood are at fault, while lymphamia, accord¬
ing to Muller, is oonfined to the haematic organs.
Etiologically, several hypotheses are offered, (a) In¬
fection, which is inferred from the rapid prostration, and
in this case supposed to be latent. This was absolutely
negatived by injecting two guinea pigs with 10 cc.
of the patient’s blood, when no changes were pro¬
duced in the animals' blood. The same negative results
followed inoculation. ( 4 ) The second hypothesis in acute
lymphiemia is attributed to the polynuclear leucocytes
in the blood l>eing greatly diminished, which is the more
probable explanation in this case.
%ht ©perating theatres.
ST. THOMAS’S HOSPITAL.
Abscess in Connection with Appendicitis. —Mr.
Anderson operated on a girl, let. 13 , suffering from pain
in the right iliac fossa and fever. On examination
fulness with muscular tension was found over the posi¬
tion of the cffcum and along the line of Poupart's
ligament as far as the internal inguinal ring. The
patient had had no intestinal symptoms, but a vaginal
discharge had set in on the day preceding the operation.
A diagnosis of appendicitis was made with some re¬
servation, as the symptoms might have pointed to
salpingitis. An incision was made about 2) ins. internal
to the anterior superior spine and extending down¬
wards along the upper half of Poupart’s ligament
and upwards for a distance of 1$ ins. On reaching the
subperitoneal tissue a small abscess was found close to
the internal abdominal ring apparently not communi¬
cating with the peritoneal cavity. The pus was
evacuated and the cavity temporarily plugged with
cyanide gauze. The peritoneal cavity was then opened.
The appendix was found surrounded by inflammatory
adhesions running downwards and inwards, the tip
becoming adherent to the parietal peritoneum at
the internal inguinal ring at the point opposite to
which the subperitoneal abscess had formed. No pus
was found in the peritoneal cavity. The appendix was
removed in the usual manner. It was found to be in a
state of catarrhal inflammation, and contained a small
fajeal concretion. The peritoneal wound was carefully
sutured, the lower end of the incision through the skin
and muscles being left open for drainage of the abscess
cavity. Mr. Anderson remarked that the symptoms
were obscure, and that it was difficult to make a positive
diagnosis between appendicitis and salpingitis. The
condition revealed was peculiar in that the diseased
appendix which ran in an unusual direction had led to
Digitized by LjOOQie
428 I'm Medical Pbess. THE OPERATING THEATRES.
suppuration in the subperitoneal tissue, while the peri¬
toneal cavity showed no sign of pus, although consider¬
able inflammation had been going on around the affected
structure.
A week after the operation the patient was going on
satisfactorily.
WESTMINSTER HOSPITAL.
8upba-Condyloid (Stokes-Gbitti) Amputation of
the Thigh fob Myeloid Sabcoma of the Tibia.—
Mr. William Tubnbb operated on a man, ret. about 32,
wno had a large swelling in the upper end of his right
tibia, which extended down the bone for at least six
inches; its surfaoe was irregular, soft in parts
and hard in others, and on the outer side extended nearly
to the head of the fibula, where it was soft and dis¬
tinctly pulsating; the skin was unaffected, and there
was no oedema, but there was marked local heat in the
region of the swelling; the temperature, however, was
normal, the knee-joint was unaffected, and movements
were fairly good, though extension of the joint produced
pain; the muscles of the leg and thigh were
very wasted; the glands in the groin were unaffected.
The patient stated that he had had pain for
nearly ten months; that he recently had an
injury, after which he noticed a swelling; the
original aching pain in his leg had at first been
ascribed to varicose veins, but although the subcutane¬
ous veins all over the swelling were enlarged at the time
of admission, there was no definite disease of the veins.
During the week following admission the swelling had
increased about an inch in circumference. A photograph
by the X-rays taken of the limb showed that the
upper half of the tibia was affected by a mass
not so opaque as the ordinary bone. About 2 ins.
from the head of the tibia there appeared to be
a fracture of the compact portion of the bone as indi¬
cated by an irregular clear break in the shadow. As the
diagnosis was clearly that of myeloid sarcoma, and the
extent of the disease far too great to allow of excision of
the growth, amputation was decided upon. After the
administration of an anaesthetic, a tourniquet was
applied about the middle of the thigh, and, the usual
antiseptic precautions being taken, a horse-shoe shaped
incision was made from the posterior part of the
internal condyle of the femur downwards, and then
across the head of the tibia just above its tubercle and
up on the outer side to a corresponding situation at
the external condyle ; the skin and subcutaneous
tissues were dissected up in this flap to the upper
border of the patella ; the posterior flap was made
by joining the ends of the first incisions by a
straight cut at the centre of the popliteal space, this flap
was dissected up about 5 of an inch in all. The ligamentum
patellae was then divided close to the head of the tibia,
and the knee-joint opened at the same spot. The
ligaments and tendons on the inner side were next
divided, and the same procedure adopted on the other side;
the knee-joint being then flexed the crucial ligaments
were next cut across, and all the structures in the
popliteal space finally divided by one sweep of the
knife, care being taken not to injure the posterior flap.
The patella was then held up, and the condyles of the
femur cleared for the saw, which was put on just at the
unction of the condyles, and the shaft, i.e., just above
the position of the adductoz tubercle. The sidee of the
Oct. 25, 1899. _
patella weie then cleared, and the ligamentum patella.'
being firmly held upwards by a pair of lion forceps, the
cartilaginous portion of the bone was removed by a fine
saw. The patella was then fitted against the sawn
ends of the femur, to which it adapted itself
perfectly, and was fixed in its new position by
means of two stout pieces of kangaroo tendon
passed through the patella and through the femur twice
on either side in the eame manner as a Halstoad’B stitch.
The part of the ligamentum patellte 'that had been
held in the forceps was removed. The large vessels
were then picked up, and the popliteal nerves
cut short, the tourniquet was then removed, and
all bleeding arrested. The wound was stitched up
by means of three fairly thick silk sutures,
and then a continuous fine silk suture brought the
edges of the skin into apposition; a drainage tube
was inserted in the centre of the in vision to drain what
remained of the popliteal space, and a dressing applied.
Mr. Turner said that the reasons for which he chose this
operation in preference to any other were: that a
Stephen’s Smith amputation through the knee-joint was
in this instance impossible as the growth was so super¬
ficial, and had so evidently penetrated the periosteum
of the tibia that the flaps required could not have been
made without going through sarcomatous tissue. There
was also the danger that the knee-joint itself might be
involved (but this proved at the operation not to be the
case), the other amputations through the condyles, namely,
Carden’s or Lister’s modification of it have, he
pointed out, the disadvantage that the end of
the stump is much larger than the rest of the femur,
and the bone is only covered by the skin flap, and
it is generally stated that patients are often unable
to bear weight on the end of the stump ; the disadvan¬
tage of Gritti’s amputation is that the patella does not
fit on to the lower end of the femur, and in the majority
of cases tilts forward, and so bony union does not occur
between tbese bones. Stoke’s modification of this
operation consists in the removal of the condyles, so
that the patella when affixed to the end of the femur
forms a complete covering to the end of the bone, and
on account of this slight decrease in length of the femur,
the liability to the shifting is reduced to a minimum if the
bone is firmly stitched in position. The scar is posterior,
and well outof the way of all pressure. The only disadvan-
tagehe pointed out to the operation consisted in the fact of
the surgeon having to leave the sub-crural pouch of
synovial membrane behind which might give rise to
some trouble if it became inflamed ; he also added that
if by any chance antiseptic precautions were not com¬
plete in such an operation this pouch would be a source
of great difficulty to the surgeon and danger to the
patient.
It is satisfactory to state that the patient was dis¬
charged convalescent three weeks after the operation,
although he had rather severe oozing from the wound
for the first 24 hoars, this was controlled by pressure
and elevation of the limb. The drain tube had to be
kept in longer than usual owing to the space it was
draining being filled with blood clot. During the second
week the patient was able to have the end of the stump
knocked with the flat of the hand without feeling any
pain.
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Per. 25, 1899.
LEADING ARTICLES.
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“ SALUS POPCLI SUPREMA LEX.”
WEDNESDAY, OCTOBER 25, 1899.
THE SCIENCE AND ART OF EDUCATION.
“ Doctrina vim promovet insitam.” In these
/our words the great principle of education is stated .
doctrina, or teaching; promovet, promotes ordevelopes
vim insitam, the inherent energies or qualities of the
pupil. And if we make Doctrina a predicate, as pro¬
bably Horace, philosopher as well as poet, would have
allowed, we should say that any system of education
that does not follow this principle is not doctrina at
all, but is dangerous and injurious in its exercise. If
we limit ourselves now to the consideration of how
to carry out this principle in respect to the educa¬
tion of those who intend to devote themselves to the
profession of Medicine and Surgery, we may assist
both the teachers of the young and their parents,
in the development of the vim insitam. We should
advise both to examine carefully whether this exists,
and is of such a nature as probably to repay the
culture bestowed upon it, when the object in view is
the practice of medicine. What are the qualities
which fit a man to be a good doctor ? They differ
much from those required for a good lawyer or a
good man of business. We won’t say for a good
clergyman, for in the character of such a man
as the late Bishop of Bloemfontein we see the
doctor and the clergyman may be combined in one
person. The moral and mental and physical qualities
require each of them to be carefully studied before
the system of teaching is commenced. A good
hand and a good eye, and a firm but gentle nature,
are necessary for the profession of medicine. Those
peculiar mental qualities which distinguish the
classical scholar from the mathematical, are neither
of them of special value to the physician or
surgeon. In the study of such a complex organism
as the human body but little assistance is gained from
the study of the language and literature of the past;
and if we look back to the lives of those who have
been distinguished in the profession we find no evi¬
dence of great mathematical power. Indeed, where
it did exist, as in such men as Thomas Young,
Woollaston, and a few more, the tendency they
showed was to leave the science and art of medicine
for the more exact and satisfactory subjects included
in the general term mathematics, or to Borne branch
of exact science. The question of education is one
really in which the Profession ought to take a great
interest, for none are so well qualified to analyse
the vim insitam of the young as those that have
had to treat them, and their parents, professionally.
There is an idea which to some, indeed, to many,
seems very clear, and that is, that in education the
chief point to keep in view is the “ training of the
mind.” At most of our schools it is considered
“bad form” for a boy to say what he is going
to be, or for the masters to have anything
to do with this. Even at our universities the same
spirit prevails, and the Doctrina mentis in college
is conducted very much on the same principles as the
doctrina Corporis on the livers. A young fellow when
in training has no idea of ever making anything in the
way of earning a living from it. Thus the training of
the mind and the body are separated, and to some
extent are opposed to one another; at least, they used
to be so more than during this last half century.
But when we ask what is meant by training the mind,
we are generally met with a placid and somewhat
contemptuous refusal to go into such a matter.
To ask such a question is regarded as an
evidence of the greatest ignorance. One
naturally feels disposed when the expression is
used to ask what’s to be done if there isn’t any mind
to train, so far at least as Greek, Latin, and mathe¬
matics are concerned. There is no use in arguing
this question with the mind-trainer, and the best
plan is to leave him alone. It is very important for
us to consider to what extent knowledge of various
kinds is learnt from books and words. Classics and
mathematics can be learnt from them ; but when we
come to deal with the teaching of any arts where
technical skill is required it is a very different
matter. It is not by words or books that
music, painting, engineering, surgery in all its
branches, and, lastly, medicine, will be learnt.
On what “ vim insitam” will the “ doctrina ” of any
such sciences as chemistry, geology, or astro¬
nomy depend except on the organ of sight. For
a classical mastev to treat the subjects generally
classed under the term natural science with in¬
difference, is to disqualify him completely from
directing the education of those whose vis insita
justifies them to excel in the study of science. This
is the point to which great attention ought to be
given; and it is chiefly, we believe, because our
American cousins have not neglected it that we find
they have been making progress in those improve¬
ments which attract the attention of visitors from
this side of the Atlantic. In the interests of the
Digitized by LjOOQle
430 The Medical Press^
young, who will have to support themselves by their
work and have no capital to fall back upon, the pro¬
fession ought to exert itself in providing for better
education than is at present afforded in the great
middle class of this country.
THE CONTROL OF NIGHT SHELTERS.
During recent years the attention of sanitarians
has been repeatedly drawn to the presence of a new
danger that has arisen in the midst of the community,
namely, the establishment of charitable or pseudo-
charitable night shelters for the vagrant and destitute
poor. The absolute necessity of stringent control in
the case of the common lodging-houses has been
recognised by the legislature, which has provided, in
the Public Health Act of 1875, for the registration :
and the enforcement of a good structural and
sanitary standard by the local sanitary authorities.
In the new class of shelters; founded on professedly
philanthropic motives, a charge ranging from one |
penny to sixpence per night is almost invariably ,
made in return for the accommodation afforded.
That the majority of these institutions yield a sub¬
stantial margin of profit appears to be a reasonable
conclusion when we take into consideration the rents
and working expenses that can be estimated with a
tolerable degree of accuracy. Besides, if the common
lodging-houses can cany on their business at a profit
in spite of the cost of compulsory conditions of
tenure, it surely stands to reason that their pseudo-
charitable competitors, who have no limit and no
costly sanitary standards, will also show a profit side
to their ledger. The fact is that some of the
Salvation and other shelters are common lodging-
houses in all but name. They have kitchens and
general rooms for the use of all comers, who pay in
some instances a larger sum, sixpence to wit, than
that required by the common lodging-house keeper.
On the other hand the pseudo-charitable shelters are
practically outside sanitary control. They are :pen
to the visits of the Medical Officer of Health cmy in
the day-time, that is to say, when the places are
empty. At night, official admission can be gained
only as a favour, or by virtue of a magistrate’s warrant
when a nuisance is suspected to exist. From
these statements it will be clear that the
“ shelters ” are free to do as much or as
little as they like by way of absolute sani¬
tation as regards their inmates, or relative
sanitation so far as the outside community is con¬
cerned. There is abundant evidence that serious
abuses exist in these institutions. In July, 1895, a
conviction was obtained by the Medical Officer of St.
George’s, Southwark, for gross overcrowding in a
Salvation shelter situated in his district. In the
last serious epidemic of small-pox in London, no less
than thirty-nine cases of infection were traced to
night refuges belonging to the same body. Lastly,
the London County Council has issued a report which
discloses all kinds of structural and administrative
shortcomings in the shelters of the Metropolis. The
County Council secured a promise in April, 1898,
Oct. 26, 1899. _
from the Local Government Board, that a Bill for
the consolidation and amendment of the Common
Lodging-houses Acts would be prepared forthwith.
However, the Government that has been strong
enough to pass the revolutionary and retrograde
measure abolishing compulsory vaccination, has
apparently not found sufficient energy or leisure
to bring forward an urgent and comparatively
simple reform. The reason is possibly political :
the anti-vaccinators are a small but clamorous
and united body; the medical profession is
without any organisation or voice capable of affect¬
ing Parliamentary elections. The Salvationists and
other bodies that found the shelters have, as a rule,
perfect union and far-reaching social influence. The
day of reckoning, however, cannot be far distant,
for the existence of these officially-controlled collec¬
tions of vagrants in the midst of our great centres of
population cannot be much longer tolerated. Unfor¬
tunately, the law dealing with them is uncertain-
The London County Council recently summoned for
failure to register as common lodging houses one each
of the Rowton and the Victoria Homes and a Salvation
Army shelter as test cases. In each instance*
the application was dismissed with costs. The magis¬
trate decided that the Rowton Home was not a
common lodging-house, and that both the Victoria
Home and the Salvation Army premises were charit¬
able institutions. While he agreed that there was
nothing in the statute to confine its remedial action
to commercial undertakings, he felt bound to decide
the case on the terms of Booth v. Ferrett, in which
it had been laid down that a common lodging-house
must be kept for purposes of gain. It is satisfactory
to know that the County Council will carry two of
the cases to the High Courts. As regards the
Victoria Home the magistrate was satisfied that
although a profit was made, the home was not
kept by a person or persons for the purposes of gain.
It seems to us that before these extraordinary para¬
doxes are accepted by the public they have a right
to demand authenticated balance sheets from all
the bodies who profess themselves to be philanthro¬
pists, but who, nevertheless, made profits out of the
pence of the most destitute class of the community-
Well may the common lodging house-keepers call
out against the partiality of the law towards his
pseudo-philanthropic rival. In the interests of the
public and of systematic prevention it is to be hoped
that this question of the control of night shelters or
refuges will be speedily settled upon a firm legislative
basis.
THE HARVEIAN ORATION.
It must be a difficult question for the Fellow of the
Royal College of Physicians, London, who is
honoured with the appointment to deliver the
Harveian Oration, to decide how he ought to treat the
subject. There is a natural tendency to exaggerate
the claims of a great man of the past upon the
gratitude of the present, when those claims are put
forward in an address to a meeting called for the
LEADING ARTICLES.
Digitized by v^ooQle
NOTES ON CURRENT TOPICS.
Oct. 26, 1899.
purpose of hearing a panegyric in their laudation.
At the College of Surgeons the memony of John
Hunter as a surgeon and anatomist is once a year
thus treated; while at the College of Physicians, the
memory of William Harvey as the discoverer
of the circulation of the blood, and as a
physiologist, is kept alive by an oration. So
much has been said about the discovery itself
and the claims of Harvey to honour for discovering
what was new and original that nothing can be
added to what has been don*» in this direction.
This year Dr. Poore has chosen to analyse the
motives which prompted Harvey in the work he
loved to do. and to hold him up as an example which
now and at all times must be followed by those who
desire to add to human knowledge. He dwelt upon
the glorious pleasure derived from the study of
Nature as being beyond that afforded by any other
occupation in life, and how the value of research and
experiment exercised in freedom from fancy and
imagination, is of the greatest influence in raising
the mind above the lowering tendencies of much that
attracts and occupies the world in general. The
Oration was delivered with grace and dignity, and
was appreciated highly by those who listened to it.
There could have been very few who regretted the
change made in 18*55 from Latin to English, and the
support it received from Sir Thomas Watson, when
he was president, may be recognised as evidence,
that high scholarship may be combined with good
common sense. Dr. Poore’s text was, in the words of
Harvey’s gilt, “ to search and study out the secrets
of Nature by way of experiment.” But this was not
so much the purpose for which Harvey intended the
oration, as that it should be in “ commemoration of
all the benefactors of the said college, with an
exhortation to others to ‘imitate these benefactors.’ ”
We fear that the reason why this purpose of the
Annual Oration has received but little attention is
because there has been little reason for its doing so.
Why so few should leave anything when they could
well afford to give generously, and when they must
be aware how little the College possesses, it is diffi¬
cult to understand. In the City we see a very
different spirit prevailing, and it would be well for
the Harveian orators in the future to exhort others
to “ imitate ” far more than they do. Harvey was
not the man to want his name extolled to the skies,
“ for to do so would not be to search and study out
the secrets of nature.” The spirit in which he worked
requires encouragement as much to-day as in
Harvey’s time, and we hope this will be kept in view
as Dr. Poore has done, by future Harveian orators.
.ilotes ott Current topics.
Instruction in Dispensing.
One of the most serious arguments advanced by
pharmacists in their attack upon the practice of
allowing medical men to dispense their own medi¬
cines is the utter inadequacy of the instruction pro¬
vided by our medical schools in that department.
Thi Mkdical Pbk8B, 431
Some half-dozen attendances in the dispensary is
usually all that is demanded of the student, and as
the dispenser in chief has his hands full of other
work it can easily be imagined that the future
practitioner escapes with a modicum of practical
teaching. Even a diligent student under the most
favourable circumstances cannot be expected to
obtain much insight into the practical details of
pharmacy, nor do we see how it can lie otherwise.
To allow every tyro to educate his hand by assisting
in the dispensing department of public institutions
would be to court disaster. There is really only one
way to learn dispensing other than by putting in
time with a retail chemist, and that is in the surgery of
the busy practitioner, but this unexceptionable way
opportunity was virtually wiped out of existence by the
General Medical Council when the abolition of the old-
fashioned apprenticeship was decreed. It is still open
to the senior student, it is true, in his last year, to avail
himself of this opportunity, but the fact remains that
but a infinitesimal proportion of the general body of
students do avail themselves thereof, and as a rule
the newly qualified man has to learn it as best he
may on commencing practice. It seems to be for¬
gotten that dispensing is an indispensable depart¬
ment of the practice of medicine, even though the
practitioner may not take up a class of practice in
which dispensing is admissible. A practical know¬
ledge of pharmacy is a necessary step to writing
good workable prescriptions, and the decay in the
standard of preemption writing which characterises
the present generation of medical men is directly attri¬
butable to their want of instruction in this department.
The result is seen in the ever increasing disposition to
have recourse to ready-made preparations of which
the manufacturing chemist is yearly becoming more
profuse. In France, where dispensing has always
been more or less tabood, the empire of the specialty
is absolute, and prescribing proper is a lost art. We
are not concerned to deny that dispensing “ pays,”
but that fact, if fact it be, is rather another argument
in support of the contention that better provision
should lie made for teaching it. What with doctors
who have never learned to dispense, and unqualified
dispensers who have had no practical training in
their duties, it is something to be thankful for that
accidents are so rare, and disaster so infrequent.
Room ought to be made in the curriculum for the
subject, and we would appeal to the members of the
General Medical Council to see that the subject re
ceive the attention it deserves.
A Protest Against What?
Dr. W. W. Keen, of Philadelphia, is one of the
rare American surgeons who do not believe in
eliminating every appendix which makes its presence
felt. At a recent meeting of the American Medical
Association he declaimed as follows :—“ I protest
against the argument that every case of appendicitis
ought to be operated on, and that the appendix
is never to be left. Out of 300 post-mortems on as
many bodies it was found that 100 of the in¬
dividuals had had appendicitis at some time in
Digitized by Google
432 The Medical Feess.
Oct. 25, 1899.
NOTES ON CURRENT TOPICS.
their lives and had all recovered from the disease.
I dispute the assertion that through surgical
operations all but 2 per cent, can be saved. I
challenge any operator in the room to take 100 well
persons, and operate upon them without killing more
than 2 per cent. We all fail, gentlemen. I do not
know why, but we all fail. I do not believe in opera¬
ting on all sorts of appendicitis. I’d rather have a
live man with an appendix than a dead one without.
I do not believe with the witty Frenchman that no
case is complete without an autopsy. If the patient
is no worse after forty-eight hours of observation,
let him alone, let him get well." We cannot but
wonder what windmill this medical Don Quixote is
tilting against. Whoever, in the land of Nicholas Senn,
advocates operation unless (1) the condition is of
itself serious, or (2) has recurred on several occasions?
We have never heard anyone advocate removal of
this intestinal tag for a first offence, unless of a very
heinous description, and if it prove incorrigible—by
medical treatment—there is nothing for it but to
pluck it out.
The Rating of Hospitals.
We have received a number of communications
concerning the proposed exemption of hospitals from
rating, a subject which we dealt with last week. It
is pointed out that to exempt a hospital from the
payment of rates is tantamount to making a donation
to the funds of the institution equivalent to the
amount which would otherwise be paid. This, then (
is the first step-in the direction of the muuicipalisation
of medical charities but with this disadvantage—
that whereas if the municipality voted a certain
sum per annum to the funds the gift would
convey the right to be represented on the manage¬
ment which mere exemption from rates does not.
Then, too, it is urged that there are other charities
besides hospitals, which, once the thin edge of the
wedge introduced, might reasonably claim to have
similar treatment meted out to them, and this
would land us in a dilemma, because many of these
charities are more or less denominational in
character, and if any claim were admitted, the others
must necessarily follow. A more practical sugges¬
tion is that a better means of helping these institu
tions would be to agitate for the remission of the ten
per cent, legacy duty which is now levied by Govern¬
ment on all bequests for charitable purposes, and in
this we heartily concur.
Public Health and the Profession.
Doubtless the editor of the Public Health En¬
gineer is wise in looking to the medical profession
for aid in carrying out those reforms in all matters
affecting the public health, and which require
care and study. It cannot be questioned that
the profession generally, particularly the younger
members of it, are devoting attention to those
necessary evils which arise in great towns, and
which are the cause of much illness. No class
of men are so well prepared to study matters
of public health as those who have entered the pro¬
fession and if we look back to the chief influence that
has been exerted during the latter half of this
century on the advancement of sanitary science, we
see how much is due to our profession. The Public
Health Engineer will be found to contain a great
deal that must be of interest to all practitioners
particularly those who are required to consider in
their practice the maladies which arise from over¬
crowding and other injurious conditions common in
crowded communities. Through the profession the
public is more likely to be educated in such matters
than in any other way, and we think that it will add
to the esteem in which the public holds it if it assists
in this work of education.
The New Entries at the Medical Schools.
The returns of the new entries at the medical
schools in England has just been issued, and,
judging generally from the numbers, a falling off is
noticeable in this respect. In the London schools
St. Bartholomew’s heads the list, as usual, with 115
new students for the whole curriculum ; next follows
the London, with 83 ; Guy’s, with 79 ; St. Thomas’s,
with 59; St. Mary’s, with 50; University College, with
36; St. George’s, with 27; Charing Cross, with 20;
Middlesex, with 24; King's College, with 21 ; West¬
minster, with 17; and the London School of,
Medicine for Women, with 17. In the provinces;
Cambridge University claims 141 new entries
Owens College, Manchester, 76; University College>
Liverpool, 58; University of Durham. 32. This
Northern University seems to have fallen upon
evil times. A few years ago it had an entry of 1,198
students for the whole course. Why, then, this retro¬
grade record? Of the Metropolitan schools the most
successful list is certainly that of the London
Hospital. Apparently, the profession, as well as the
public, appreciate the forward policy which has
been displayed in the management of the institution.
The small entries at several of the other schools is
suggestive of the reflection that the authorities con¬
cerned must have a very difficult matter in making
both ends meet.
What is Fibrinous Rhinitis ?
A diffbrence of opinion exists among throat
specialists as to the real etiology of what is called
fibrinous rhinitis. In a paper fully discussing the sub¬
ject, Wishart, of Toronto, in the current number of
the Canadian Journal of Medicine and Surgery, quotes
Lennox Browne and Walsham in this country, and
Bosworth in America, to the effect that the disease is
a benign one, distinct from diphtheria, and that it is
non-contagious. On the other hand, Ravenel, of
Philadelphia, holds that “ patients suffering from
fibrinous rhinitis are always a possible source
of contagion, and that they should be isolated
like those affected with the more common
types of diphtheria.” Thus two practically
divergent views are held respecting the etiology
of the disease. The author, in describing his
own cases, states that they were certainly
diphtheritic, but of an unusually mild character. He
Digitized by V3 ooQle
Oct. 2i», 1899. NOTES ON CURRENT TOPICS. The Medical Press. 433
further adds that in a collected series of ninety-eight
cases the Klebs-Loeffler bacillus was present in sixty-
nine. This result is again at variance with those
who affirm that this bacillus is never found in cases
of the kind. From his observations, then, he sub¬
mits that the accumulated evidence seems to prove (1)
that fibrinous rhinitis and diphtheria are not distinct
diseases; (2) that all cases of the disease need the
Bame precautions as to isolation that diphtheria
requires. It is curious that such diversity of opinion
should prevail in regal'd to this disease.
The Guild of St. Luke.
The Annual Festival Seiwice of the Guild of St.
Luke was held at St. Paul's Cathedral on the 19th
inst., and was largely attended. The Lord Mayor
and Sheriffs were present in State, accompanied by
the chief officers of the Corporation and members of
that body. In the procession which passed up the
nave the members of the Guild and their friends were
robed in their various coloured gowns, and a very
striking scene was thus produced. A choir of three
hundred voices, furnished by the London Gregorian
Choral Association, rendered most efficiently the
musical part of the service. The sermon was
preached by the Bishop of Stepney, the Canon in
residence, his text being : “ Jesus went about all the
cities and villages, teaching in their synagogues, and
preaching the Gospel of the kingdom, and healing
every sickness and every disease among the people."
In drawing a comparison between the clerical and
the medical professions, the Bishop proceeded to
discuss how the two professions might draw
closer together, expressing the opinion that the
clergy should bear more in mind the value the
medical profession placed on accurate observa¬
tion. If the training of doctors, he said, made
them on that account more slow to accept the truths
of religion, then the clergy should sympathise and
appreciate that. Still, medical men should bear in
mind that there was a science of medicine as well as
a science of theology. The reasons, for example, for
the clergy believing in baptism were based on as
sound deductions as the reasons the doctor had for
believing in vaccination. All the truths of religion
required as much balanced thought and deep studies
as anything taught in the hospitals. The Bishop
incidentally mentioned that the late Bishop of
Bloemfontein was the only clergyman who was a
Fellow of Royal College of Physicians (London). The
discourse was listened to with keen attention, and the
appositeness of many of the points to which expres¬
sion was given must have been forcibly impressed
upon the audience which thronged the cathedral.
Leicester Triumphant.
The citizens of Leicester are triumphant, inasmuch
as the official returns for the week ending October 14th
showed a remarkable reduction in the local mortality.
The number of deaths in the town was only 49, or a
decrease of 11 as compared with the corresponding
week of 1898. Thus “ au almost ideal death-rate,” as
the Leicester Daily Post described it, of 12 per 1,000
was attained. Despite, however, this apparently
strong proof of the salubrity of the town, diphtheria
seems to be very prevalent, a condition of things which
should surely be capable of impi-ovement. The people
of Leicester are, nevertheless, to be congratulated upon
the lowness of the death-rate, and hence it is that
regret must l>e felt that they cannot forego the absurdity
of ignoring the vaccination laws. Of this the towns¬
people may rest fully assured, that by courting an
epidemic of small-pox by refusing the protection of
vaccination, their “ ideal death-rate ” is likely before
long to be speedily disposed of. It is an especially
dangerous and inexpedient policy to trifle with a
zymotic disease as virulent as variola.
Revocation of the Muzzling Order for
London.
Recent reports to the Board of Agriculture show
that for some time past the Metropolis has been quite
free from rabies, so that the Home Secretary is at
last enabled to defer to the popular feeling in favour
of rescinding the Muzzling Order in so far as that
area is concerned, and its withdrawal is to take effect
within the next few days. While we cannot but feel
satisfaction at the excellent result achieved by this
measure in the teeth of active and persistent oppo¬
sition, the wisdom of allowing dogs to run loose in
our large cities is one that may fairly be called in
question. The crowded centres of population are
ill-suited for dog life, and as the transformation
of London into a city of flats proceeds this
will become more and more obvious. When next
the County Council requires to look round for a
fresh source of income, they cannot do better than
apply to Parliament for power to levy a supplemen¬
tary tax on town dogs, a municipal tax as in addition
to the Government tax. This would discourage people
from keeping dogs under conditions which are unfavour¬
able to the well-being of the animals themselves and
dangerous to human beings. The only Muzzling Order
that will remain in force is that applying to South
Wales, and even this, it is hoped, may be dispensed
with before the end of the year. After such a
decisive experience we suppose that none will ques¬
tion the efficacy of this ready means of stamping
out rabies. We presume, however, that the precau¬
tions with respect to imported dogs will be main¬
tained, otherwise the respite from hydrophobia may
prove but ephemeral.
Atmospheric Climatology and Health.
What we understand by climate is in the main
an average of the vicissitudes which characterise the
atmosphere of a given place. Some climates are
described as bracing, while others are said to be
enervating, but these terms are only relative because
climate is but one factor in the production of physio¬
logical effects, the other factor being individual tem¬
perament. No very clear idea obtains of the physical
conditions which underlie the influence of climate, but
certain considerations throw light on the conventional
meaning attached to these terms. A dry wind is
bracing because in the healthy organism it provokes
434 The Medical Press. NOTES ON CURRENT TOPICS.
Oct. 25, 1899.
free perspiration and evaporation and the cold thus
caused stimutates the individual to muscular exer¬
tion in order to make up for the loss of heat. The
physiological activity thus engendered is reflected in
an increase of appetite and a heightening of func¬
tional activity. Moreover, as the air contains only a
comparatively small percentage of moisture the pro¬
portion of oxygen is pro tanto larger. The opposite
conditions obtain in a moist atmosphere, especially
if a low temperature be superadded. The functions
of the skin are reduced to a minimum, and the
presence of moisture at, or about saturation point in
the air, displaces so much oxygen, just in the same
way as in administering chloroform the life-main¬
taining air is displaced by the vapour which, if
present in unduly large proportions, leads to
asphyxia. A very hot air, it is true, if dry, stimu¬
lates the excretory functions of the skin, but it acts
unfavourably on the muscular system because the
heat already being excessive the tendency is
naturally to avoid movement which would add to the
body heat. Moreover a hot air means more or less
rarefied air, and as the volume of air increases with
every additional degree of temperature it follows that
a given bulk of hot air contains proportionally less
oxygen than the same quantity of cold air. Respira¬
tion is, therefore, increased in rapidity to make up
for the deficiency. With hot air which is also moist
the conditions are distinctly unfavourable to health
and comfort. Nature’s plan of resisting the tendency
of the body temperature to rise above normal, by
provoking perspiration and free evaporation, is
hindered by the inability of the air to take up more
moisture, and a condition of discomfort supervenes.
In normal health the human machine works at such
low pressure that there is ample margin, but if any
of the vital functions happen to be disorganised
unfavourable climatic conditions may promptly turn
the scale in the direction of disease.
Royal Academy of Medicine in Ireland.
The annual general meeting of the Royal Aca¬
demy will be held in the Dublin College of Physicians,
on next Friday, October 27th, when the election of
officers will take place. The following Notices of
Motion will come up for discussion. 1. “ Rule 67.—
The Academy, however, shall not hold itself respon¬
sible for the payment of the printing of such papers,
unless they are deemed by the General Council
suitable for publication in the ‘ Transactions. ’ ” 2.
“ That the following be elected Honorary Fellows of
the Academy :—Sir J. Burdon-Saunderson, Oxford,
Prof. Howard Kelly, Baltimore, Prof. Koch, Berlin,
Prof. Kocher, Bern, Prof. Th. Leber, Heidelberg,
Sir W. MacCormac, London, Prof. Martin, Berlin,
Prof. Notbnagel, Vienna, Prof. Osier, Baltimore, and
Sir W. Turner, Edinburgh. 3. ‘’That the Council
be authorised to nominate Corresponding Members
of the Academy from time to time. 4. Dr. F. W.
Kidd—“ That any Fellow dropping his sub¬
scription for a year or more may be readmitted
to his Fellowship on payment of subscription
of current year, without the payment of an
entrance fee, should the general council approve.”
The report of the Council presents the Academy in a
fairly flourishing condition. The number of Fellows,
for the past session was 240, of members 32, and of
associates 20, and in each class there has been a
slight increase. The finances are, however, not so
satisfactory, inasmuch as the year commenced with
a credit balance of £21 in bank, and ended it with an
overdraft of £33. In other words, a loss of over £50
was sustained, which the Council attributes to the pur¬
chase of £100 worth of microscopes. This was, how¬
ever, an exceptional and a necessary item of outlay,
and will be readily approved, but we cannot recog¬
nise equivalent value to the Academy for the item of
£172 for printing the transactions which, unless
they be indispensable as a record of the work done,
for preservation in libraries, are. we say, of no
use whatever to the Academy. A rechauffe of papers
read at the sections, issued as it necessarily is, nearly a
year after the reading, and usually many months after
interest has waned in the subject of which they treat,
is not readable matter then or thereafter, and, as a
matter of fact, we will undertake to assert that not
one in a hundred of the Fellows makes any pretence
of perusing them. We observe, also, that the Royal
Colleges of Physicians and Surgeons each accept
fifteen guineas a year for the gas, coal, and attend¬
ance required for the sectional meetings, and we
consider it entirely beneath their dignity to accept
such a tip from an institution maintained for the
advancement of medicine and surgery in Ireland. If
this sum of thirty guineas were added to the £172
which is wasted on printing of the Transactions the
Academy would be in a position to do something
handsome to advance its legitimate objects.
The Chemical Diagnosis of Gastric Disease.
It is to be feared that the striking progress which
has been effected during the last ten or fifteen years
in the diagnosis of diseases of the stomach by chemical
examination of the gastric contents is not reflected in
the methods employed to arrive at a diagnosis in
general practice. One continues to prescribe acids
or alkalies more or less at hazard, in ignorance of the
precious information that can be gleaned by a few
examinations of the gastric contents. This aspect of
gastric diagnosis was very lucidly explained in a lecture
recently delivered by Dr. V aughan Harley at University
College, and subsequently published in the Practitioner m
The lecturer insists on the importance, from a therapeu¬
tical point of view, of ascertaining by direct observa¬
tion the nature of the gastric contents after a test
meal, for by this means it is possible to ascertain the
precise nature of the disturbance, and even to pro¬
vide data for a scientific diagnosis of the physical
conditions underlying that disturKhnce. This method,
which is carefully described, furnishes the only
trustworthy means of distinguishing between dys¬
pepsia associated with excessive secretion of free hydro
chloric acid and the forms in which this constituent
is wanting. Without this information treatment
must be empirical and may even be detrimental.
1 The existence of a gastric ulcer and the recent
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Oct. 25, 1899. xNOTESON CURRENT TOPICS. The Medical Press. 435
occurrence of hsematemesis are tbe only contra¬
indications to this method of investigation, and tbe
discomfort which the procedure entails to the
patient is amply compensated by greater efficacy of
treatment. The amount of mucus and the propor¬
tion of volatile acids in the gastric contents are
details of considerable importance, but it is also
possible to estimate the degree of dilatation in cases
of gastroptosis, and by microscopical examination to
define the nature of the fermentative changes going
on. In short, we can trace the affection to its
immediate cause and decide to what particular error
of diet or function it is attributable.
Scalpel versus Hooked Nails.
A good deal is heard of the experiments upon
lower animals necessary to carry out research upon
the origin and the cure of the various diseases that
affect mankind. On the other hand little is said
about the barbarities every day perpetrated in the
sacred name of sport. In an account of a run by the
Queen's Buckhounds on October 13th it is stated that
the deer failed to clear a five-foot fence with hooked
nails running along the top of it, at Farnwood, and
was suspended for a minute or two by one of the
hind legs. After some of the nails had been
pulled out by the struggles of the unfortunate
creature it got away. This is the kind of ex¬
perience that tbe Duke of Portland deliberately
claimed in St. James’s Hall, at a public meeting
of the anti-vivisectors, was good for the deer,
on the ground that they were preserved from
extermination by the sportsman. We venture
to say that scientific men who carry out carefully
considered experiments upon the lower animals would
recoil in horror from the thought of driving a deer to
suspend itself by the hind leg from a barbed five-foot
fence. The aims of the scientist, however, are for
the good of humanity in general, whereas those of
the sportsman are for the amusement of the indi¬
vidual. The sportsmen, if attacked by deadly disease,
say the plague, gladly avails himself of discoveries
that could only have been made through the agency
of vivisection, that is to say by inoculation experi¬
ments. So would any anti-vivisector of them all, for
that matter ; but why do these sentimentalists strain
at the scientific laboratory while they swallow the
Queen’s Buckhounds ? -
The “ Barker ” Anatomical Prize.
The Council of the Royal College of Surgeons of
Ireland, with whom rests the grant of this Prize, has
been unable to confer it this year upon any one-
The Prize is for the best dissection of a special
region, put up as a Museum preparation, and, apart
from the distinction which the winning of it confers,
it is worth £21 in cash. We regret to learn that the
reason why it has not been awarded this year is that
but one competitor entered the lists, and his dissections
were not considered to show sufficient merit. It
certainly seems strange that a valuable distinction
jike this, which is within the grasp of every assiduous
anatomical student, is not sought for by more than
one or two.
Irish Poor-law Doctors’ Holidays.
An important legal opinion has been presented
to the Guardians of the Boyle Union by the
MacDermott, Q.C. He advises (a) that the Local
Government Board has power not only to approve
but to direct the payment of a reasonable fee for
locum tenens’ work; (b) that no part of this pay¬
ment can be deducted from the salary of the absent
medical officer without special sanction: (c) that
practitioners can effectually sue the Guardians for
services rendered as consultant; (di that there are
no regulations “applicable to workhouse medica
officers of later date than the General Orders of
October 18th, 1882, which enable guardians to give
reasonable compensation to a substitute ” ; (e) that,
j under the new rules, the dispensary medical officer
1 is not entitled to a full month’s holiday if the
guardians refuse to give it to him.
The Value of Glycerinised Calf Lymph.
The use of glycerinised calf lymph in vaccination
has met with high approval in America. Dr. Albert C.
Barnes, of Philadelphia, in an elaborate inquiry into
the subject has shown that the successful inoculations
1 amount to from 90 to 100 per cent., in the cases in
which it is employed in primary vaccination. Moreover,
: the lymph has many other obvious advantages which
experience has plainly demonstrated.
Insanitary Areas.
The London County Council is making an effort
to do away with some of the insanitary areas with
which London is riddled. The Working Classes
Committee have recommended the Council to deal,
under Part I. of the Housing of the Working Classes
Act, 1890, with several areas that have been declared
insanitary by their local medical officers of health.
In each case it is proposed to build on the sites
accommodation for more persons than it is proposed
to displace. Tbe sums that will be actually dis¬
bursed in carrying out these schemes will be enor¬
mous, notwithstanding a business-like handling by
the Council of increased values and surplus lands.
The first scheme deals with property in Shoreditch,
where it is proposed to clear an area of two three-
quarter acres in extent. Considering the value of
land in these densely populated districts the con¬
templated net expenditure of £144,850 does not
seem too extravagant. The next scheme is for the
benefit of the unsavoury neighbourhood of Leather
Lane, Holborn, where 1,402 persons are to be dis¬
lodged, and where rehousing accommodation for
1,400 is to be provided at an estimated net cost of
£169,800. Tbe third scheme embraces two large
areas, nearly seven acres in extent, in the poor and
densely crowded Parish of St. George’s, Southwark.
In this instance, the total net cost of clearing and
rebuilding is estimated at £152,590. Lastly, there is
a small scheme to carry out similar operations in
Poplar at a cost of £16,500. With the general
principle involved in these clearances all sanitarians
will probably agree. It is to be regretted, however,
that no provision has been made for converting
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436 The Medical Press.
SCOTLAND.
part of the areas into open spaces, and that some
way of rehousing the displaced inmates during
rebuilding has not been devised. Under present
conditions they will be driven away into distant
suburbs.
“Physician” and “Apothecary.”
It will be recollected that much excitement was
created a couple of years ago within the ranks of
the Licentiates of the London Apothecaries’ Hall, by
the prosecution, under authority of the General
Medical Council, of Mr. Hunter, a licentiate of the
Hall, for calling himself a “ physician ” and
“ surgeon.” It was admitted that the terms of the
Medical Acts entitled him to practise medicine,
surgery, and midwifery, but the rival colleges
maintained that while he could do this as an
apothecary, he could not call himself by any other
name, and the High Court sustained this contention.
Apparently the Hall is determined to carry the dis¬
pute to the House of Lords, for it has obtained the
opinion of Sir Edward Clarke, which is diametrically
opposed to this decision. He urges that it is a
reductio ad absurdum to license a man by Act of
Parliament to practise medicine and surgery, but to
forbid him to call himself “ physician ” or “ surgeon.”
New Use for the Irish Dispensary.
A fortnight since we referred to the fact that the
Guardians of the North Dublin Union had made an
order that the outdoor relief to paupers should,
henceforth, be distributed at the medical dispensary
house of each district, and we urged that such an
arrangement was highly objectionable from the
sanitary and every other point of view. We note
with satisfaction that this objectionable order has
been withdrawn, and in future the dispensary house
will be devoted to its legitimate use.
PERSONAL.
Dr. James Dunsmure has been elected President of
the Royal College of Surgeons, Edinburgh.
Mr. A. O. Davies, M.R.C.S., of Machynlleth, has
been appointed a Magistrate for the County of Mont¬
gomery.
Mr. T. I. JBirkin has offered to place at the disposal of
the managers of the Children’s Hospital, Nottingham,
a mansion known as Forest House, with an adequate
amount of land, for the purpose of a larger hospital,
the present buildings being quite inadequate.
Mb. Arthur Hamilton White, Professor of
Pathology and Bacteriology in the Royal College of
Surgeons in Ireland, and sometime assistant in the
Pathological Laboratory of University College, has been
appointed Pathologist to the Meath Hospital, Dublin.
After the delivery of the Harveian Oration at the
Royal College of Physicians of London on Thursday
last, the Baily medal was awarded to Professor Sherring¬
ton, of University College, Liverpool; and the Bisset- •
Oct, 25, 1899.
Hawkins medal to Dr. Burn Russell, for his services to
sanitary science during the past decade.
At the close of the mayoralty of Dr. Finny, of
Kingston-on-Thames, next month, the Speaker of the
House of Commons will unveil a new stained glass
window in the Town Hall. After the ceremony Dr.
Finny will entertain the Corporation, magistrates, and
representatives of public bodies at a cUjeun r.
Dr. Wallace, of Steventon, has recently been the
recipient of a presentation by the inhabitants of
Steventon in the shape of a specia’ly constructed
brougham and an illuminated address as a recognition
of his valued servioes as medical practitioner in the
town for the past thirty-eight years.
The King of Greece having conferred the Royal Order
of the Saviour, in recognition of services to the Greek
wounded during the late war, on Mr. F. C. Abbott,
F.R.C.S., Mr. Samuel Osborn, F.R.C.S., Mr. Hy. A.
Moffatt, F.R.C.S., and Mr. R. Fox-Symons, M R.C.S.,
Her Majesty the Queen has granted unto the recipients
Rojal licence to aocept and wear the insignia of this
order.
The Home Secretary has notified the Mayor of New-
castle-on-Tyne that the Queen has been exceedingly-
gratified to hear of the Jubilee Commemoration for the
erection of an infirmary, towards which the public have-
subscribed the magnificent Bum of two hundred thousand
pounds. It is understood that although her Majesty
will be unable to lay the foundation-stone in person, she-
will be pleased to depute a member of the Royal family
for the oeremony.
A deputation of the chief magistrate and Town
Council of Berlin waited on Professor Virchow, on
Friday last, and congratulated him on his fortieth
anniversary as member of the Berlin Town Council.
Virchow, our correspondent says, was greatly overcome
by the unexpected ovation, and after thanking the
deputation for the honour done him. said he regarded
communal activity as the first duty of the citizen next
to the care of his family, and he was proud to have been
able to fulfil this duty to the satisfaction of his fellow
citizens for so many years.
Jfcotlattb.
[From Our Special Correspondent.]
Univer8itt of Glasgow.— At a meeting of the
University Court on the 17th inst., it was announced
that the trustees of the late James B. Thomson had
made a grant to the University of £10,000 to be applied
to the reconstruction of the anatomical department of
the University. With this handsome legacy in hand we
hope to see the present corrugated iron builaing removed
before the 1901 Exhibition, which will, no doubt, bring
many strangers to the city. The several medical
schools and the University are very busy just now. In
the University the matriculation, which began on the
18th inst., is quite exceptional this session, the
numbers as yet far exceeding those of the
past few years. The number of students
who matriculated on that day numbered 350, and it iB
anticipated that this number would be exceeded on
the following day. The new professors have made
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CORRESPONDENCE.
Oct. 25 , 189P.
their debut amidst great acclamations of delight,
the students giving each one a right royal recep¬
tion. Professor Gray comes back, so to speak, to
his former hunting grounds, as he is a Glasgow student,
and at one time assistant to Lord Kelvin. The suc¬
cessors to Professor Murray and Professor Lodge are
entirely new to the University, but from their initial
start it is expected that the chairs will be ably filled.
Andebson’sColligb. —The winter session was opened
on the 2oth, and from all appearances there is every
indication of a good session, the enrolment of students
with regard to numbers being considered most en¬
couraging and satisfactory, as an unusually large number
of students have already enioiled. Professor A. M.
Buchanan, of Anderson’s College, Professor of Anatomy,
we are pleased to say is back again to duty, his health
being quite restored after his serious and prolonged
illness. It is a great gratification both to his colleagues,
students, and to all who have the pleasure of his
acquaintance that he is able to resume his professional
teaching.
St. Mart's College. —Winter Session was opened on
the 20th inst. with an introductory address by Professor
Barlow, who took for his peroration, “ How to Become a
Medical Practitioner.” He said, of the five intellectual
professions lelating to the necessities of life, the
medical profession must be regarded as the most
beneficial. It was always full of scientific interest. It
was, however, he thought at present overstocked, but
there was still plenty of room at the “top.” He pointed
out the advantages of the school in being attached to the
Royal Infirmary, and exhorted the students to uphold
the reputation of the College. Here, as in the other
medical schools, a large number of students have been
enrolled.
Unfounded Charge against Nubses.— For some time
past complaints have been openly made by some dis¬
satisfied parents that during the time their children
were in the fever wards of the Paisley Infirmary they
were cruelly treated by some of the nurses. The com¬
plaints having been submitted to the directors of the
Infirmary, they have since made careful investigation
regarding the charges, and have now issued an official
communication denying that there are any grounds for
charges made against any of the nurses.—The fever out¬
break in the town shows a very serious increase in the
number of cases, scarlet fever and enteric fever being
the principal cause of the increase, which brings up the
total to 162. 31 new cases having been admitted during
the week.
MEDICAL SOCIETY OF LONDON.
Th* meeting on Monday evening last was devoted to
a discussion on “The Infectivity of Malignant Growths,”
initiated by Mr. Bellingham Smith and Dr. Washbourn,
in a paper which embodied the following conclusions—(1)
Malignant growths may be regarded as local in origin and
as possessing the power of infecting adjacent and distant
parts of the individual; (2) Inoculation may take place
from one part to another of the same individual apart
from transmission by the natural channels; (3) There is
good evidence to show that one individual may be in¬
fected with growth from another; (4) There is experi¬
mental evidence to show that growth may be transferred
from animal to animal of the same species by inocula¬
tion ; (5) There are found in many malignant growths
bodies which have a resemblance to micro-organisms
and which have been regarded as belonging either to
the protozoas or the blastomycetes ; (6) a new growth
having the structure and also the behaviour of carci¬
noma has been described as occurring, and at any rate in
two instances, from inoculation with a form of blasto-
mycetss ; (7 ) These experiments are highly suggestive
that the bodies found in cancer are the cause of the
disease, though evidence is wanting that the two are
directly associated.
Mr. J. Jackson Clarke concurred in the views of the
authors, and Dr. Symes Thompson mentioned an instance
in which two men who had married two sisters, but who
were not otherwise related, both developed cancer of the
The Medical Press. 437
tongue; also a case in which an epithelial cancer of the-
tongue was followed by sarcomatous growths in the neck.
Dr. Hey wood Smith related a case in which he felt
convinced an ovariotomised woman had been infected
from a patient who had been previously operated on
for malignant disease of the ovaries.
Dr. Lacke combated the parasitic theory, urging that
the actual cells were conveyed, and Dr. Aula thought
the type of growth was dependent upon the conditions
present at the site of transplantation.
Dr. MacFadyan insisted on the necessity in this dis¬
cussion of clearly distinguishing between connective
tissue and epithelial growt hs, and suggested that growths
described as sarcoma might merely be the reaction of
the tissues to living irritants. He urged that there was
no dissimilarity between the structure of sarcomata and
many bacterial growths, which would negative the pos¬
sibility of some of them at any rate being due to bacte¬
rial irritation. He recalled the fact that actinomycotic
tumours were formerly described as sarcomata. In
respect of transplantation, he asked for examples of
this sort occurring with lesions known to be parasitic.
Dr. Washbourn then replied, rema-king that veteri¬
nary pathology had not yet reached a stage which
would enable it to throw much light on these questions,
and he anticipated that future observation would show
growths of this class to be much more common in the
lower animals than was at present thought.
Comsponbcncc.
We il.i not hold ourselves responsible for the opinions of our
correspondents.
“ ANESTHETICS.”
To the Editor of The Medical Press and Circular.
Sir, —Under the heading “A Correction,” a letter
appears in your paper of to day from Mr. E. Willett
taking exception to my figures in the review of St.
Bartholomew’s Reports.
Had Mr. E. Willett’s letter been marked " A
Vindication” the heading would have been more
accurate. He accurately quotes my figures, to wit:—
“During the year 1897 anaesthetics were administered
4,893 times, chloroform 1,959 times, ether 201 times.”
But he goes on to say that gas and ether wore adminis¬
tered 1,261 times. He, however, overlooks the fact that
I distinctly stated chloroformisation and etherisation.
The fact that gas preceded ether in so many cases
goes, I think, to show that etherisation pure and simple
was not found suitable in those 1,200 odd cases, and
that the drug of itself was seldom used even by its
warmest advocates.
By the method referred to by Mr. E. Willett, many of
its more dangerous and unpleasant effects are got rid of;
withal, we find that even under such favourable con¬
ditions chloroformisation was adopted in more cases
than etherisation and gas and ether anujsthesia by
gentlemen whose partiality for ether, as against chloro¬
form is notorious.
I thank Mr. Willett for so pointedly vindicating my
statement a3 to the value of chloroform as a safe,
efficient, and generally useful anesthetic.
I am. Sir, yours truly,
The Reviewer.
Infectious Disease in Liverpool.
An alarming increase in the number of cases of infec¬
tious disease is reported from Liverpool. Scarlet fever
has increased from 1,600 to 1,800; measles from 1,900
to 3,600; typhoid fever 718 as against 541; while in
respect of diphtheria the number has risen from 327 to
575. This disquieting state of things is engaging the
attention of the Sanitary Authorities, who are greatly
hampered by the inadequate accommodation at present
available for the reception of the sufferers.
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LITERATURE.
Oct. 25, 1899.
438 The Medical Press.
literature.
DISEASES OF THE STOMACH, (a)
It was to be expected that sooner or later we should
get a volume on gastric disorders from the American
School. The diseases of the stomach have latterly
lent themselves largely to methods of chemico-physical
examination, and of late years the American school have
shown a remarkab’e aptitude for that direction in medical
work. The authors of the present work produce a volume
which shows an extensive acquaintance with the work
on the same lines done in Europe, while at the Bame
time one it bears the impress of an extensive clinical
experience.
The work is divided into six sections of which the first
is only introductory. The second deals with general
diagnosis and describes very fully the most modem
methods of investigation of the gastric form and func¬
tions, without neglecting the older ones, which will never
lose their importance, however the newer methods may
be modified or superseded. The third section, of a hun¬
dred pages, deals with the general principles of treat¬
ment and contains much valuable matter on dieting
The relative value of natural and so-called artificial
foods, and their appropriateness in various conditions,
are fully discussed. In Sections IV. and V. the diseases
of the stomach are discussed in detail under the heads
of dynamic and anatomical respectively. The dynamic
affections are considered in three classes—the sensory,
the secretory, and the motor; while the anatomical divi¬
sion deals fully with gastritis, ulcer, cancer, and dis¬
placements. We confess to being incompletely satisfied
with this classification, and hardly persuaded of the
diagnostic individuality of some of the diseases included
in the dynamic group. Thus, adenohypersthenia
gastrica (what a rattlesnake of a name!) is
capable of analysis into hyperchlorhydria, diges¬
tive hyperchylia gastrica, and paroxysmal hyper-
cbylia gastrica. No doubt, to the specialist in gas¬
tric diagnosis such nanus are valuable symbols for his
conceptions or knowledge of morbid states, but we have
no proof that they really represent morbid entities ; and
we are not without fear that to the easily satisfied dis¬
ciple they may bring Buch comforting self-conviction of
knowledge as is recorded of “ that blessed word of grace,
Mesopotamia.” But the fact remains that all or almost
all the phases of gastric disease are described here with
a detail which has hardly any other fault than that of
occasional overlapping.
The last section deals with the inter-relations of
stomach disorders with those of other regions, and we
could have wished that it had been fuller. The rest of
the book is so complete and satisfactory that we are dis¬
appointed at not having a more extensive discussion of
the relation of the morbid stomach to Buch conditions
as chronic nephritis, gout, gall-stones, neurasthenia, and
others. Perhaps, however, the authors desired to avoid
the not uncommonly merited opprobrium of the spe¬
cialist, that he would reduce the whole world of patho¬
logy to his own petty horizon. We can cordially recom-
m nd the volume before us as an up-to-date exposition
of the diagnosis and treatment of gastric disorders.
TALBOT ON DEGENERACY. ( b)
One rises from the perusal of this book—one of the
Contemporary Science Series— with the feeling that the
author has written an interesting and instructive
volume, and while one may feel that he has viewed the
subject too widely qua degeneracy, and gone over entirely
•to the school of wholesale degeneracy; he treats of the
matter with a wide knowledge of the literature of the
subject, and quotes freely, and often in a most apposite
and intelligible manner the views of the many who have
written on different branches of the subject. To the
a) “ Diseases of the Stomach.” By Van Valzah and Nisbet.
;m >erial octavo. Pp. 674. London: Bebmnn Publishing Co. 1899.
i b) " Degeneracy : Its Causes, Signs, and Results.” By Eugene
fi, Talbot, M.D. London: Walter Scott, Limited.
many authorities quoted ample acknowledgment is made,
and we would merely criticise to the extent that in
the historical risume at the beginning of the work
there is a want of chronological sequence here and there
that is rather disheartening, and a closeness of quota¬
tion that at times makes the page look more like a bio¬
graphical index. On the subject of causation the author
is perhaps not so exhaustive as he might be, and on the
heredity of epilepsy he pins his faith too much to experi¬
ments on animals. His frank confession that in America,
as late as the date of the Guiteau trial, a school of emi¬
nent men existed who denied oertain well ascertained
facts in human degeneracy is astonishing, Alongside
this we are glad to recognise as advanced men and sound
thinkers many who have since made their name in
American psychiatry. On the subject of heredity of
acquired defects we are quite in accord with the
author, and note with pleasure his repudiation of
the views of Weismann. In this relation his quota¬
tions of exceptional experience on the hereditary results
of circumcision are valuable. A glance at the book will
satisfy the reader that the author has enhanced a wide
range of topics related to the subject, but they are not
all treated at length, or the volume would extend to
great dimensions. None the less are we disappointed
that more has not been said regarding them. Thus we
should like to read more of such practical subjects as the
influence of opium eating, of unequal and immature
marriages, alcoholic excess, Ac., on the progeny. The
work is specially intended for educators and parents.
Its chief aim is to state general principles and to serve
a practical purpose. In a large measure it has achieved
its purpose.
MAX VERWORN’S PHYSIOLOGY, (a)
Professor Verworn's book iB already well-known to
English biologists in its original German dress. Pro¬
fessor Lee’s dear and idiomatic translation cannot fail
to introduce it to a much wider circle of readers, and
the time of its appearance is opportune.
For although both the student of medicine and the
physiological specialist are already well provided with
text-books of physiology in the ordinary sense, it is not
possible that in any of these, the general problems of
life and the general phenomena of living things, should
be so exhaustively dealt with as in a treatise exclu¬
sively devoted to their consideration. Until recently,
indeed, the materials for a book on general physiology
were so scanty and so scattered that but little fruit
might have been expected from an attempt to bring
them together and to arrange them in logical order. But
in the last twenty years it has become more evident
that all the deepest questions of the special physiology
of particular organs or organisms are in the last analysis
questions of the physiology of the cells of which these
organs or organisms are built up. Physiology has,
therefore, in an ever-increasing degree, and with con¬
tinually augmenting success “ extended its inquiries to
the cell.” The result is the imposing and interesting
body of knowledge for the first time systematically un-
I folded and adequately discussed in the volume before us.
Starting with a suggestive, though somewhat dis-
• cursive chapter on the aims, the history and the methods
I of physiological research, the author next considers the
i general, chemical, physical and morphological properties
of the living Bubstance. His defence of the view that
the living substance is of liquid rather than of solid
consistence, and this exposition of the present state of
opinion as to the structure of the nucleus seem to us
particularly strong features of this portion of the work.
The elementary vital phenomena are then passed in
review. Under this head are included the phenomena
of metabolism, the changes of form that occur in develop¬
ment (with discussions on heredity, cell-division, and
(a) “ General Physiology, An Outline of the Science of Life.”
By Max Verworu, M.D., Ph.D., A O., Professor of Phvsioiogy in
the Medical Faculty of the University of Jena. Translated from
the Second German Edition, and edited by Frederic S. Lee, Ph.D.,
Adjunct Professor of Physiology in Columbia University. Pp. 615,
with 285 illustrations. London: Macmillan and Co., Limited.
New York: The Macmllinn Co.
Digitized by G00gk
Oct. 25, 1899
LITERATURE.
Thk Medical Press. 439
■fertilisation), and the phenomena of the transformation
of energy within the cell, including the production of
movements in plants and animals. The general condi¬
tions of life are dealt with in a separate chapter, which
embraces also a criticism of the theories of the origin of
life on the earth, and a discussion of the phenomena
and the causes of death.
The nature of stimulation, and particularly the phe¬
nomena of the stimulation of unicellulai organisms, are
expounded at great length. While in general the treat¬
ment of this section is fresh and interesting we cannot
help thinking that it would be improved by condensation,
and especially by the omission of a good deal of matter
which convention has assigned to the ordinary text¬
books of physiology.
In the last chapter, entitled “ The Mechanism of Life,”
an attempt is made to “ construct a bridge between the
vital phenomena and the vital process, and so far as the
present condition of our knowledge allows, derive the
former mechanically from the latter.” It is hardly
necessary to say that this is the most unsatisfactory
portion of the book, and although the author grapples
manfully with his self-imposed task, the "bridge”
which he “ constructs ” has as many broken archee as
the famous structure of the Vision of Mirza. This
is inevitable in the present state of our knowledge. And
not even the plentiful use of such terms as “ biogens,”
“ axial orientation ” and “ bistomis ” (even when “ ex¬
pressed by the factor ^ or expanded into the formula
a + a, + a.,
d"
d + d,
+ d.
’) nor the deftest
manipulation of Pfliiger’s theory of the role of cyano¬
gen radicals in the living proteid molecule, nor the
subtlest conjuring with the magic words “assimilation ”
and “ dissimilation ” will at present suffice to tell us why
the molecules of the relaxed muscle or the resting gland
cell slip at the signal of the nervous impulse into the
configuration and motions that characterise the con¬
tracted muscle and the active gland cell. The bridge is
not yet built. We know only dimly the depth and the
breadth of the chasm.
Thomas Grainger Stewart, the President of the British
Medical Association, and to many of his old students,
and many who did not enjoy that privilege, the appear¬
ance of “ The Good Regent ” must have been a pleasant
surprise. The history of the religious life and character
which has so peculiarly distinguished Scotland, is natu¬
rally well known to the author, and he has dwelt with a
fond interest and understanding on the central figure
of the drama as he has moved the scenes from place to
place. If we might offer a faint criticism, it is this, that
there is somewhat of staccato abruptness in the scenic
transitions, a want of introduction which those less
versed in Scottish history would find helpful to the con¬
tinuity of the whole conception. This, by the way. Sir
Thomas has given us a just conception of the Earl of
Moray, Regent of Scotland, and in an agreeable style.
HALLIBURTON’S CHEMICAL PHYSIOLOGY, (o)
“The rapid advances which chemical physiology has
made during the past few years has rendered a good
deal of attention necessary in the present edition. The
practical exercises are, however, but little modified ; the
changes introduced there are principally in arrangement;
still it has been thought necessary to amplify a certain
number of these, particularly in the advanced course.
The lessons on the urinary pigments and crystallisation
of egg-albumen are entirely new. The main changes in
the book will be found in the large text; this has been
considerably extended, and the sections relating to the
proteids have been entirely re-written.”
The above extract from the preface to the present
issue of this conveniently-sized and handsomely printed
manual contains the author’s own account of the new
features which the Btudent and critic are invited to
examine. As the reputation of the book in its former
editions has already been thoroughly established, we
will not wait on the present occasion, longer than while
saying that Professor Halliburton has done everything
necessary to bring the present issue thoroughly up to
date. It iB really a beautiful as well ns reliable scientific
manual, and should be in the hands of every student of
physiology.
METHODS OP STAINING, (a)
It may be thought by not a few that literature in this
department of histology is sufficient; but while this might
be true a few years ago, it is not so now, for the army
of workers in neurological laboratories has increased,
there is greater activity in the investigation of micro¬
scopic methods, and new results have been reported
worthy to appear in an up-to-date text-book. This little
volume, therefore, comes to hand very opportunely, and
the author and the translator are to be congratulated on
its appearance in the English language. It dealB briefly
with methods of brain section, hardening for preserva¬
tion, and preparations of models of pathological speci¬
mens. It gives directions for all the minutiae of harden¬
ing, staining, labelling, embedding, Ac. The chief part
is devoted to the method of staining, and while the new
is amply referred to, the old is also described in so far as
it is necessary, and where it has not been entirely super¬
seded by more modern methods. Naturally the methods
of Nissl, Golgi, and Ehrlich receive the largest share of
attention. We have pleasure in commending this little
handy guide-book to those interested in neurological
work.
THE GOOD REGENT. (6)
It is good for medical men, if their bent that way
lies, to have literary recreations, and when one has
known a medical teacher and writer of distinction as
such for years, his appearance in a new field of literature
as poet, philosopher, or historian is a welcome revela¬
tion. In this way we regard the latest venture of Sir
o) " Methods of Staining the Nervous System.” By Dr. Bern-
hard Pollack. Translated from the Second German Edition by
W. K. Jack, M.D., B.L. Glasgow : F. Bauermeister.
{b) ” The Good Regent: a Chronicle Play." By8ir T. Grainger
Stewart, M.D..LL.D. Edinburgh and London: Wm. Blackwood
and Sons.
TRANSACTIONS OF THE SOCIETY OF
ANAESTHETISTS, {b)
Since Sir Thomas Watson founded the Clinical
Society no province of medicine ever offered a more
fruitful field for research than that of anaesthetics; and
no Society was ever better situated for carrying on the
r- search than the “ Society of Anaesthetists.”
All sorts and conditions of men pass through the
principal London hospitals. They come of every race
and from every climate. The anaesthetist meets with
the robust dock labourer admitted for an accident, and
the weary, worn-out seamstress seeking surgical relief for
chronic suffering.
Above all, the great numbers that pass through the
London hospitals allow of a tolerably fair estimate of
the comparative values of the anaesthetics used.
Let us see how the Society commences its career, and
as we open the dainty, well-printed volume before us we
regret to find neither a table of contents nor an index;
we are left to turn page by page without guidance of any
kind.
The opening paper, “ On the Addition of Ether Vapour
during Chloroform Administration,” by Mr. Walter
Tyrrell, is a good, practical contribution to the admini¬
stration of anaesthetics; and the discussion consequent
on it brought out a very interesting story of prolonged
ameBthesia from nitrous acid by Dr. Flux ; the influ¬
ence of suggestion in causing profound anesthesia in
hystero-epileptics was freely and ably discussed, and
some illustrative cases given by Messrs. Braine, Tyrrell,
and Starling.
(a) “The Essentials of Chemical Physiology: for the Use of
Students." By W. D. Halliburton, M.D., F.R.S. Third edition,
London, New York, and Bombay: Ixmgmaus, Green, and Co. 1899.
lb) "The Transactions of the Society of Anaesthetists.” Volume I.
1898. London : The MetUcal Publishing Comoanv
Digitized by CjOOglC
440 The Medical Pats*.
MEDICAL APPLIANCES.
Oct. 26,1899.
“ Resuscitation in Emergencies under Anesthetics ” I
is the title of Mr. Wilson’s paper, in which we find
no mention of the use of oxygen. Of inversion the
author writes not very favourably, being influenced by
theory, and withal not familiar with Dr. Chisholm’s good
results from it. Influenced by M. Roger’s theory of the
“ conditions of the vascular system produced by shock,”
Mr. Wilson does not put much faith in the value of
hypodermics of strychnine. We quite agree that if the
use of the drug is too long postponed it is of no value.
When death is practically present no drug is of any use. i
But why wait too long P Given in time, however,
strychnine is of undoubted value.
“ The Dosage of Anaesthetics ' is an able survey of our
knowledge of the subject by Dr. Waller. We think, }
however, that too much stress is placed on the apparatus I
used, and not enough consideration given to the patient
and his condition. Three cases of death under anaes¬
thetics were reported by Mr. McCardie. Administering 1
anaesthetics through the nose was the subject of a paper
by Mr. Coleman, in which he credits the late Sir B. W.
Richardson with being “ the firBt to try in an operation
on the mouth the insertion of a tube, connected with a
chloroform inhaler, into one nostril ” If Mr. Coleman
will consult the “Manual of Military Surgery” for the
use of the surgeons of the Confederate 8tates, he will
find that in 1S61-62 the method of chloroformising by 1
the nostrils was adopted by Dr. J. Julian Chisholm, of
South Carolina, in order to save the chloroform, as their
sole source of supply was that captured from the Federals
and the small quantity that ran the blockade.
Space does not allow of a more extended notice;
indeed, we have gone beyond the usual limit with this
one. We did so, for we felt that the good work the
Society is doing should be known, and we think every
anaesthetist should familiarise himself with these Trans¬
actions. They contain very useful and practical matter, |
much of which, although not new, is well worth re- :
telling.
There is, withal, a fault the London members appear
to be permeated with—an unreasoning fear of chloroform.
ELEMENTS OF ALKALOIDAL ETIOLOGY, (a)
It is always refreshing, and very often highly instruc¬
tive, to examine the work of a heterodox writer, who |
has mastered his subject, and knows how to convey his
ideas to his readers. Earnest students of the history
of the advancement of human thought and human
research are well acquainted with the truth of the state¬
ment—which to the multitude will always appear a
startling paradox—that the great bulk of our existing
knowledge is due to the work of heretics, or of those who
have been persecuted as such.
In the present instance our author traces disease to
the accumulation of necessarily existing alkaloidal
poisons—the ash of the combustion of the animal cell.
He has earnestly worked out his theory ; and, evidently,
earnestly believes in it. “ As we have seen (he tells us
on page 34), the blood necessarily disposes of its
poisonous accessaries through the various organs of
elimination, and consumes them in the circulatory
current in contact with the red globules. This being
the case, can the blood be regarded as otherwise than
toxic 'r ”
On p. 76, he states forcibly the position which the
heroes of bacteriological pathology will dispute with most
vigour. “ But leaving leading germ-pathologist3 to ex¬
ploit their new position, we must insi«t that the
phenomena of disease, even to the most essential pro¬
cesses, are possible without the intervention of micro¬
organisms, bacillary or otherwise.”
The position assumed by our author involves too many
points of possible or probable dispute for discussion
within the limits of a necessarily short review. But we
would strongly recommend all earnest students of medi¬
cine to examine its contents for themselves. Whether
they agree with hiB conclusions or no, his arguments
will give them ample material for examination and
reflection.
(a) “ Elements of Alksloidal Etiology, Introductory to the Study
Auto-Intoxication in Disease." By A. M. Brown, M.D. London:
onry Kimpton. 1*91'.
^ftcbital anb Surgkal Jlyptacts.
A NEW URINE TEST CASE.
The new Urine Test Case devised by Mr. W.
Harrison Martindale, Ph.D., is certainly the most com¬
pact and complete arrangement of the kind we have yet
been privileged to inspect. It is contained in a neat
mahogany cabinet, measuring 6 X 2i X 4 inches, and
the contents comprise all the apparatus and reagents
for the qualitative and quantitative examination of
urine in respect of albumen, glucose, and urea. These
are neatly and firmly packed, so that the case, which is
provided with a handle, can be safely carried about
without fear of damage.
Every careful practitioner must have experienced the
need of a portable apparatus of this kind which
facilitates immediate diagnosis in new cases, and it
obviates the necessity for taking home, or arranging for
the dispatch of. samples of urine for analysis.
The picric acid test, which is the one selected as the
tebt for the presence of albumen, is, on the whole, more
convenient, and fully as delicate, as the ordinary method
by boiling. If, however, the latter test be preferred,
there is a spirit lamp which enables a control estimate
to be made by the alternative method.
A little book of instructions, with a supply of charts,
complete the equipment which could not well be made
more comprehensive. It is sold by Mr. Martindale, of 10
New Cavendish Street, W., at the very moderate price
of 178. 6d.
POCKET CASES FOR DRUGS.
Among other novelties of recent introduction by Mr.
Martindale we may note (1) a pocket case to carry one
dozen nitro-glycerine tablets ,• (2) a similar portable
case to contain three amyl nitrite capsules. These go
easily into the waistcoat pocket, and will doubtless be
appreciated by anaesthetists and others.
^ftcbical
For the Troops in 8outh Africa.
We are asked to announce that Messrs. Nestle have
received several large orders from the War Office for
their Swiss Milk, and Viking Unsweetened Milk, for
use of the troops in South Africa.
Messrs. R. Ellis and Son, of Ruthin, have generously
offered 10,000 bottles of their well-known brand of soda
water for the use of the British troops engaged in South
Africa, which will doubtless be greatly appreciated.
Messrs. Ellis and Son are now in correspondenae with
the War Office as to the slvpment of this large con¬
signment, which we hope will before long be helping to
refresh many of our brave fellows in the Transvaal.
Vital Statistics.
The deaths registered last week in thirty-six great
towns of England and Wales corresponded to an
annual rate of 18 - 7 per 1,000 of their aggregate population,
which is estimated at 12,786,832 persons in the middle
of this year:—
Digitized by CjOO^Ic
Oct. 25, 1899.
MEDICAL NEWS.
The Medical Press. 441
Birkenhead 13, Birmingham 17, Blackburn 20, Bolton
19, Bradford 18, Brighton 18, Bristol 18, Burnley 20,
Cardiff 15, Croydon 15, Derby 13, Dublin 33, Edin¬
burgh 16, Glasgow 19, Gateshead 18, Halifax 12,
Huddersfield 17, Hull 20, Leeds 16. Leicester 12, Liver¬
pool 25, London 18, Manchester 21, Newcastle-on-Tyne 16,
Norwich 11, Nottingham 20, Oldham 19, Plymouth 20,
Portsmouth 16, Preston 19, Salford 21, Sheffield 19,
Sunderland 20, S.vanseal5, West Ham 13, Wolver¬
hampton 20. The highest annual death-rates per
1,000 living, as measured by last week’s mortality,
were From measles IT in Hull and i'4 in Birken¬
head ; from fever, IT in Nottingham and in Sunder¬
land. and 13 in Bolton; and from diarrhoea, 10 in
Sheffield, IT in Liverpool, D2 in 8alford, 1 4 in Cardiff
and in Burnley, 15 in Gateshead, 1'8 in Bolton, and 27
in Preston. In none of the large towns did the death-
rate from scarlet fever or from whooping-cough reach
It) per 1,000. The 114 deaths from diphtheria included
57 in London, 10 in Sheffield, 6 in Leeds, 4 in Ports¬
mouth, 4 in Liverpool, and 3 in West Ham. Four
deaths from small-pox were registered in Hull, but not
one in any other part of the United Kingdom.
Death under Chloroform.
An inquest was held last week at Hornsey on the body
of a single woman, tet. 65, who succumbed to the effects
of chloroform, administered for the purpose of enabling
Dr. Herman to perform an exploratory operation. The
chloroform was administered by the family doctor, but
breathing suddenly ceased before the examination could
be completed, and attempts at resuscitation failed. No
information was elicited as to the method of adniinstra-
tion employed or as to the amount of chloroform used.
The usual verdict was returned.
Patriotic Medical Students.
The departure of the anatomical porter of Mason’s
College, Birmingham, to rejoin his regiment, he being a
reservist, was an opportunity not to be missed by the
medical students of that institution, who turned out and
marched through the streets, flags flying, to see him off
by train. We regret to see that “one rowdy young
medical” had to be removed by three sturdy porters
from the railway station, but this was the only untoward
incident of a very enthusiastic demonstration.
A Good Analysis at Paris.
During September the Paris Municipal Laboratory
made 653 analyses of wines, with the result that 139
were judged good, 221 passable, and 196 bad. Of beers
39 were good, 29 passable, and 14 bad. Spirits were
declared good in 132, passable in 31, and bad in 23.
When we turn to food stuffs proper the result is less
satisfactory, for the analyses of milk gave only 121
good, with 102 passable, and 201 (!) bad; while of 73
samples of meat 53 were good, and 20 bad. One never
hears much of prosecutions for alimentary adulterations
in France, and one wonders what useful purpose is
served by these analyses. The mere fact that 201 out
of 424 samples of milk were described as bad, shows
clearly enough that the delinquents are not seriously
dealt with.
Civilian Medical Officers for the Army.
In order to fill the vacancies in the Royal Army
Medical Corps at Woolwich, consequent upon the de¬
parture of medical officers in South Africa, recourse
has been had to the employment of civil practitioners,
of whom the following have been ordered to report
themselves to the Principal Medical Officer at Herbert
Hospital: — Messrs. C. H. Furnivall, T. Hartigan,
E. S. B. Eames, R. L. Jones, A. J. Wernet, T. W. Atkins.
Capt. C. E. G. Stalkartt, R A.M.C, has this week joined
at Woolwich for duty.
Lectures at the Central London Throat Hospital.
The usual winter course of lectures at the Central
London Throat and Ear Hospital, Gray’s Inn Road, is
announced, and promises to be interesting. The first
lecture is to be given by Mr. Lennox Browne on Monday
next, the 30th inst., and will treat of “ the recurrence
of enlarged tonsils and adenoids after removal by opera¬
tion,” a subject of .considerable importance to all prac¬
titioners.
The Mortality of Foreign Cities.
The following are the latest official returns, and re¬
present the last weekly death-rate per 1,000 of several
of the populations Calcutta 28, Bombay 42, Madras
33, Paris 16, Brussels 15, Amsterdam —, Rotterdam —,
The Hague —, Copenhagen 15, Stockholm 15, Christiania
17, St. Petersburg 18, Moscow 24, Berlin 18, Hamburg 16,
Dresden 20, Breslau 21, Munich 23, Vienna 17, Prague
20, Buda-Pesth 19. Trieste 25, Rome 13, Turin —, Venice
—, Cairo 41, Alexandria 27, New York —, Philadelphia
15.
PASS LISTS.
Royal University of Ireland.
First Medical Examination.
Pass. Anna E. Adderlqy, Oath. Univ. and Roy. Coll. Sci.; Lily A.
Raker, Roy. Coll. ->ci.: John Brady, Univ. Coll., Dub.: Michael
Caiiney, Q. Coll., Cork: John J. Clarke Univ. Coll., Dub.; William
M. Crofton, Univ. Coll.. Dub.; John Dowling. Q. (.'oil,. Galway;
Edward Fitzgerald, Q. Coll.,Belf.; Maurice Fitzgerald, Univ. Coll.,
Dub.: Daniel Gillespie. Q. Coll. Belf.; Marie E. Hays, Roy. Coll. Sci.;
Charles G. Lowry, Q. Coll., Belf. j Jonas Morris, Q. Coll., Cork ;
Michael J OFlynn, Q. Coll. Gal.; Pierce Power. Q. foil., Cork;
John J. Rogers. Univ. Coll., Dub.; Francis C. Sampson, Univ. Coll.,
Dub. ; and David H. Vickery, Q. Coll., Cork.
Recommended for Honours.—L ily A. Baker. Botany, Zoology
and Chemistry ; Michael Cagney, Zoology, Chemistry and Phy*ice;
John J. Clarke, Chemistry; William M. Crofton. Boranv, Zoology,
Chemistry. Physics; John Dowling, Zoology ; Maurice FitzGerald,
Zoology; Daniel Gillespie, Botany, Chemistry ; Marie E. Hayes,
Chemistry, Physics; Charles G. Lowry, Chemistry : Michael J.
O’Flynu, Zoology ; John J. Rogers, Zoology; Francis C. Sampson,
Zoology; and Daniel H. Vickery, Zoology.
Second Medical.
Upper Pass.—‘S ydney H. G. Blakely, Q. Coll., Belf. ; Thomas
Carnwath, Q.Coll., Belf.; ‘Rol>ert H. Caughey, B.A.. Q. Coll., Belf.,
•John P. J. Hnrty, Q. Coll., Belf.; "William B. Hayden, Q. Coll.;
Belf.; ‘Henry M. Johnston, Q, Coll., Belf.: "Tnotnas Killen. 6.,
Coll., Belf.; "John Shipsey, Q. Coll., Cork ; James K. Small, Q. Coll.,
Belf.; ‘William Warnock, Q. Coll., Gal.
Candidates marked thus * are recommended for Honours.
Pass. John D. Buchanan, Q. Coll., Belf.: Alfred A. Chaucelor,
Q. Coll., Belf; William Cummings, Q. Coll., Belf. ; Peter F. Dolan,
M.A. Cnth. Univ. Seh. Med.: Roger J. Dwnue. Oath. Univ. Sch.
Med.. Alfred J. Foote, Q. Coll., Cork : John J. Gillis, Q. Coll., Belf.;
Alfred W. Hamilton. Q. Coll., Belf.; Samuel T. Irwin. Q. Coll., Belf.;
James W. Killen, G. Coll., Belf.; Janies T. McDermott, Q. Coll.,
Cork; Thomas MuFeteridge, Q. Coll. Cork : Francis A. McOstrich.
Q. Coll., Cork ; Patrick J. Murray, Cnth. Univ. Sch. Med.: William
F. O’Connor, Q. Coll., Cork ; Daniel J. Botfantree, Cath. Univ. Sch.
Med. ; Charles E. Suffern, Q. Coll., Belf.; Thomas H. Suffern, Q.
Coll..Belf.; Andrew T. Swan,Cath. Univ. Sell. Med.; John Thompson,
. Coll., Belf.; Margaret Toner Q. Coll., Belf.; James W. A. Wilson.
. Coll., Belf.
The examiners have recommended that the following
candidates be adjudged to have passed the undermen¬
tioned examinations.
M.B., B.Ch., and B.A.O. Examinations.—Upper Pass; Isaac M
Byers, (a) John E. Clements, Belf.; James Good, William Hart
nett, Cork ; (a) William M. Hunter, (a) David Kernolinn, Q. Coll.
Belfast; Wm. Lapsley, Q. Coll., Cork; Thos. J. McDonogh, B.A ,
and (a) Bernard A. O'Flynn, Cath. Sch. Med.; and (a) John W.
West, Q. Coll., Belf.
Pass.—Annie H.Crawford, Arthur W. Crawford, Henry L. Craig,
Emily M. Crooks, and John H. Davis, Q. Coll.. Belf'.; Bertram
H. Dinnis, Q. Coll., Cork,and Univ.'Edin.; Hugh Donnelly, Q. Coll.,
Belf ; Frances A. Dreoper, B.A., Cath. Sch. Med : I'avnl Finnegan,
John R. Gillespie, M.A., Galbraith H. Grills, Samuel Hill, Alexan¬
dria C. Huston, and George Jefferson. Q. Coll.. Belf.; Charles
Kidd, Q. Coll., Gal., and Sch of Med., Edin.; Kathleen F. Lynn
and Samuel M'Cann, Cath. Univ. Sch. Med.: Edwin W. S. Martin,
Douglas C. Moore, and Patrick J. Morgan, Q. Coll., Relf.; Thomas
F. O'Keefe, Q. Coll., Cork, and Cath. Univ. Sell. Med.: Patrick M.
Quinn, Cath. Univ. Sch. Med.; James Ritchie, Q. Coll., Belf.;
Frederick Ryan, Cath. Univ. Sch. Med.; and Joseph J. Waters, Q.
Coll.. Gal., Cath. Univ. Sch. Med., and Soli. Med., Edin.
M B. Degree Examination. Ignatius J. Flynn, M.B., B.Ch.,
B.A.O., Cath. Univ. Sch. Med.; Thomas Houston, B.A., M.B.,
B.Ch., B.A.O., Q. Coll., Belf., and Robert Watson, M.B., B.Ch.,
B.A.O., private btudy.
(a) Indicates that the candidate may present himself for the
further examination for honours.
Royal College of Burgeons, Edinburgh.
At the annual meeting of the College on the 18th
inst., Dr. James Dunsmure was unanimously elected
President for the ensuing year, and the following gentle¬
men, having passed the requisite examinations, were
duly elected Fellows of the College:—
Francis Horatio Anmer, L.K.C.S.E., Tongkah. Siam ; Nathaniel
Thomas Brewes, F.R.C.P.E., Arthur Mayers Connell, M.R.C.S.
Eng., George Aubrey Jelly, M.B.C.S.Eng., Robert Holbourne
William Johnson. L.B.C.S.E., John Norman Mncleod. M.B., C.M.
Glasg., Robert Henry Parry, L.R.C.S.E.Glusg., Henrv Carden
l'earsou, M.B., C.M Edin., John Connel Ramsay, L.R.C.S.E.,
Donald Ferdinand Schokman, L.B.C.S.E., John William StrutheTS.
M.B., Ch.B.Edin., and Andrew Hutton Watt, M.B., C.M.Ed'n.
Digitized by GoOglC
442 The Medical Press. NOTICES TO CORRESPONDENTS. Oct. 25,1899.
Notices to
(tarrcsponbents, §hort "JCcttcrB,
Mr. Lennox Browne's lecture on “The Becurrence of Enlarged
Tonsils and Adenoids after removal by operation.
Qaamctas.
tiT Correspondents requiring a reply in this column are par¬
ticularly requested to make use of a distinctivs signature or
initials, and avoid the practice of signing themselves “ Eeader,”
•• Subscriber,” “Old Subscriber," Ac. Much confusion will be
spared by attention to this rule.
WHERE THE CHAMPAGNE GOES.
According to a recent report the total number of litres of
champagne exported nttaius the respectable dimensions of close
upon twenty millions, representingnbout £3,500,001). England stands
first on the list of customers with 10,600,000 bottles, then Belgium
with 2,778,700. Germany with 1,859,200, and the United States (with
Canada) 1,419,0*10. Russia only absorbs -198,500 bottles, but these are
of the very first brands, and Holland follows closely with 408,400.
Sweden buys 258,2'n bottles. Denmark 188,700, Austria 152,30(1,
Switzerland’ 141.'4i«>, Italy 129,700, Australia 125,600, Norway 106,200,
and India 100,uO" bottles. The price en grot of the wine is four or
five francs, showing what an enormous profit is made on champagne
when sold en detail.
Spes.—S ince 1882 venereal disease in the British army lias
increased 15 per cent., as shown by the official records.
IRISH POOR-LAW MEDICAL OFFICER'S RESIGNATION
BEFORE SUPERANNUATION.
A. A. asks to be informed if it is necessary for a Poor-law medical
officer to resign before applying for superannuation allowance, and
if so, please state authority for your answer.
[The resignation must be a completed transaction before the guardians
can consider the question of pension. It is essential that a month’s
notice should U- given by a guardian to move the grant of a pension,
but it is )iof essential—ns was formerly supposed—that the resigna¬
tion should be handed in at same time. It may be withheld until five
miuutes before consideration of the motion, and may, therefore, be
withheld altogether if the motion does not seem likely to pass.—En.]
I. V. R. (Birmingham).—Our correspondent cannot improve upon
the course which lie has decided to adopt.
Omega.— The disease depends upon the toxin generated by the
action of the l aci >i.
THE LATE SIR Wm. GULL ON “ DON’TS.”
In his recent address at Mason University College, Professor Cliiene
repeated, for the l*enerit of his audience, the oft-quoted " don't* ”
accredited to the l.teSir Win. Gull:—Don't talk to your.pntients
nbout your patients. Don’t hesitate to ask for a consultation if
you are in doubt. Don't refuse a consultation if a patient desires
it. Don't give two prescriptions, with the remnrk, “ If the one
fails try the second :' it savours of experiment, and no patient
likes to* be the subject of experimental research. Be silent when in
doubt. Take careful notes of your cases. Have a hobby ns a
means of losing time wisely.' 1
Nuclei's.— It is possible that a plastic operation would be of
service.
SPASM OF LEVATOR ANI.
H. S. M. asks for information about the treatment of spasm of
the ievntor imi. Cause of the disease in this case unknown, and
heat the only thing of use.
Meetings of the §oricties attb Xectuvce.
Wednesday, October 25th.
Dermatological Society of Great Britain and Ireland (29
Hanover Square. W.j.— 4 30 p.m. Informal Exhibition of Cases.
5 p.m.—Ordinary meeting. . , _ ,, ....
Hunterian Society.— 8.30 p.m. Chmcal Evening. Cases will be
shown by Sir H. Boevor, Dr. F. J. Smith, Dr. Ross, Mr. Baruard,
and other Fellows. .
St John's Hospital for Diseases of the Skin (Leicester
Square).—4.30p.m. Dr. Eddowes : Sycosis (Post-Graduate Course).
. Thursday, October 26th.
British Balneological and Climatological Society (20 Hanover
Squnre, W.).- 8.:J0 p.m. General Meeting. Dr. J. I. Murray
(President) : A Retrospect and a Forecast.
Neurological Society of London (Medical Society s Rooms, 11
Chaiido* Street, W.p.m. Clinical Meeting. The following
cases will be shown:—Dr. F. E. Batten : Unusual Form of Muscular
Atrophy—Dr. T. Buzzard: Myasthenia Gravis.—Dr. J. Taylor:
Myopathr of Lan louzv (DCjerine Type).—Dr. W. Harris : Myopathy
of Landouzy (Dejerine Type), and other cases.
Friday, October 27th.
Clinical So, iety of London (20 Hanover Square, W.).-8.30 p.m.
Clinical Evening. The following cases will be shown: Dr. Guthrie :
Cerebellar Symptoms relieved by Trephining. — Mr. G. R.
Turner- (1) A Case of Actinomycosis in Process of Cure: (2) A Case
of Ostitis Deformans.—Mr. J. Jackson Clarke: A Patient in whom
Kraske's Operation was performed (with specimen).-Mr. Watson
Cheyne • Old-Standing Dislocation of the Hip. with Fracture or the
Acetabulum, reduced by Operation.—Other cases will be shown.
Patients will be in attendance at« p.m.
British Laryngolooical, Rhinological, and Otological
.Association (11 Chnndos Street, Cavendish Square, W.).—1 p.m.
Meeting.
Monday, October 30th.
Cektbal London Throat, Nose, and Ear Hospital.— 5 p.m
Bethlehem Hospital, London.—Two Resident House Physicians.
Apartments, complete board, and washing provided, and an
honorarium at thernte of £12 12s. per quarter. (See advt.)
Birmingham City Asylum.—Senior Medical Officer unmarried.
Salary £150 per annum.
Carrickmacross Union.—Medical Officer. Salary £100 per annum,
together with the Vaccination and Registrations Fees. Applica¬
tion to Clerk of Union.
County Asylum, Prestwich, Manchester. — Assistant Medical
Officer, unmarried. Salary to commence at £125, with board,
apartments, and washing.
County Borough of Great Yarmouth.—Medical Officer of Health,
Medical Officer for the Borough Isolation Hospital, and Port
Medical Officer of Health. Salary £400 a year. Apply to the
Town Clerk, Town Hall, Great Yarmouth.
County of York, West Riding Asylum, Wakefield.—Junior Assistant
Medical Officer. Salary commencing at £100, with furnished
apartments, board, washing, and attendance
Hospital for the Insane, the Cippice, Nottingham.—Assistant
Medical Officer, unmarried. Salary £150 i>er annum, with apart¬
ments, board, attendance, and washing.
Manchester, Chorlton-upon-Medlock Dispensary.—Resident Honse
Surgeon, unmarried. Salary £120 a year, with furnished rooms
and attendance.
Nottingham General Dispensary.—Senior Resident Surgeon, un¬
married. Salary £180 a year, increasing by £10 annually to £200.
Specinl arrangement for board, fee.
Parish of Fulham.—Assistant Medical Superintendent for the Infir¬
mary, St. Dunstnn’s Rood, Hammersmith, unmarried. Salary
commencing nt £129 per annum, with l<oard, imirtments, Ac.
—Applications to the Clerk, 75 Fulham Palace Road, Hammer¬
smith, W.
Pontefract Geueral Dispensiry and Infirmary.—Resident Medical
Officer. Commencing salary £130 per annum, rooms, fire, lights,
and attendance.
Stoke-upon-Trent Union.—Resident Medical Officer for the Work¬
house. Salary commencing at £13t, with board, washing, Ac.
—Applications to the Clerk, Union Offices, Stoke-upon-Trent.
^ppointmentB.
Bailet, Reginald Threi.fall, M.R.C.S., L.R.C.P.Lond., Resident
Medical Officer to the (Lock Dept.) Roynl Infirmary, Liverpool,
and House Surgeon to the Ophthalmic Laryngologienl and Aural
Dapartments.
Coon be, Russell, M.A , M.D.Cantab., F.R.C.S.Eng., M.R.C.P.
Bdin., has been appointed for duty in connection with the
medical charge of troops at Exeter.
Davidson, W., L.R.O.P , L.R.C S Edin., Medical Officer for the
Sixth Sanitary District of the Beverley Union.
Dunn, J., F.R.C.S.Edin., L.R.C.P., L.F.P.S.Glnsg., President of the
Halifax aud District Medical Society.
Evans, J., M.R.C.S., Medical Officer for the Children’s Homes of
the Cardiff Union.
Hukton, R., M.B., C.M.Edin., Medical Officer for the Hartlepool
aud Stanton Sanitary District of the Hartlepool Union.
Morshead, E. G. A., M.D., L.R.C.P.Lond., M.R.C.8.,an Honorary
Medical Officer of the Royal Surrey County Hospital, Guildford.
Muir, J. C. M.B.Cnmb., M.R.C.S., Second Resident Assistant
Medical Officer for the Crompsall Workhouse, Manchester.
Oliver, C, P , M.D.Loud., L.R.C.P.,. M.R.C.S., Medical Officer of
Health to the Maidstone U rban District- Council.
Per net. George, M.R.C.S.. L.R.C.P., Honorary Pathologist to the
Hospital for Diseases of the Skin, Blackfriars.
Sissons, A. T., M.B., B.Ch.Viet., Junior Resident Assistant Medical
Officer for the Crumpsull Workhouse, Manchester.
Smith, W. R., M B., C.M Edin., has l>een appointed President of
the Central Board of Health for South Australia.
Trotter, Edward, M.B., Ch.B., House Surgeon to the Hospital
for Women and Children at Leeds.
Windsor, C. W., M.D Camb., L.R.C.P.Lond., M.R.C.S., Medical
Officer for the Workhouse of the Royston Union.
#irihs.
Andre. —On Octobar20th, at Sidlesliaui near Chichester, the wife-
of J. E. F. Andre, M.R.C.S., L.R.C.P., of a son.
Cook.— On October 18th, at 1 Porch ester House, Loudon, W„ the
wife of F. William Cock, M.D., of a son.
Fairweather. On October 18th, at “ Glenesk,” Wood Green, N.,.
the wife of D. Fairweather, M.A., M.D.Edin., of n son.
Reece.—O n October 16th, at Addison Gardens, London, W., the
wife of Richard J. Reece, M.A., M.D., of a son.
Stocken.— On October 17, at Winchester House, Ealing, the wife
of Leslie Maury Stocken, M.R.C.S., L.R.C.P.. of n daughter.
^Earrmgcs.
Bradford-Roberts. —On October 17th, at St. Phillip's Church,
Ad'lerley Edge, Manchester, John Rose Bradford, M.D., F.R.8.,
to Mary (May) daughter of the late Thomas Foulkes Roberts,
Palmer. -On October 2lst, nt Lancaster House, L mcoln, E’.winC.
Palmer, M.A., M.B., B.Ch Cantab., aged 34.
oogle
Digitized by
“SALUS POPULI SUPREMA LEX."
Vol. CXIX. WEDNESDAY,
(Original Communications.
THE
AFTER-EFFECTS OF REMOVAL
OF THE
APPENDAGES
AND OF
REMOVAL OF THE UTERUS, (a)
By J. FURNEAUX JORDAN, M.B., F.R.C.S.,
Surgeon to the Birmingham and Midland Counties Hospital for
Women.
At the Women’s Hospital in Birmingham we have,
like all other hospitals, an annual meeting at which the
report of the work done in the in-patient department is
next, perhaps, to the balance-sheet, the most important
document produced. In this report, rightly enough, no
mention is made of the previous history, or of the con¬
dition at the time of entranoe, or of the after history of
the patients under our care; but great stress is laid on
the mortality rate. Is it under 5 per oent. or over 5
per cent.? I have never yet come away from this
meeting without feeling how little light is thrown on
our work' by this necessarily bare report. At the time
of drawing up this report, it is impossible to do more
than put on record the immediate result of the operation.
I am venturing then to-night to dip a little deeper into
the notes of my cases to review them right up to date,
to state their present condition, and to point out what
lessons I have learnt from this after history of my cases.
The great difficulty in bringing the reports up to date
is that some of the patients disappear altogether from
observation. The poor people in the crowded parts of a
Birmingham and the towns of the Black Country think ]
far less of moving house than we or our wives do of a
spring cleaning. In spite of this however—thanks
largely to the Post Office—I have been able to trace all
but two of them. Another drawback to such a report is
that I was not born ten years earlier; none of my cases
can present a post-operative history of more than a few
years, sinoe I did not begin operative gynaecological
work till the beginning of 1898. There are, of course,
many cases in which after recovery from an operation
the patient remains, as far as the effects of the opera¬
tion are concerned, in a stationary condition, but it is
distinctly different in cases in which the operation
involves removal of the uterus or its appendages. It is,
therefore, the post-operative progress of these cases that
I wish to consider to-night.
I have tabulated my cases of removal of both appen¬
dages for disease up to September of last year; the
shortest after-history is thus of twelve months’ duration.
The number of cases operated upon is 43, of these 3
died as a result of the operation. These three deaths
followed operation for removal of double pyosalpinx,
and were due in each case to perforation of the bowel,
and peritonitis on the second or third day after the
operation. The total number of cases of pyosalpinx
operated upon is 20, the mortality, therefore, of these
(a) Beid at a msetimjr the British Gyn:ecolo*-ical Society on
October 12th. 1899.
NOVEMBER 1, 1899. No. 18.
cases is exactly 15 per cent. None of the other cases
have died. It is impossible in a table to go into minute
details as to the severity of the disease. I have indicated
the main conditions, and you can see that some of the
operations were most difficult, the appendages being
buried in adhesions, that others were easy, adhesions
being slight or absent, and that between the two
extremes were operations of varying severity. Of the
40 cases which recovered, I have got full information of
the after progress in 88. Two of them I have been
unable to trace. Of these 38 in the table, the report in
35 cases is founded on a personal interview held within
the last month, in two cases the report is founded
on a written statement sent me by the patient in reply to
my questions. One case died two months after the
operation from exhaustion due to advanced tuberculous
disease. We therefore have the after-history of 37
cases, and inquiries were made as to the following
points:—
The severity and duration of the symptoms due to the
production of the menopause, and their occurrence at
fixed periods.
The continuation of menstruation after operation and
the occurrence of vicarious menstruation.
The effect of the operation upon the body-weight.
The effect upon the marital functions.
The condition of the scar of the abdominal incision.
The state of the general health, and the capacity for
work.
I made a personal examination of the abdominal
incision, and, when I thought it necessary a bimanual
examination of the pelvis. I shall neither spend your
time nor weary you by reading all the details of Table I.
I will try and present you with a summary.
First, then, as regards the severity and duration of
the climacteric symptoms.
Taking the latter first I can only give the duration in
twenty-four cases ; in the other cases the symptoms are
still present more or less. The duration varies between
five-and-a-half years and a year. The average duration
in the twenty-four cases is about three years. In
examining into the severity of the symptoms I divide
the cases into four classes—very severe, severe, moderate,
and Blight. By “ very severe ” I mean that the patient
not only suffered from heats and flushes and attacks of
giddiness, Ac., but was occasionally laid up by them and
prevented from working. By “ severe ” I mean that the
patient felt them badly, was very distressed during
their occurrence, but was never actually laid up by
them. By “ moderate ” I mean that the symptoms were
troublesome more than distressing, and were less fre¬
quently felt than in “ severe ” cases. By “ slight ” I
mean that the patient was very little troubled by them.
Three patients, 8'1 per cent., suffered very severely;
twelve, 33 2 per oent., severely; ten, 26 per cent,
moderately •, and seven, 19 4 per cent, slightly.
The average age, at the time of operation, of those
who suffered very severely was 27, of those who suffered
severely the average age was 31, of those who suffered
moderately 34, of those who suffered slightly, 32. On
the whole we can draw the conclusion that the younger
the patient the greater will be her sufferings from an
artificial menopause. A noticeable feature is the youth¬
fulness of the patients—thirteen of them, i.e., nearly a
third, were under 80 at the time of operation. In ex-
Digitized by Google
444 The Mkdical PBE88. ORIGINAL COMMUNICATIONS.
Nov. 1. 1899.
planation of this we most remember that many of these
cases—the majority of the pyosalpinx cases and many
cases of thickened and occluded tubes with adherent
cystic ovaries—are due to gonorrhoea. In the poorer
classes it is the young child-bearing women who con¬
tract this disease from their husbands. Of the thirteen
cases under 30 years of age seven suffered from pyosal¬
pinx, one from thickened occluded tubes with cystic
ovaries, and five from cystoma of both ovaries. This
condition, which I have briefly described as “ thickened
occluded tubes with cystic ovaries ” is one which I have
no doubt you all know as well or better than I do. The
patient usually has a history of old gonorrhoea, the tube
is thickened and softened, the ligature cuts through it,
the contents are a grumous muco-purulent fluid, and you
would not be surprised if you found pus. The tube is
adherent to a large cystic ovary, the two forming one
swelling adherent to broad ligament, uterus and often
bowel or mesentery.
To come back to my table, in seven cases the symptoms
were distinctly worse every four weeks, and in two cases
occurred only every four weeks. As regards the con¬
tinuation of menstruation after operation I find that it
ceased entirely in twenty-seven cases— i.e., in 73 per
cent. In ten cases menstruation occurred after opera¬
tion. The particulars are as follows : —
No. 10. Menstruated regularly for six months after
operation; the quantity lost diminished at each suc¬
cessive period.
Nos. 11 and 12. Menstruation continued regularly,
rofuse loss and great pain until relieved by vaginal
y8terectomy.
No. 14. Menstruated every three months for a year
after operation.
No. 19. Menstruated once, three months after opera¬
tion ; six months after operation had an attack of epis-
taxis, which was repeated at the ninth month, and finally
in another three months had haemorrhage from the
bowel.
No. 21. Haemorrhage from a small pile every four
weeks, never at any other time.
No. 22. Menstruated every three months for two years
after operation.
No. 34. Menstruated for nine months after operation,
but irregularly.
No. 36. Menstruated once, three months after operation.
No. 37. Menstruated every month since operation
twelve months ago, the quantity lost is diminishing.
In all the cases in which menstruation continued
after removal of the appendages there were very dense
adhesions, and it is quite probable that some ovarian
tissue was left behind, which went on ovulating for some
time until it became used up as it were. Especially is
this so in the two cases, in which a double pyosalpinx
was removed by post-vaginal codiotomy. In all the
cases but one, No. 37, the symptoms of the menopause
were slight, and I am therefore not sure that the
patients were any the worse off for a slight persistence
of menstruation. They were, as it were, let down easily.
In two cases, Nos 11 and 12, the menstruation con¬
tinued without any change for the better until relief was
afforded by a vaginal hysterectomy
In No. 11, after removing from dense adhesions a
right tubo-ovarian abscess, I found the appendages of
the left side so strongly adherent that I felt at the time
I had not removed them entirely. Her condition was so
bad after the operation that she begged me to do some¬
thing to relieve her. I waited two years to see if there
was any improvement, and then did a vaginal hysterec¬
tomy, the most difficult one without exception that I have
ever done. I had to cut the uterus out of a mass of
adhesions, so dense that it was absolutely immovable.
The relief has been very marked, and she would, as she
says, be comfortable if it were not for chronic bronchitis,
as a result of which she has a hernia of the scar in the
abdominal wall. This I have operated upon once, but
owing to her persistent cough it is giving way again.
In No. 12, too, the appendages were very adherent,
so much so that the htemorrhage on separating them
was profuse, and led me to use a drainage tube. She,
too, got a hernia of the scar four months after operation,
which I operated upon immediately with a permanently
good result. Twelve months ago she contracted
gonorrhoea, and following this her menstruation became
more profuse and acutely painful. I did a vaginal
hysterectomy for her six months ago, and already she is
much better in health. I have gone more fully into
these two cases because they perhaps raise the question
whether I ought straightway to have done a vaginal
hysterectomy, or even the radical vaginal operation.
Discussion on this question I will leave for a minute
till I speak of the lessons to be learnt as a whole.
As regards the effect on the bodily weight, in ten
cases there was a distinct increase, in nine a slight
increase, in thirteen no effect at all, and in three cases a
decrease. Of these three, one is getting into a condition
of chronic melancholia, one suffers from phthisis, and
the cause of the decrease in the third case I cannot
explain. It is difficult to speak positively as to the effect
on the marital functions. The great majority at once
replied that it had made no difference; of the others
pain on coitus has persisted in three cases, in two cases
the desire for coitus has disappeared. Three of them
said that they never cared for it and were just the same
now. One of the three cases in which pain has persisted
is No. 11, already fully referred to Another, No 30, had a
sharp attack of peritonitis after the operation and was
in bed ten weeks. On examination I found the
uterus tender and very slightly movable. There is no
doubt that it is to a considerable extent adherent to
neighbouring viscera. In the third case, No. 31, I
cannot discover the cause of the pain.
We come now to the progress of the scar in the
abdominal wall.
In two cases, 4 and 16, there is a little stretching and
thinning in the lower part of the incision. It is quite
probable that without great care a hernia will form in
these cases. A drainage tube had been used in No. 4.
No. 10, in which also a drainage tube had been U3ed,
developed a hernia in three months, but since I operated
upon her four years ago there has been no sign of any
recurrence. Nos. 11 and 12 I have already referred to.
No. 28 has had a persistent sinus ever since the operation
and I have no doubt that in time a ligature will come
out or be removed. In the other 31 cases, i.e., in 86 per
cent., the scar has never given any trouble and shows no
sign of weakness.
Lastly, as regards the general condition of the patient
and her capacity for work, I find that, often after a
stormy time, good and even robust health ha3 come
back to her. I have in many cases put the exact words
of the patient into my table, if not in her own words, I
have endeavoured briefly to give you an idea of her
condition.
Are the results, on the whole, as good as one would
wish 'i Not quite, for 1 can see now how I might have
done better in some of the cases. It is not the final
results that are unsatisfactory, it is the intermediate
amount of suffering. We must bear in mind, though,
that in these cases where adhesions are the rule, it would
be foolish to expect no pain or trouble after con¬
valescence. Adhesions and inflammatory deposit round
the stump may act for some time as a source of irrita¬
tion, and may even help in producing post-operative
menstruation. Although my eariler cases were free from
acute peritonitis after operation, yet I had distinctly
more trouble in the after-treatment than I have now.
This was probably due to the fact that I did not then
carry out the principles of asepsis as thoroughly as I do
now.
The cas’S of hernia of the scar are all among the
earlier numbers, for I drained more frequently then, and
wi^h a glass tul>e, than I do now. I believe my cases of
pyosalpinx which died would have lived if I had opened
and drained them freely by posterior vaginal codiotomy.
I reported a few cases treated by this route in the
British Medicul Journal a few months ago, when I said
that in cases of long duration, in which the pyosalpinx,
or an abscess communicating with it, can be felt filling
up Douglas’ pouch, the o[ oration to be preferred is
incision and drainage by vaginal codiotomy. Further
experience has only confirmed me in this opinion. In
removal of pyosalpinx by the abdominal route it is
necessary sometimes to drain. Would not this be better
zed by Google
Die
Nov. 1, 1899.
ORIGINAL COMMUNICATIONS. Thx Medical Press. 445
carried out by incision into Douglas’ pouch from the
vagina than by a glass tube in the abdominal incision ?
We should then do away altogether with the chance of
hernia.
Id cases of bilateral suppuration in the appendages,
unless there is co-existing marked disease of the uterus, 1
should certainly not remove the latter organ Severe cases
of double pyosalpinx or tubo-ovarian abscess can be treated
as I have already indicated, by the vaginal route with¬
out sacrificing the uterus. Removal of the uterus to
make a way for the appendages is, under ordinary cir¬
cumstances, unjustifiable. I recognise that twice I have
had to perform vaginal hysterectomy after a previous
removal of the appmdages, and I grant that in No. 11
I should have had a tetter result if I had done a
vaginal radical operation at first, not, however, because
of any disease of the uterus, but because, »ith her
chronic bronchitis, it would have been tetter to
sacrifice the uterus in order to make a way to the
very adherent appendages, than to expose her to the
probability of a ventral hernia. In the second case the
patient contracted a gonorrhcea, subsequently to the
original operation.
I operate less frequently than I did for inflammatory
diseases of the appendages, for I am more porsistent in
insisting on rest; unfortunately in many cases one is
compelled in the end to operate in order to render the
patient capable of doing her necessary work. In spite
of the severity of the symptoms of the menopause I
have been struck by the almost universal restoration
to health in these cases. With this return of health
comes a corresponding capacity for work. Unfortu¬
nately, coincident with this is inability of the woman
any longer to bear children. In view of this we have
already begun to be more conservative in our operations,
preserving whenever possible the appendages of one
side, or if not the entire appendages then suffi¬
cient to give the woman a chance of becoming
pregnant. These cases do not enter into the
scope of my paper to-night, pleasant thought it would
be to dwell upon them. At least, I may say this, that
this conservative spirit, preserving what is healthy,
sacrificing what is harmful, has already caused a con¬
siderable diminution in the number of cases of removal
of the appendages for chronic salpingo-oi'phoritU.
Everything that will tend still further in this direction
should engage our earnest attention, and it is for that
reason that I think we cannot value too highly Mr.
Taylor’s recent contribution on the treatment of gonor¬
rheal salpingitis. If we can succeed, as he has succeedeu,
we shall still further reduce our number of cases of
“ removal of the appendages.” Another thing, too,
which will, I think, tend to render the post-operative
time more tolerable is the adoption of the vaginal route
in suitable cases. I cannot compare the results of the
two routes to-night, for nearly all my cases operated upon
by the vaginal route have been either for the removal
of disease of one side only, or are too recent to present
an after history. The more I u j e this route the better
I like it, and the less troublesome do I perceive the
after history to be.
One other word I wish to add is this, that we see to
it that the patients after these operations g-t good advice
and treatment during the artificial menopause. Two or
three of those who suffered most had had little or no
treatment. Especially does this apply in the tuberculous
cases. With one exception they have done well, but
have required constant constitutional treatment. The
exception never pulled up, but slowly sank two months
after operation.
To sum up, then :
The final result in cases of removal of the appendages
for inflammatory diseases is uniformly good
’1 he severity of the artificial menopause is most marked
in young women.
The mortality in severe cases of pyosalpinx treated by
abdominal section is higher than one would wish.
The use of the drainage tubes involves a weak
spot in the scar.
The likelihood of leaving behind some portion of
ovarian tissue is great in cases of very dense adhesions.
The effect of this passes off in time.
If the appendages are fully removed, menstruation
ceases entirely.
The necessity for, and the advantages to be derived
from, removal of the uterus will rarely occur.
I may now add—
Be as conservative as possible, especially in young
women, and in “ conservative ” I include not only
operative, but also non-operative measures.
Treat the severe cases of pyosalpinx, if possible, by
the vaginal r^ute.
Do not drain unless absolutely compelled to, and
then consider the possibility of draining by the vagina.
Do not get disheartened if the patient does not get
the full benefit of the operation for some little time.
We come now to a consideration of the cases of
myoma for which I have either done a hysterectomy or
removed the appendages. I have done one or other or
both of these operations on twenty-four patients with
myoma of the uterus. Details of the cases are given in
Table No. II.
I removed the appendages seventeen times, but from
two of these seventeen I subsequently had to i emove the
uterus.
I did a hysterectomy in the other seven cases, but in
one of them the appendages had been previously re¬
moved by another surgeon.
No. 1 of the cases in which I removed the appendages
died the day after operation with symptoms of haemor¬
rhage, but I was unable to get a post-mortem exami¬
nation.
One of my cases of hysterectomy died. This case I
shall refer to later on, since it taught me a lesson I sha'l,
I hope, never forget.
The chief points I wish to investigate are :—
(a) The effect on the myoma of removal of the
appendages.
(4) The severity of the menopause following this
removal as compared with—
(c) The severity of the menopause following hysterec¬
tomy.
(d) The general health of the patient subsequent to
the operation.
(a) The effect on the myoma of removal of the
appendages: Since one of the cases died there are
sixteen into whose subsequent history we can examine.
You will see that I had to peiform hysterectomy later
on in two of these cases, but in one (No. 2) it was, I
think, a mistake to remove the appendages. The
patient, a-t 5(5, suffered intense pain from a myoma at
the back of the uterus, which was almost as hard as a
stone. The pain on defalcation kept her in a condition
of chronic constipation and its attending discomforts.
There w*s no hiemorrhage. I might have known that
removing the appendages would have no great effect
on such a fibroid. Although it diminished slightly in
size for nearly three years, yet in 1890 the uterus as a
whole began to enlarge, the pain got worse, and I
thought it best to remove it entirely. This I did on
December 4th, 1896, and found not only the posterior
hard myoma, but a largish interstitial one, becoming
submucous, in the body of the uterus. Whether this
was present, in embryo as it were, at the time of the
first operation, I cannot say.
The other case in which I had to do a second operation
wa» No. 11. The fibroid was a large single one, reaching
some way above the umbilicus. The patient was very
aniemic from the haemorrhage. For a few months the
tumour diminished in size and the hfemorrhage ceased,
but then it began to grow again rather rapidly accom¬
panied by severe haemorrhage. I then did an abdominal
hysterectomy, for which she is very much better,
although she has had a great deal of pain. With the
exception of these two cases, the effect of removal of the
appendages has been most satisfactory. The tumour
has disappeared entirely except in two cases where it
has hardly had time to undergo this process, and in
these two. Nos. 23 and 24, it is distinctly smaller.
(6 and r) The severity of the menopause following
removal of the appendages : I find that the sufferings of
the artificially created menopause are here much less on
the whole than in cases of removal of the appendages
for disease. But then compare the average age of the
Die
izea Dy
lOogle
ORIGINAL COMMUNICATIONS.
446 The Midica j.. P ress.
two classes of cases. In the latter it was about 30,
while in these cases of myoma it is 37 5. The meno¬
pause following hysterectomy is a little less severe than
in cases of removal of the appendages, but again the
average age of the patients at the time of operation is
higher than that of the patients who underwent the
operation of removal of the appendages, it is as high as 40.
On looking over both tables I cannot help noticing that,
as a rule the younger the patient the more she suffers
from the artificial production of the menopause, and
since the difference in the severity of the symptoms
between the cases of hysterectomy on the one hand, and
the removal of the appendages on the other hand, is not
any more marked than the difference between the
average ages would lead you to expect, I cannot put
down the comparative immunity of the hysterectomy
cases from severe symptoms to the fact that the ovaries
were left behind instead of being removed. I think it
is of the utmost importance that we should find out for
certain if, taking all the cases of hysterectomy, the
patients suffer less after the operation than they do after
removal of the appendages. I wish that my cases were
more numerous so that I could speak with more certainty.
At the same time. I think that, if every operating gyne¬
cologist were carefully to place on record the after con¬
dition of all his cases, we should not be long in arriving
at a definite conclusion. Possibly it would be different to
mine, viz., that the variations in the severity of the sym¬
ptoms are due mainly to the relative age rot the patients
Certainly I do not see that the difference is such as to
warrant us bringing forward the preservation of the
ovaries as a strong argument in favour of hysterectomy.
I equally certainly believe, though for other reasons,
that in some cases of myoma, hysterectomy will give us
a better result than any other operation. I recognise
that there are cases in which the artificial menopause is
felt slightly in young women and severely in older ones.
These, however, are exceptional, and we must always
bear in mind the many conditions which influence the
course of the menopause, as the degree of susceptibility
of the nervous system to stimuli, tne surroundings and
the habits of the patient, the original cause of the illness
and the continuance or not under treatment, judicious
or otherwise.
(d) The general health of the patient after operation :
On the whole the final result is very good, with the
exception of Nos. 3 and 4 they are all in excellent health,
and express themselves as feeling better than they
have been for some years past.
From a consideration of these cases, and of the case3
I have not operated upon, I have come to one or two
conclusions as to the treatment of myoma of the uterus.
First, I find that cases do occur in which no
operation is immediately called for, which under the
continuous administration of ergot and hydrastis com¬
bined with rest, may be safely kept under observation
for some time, provided always that they do not steadily
increase in size.
Secondly, that there are cases which distinctly call
for removal of the appendages in preference to hysterec¬
tomy. Every now and then we meet with cases where
the haemorrhage has been so severe that the patient is
absolutely blanched, where her life has been placed in
jeopardy from the haemorrhage, she lies in bed, white as
a sheet, with a small quick pulse, and so feeble that
she can hardly speak or move, certainly raising her up will
probably cause her to faint. I have had three such
cases. Nos. 14, 16, and 24. However skilfully, or by
whatever method, a hysterectomy may be done, and how¬
ever favourable the conditions are, it takes longer, and
inflicts more shock upon the patient than removal of
the appendages. The extra time and the extra shock,
which in an ordinary case will not affect the ultimate
result, may in these blanched and almost blood¬
less patients I have referred to, be just the
last straw that breaks the camel’s back. In
Nos. 14 and 24 I removed the appendages
and the result has been even better than I expected, in
No. 16, because the tumour was not quite so large, and
was situated more in the pelvis than the abdomen, I did
a vaginal hysterectomy. I had to slit up the uterus and
remove the tumour in pieces and finally complete the
N ov. 1, 1899-
removal of the uterus. I did it fairly quickly, she lost
no blood at the operation, and I took every possible pre¬
caution against shock, but she never rallied from the
operation, dying the same afternoon. I shall never, if I
can possibly help it, do hysterectomy again in cases of
this kind. Thirdly, for large, unwieldy tumours, dan¬
gerous from their very size as much as aoything else,
and for tumours blocking up the pelvis, rendering life
miserable from intrapelvic pressure symptoms I believe
hysterectomy is the treatment. I have had, I think, an
undue proportion of these intrapelvic fibroids. The
operation is not an easy one, but it is well worth all the
trouble involved since the relief to the painful symptoms
is immediate and complete. This hysterectomy is, I
think, done most easily by the combined method, and
in mentioning this I do not wish in any way to raise the
question as to the choice of the abdominal or vaginal
route, lo my mind the route does not enter into this
question. In doing a hysterectomy unless you leave a
subperitoneal stump you are obliged to open the vagina
into the abdomen. In the combined method you de¬
liberately do all you can from the vagina, cleansing the
vagina easily, and separating the vaginal attachments
of the uterus with the greatest ease, and if possible liga¬
turing the uterine arteries and opening the anterior and
posterior peritoneal pouches Having done all this extra-
peritoneally you can easily complete the removal of the
tumour from the abdomen.
Lastly, for small myomata demanding interference
from their rate of growth, from the haemorrhage and
from the pain I confess frankly that I should hesitate
between vaginal hysterectomy and removal of the
appendages. I think I should be guided by the stout¬
ness of the patient or by the capacity of the vagina, a
stout patient leading me to prefer the vaginal hysterec¬
tomy, a small vagina leading me to prefer removal of
the appendages. Each case must be judged for itself,
it being impossible to lay down any hard and fast line.
Before concluding this consideration of the effects
of removal of the uterus, I must refer to three
cases in which I have been compelled to perform
vaginal hysterectomy for intractable uterine haemor¬
rhage. The haemorrhage had only been slightly relieved
by curetting, and no treatment that I could think of
had the slightest effect on it. The uterus in each case
was enlarged, apparently by a general fibrous thickening
of its wall. In each of these cases I left the ovaries
alone, but they have all three suffered, two of them
very severely, and one moderately, from the meno¬
pause, but now four years, two years, and eighteen
months respectively since their operations, they are
over the worst of their troubles. The two who
suffered very severely were 23 and 27 years old, the
third one was 43. I fail, therefore, to see that if you
remove the uterus you save a woman from all trouble
by leaving the ovaries. I would save the ovaries by
all means if they can help a woman towards ordinary
menstruation or child-bearing, but that I ought to
prefer to remove the uterus rather that the appendages
in a case of myom«, because the woman will suffer
lees from the former operation than from the latter; I
will not say I do not believe, but certainly my own
experience does not justify me in believing. I have
already indicated what I believe to be the operation best
suited to each case, and while believing that a large
number, if not the majority, of cases are beBt and soonest
cured by hysterectomy, yet I hold that there are cases
which can be best and most safely, if not most quickly,
cured by removal of the appendages.
Lastly, there is one case which I overlooked until too
late to insert in the table, but which would render
my results incomplete if left out. On September
14th, 1897, I removed the appendages in a case
of myoma, reaching about half way to the um¬
bilicus, growing rapidly and causing profuse
menorrhagia. She went on very well for about thirteen
months with no haemorrhsge and diminution in size of
the tumour, when she became insane and committed
suicide just about this time last year. Whether the
insanity was a case of post hoe proctor hoc, I cannot
say. The suicide should certainly have been prevented.
Digitized by CjOO^Ic
Niimlicr.
Nov. 1, 1899.
ORIGINAL COMMUNICATIONS.
The Medical Press. 447
TABLE I. REMOVAL OF THE APPENDAGES FOR DISEASE.
Date.
Condition for which
Ojieration was done.
Severity A
Duration of
C liuiactiTic
Symptom a .
Post Opera¬
tive Men¬
struation or
Vicarious
Menstrua¬
tion.
Effect on
the Body-
weight. ’
Effect on
Marital
Relations.
Condition
of Scar.
General Health.
Appendages very ad- Severe,
lierent. Tubes swollen. Lasted 3
indnrated and occluded. years.
Contents—cheesy pus.
22 11*1 .'hi
Double pyosalpinx.
Both tubes contained
over two ounces of pus.
Universal and strong
adhesions.
h 2 0; 21 Very adherent pvosal-
piux on the right side
and adherent ap)*en-
dages on the left. Three
months pregnant.
11 5 94 34 Apjiendnges hurieil
•tinder very dense ad¬
hesions. Chronic pjo-
salpinx of left side und
blood cyst ot right
ovary.
Moderate.
Chiefly felt
every 4
weeks .
Lasted over
2 years.
After safe
delivery of
full term
child, s u f-
fered very
severe!y .
E-peci ally
every 4
weeks. Still
suffer s
slightly
Slight. For
near! y :!
years.
None.
None.
None.
None.
Slight in¬
crease.
None,
Coitus al¬
ways painful
before op-
e ratio n.
yuite free
from ]>ain
since.
(Widow.)
None.
None.
Increase.
Good. | “ Stronger than she
has ever l*een.’'
Good. i “ Very gool."
Good. Suffers from severe
| migraine, and at hicks
of j>ain in both groins
after hard work. On
examination uterus was
found to be tender and
fixed by adhesions.
None. Thiu and Recovery delayed by
stretched in abscess breaking into
the lower bladder and passage of
part. silk ligature per ure-
thraui. Health now very
goo-1
10
25 5 94
22
Right pyosalpinx and
left hydrosalpinx.
S e v c r c ,
Lust cd 4
years.
None.
1 Increase.
None.
Good. Still occasional pain
, in the groins after hard
, work, otherwise good.
29594
49
Double hydrosalpinx.
Overl-eforc
operation.
None.
None.
G oi *d. “ Very good.''
14.ii.94
32
Large double tuber-
culous pyosalpinx. Tu¬
berculous jieritoiiitis
with ascites.
Very slight.
None.
1 Increase.
None.
Good. i Much improved.
“ Feels very strong nnil
well."
29 0 94
29
Cystoma of l>oth
ovaries.
Slight. For
over 3 years.
None.
None
None.
Good. 1 “ Is very well indeed.”
22*94
30
Both ovaries enlarged
and in n condition of
cystic-ovaritis.
Moderate.
N o t o v e r
yet.
None.
Slight in¬
crease.
Pain
coitus.
on Good. No examination made,
as patient lives n long
way from Birmingham.
( -he writes that she has
- improved considerably
1 in general health.
4 10 94
32
Tidies thickened, oc¬
cluded and adherent to
cystic ovaries.
Moderate.
Lasted
nearly 4
years.
Regularly
(but dimi¬
nishing) tor
six months
None.
None.
In three “ Excellent.”
months de¬
veloped a
h erni a of
0 10 04 42 Densely adherent
right tulio-ovuriaii abs¬
cess ami inflamed left.
api>en(lages. Some
ovarian tissue on left
side left behind.
12 16 10 04 :{ti
after opera-
tii>u.
Reirularly: None.
I>uin severe;
o n 1 y r e -
lieved l,y a
s u hse-pient
h y s t e rec-
t o in y (va-
ginuli.
No relief
to pain on
coitus until
after second
operation.
5 12,'94 42
14 10/1294 43
15 27 2,95 23
Inflamed adherent
t uties with cystic
ovaries. Adhesions icrv
dense and free ha-uior-
rhage on separating
them.
Regnln rly.
Not so pain¬
ful or fris*
as b c foie
o pera tion
till twelve
months ago
when the
pain in-
creased. Re¬
lieved hy-
vaginal hys¬
terectomy.
Increase.
None.
Both tubes dilated,
occluded and adherent
Severe —
worse every
None.
Decrease.
No pain,
but dislikes
to large cystic ovaries.
4 weeks.
baling coi¬
tus.
Appendages adherent.
Moderate,
Every 3
Slight in¬
None.
Tubes thickened and
dilated.
L a s t e d
n e a r 1 y 2
years.
months for
the year
after opera¬
tion.
crease.
1
Chronic salpingo-
oophoritis with adhe¬
sions.
Severe for
12 months,
slightly for
two years
N one.
None.
None.
j
the scar.
Operation in
Feb.. iMpj.
Con d i thin
now very
good.
Hernia of
scar grad¬
ually devel-
oiHsl.Opera-
t i o n two
years ago,
but is re¬
turning.
In a few
months her¬
nia of scar.
O p e mtion.
1**9V Con¬
di t ion of
sea r now
very good.
Has lieen a “chronic
bronchitic ” for years,
with very severe cough
which is very trouble¬
some, and probably ac¬
counts for her hernia.
History of attack of
gonorrheeu 12 mouths
ago. Af.er a great deal
of suffering is now get¬
ting steadily better.
Good. Is almost in a condi¬
tion of melancholia. Ap¬
petite bad, and slowly
losing flesh. Was very
depressed before opera-
, tion.
Good. “ Has not felt so well
for years.”
Good. | Iu Sspt. of same year
as operation contracted
| syphilis. Have lost
sight of her for last
: twelve months.
D
Digitized by
Google
448 in Medical Press. ORIGINAL COMMUNICATIONS.
Nov. 1, 1899.
TABLE I. REMOVAL OF THE APPENDAGES FOR DISEASE —(Continued).
Date.
Cod ition for which
Operation was done.
Severity &
Duration of
Climacteric
Symptoms.
Poet • opera¬
tive men¬
struation or
Vicarious
Menstrua¬
tion.
Effect on
the Body-
weight.
Effect on
Marital
Relations.
Condition
of Scar.
General Health.
None.
Increase.
Freedom
from pain
on coitus.
A little
thinning in
the lower
Good.
None.
Increase.
None.
Good.
Fair. Suffers from
chronic dyspepsia.
None.
None.
None.
Good.
“ Very good ”
3 months
post op
6 months
epistaxis.
9 months
epistaxis.
12 months
after h te-
mor r h a g e
from bowel.
Slight in¬
crease.
None.
Good.
Is very well and strong
None.
None.
None.
Good.
la not very strong,
but on the whole “en¬
joys good health.”
H e morr-
hage from
small pile
every four
weeks.
Slight in¬
crease.
None.
Good.
Good.
Every 3
months for
2 years. No¬
thin g for
last ten
months.
None.
None.
Is in better health than
she has been for some
years.
None.
Slight in¬
crease.
None.
Good.
(s quite well, except
for tome pain from a
movable kidney on the
right side.
None.
None.
None.
Good.
Good.
None.
Very slight
increase.
None.
Good.
Has chronic phthisis.
Suffers from cough and
shortness of breath.
None
None.
None.
Good.
Very good.
None.
Increase.
None.
Good.
Very good.
None.
Slight in-
cieaee.
(Single.)
Good.
Suffers from the heats
and flushes and giddi¬
ness. Is quite free from
her old pain.
None.
Increase.
None.
Persistent
sinus explo¬
red twelve
months ago
with no re¬
sult Still
present.
Good.
Very good. Sinus
troubles her very little.
None.
Increase.
Slight
pain on coi¬
tus.
Fair. Has bad scarlet
fever since the oi>era-
tion, and has not long
been convalescent.
None.
None.
Pain on
coitus di-
m in i s hed.
but not
gone.
Good.
Is very well except nt
the monthly exncerla-
tions.
None.
Slight in¬
crease.
None.
Good.
Occasional attack* of
pain in left groin, other¬
wise is well. On exami¬
nation can find nothing
wrong
None.
None.
None.
Good.
Very good.
Continued
for nine
months ir-
Slight in¬
crease.
None.
“ Fee’s better in every
way for her operation. '
16 19/4 95
17 j 17 7,95
18 28.9,95
19 24 2/96
20
23 8/2,97
8,4,97
26 | 16,8/97
27 | 13,10, 97
28 6,11 97
29 ; 7/12/97
30 11/1,98
31 j 18,2/98
32 , 10,3/98
33 j 23/5 98
6,7/98
35 13/7/98
32 Chronic salpingo-
oophoritis with adhe¬
sions.
32 Both tubes enlarged,
occluded, very adherent
to cystic ovaries.
37 , Cystoma of both
j ovaries.
34 Adherent tubes and
small cystoma of both
i ovaries.
5 6/96 32 Hard cystic ovaries.
21 i 29,7,96 i 34
22 1 9/1/97 25
24 23,2/97 40
25
21
35
Pyosalpinx of right
side.
Double pyosalpinx
and adherent ovaries. !
Removed by posterior !
vaginal cceliotomy.
38 Cystoma of both
I ovaries.
Moderate
—just over
now.
Severe for
18 months.
Moderate.
For 2 or 3
years.
Moderate.
E x a c 11 y
every four
weeks, just
gettingover
them.
j Severe.
Especi ally
4 weeks
Lasted
n 'arly 3yrs.
Severe for
12 months.
Grad u a 1 ly
ceasing.
Slightly.
Very nearly
over.-
Cystoma of both
ovaries with ascites.
24 Double tuberculous
| pyosalpinx.
34 | Double pyosalpinx.
Very strong adhesions.
33 | Cystoma of both
ovaries.
31 | Chronic salpingo-
oophoritis.
21 | Double pyosalpinx.
About 15 and 5 ounces
of pus in right and left
tubes respectively.
Adherent appendages,
with thickened and
occluded tubes.
29 I Cystoma of both
ovaries.
Cystoma of left ovary, I
with twisted pedicle, i
Small cystoma of right
ovary.
Double tuberculous
pyosalpinx.
Adherent double pyo¬
salpinx. Removed by
posterior vaginal ccelio¬
tomy.
Doable tuberculous
pyosalpinx, universally
adherent. Tuberculous
peritonitis. Extreme
emaciation.
Severe and
not yet
over. Worse
every four
weeks.
Moderate
for over a
yea-. Not
over yet.
Sever e.
Every 4
weeksattack
of migraine.
Moderate.
For 18
months.
Woroeevery
4 weeks.
Very slight.
Very
severe. Still
present.
Moderate.
Severe,but
getting
much less
so
Severe ex-
acerbations
[every 4
I weeks.
Moderate.
Very slight,
nearly over.
Moderate.
E v e r y 4
weeks only.
Died two months after
the operation from ex
liaustion. Never began
to "pick up” after the
operation.
Digitized by LjOOQlC
Number.
Not. 1, 1899.
ORIGINAL COMMUNICATIONS. Th* M.dical Pbibb 449
TABLE I. REMOVAL OF THE APPENDAGES FOR DISEASE— (Continued.)
Date.
S
•<
Condition for which
Operation was done.
Severity A
Duration of
Climacteric
Symptoms.
Post-opera¬
tive men¬
struation or
Vicarious
Menstrua¬
tion.
Effect on
the Body -
weight.
Effect on
Marital
Relations.
Condition
of Scar.
General Health.
27 798
40
Double pyosalpinx,
also three small sub-
peritoneal fibroids o’
the uterus.
Slight.
Still present
Once, 3
months
utter ojiera-
t ion.
Increase.
None.
Good.
'* Feels very welL”
9 898
34
Hirmorrhagic evg-
toma of both ovaries
and right hematosal¬
pinx.
Cystoma of both
ovaries.
Regularly.
Loses too
much.
Decrease,
None.
Good
Except for losing too
much at her periods, is
very well.
15/8/28
27
V e r y
severe. Still
present.
None.
Decrease.
Pain in
the sen r
from cough-
in r.
Stiffere from phthisis,
with severe cough and
profuse night sweats.
TABLE II. CASES OF MYOMA OF UTERUS.
3 23/1/94
4 4/494
5 27 10/lrt
10 | 5/6/96
11 31/8/95
Size an 1 Position of
Myoma.
Chief Symptoms for
which Oueiation was
done and Nature of
Operation.
5/11/93 29
16 1193 36
6 1
5/11/94 ■
28
7 ‘
20/12/94 i
34
8 1
21/1/95
42
9
26/4,95
35
Median tumour <4 Hemorrhage. Removal
uterus. Softish to the of appendages,
feel.
Hard rounded mass Pain, especially on de¬
al ze of aa orange inpos- fecation. Removal of ap-
terior wall of uterus. pemlages.
36 Small filroid—inter¬
stitial exp ndiug uterus
i upwards.
30 Two fibroids — one
sub-peritoueal and a
largish interstitial one.
45 About the size of an
orange. Ctntialinan-
terior wall.
Nearly filling up pel¬
vis.
About the size of two
I fists.
Nearly up to timbili-
cna. Interstitial.
About the size of an
orunge, and expanding
> right side of uterus.
29 ■ Small and low down
in the uterus.
Severe pain and ha?mor-
rhage. Increase in size
during 6 months under
observation. Removal of
appendages.
Increasing size of tu¬
mour and bearing down
pain in pelvis. Removal
i of apjiendages.
Continual desire to
micturnte. Intra - pelvic
psin. Increasing hemor¬
rhage. Removal of ap¬
pendages.
Increasing in size with
severe heemorrlnge. Re¬
moval of appendages.
8evere htem orrhage
Also ovarian cyst present.
Removal of appendages.
Hieinorrhnge for a year.
Removal of appendages.
Acute pain and pressure
in pelvis for 4 j ears. Re¬
moval of appendages.
Severe hemorrhage for
9 months. Relieved for a
time by curetting Re¬
moval of appendages.
35 Large—3 inches above Profuse hemorrhage,
the nmbilious. Very anemic and weak.
I ; Remov. 1 of appendages.
Effect on the
Myoma.
Slight diminu¬
tion.
Disappeared.
Disappeared.
Disappe a r e d
in about 12
months.
Disappeared.
Disappeared.
Disappeared.
For 6 months
menstruat : on
continued, then
ceas * d, and
tumour bos dis¬
appeared.
No sign of
tumour to be
felt. No hiemor-
rhage since
operation.
For 9 months
no hemorrhage,
and flight dimi¬
nution.
Severity of the
Menopause.
Severe. Lasted
3 years.
Moderate for
12 months, ihen
gradually
ceased.
Moderate, bnt
over in a few
months.
Moderate,only
just getting
over it.
Moderat e —
lasted about 18
months.
Slight and
soon over.
Moderate.
Severe for 2
years, only
lately ceased.
Severe after
the susequent
hysterect o my
Not quite over.
12 20/11/95
13 j 10/7/9*1
Small hard fibroid
in posterior wall of
uterus,
I interstitial. Nearly
filling pelvis. Three
distinct fliroids.
Pain snd hiemorrhage.
Gradually getting worse
for 5 years. Removal of
npitendages.
Hod had appendages
removed in 1883. Pain
ever since Hysterectomy !
by combined method.
Disappeared.
Moderat
3 years.
for
8h'g'.it, ever
since first opera¬
tion.
14 ' 15/9,96
36 Interstitial myoma up' Absolutely blanched Disappeared Slight.
I to the umbilicus. with haemorrhage. Pulse in less than two
small and quick. Re- years.
I moval of appendages.
Subsequent History.
Died the day after
the operation.
I In 1896, increase in
general size of uterus
and increase of pain.
Vaginal hysterectomy
on December 4th, 1896.
i Large submucous fib¬
roid and small hard one
in posterior wall. Well
up to 2 years ago. Can¬
not trace her since.
Never very strong. Is
1 better than she was,
but easily tires.
Suffers from head¬
aches. Is amende. Is
very poor and has to
work hard.
Is very well Small
hernia of scar npneare I
in 1898. Operation,
April 15th, 1898. Con¬
dition of scar now is
very good.
Has steadi y gained
in health since the
operation.
In excellent li alth.
Has kept in v ry good
health.
Health very gool.
Dislikes having coitus.
Is vety well and able
to work hard.
At the end of 9 months
renewed hiemorrhage
and. increase in size of
tumour. AbdomiDul
hysterectomy May 10th,
1890. General health
fair. Has had a great
deal of pain.
Has slowly but stea¬
dily gained in health.
Distinctly better in
health. Is troubled by
a small sinus in vaginal
roof, which I liave ex¬
plored bnt without
result.
Is in excellent health.
I
Digitized by LjOOQle
450 The Medical Press. ORIGINAL COMMUNICATIONS.
TABLE II. CASES OF MYOMA OF UTERUS—(Continued)*
Date. ' §
< I
Size and Position of
Myoma.
Chief Symptoms for
which Ojieration was
done and Nature of
Operation.
Etfect on the
Myoma.
Severity of the
Menopause.
15
16
17
18
19
21
IK 1/97 38
31/8 97 42
14.9 97
27 10/97
20 11,97
:17
11/1.9K 40
hi'* 98 45
Myoma half way up
to the umbilicus, with
pyosalpiux of left side-
Large myoma, reach¬
ing to midway between
umbilicus and pubes.
Large median tu¬
mour, reaching above
the umbilicus.
Tumour largely occu¬
pying the pelvis and
rising twoTnches above
the pubes.
Tumour about size of
a large orange, project¬
ing above pubes.
Large nodular my¬
oma, tilling pelvis nnd
rising into the abdo¬
men.
Myoma of posterior
wall of uterus: tilling
up Douglas' pouch.
H.rmorrhnge, pain and
continual loss of flesh.
Vaginal hysterectomy nnd j
drainage of pyosalpiux.
Severe Iwemorrliage for ,
3 years. Blanched, almost
puls? less. Vaginal hys¬
terectomy.
Haemorrhage and rapid .
growth. Abdominal hys¬
terectomy.
Intm]>elvic pressure
symptoms and very severe
liiemorrliage. Patient very
amende. Removal of ap¬
pendages.
Severe lnemorrhage for
3 years. Removal of
appendages.
lutrapelvic pressure
symptoms and persistent
haemorrhoids. Hyster¬
ectomy by combined
method.
Pressure on rectum.
Severe pain on defe cation,
with hmmorrliage from
rectum. Vaginal hys¬
terectomy.
Disappeared.
Disappeared.
Very slight.
Moderate. Not
over yet.
Slight and soon
over.
Severe forn few
m'liths. Dimin¬
ishing now.
Slight. Occa¬
sional fits of de¬
pression.
Moderate
every 4 weeks.
12
4 5/98
36
Small myoma and
double pyosalpiux.
Profuse haemorrhage— ■
trreat pain and emaciation. •
1 The vaginal radical opera¬
tion.
Slight for a
few months.
23
24 1
4 7 98
45
Myoma, about size of
a cocoa-nut : in lower
■ ]>nrt of uterus.
Pain and continuous
growth of tumour. Re¬
moval of appendages.
Tumour dis¬
tinctly smaller.
Severe.
14 9 IK
45
! Myoma, rising above
i umbilicus.
Severe haemorrhage for ,
two years. Blanched.
Tumour much
smaller.
Pulse small and very
quick. Removal of np-
pendages.
Nov. 1, 1899
Subsequent History,
Is in splendid health.
Better than she has
been for years.
Died in a few hours
from shock.
Is in very good health.
“ Feels a new woman.”
Is in fairly good
health, but still aneemic.
Is in very good health
und feels greatly re¬
lieved by the operation.
Ha-morrlioge from
l>owel every six weeks,
getting gradually less.
A sinus was left in
vaginal roof, from which
I removed a ligature.
Present health is very
good.
Is in perfect health,
looks quite well and
plump
Much better. Gets
occasional attacks of
pain.
Twice had severe
hiemorrlmge at 3 nnd 4
months nfter operation.
Since then no ha-rnor-
rhnge and stendv gain
in health and strength.
nnd would have been, if the auviceof her doctor and my¬
self had been followed.
In conclusion, I can only wish I had had a more
interesting paper to bring before you, however interest¬
ing these i-esults may be to me. I cannot hope that they
will be equally so to you. I know, too, that 1 have
brought forward no new facts. I have not compared my
figures with those of other surgeons, my object was to
follow' each case as well as I could to its condition to-day,
and to see if we could learn anything from this investi¬
gation. If I have succeeded only in part of my endeavour
I shall he glad.
THE
RECOGNITION of ENLARGEMENTS
OF THE
LEFT AURICLE BY PERCUSSION;
AND ON OTHER CLINICAL USES OF
DORSAL PERCUSSION, INCLUDING PER¬
CUSSION OF THE PELVIS, (a)
By WM. EWART, M.D.. Cantab.. F.R.C P.Lond.,
Senior Physician to St. George’s Hospital, Loudon, aud to the
Bslgrave Hospital for Children.
In a recent paper read before the Cambridge
Medical Society {/>), an easy method was described
of determining by percussion the left auricle dulness
as distinct from the post-cordial dulness. An esti¬
mate of the size of the left auricle in mitral stenosis
is an essential element, hitherto not available, in the
la) Abstract of a paper contributed to the Section of Medicine
at the Annual Meeting of the British Medical Association, August,
J999.
(It) " On the Practical Aspects of Dorsal Percussion and in parti¬
cular of the Percussion of the Spine."—Lancet, July 29th, 1K99.
piugnosis of individual cases, unu its enlargements
and variations most important as guides to the pos¬
sibilities and the restrictions of treatment. Tracings
of great enlargements diagnosed during life and
subsequently verified after death were appended to
the paper, and also tracings from cases where the
auricle had diminished in size under treatment.
The intcrscapular dull area (a) corresponds to tlie
region of the posterior mediastinum, the contents of
which are attracting more and more attention in the
direction of diagnosis and of treatment. Its per¬
cussion is, therefore, of practical importance
no less for the physician than for the surgeon, for
whom an early recognition of diseases of the
oesophagus in particular is a practical requirement.
The resulting alteration in the percussion of this
area is demonstrated in the tracings.
The fifth spine dulness {!>) is subject to considerable
variations in individual cases, particularly during
the life period most liable to glandular affections.
M. Fernet lias endeavoured to base the diagnosis of
early phthisis upon the increased size of the glandular
dulness in this region, though he relies at the same
time upon the association of other signs at the apex
and at the base of the lung. The recognition of
the extensive dulness present in some cases of
lymphadenoma is easy; but with practice a recog¬
nition of smaller glandular enlargements is also
within tlie reach of any clinical observer. For this
purpose, however, it is essential that we should be
familiar with the small normal dull area, which
includes the dulness of the fifth dorsal spine and that
of the infratraeheal glands in their healthy state.
The post-splenic dulness ( c ) has not been lost sight
of in cl inical practice, although enlargements of tie
(6; Cf. loc. cit. (c) Cf. loc. ci .
(a) Cf. loc" cit.
Digitized by LjOOQ ic
Nov. 1 , 1S99.
ORIGINAL COMMUNICATIONS.
The Medical Pkess. 451
spleen usually extend forwards and downwards. It
is. therefore, unnecessary to dwell at any length upon
this part of dorsal percussion.
A determination of the juist-hejmtic dulness (<») is
of clinical interest in all cases, but in some it is of
primary importance. Two instances in point are
illustrated by tracings. In a case of hydatid of the
liver in a boy. considerable enlargement of the left
lobe without corresponding enlargement of the right
lobe, gave support to the diagnosis of hydatid disease
and to its successful treatment by laparotomy. In
another case of suspected hepatic abscess, the
enlargement was shown by dorsal percussion to
affect the right lol>e. In cases of simple enlargement
of the liver, the fusion of Piorry's dull nucleus
with the anterior dulness of the liver is an important
guide.
The lower dorsal dull patch associated with the
presence of pericardial effusion, but not produced by
cardiac enlargements, has been sufficiently dwelt
upon elsewhere.
The second lumbar spine dulness has only recently
been recognised by the writer as a normal feature in
dorsal percussion. Its study will probably l>e of
clinical importance since this dulness appears to l>e
due to the head of the pancreas, to the pylorus and
to the surrounding solid structures. A case illus¬
trated by a tracing may >>e mentioned, in which
dulness extended to the right of the normal spinal
dulness of the second lumbar spine, and this was the
only physical sign yielded by a mass, involving the
lower end of the stomach, which was subsequently re
vealed by laparotomy.
The upper sacral tininess is of such slight degree
that it may readily be overlooked. So far as the
writer has hitherto studied it, this dulness would
seem to be one transmitted from the bladder. The
resonance of the sacral spine is normally great, but
it might be modified by the presence of growths or
deposits.
Th renal dulness and its variations have been
constantly under clinical observation, and need not
be dwelt upon.
Pelvic percussion might be turned to greater clinical
account than heretofore, and in gyna-cology its
practical usefulness must be obvious. In a case
of which tracings were preserved a definite dulness
oyer part of the right os innominatum had led to the
diaenosis of a deap-seated abscess. The tumour,
which could be felt anteriorly was found at the
operation to consist of matted intestine, but the
abscess which gave rise to the dulness was beyond
the reach of the operation, though its presence was
subsequently verified by post-mortem examination.
- ♦
HOSPITAL ABUSE AND HOSPITAL
REFORM. ( b )
By F. J. A. WARING, M.D., L.R.C.P.I., Etc.,
Hove.
As far as “ hospital abuse ” is concerned, I fear
that the medical men attached to such institutions
are to a large extent to blame, for if they would take
a firm stand, and refuse to attend cases of acknow¬
ledged unsuitability, the attention of the general and
subscribing public would Ire more fully aroused to
the evil; and instead of hearing the everlasting cry
that our hospitals are in want of funds, we should
find that the subscriptions were ample to meet the
needs of the deserving poor. In no town in the
la) Cf. loo. cit.
( b) Abstract of Addrms delivered before the Couferenoe Hospital
Reform Association, October ''ith, IV'.
kingdom does abuse exist to a greater extent than in
Brighton. For some years past an agitation has
been going on at intervals, which first originated
with an investigation by the local branch of the
Charity Organisation Society; ttud they issued a
pamphlet, showing the astounding extent to which
this evil existed. It was, however, in the autumn of
1*95 when I first took any step in the matter. I
then showed that in 1*94 38,113 tickets had been
issued from our various charities, and that the
population of the joint towns was only 150,000. I
drew particular attention to the fact that of the
3,701 births which took place in 1894, the amazing
number of 1.240 were attended by the West Street
Lying-in Institution, which is a little over one-third
of the number; and that this relative proportion
was increased when we consider that many of the
remaining two-thirds were attended in the Brighton
and Steyning unions, and others by a merciful
society for helping young women in their first fall.
Aroused as I was by this astounding fact, I drew up
an address calling the attention of the governing
bodies of our charities to this increasing evil, and
begging them to take some steps to suppress :t. I
obtained the signatures of several medical men in
leading general practice to this address, but little
or no attention was paid to the matter, and the evil
was allowed to go on.
In 1*97 a further inquiry was set on foot, and we
learned that in 1*9G 43.374 tickets were issued by our
local charities, and that the population of Brighton
and Hove amounted in that year to 152.0»><•. But, at
the same time, there were 1 1,333 persons belonging
to medical aid associations, l>enefit clubs, and provi¬
dent dispensaries. Some of these organisations
receive hospital tickets, but most of the members are
attended by their club medical officers. If to this we
add also the asylum, the fever hospital, and Poor-law
infirmary, it may l>e said that one-third of the popula¬
tion of this progressive town pay no medical fees. It
. is asserted that a certain number of the patients come
from the country, but it must be borne in mind that
all the large towns in Sussex have hospitals of their
own, and nearly all the smaller towns their cottage
ho-pital8.
There is one other matter to which I wish to draw
your serious consideration, viz., that the Brighton,
Hove, and Preston Provident Dispensary, which
endeavours to teach the people to be a little self-
reliant, should be lacking in support, Is it not
incredible that ‘n the year 1873. with a population in
Brighton and Hove of 104.778. the number of
members on the books of that institution was more
than in the year 1*93, with a population of 152.OO0.
The cause, however, is not far to seek : it is beyond
doubt due to the ever-increasing hospital abuse in the
sister towns.
Children are now educated free, but are we not allow¬
ing the parents to become more and more demoralised
by mistaken charity. There is, however, some ray of
hope to encourage us in our efforts to press on. As
I told you that in 1894, the West Street Lying-in Insti¬
tution attended 1,240 women in their accoucheuients,
being a little over a third of the births in the joint
towns. Since then their figures have gone down
year by year, until in 1*9* they fell to only 892. In
the report of that institution, the committee say: —
! " This probably indicates that the governors are
I caking additional care to restrict their letters
■ of recommendation to suitable cases." Was
I not right in my first contention that there
was a gross abuse of that charity ? Many
of the other hospitals have also shown a marked
decreas-o in their figures for 1898, but there still
remains a great deal to be done before the evil is
suppressed, which is not only demoralising England
Digitized by CjOO^Ic
4.52 The Medical Press.
ORIUTNau COMMUNICATIONS.
Nov. 1,1899.
buo spreading its dire influence throughout the world-
No men know better than medical men the need of
the deserving poor, and no men minister more ten¬
derly or more mercifully to them in their hours of sick¬
ness ; but they should not lie expected to extend that
gratuitous aid to those who can well afford private
medical attendance.
My contention is that for a population
like Brighton and Hove of 156,761, for 1898,
we have far too many hospitals, and that
much could lie saved by some, at least, of these
institutions being housed under one roof. For 1898,
the West Street Lying-in Institution, which dealt
with only 83 in-patients and 920 out-patients, spent
£541 15s. 4d. for wages and salaries, whereas the
Sussex County Hospital, with 1,699 in-patients and
6,986 out-patients, expended £2,844 5s. 3d. Of the
Throat and Ear Hospital, which has only just moved
into new quarters, I can give no accurate account for
1898, but I contend that both these institutions might
be under the roof of the Sussex County Hospital,
occupying not more than two extra wards, and that
both in clerical staff,nursing, outlay of building, &c ,
a vast sum might be saved. The Eye Hospital
allows eight tickets for one guinea, and for
three guineas sixteen out - patients and one in¬
patient letter, and so on in proportion. The
Throat and Ear Hospital requires each patient
to present a “ Subscribers’ free letter,” or to pay at
the first attendance the sum of five shillings, pre¬
senting at the same time a (pink) letter of recomen-
dation for paying patients. (N.B.)—I want you,
my friends, to think over this “ Nota Bene.” Letters
for “ Paying Patients” are supplied to subscribers,
who can give an unlimited number away. There is
no foot-note begging the subscriber to be careful to
see that the “ Pink Letter ” is only given to the
necessitous poor. A patient suffering with the
troublesome defect of impacted wax in the ear, and
under the impression that it is of a worse nature,
may pay his five shillings and go to the hospital and
have it syringed out, whereas if he had gone
in the first instance to some young and
struggling practitioner, he would quite as skil¬
fully have performed that simple operation for
half-a-crown. The Royal Alexandra Hospital for
Sick Children takes sums varying in amount from
parents who can afford to pay. Then, again, look
at the privilege given to annual subscribers to the
Brighton, Hove, and Preston Free Dispensary, who
are allowed the outrageously large amount of twelve
letters of recommendation for one guinea. No
wonder that the numbers attended are enormous,
and that the letters are distributed without dis¬
cretion. Patients have to pay the sum of sixpence
for each letter. These letters are supposed to last
only one month. Now, some patients get as many
as six, or even eight letters in a year, and there are
cases where the same patient lias been known to get
as many as twelve letters. Why should not these
S atients have been encouraged to join a provident
ispensary ? We have in Brighton an exceptionally 1
well-to-do working class who should be induced to
pay into provident dispensaries upon a graduated
scale according to weekly earnings. Surely, if they
can pay the money when sick they can pay it when
in health, and have, in addition, the feeling that they
are not being pauperised. For thos* 1 who are really
too poor to pay anything there is our Poor-law
system to meet their case. I object to free dispen¬
saries altogether as having an evil tendency, and I
object still further to the system of hospitals and
dispensaries taking anv payment as entering into
unjust competition witb the medical practitioner.
I contend that if any money is taken, it should
go towards a fund for paying the, at present,
honorary staff. I will give in a few words the
method I would adopt to help remedy this evil, for
evil it is. I would establish in every town, at con¬
venient distances, “ bureaus,” to which the necessi¬
tous poor could apply for tickets, and if there should
be any doubt about the case let the inquiry officer
make an immediate investigation. These “ bureaus”
would be a blessing to the poor, who would at once
know where to apply in case of sickness, instead of
rushing, as I have known them to do, in all directions
to find some one with a ticket to spare. I
know that this is met by the objection that
the subscribers do not like to give up their
privilege of distribution. I would reply that
by all means let the subscribers have the power
of recommending to the officer in charge of the
“ bureau ’’ any case they choose, to the extent of their
subscription. I know that there are many subscribers
who wish to be relieved of the nuisance of being
applied to for tickets, and who frequently hand them
over to the clergy of their parish, or to the parish
visitors, who do not always act with discretion.
Whether this question is settled now, or deferred, as
many important matters are, to some future day,
depend upon it, it is an evil that must eventually be
checked.
MODERN AND CELTIC MEDICINE.
Abstract of an Inaugural Address delivered at the
Mater Misericordiie Hospital, Dublin.
By THOMAS MORE MADDEN, M.D., F.R.C.S.Ed.,
M.A.O., Honoris Causa, Royal University,
Obstetric Physician and Gynecologist to the Hospital, &c.
Within the period covered by this address the
vital importance of thoroughly aseptic conditions in
all that appertains to the care and treatment of the
sick has become universally recognised. With this
view therefore our operating theatres have been re¬
constructed, ventilation and drainage improved, and
a most efficient and well-trained nursing staff pro¬
vided for our public and private wards as well as for
the necessities of general practice throughout every
part of the country wherein the services of the Mater
nurses are in constant requisition.
Whilst such consideration has been given to the
primary purpose of these institutions, those en¬
trusted with thoir administration have in nowise been
oblivious of their secondary and almost equally im¬
portant function, viz.: that of serving as a centre of
clinical medical education and scientific teaching, and
the influence of such clinical teaching has been dis¬
persed abroad and at home, orbi et urbi.
Thus in every clime, or place, or circumstance,
when medical men have faced death to save the lives
of others, from the fever-stricken districts of our own
land, to the malarial swamps of Africa, the plague-
infested cities of the Far East, or the battle fields of
the Soudan or of the Indian frontier, there have they
been found discharging their mission of mercy to
humanity.
Turning for a moment from the work of the
hospital to that of the healing art, of which it is the
clinical theatre, we find here, as elsewhere, the most
distinct imprint of recent progress in every depart¬
ment of practical medicine, surgery, and gynaecology,
as well as in ophthalmology, dermatology, and the
other special branches of modern medico-cbirurgioal
science. The rapidity of this advance has been such
that the highest professional accomplishments attain¬
able twenty years ago, have already become almost
as obsolete for a student as the knowledge of Hippo¬
crates in physic, or the skill of Ambrose Pari) in
surgery, might prove, could either be now tested ;by
a modern Conjoint, or Royal University Medical
Examination.
Digitized
LjOOg
Nov. 1, 1899.
ORIGINAL COMMUNICATIONS.
The Medical Press. 453
So many and complex are the factors in that
revolution in medicine, that it would be useless to
attempt any survey, however brief, over a field of
such extent.
In the domain of surgery the evidence of rapid
advance since my former address is yet more apparent
than in that of medicine, as may be exemplified by a
moment's reference to the upgrowth and develop¬
ment of antiseptic chirurgical practice within that
period. The fruits of this are, perhaps, most con¬
spicuous in the successful operations now resorted to
in countless cases —such, for instance, as tuberculous
S eritonitis, renal, intestinal, gastric, and other
iseases and lesions within the peritoneal cavity
from any effective interposition with which our
predecessors were almost necessarily debarred.
These procedures, with many others of equal im¬
portance that need not be here enumerated, which in
my earlier days were either altogether undreamt of,
or which, if occasionally attempted, were then asso¬
ciated with such fatality as to preclude their general
performance, are now daily accomplished with
smaller risk than might have attended the opening
of a whitlow in pre-antiseptic days.
I cannot altogether refrain from alluding to
the branch of medicine with which I am most inti¬
mately concerned, but however tempted I may be
to dilate on the progress of modern gynecology, I
shall confine, within the narrowest possible limits,
my reference to a subject that, however interesting
to myself, would probably prove intolerably weari¬
some to the majority of my present audience. It
will, therefore, be enough to say here that this
youngest of the tripart divisions of the healing art
nas exhibited a progressive development fully equal
to that of either of its medieo-chirurgical parent
sciences, and that this specialism, the very name of
which was unknown in my youth, has within
the past few years advanced by leaps and bounds to
its present prominence in the foreground of medical
progress.
The diseases and abnormalities of what was
formerly the terra incognita Australia of pathology,
viz., the region of the uterus and its appendages,
have now become as accurately differentiated and as
successfully treated as those of auy of the external
structures of the body. Thus, for instance, fibromyo-
mata and carcinoma of the uterus, the various dis¬
placements of that organ, the affections of the
ovarian and tubal adnexa, with numberless other
gynaecological disorders, the victims of which were
formerly in many instances, abandoned to lives of
hopeless misery, have now been brought within the
reach of accurate diagnosis, and generally successful
treatment.
Gentlemen, on entering the medical profession,
you must assume many responsibilities as well as
gain some privileges. On you, therefore, it will
devolve to support the reputation of your calling by
a conscientious zeal in the honourable discharge of
your great mission to the poor and suffering. More¬
over, it will lje your duty to add your mite of ex¬
perience and of knowledge to that cairn of medical
science which has been brought up to its present
height by the aggregation of the individually minute
contributions ot your predecessors - and so main¬
taining the great traditions of Irish medicine, to
hand it down to your successors improved and per¬
fected by your labours.
Celtic Medicine, its History and Lessons.
Lastly, I may for a moment refer to the too gene¬
rally forgotten fact that Irish medical men can
lay claim not only to the traditions they inherit
from their more immediate predecessors, but also
to a history deserving of larger consideration than
is commonlj given to it. For, as I have else¬
where shown, the practitioners of the healing art
in this country are, in truth, the legitimate heirs of
the oldest professional culture of which there are
in existence the records in the living language of
any European nation. Let me, therefore, remind
ou that in distant ages when the lamp of medical
nowledge was unkindled in most other countries,
its light shone with comparative brilliancy in this
remote Ultima, Thule. Thus, there are still extant
and accessible in the libraries of the Royal Irish
Academy and Trinity College in this city as well as
in other similar collections elsewhere, a vast b idy ot'
ancient Gaelic MSS. documents in which the distin¬
guished history and character of early Irish medicine
are well illustrated.
From these sources we find that from the oldest
period of authentic history the classic literature of
Greek and Roman medicine as well as a still more
ancient native leechcraft. was cultivated in our own
country. Nay more, we have clear evidence that the
marvels of modern hypnotism and the employment
of anaesthetics on which we plume ourselves as the
most beneficent discovery of the present age, were
although in cruder forms, here anticipated by our
remote predecessors.
Among the numerous collegiate centres of pro¬
fessional as well as of ecclesiastical learning with
which this Insula Sanctorum et Doctorum was
studded over between the sixth and sixteenth
centuries, one, at least, is of special interest to us
as of a distinctly medical origin and character, viz :
Tuaim Brecain. near the present town of Belturbet,
which was established by a medical practitioner of
no little eminence, viz., Saint Brecin, whose chirur¬
gical skill is celebrated in our oldest annals. From
these institutions were sent forth men such as
Alcuin, the founder of the University of Pisa,
Johannes Scotus Erigina, who in the eighth century
was professor of philosophy in Paris, and countless
others to diffuse the lights of learning and science as
well as of faith to the ends of the earth.
To the destruction of those Celtic monastic
universities, may be dated the origin of the dis¬
abilities in the matter of higher education that for
three centuries have pressed, and still press heavily
on the majority of the Irish people, aDd on none
more forcibly than on those of them belonging, as
so many here do, to the medical profession.
The latter, during all these generations, have been
thus unfairly handicapped in the race of existence
by the impossibility of securing, in accordance with
their conscientious convictions, that full measure of
academic training within the halls of a University
which is so conducive to success in the higher walks
of professional life or public employment, and which
is accessible to their compeers of every other per¬
suasion.
We may, however, rest well assured that in this,
as in all other matters, justice, although long delayed,
must like that truth on which it is founded, even¬
tually prevail. And therefore can we confidently
anticipate than this last vestige of the dark shadows
cast o er our land by the successful intolerance of a
bye gone age may for ever be swept away in the near
day-dawn of the Twentieth century which we trust
will usher in the final and equitable adjustment of
the Irish University Question. Whether in our day
this long-cherished hope be realised or not, will, we
are equally confident, in no wise affect your kindly
relations and zealous co-operation in the mission of
medicine with your brother practitioners of all other
schools and denominations. Nor need we attempt to
stimulate your esteem and respect for men among
whose professional ancestors were included names
such as those of Cusack, Carmichael, Graves, or
Stokes, which at home and abroad are as imperish-
ably engraved on the annals of our science—as those
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454 Thk Medical Prbss.
TRANSACTIONS OP SOCIETIES.
Nov. 1, 1899.
of their Catholic compeers—Corrigan, O'Reilly,
Lyons, or Hayden. Or who. like the Anglican
founder of Sir Patrick Dun’s Hospital, or Bartholo¬
mew Moss, to whom Ireland owes her great school of
midwifery, the Rotunda; have left in our city
enduring monuments of a medical benevolence as
far above all sectarian considerations as that of
the founders of the four Catholic hospitals which
are so largely supported by Irish charity in Dublin.
In conclusion, I would only venture to express my >
trust that in the fulness of years, you, gentlemen,
may one and all leave behind you such imprints on
the sands of time as those I have just named did.
Thus will you not only honour yourselves and your
calling, but also perchance reflect some of your well-
won credit on your clinical aim i mater, and on those
who were once your teachers in the Mater Misericor-
dia- Hospital.
Clinical Jlccortis.
ST. MARY’S HOSPITAL.
A Cast of Paresis of both External Recti Muscles of the
Eyes, with Retinal Hicinorrhagcs and Stagger.ng Gait
Simulating Intracranial Disease, (a)
Under the Care of IIknry Juler, F.R.C.S.,
President of tlie Harveian Society.
William B - , a-t. 35, fishmonger, on October 4th-
1899, was suddenly attacked with diplopia and vertigo.
There was no history of syphilis. Seven years ago he
was laid up from a blow on the head caused by a fall of
fourteen feet and followed by delirium. Has been a
hard drinker, chiefly oi' beer. Has been treated for some
time for “ kidney disease.”
On admission to St. Mary’s Hospital on October 13th,
his right vision was f\. and J 1, left vision -f,- and J 20.
He had paresis of both extemi and consequent con¬
vergent strabismus. On fixing with right eye the left
eye turned inwards from 10 to 15 degrees. The move¬
ments of both eyes are good in all directions except
outwards; each eye on attempting abduction becomes
nystagmic and cannot be moved beyond the middle
line. He is unable to walk with both e\es open on !
account of diplopia. With one eye closed he can walk j
better but still unsteadily. Both pupils active to light |
and accommodation.
Both optic discs hyperft'tnic and slightly blurred in j
outline. One or two torch-like htemorrhages in the right !
retina.
Knee-jerk present and equal. Grasp good on both i
sides. Urine sp. gr. 1018 , containing more than a trace ;
of albumen.
On October 12tu he had a kind of fit. His sister, who
saw it, says that it lasted about half an hour. It began
with convulsive movements of the feet and legs and
then passed over the whole body. He was delirious and
talked incessantly, but he does not remember the attack
Dr. Caley saw the ease and admitted him to the ,
wards, and found the pulse of slightly increased tension :
the heart hypertrophied on the left side ; the urine still
albuminous, and presenting signs of chronic nephritis
in the shape of slight granu’ar casts. After admission, 1
there was rapid improvement of the ocular symptoms,
so much, indeed, that to-day, six days later—the ocular
palsy has almost disappeared, there being only slight
paresis of the right ext. rectus appreciable. The diplopia
also has nearly disappeared, although he still prefers
to shade one eye.
There has been no return of the ataxic symptoms
which were present at first, nor are there at the present
time any positive indications of organic intracranial
disease or of a nuclear lesion.
This fact taken in conjunction with the rapid sub¬
sidence of the ocular paralysis, strongly suggest a toxic
origin for the latter. The toxa-mia in this case might
either be alcoholic or unvmic. It is very unusual to find
ocular palsy of alcoholic origin without evidence of
(rtj Read before tne Harveian Society of London, Oct. tilth, 1*30.
alcoholic multiple neuritis. On the other hand, had it
been due to uriemia we should have exjiected unequi¬
vocal ura-mic manifestations, but inasmuch as he was at
the time suffering from definite nephritis we clearly
cannot exclude uraemia.
The case is one of preat clinical interest, and it may
prove itself to be due to the alcohol plus nephritis.
transactions of §ocicttcs.
CLINICAL SOCIETY OF LONDON.
Meeting held Fbidax, October 27th, 1899.
Sib Richard Douglas Powell, Bt., President, in the
chair
Clinical Evening.
CEERBELLAR SYMPTOMS RELIEVED BY TREPHINING,
Db. L. Guthrie and Mr. Stanskield Collier showed
I a case of tumour of the middle lobe of the cerebellum
I treated by trephining and drainage. The patient was a
] boy, set. 9, who at present, eighteen months after the
, operation, is in perfect health except for blindness due to
j double optic neuritis. Dr. Guthrie observed that the
I operation ought to have been done a month earlier for
I in such a case he believed sight might have been
preserved,
' The President remarked that if it were really a case
] of glioma, it was surprising that there were do further
symptoms.
CASE OK ACTINOMYCOSIS IN PROCESS OK CURE.
Mr. G. R. Turner showed a case of actinomycosis on
the mend. The patient first came to the hospital with
I what looked like an abscess of the neck. This had pre-
! viouslv been incised, leaving a fistula discharging a thin
serous purulent fluid which, on examination, proved to
| contain the ray fungus. Iodide of potassium was given
i in doses of 15 grains, rapidly increased to 45 and up-
! wards. The abcess cavity had also been scraped. Tho
I result had been most satisfactory.
Mr. Slater, who had examined the secretion, remarked
that the fungus was not readily found in man, and raised
the question whether there was any actual proof of the
disease being caused, as supposed, by the fungus. He
suggested that it might be caused by more than one
organism.
Mr. Barker remarked that as the disense usually
occurred in some sort of connection with the alimentary
ca 1 al, it was reasonable to suppose that this was tho
channel by which the fungus entered. He admitted,
however, that the disease sometimes occurred in other
situations, and he mentioned a case in which the growths
were located in the abdominal wall in a piatient, who
presumably had never come into contact with hay, he
being dispenser to a country doctor.
CASE OK OSTEITIS DEKOKMANS.
Mr. G. R. Turner also showed a man, a-t. 74,
admitted to St. George’s, complaining of swelling
of the upper jaw, principally affecting the alveolar pro¬
cess, and most marked on the right side, of about eight
weeks’ duration. There was also general enlargement
of the head, evidenced by inability to put on his hat.
The tibiie and ril>3 were also affected, and the breathing
was principally daphragmatic. No venereal history.
The nervous system appeared normal, but he walked with
a shuffling gait. He had improved under iodide of
potassium.
Dr. Ewart asked if accurate measurements had been
taken. He himself had often failed with the iodide.
The President asked whether there had been any loss
of weight:'
Mr Turner replied in the affirmative and admitted
the possibity of malignant disease.
KRASKE’S OI'ERATION.
Mr. J. Jackson Clarke showed a man, a?t.5(>, on whom
i he had performed Kraske’s operation for the removal of a
1 cancerous growth of the rectum. He remarked that
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Nov. 1. 1899
TRANSAC TIONS
with patients not too old, and whose general health was
good, he much preferred this operation to colotomy.
OLr> DISLOCATION OK THE HII' WITH FRACTURE OF
.‘.CETABU I.KM.
Mr. Watson Cheyne showed a man. set. 6<> who six-
weeks before had sustained a severe injury, for which
he was treated at a hospital. When first seen by him
he was quite unable to stand, and when assisted into
the erect posture on one leg, the right thigh was Hexed
and the foot everted. Flexion and adduction, with ex¬
tension, wt-re possible, but abduction was very limited.
Nine weeks after the injury he cut down on the joint
and found a dorsal dislocation, pi m a fracture of the
acetabulum, the cavity of which was filled with soft
material. He reduced the dislocation by manipulations,
and after two months he was able to get about, the legs
being then of the same length.
SUPPOSED CYSTIC DISEASE OK THE KIDNEYS.
Dr. Sidney Phillips showed a patient who, after an
accident, had hiematuria, and was supposed to have
ruptured his kidney, but he soon recovered, and re¬
mained well until October 2nd when he came com¬
plaining of pain in the shoulders and in left side of the
abdomen. The urine was dark. On admission into St.
Mary's, there was some effusion into the joints, and on
examination he discovered two previously unnoticed
tumours in the abdomen, the left being the larger. The
tumours were large, movable, and well defined above
He presumed that the tumours were renal. The patient
passed (it-ounces of urine daily,sp. g. loll,containing 1-20
of albumen. His general health was good, and there were
po symptom* referable to the tumours, which had a
nodular surface, and no fluctuation. Dr. Phillips
suggested that the patient had congenitally cystic
kidneys, which had undergone sudden development.
Dr. Coode Adams referred to the case of a boy, set.
11 , who had been under his observation for two years.
He had been unable to discover anything wrong. The
patient was found dead in bed one morning, and post¬
mortem cystic disease of both kidneys found. In reply
to the President he said that the heart was normal.
Dr. Phillips, in reply to the President, said the
excretion of urea was normal, fn view of the history
he did not think malignant disease was likely, especially
as there were no symptoms.
upward dilatation ok THE STOMACH.
Dr. Ewart showed two patients illustrating upward
dilatation of the stomach and its bearing upon the heart
and respiration. He showed diagrams illustrating the
different directions which the dilatation might take. In
one form respiration was principally interfered with,
while in the other the patient suffered from severe
anginal attacks. He advocated mechanical treatment
from above, supplemented bv mechanical treatment
from below— eg., reinforcing the abdominal muscles by
an abdominal belt.
ratnaud’s disease with chronic rheumatism.
Dr. Herrinoham showed a young man, set. 3o, suffer¬
ing from scleroderma with local syncope. Since Christ¬
mas he had complained of pains in the hands and arms,
subsequently extending to the shoulders, followed in the
spring by attacks of “ deadness ” of the hands. During
the attacks the hands became white and cold, though
the radial pulse was normal. Since then he had been
kept in bed and the attacks had subsided. He pointed
out that local syncope was one of the forms described by
Raynaud, but in this case the condition of the skin was
the primary and principal disease, and it involved other
parts, such as the back. The flexor muscles of the
wrist were contracted, and on movement the tendons
grated in their sheaths. The feet were also involved.
The patient had never had syphilis and was the father
of two healthy children.
recurrent carcinoma ok the breast treated with
thyroid extract and oophorectomy.
Mr. R. Ev* showed a woman, a-t. 44, who in 1892 first
noticed a lump in the right breast. She came to him
in 1893 with ulcerated schirrus, adherent below. Glands
not obviously enlarged. He removed the breast freely
OF SOCIETIES. The Medical Press. 455
and cleaned out the axilla. She continued well till the
summer of 1898, when she presented herself with nodules
| in the skin above the scar and very definite infiltration
at the centre of the scar The superclav cular glands
! were enlarged. He removed the ovaries and soon after
put her on thyroid extract, 15 to 20 grains daily.
Within three mcnths the central infiltration had dis¬
appeared along with the glandular enlargement, so that
in March last she was apparently quite free from
disease. At present, however, nodules had formed
around the scar and the glands were enlarged in the
posterior tiiangle. He concluded that, although the
disease had been greatly delayed, it had evidently only
been latent
I Mr. Stanley Boyd observed that it was very difficult
i for any individual surgeon to form a clear idea of the
j value of oophorectory in these cases, for while it had
a marked effect in some case3. it had no influence what-
I ever in others. Moreover, the good results were obtained
in some of the most unlikely cases. He referred to a
case which he had seen with Mr. Watson Cheyne, of a
] large recurrent ulcer ovor the chest in a woman of 48,
who was still menstruating regularly. Oophorectomy
was performed in June, and by September the surgeon
j had written to say that a cure had taken place,
i Mr. Watson Cheyne referred to two other cases of
his own during the present year. The first caso had
improved for six months, and had then gone to the hail.
The second case was that of a lady whose breast had
been removed six years ago. She came five years
j afterwards with very extensive recurrence. This he
removed, but in six months she returned with enlarged
glands deep down in ti e neck. Oophorectomy was
done in July, and when seen the other day the whole
I of the disease had disappeared. He also referred to a
I third case which came under his notice in May. The
j patient had had several operations for cancer of the
j breast, and presented herself with a large cancerous
• mass impossible of removal. As she had a large fib¬
roid, and was losing large quantities of Mood, he felt
( justified in removing the ovaries, at the same time
i removing as much as possible of the cancer. That was
! six months ago, and since that time the fibroid has
1 disappeared, and the cancer had not yet recurred. He
I agreed that it was impossible to say beforehand which
! cases would benefit by the operation, and which not.
Mr. Eve, in reply, mentioned the case of a lady, a-t.
43, with a large schirrus, involving the skin and the
j axillary glands He operated, and then gave thyroid
1 extract, but the disease recurred within two months,
, and rapidly spread over the chest. As a last resource
I he performed oophorectomy, and continued the thyroid
I treatment, but without the slightest effect.
BMli’s SI'LINT FOR FRACTURED CLAVICLE.
Mr. Bliitt showed a man who had sustained a severe
I comminuted fracture of the outer third of the clavicle,
! treated by his specially devised splint, and he insisted
j on the advantaiies which thiR splint presented in secur¬
ing perfect immobility of the fractured surfaces, with
consequent small formation of callus.
BRITISH GYNECOLOGICAL SOCIETY.
Meeting held Thursday, October 12th, 1899.
The President, Dr. Macnaughton-Joxes, in the chair.
{Continuetf from page 425.)
Mr. J. Fukneaux Jordan (Birmingham) read a paper
ON THF. AFTER RESULTS OF OPERATION FOR THE
REMOVAL OF THE UTERUS AND APPENDAGES,
which will be found on page 443 under the heading of
“ Original Communications.”
In the discussion that followed the reading of this
interesting paper—
Dr. Arthur Giles expressed his appreciation of Mr.
Jordan’s excellent and useful paper. The after-resul
constituted one of the chief warrants for certain oper^
tions, and there was too little known about the
Hence such a contribution as Mr. Jordan’s was of t*n
Digitized by Google
TRANSACTIONS of societies.
Nov. 1. 1896.
456 The Medical Press.
greatest value. With regard to the operation for the |
removal of diseased appendages, his experienoe was tha* |
such patients did not suffer markedly from the effects of
the artificial menopause. This was no doubt due to the
fact that for some time the diseased organs had not been
carrying on their functions properly, and consequently
their removal had less effect than was the case with
relatively healthy organs removed for myoma, for
instance. This was an additional argument in favour
of hysterectomy rather than oophorectomy in the treat¬
ment of myoma. He observed that Mr. Jordan had
had comparatively few cases of oophorectomy among
his later operations for myoma.
Dr. Hey wood Smith said that it was very interesting
lo note in the second table the disappearance of the
tumour in so many cases, especially among the younger
women. The removal of the ovaries after the time of the
menopause was, however, also followed by diminution
in the size of the tumour, as he had found in many
cases ; but this was rather difficult to explain scientifi¬
cally. He thought that even now they should consider
in certain cases the advisability of removing the ovaries
for myoma, as against hysterectomy ; on the other side
the fact was to be remembered that after oophorectomy
the uterus might go on increasing in size. The question
was a large one and might profitably occupy a whole
evening's discussion. He noticed that among the cases
of diseased appendages, four were put down as tuber¬
culous ; probably many of these caies were overlooked
in the ordinary course of things. Sixteen oases were
gonorrhceal, and it was important to note that infection
might be conveyed by men whose gonorrhoea was
thought to have been cured years before. He would
ask Mr. Jordan whether he had tried ovarian extract in
cases where women had had symptoms after removal of
the ovaries, and if so, with what result ?
Dr. Herbert Snow endorsed the remark e of a previous
speaker on the interest and great importance of this
paper. He noticed in the second table that among
38 cases, only one was mentioned as single ; were all the
others married? With regard to the question of
removal of ovaries or uterus for myoma, he believed that
most women would prefer to have the tumour removed
once for all, rather than even to watch the process of
its getting smaller. The disappearance of tumours
should always be received with great reservation, in the
absence of a post-mortem examination; diminution in
size was not uncommon, but disappearance was rare.
Mr. Bowreman Jessett, referring to the treatment of
pyosalpinx by vaginal drainage, said that it seemed to
him a very good plan. In cases where pyosalpinx had
been dealt with by laparotomy he had seen the
abdomen flooded with pus. The operator would be
spared much anxiety and the patient much danger if
these cases were treated by vaginal drainage. For
myoma he preferred to remove the uterus and leave the
appendages, rather than remove the latter and leave the
tumour; the risk of hysterectomy was not now much
greater than that of oophorectomy. He had treated a
certain number of patients with ovarian extract, after
removal of the appendages and in some cases with
marked benefit. He would like to hear Mr. Jordan’s
experience on this matter.
Dr. R H. Hodgson asked Mr. Jordan whether he
had any experience of tubes becoming affected after
curetting; and whether it might not occur in such a
case that the infection travelled by direct continuity
between the uterus and tubes ?
The President thanked Mr. Furneaux Jordan on
behalf of the Society for his valuable and interesting
paper. Some of Ihe questions which it raised had been
discussed at the recent Amsterdam Congress; thus
Doyen and Schauta had quite discarded oophorectomy
for myoma. But it was strange how the experience and
teachings of Battey, Tait, and many of the American
school had been overlooked. For his own part,
he did not at all agree with the idea that myoma
must always be treated by hysterectomy, for he
thought there was a class of case in which oophorec¬
tomy was much better. It was a growing opinion,
both in Great Britain and in America, that the uterus
was removed in a great number of cases in which it
would be much better left alone. For instanoe in some
Continental towns the uterus was removed in every case
of adnexal disease. The radical treatment was. how¬
ever, necessary in some cases; and he believed that in
pyosalpinx with adhesions the classical treatment was
removal of uterus and appendages and drainage through
the vagina. Tne high mortality of operations for
pyosalpinx was easily understood; for pus sacs might
rupture and give rise to septicaemia, even when the most
olaborate and careful aseptic preparations had been
adopted ; this was the reason, it seemed to him, why the
best treatment was panhyster. ctomy and drainage. A3
regards removal of diseased appendages by colpotomy,
he did not think the vaginal route was the easiest, but
he believed that this was the operation of the future
for conservative operations on the appendages, and in
some cases, for their removal. As to drainage, glass
drainage tubes should be relegated to museums; soft
tubes were better, and iodoform gauze better still. The
iodoform should, however, be sterilised befoie use, other¬
wise it might be most dangerous. He believed that in
most cases sexual feelings were not affected by opera¬
tions for the removal of the appendages. A patient on
whom he operated ten years ago for disease of eighteen
years’ standing, had got married within the last year;
and she had not lost sexual feeling and desire. He
believed with Lawson Tait that in most cases troubles
arising after the removal of the appendages were the
result of incomplete operations.
Mr. Fcrneaux Jordan, in reply, thanked the Fellows
of the Sooiety for their appreciative hearing of his
paper. The main object of his inquiry was to discover
whether p itients suffered most after removal of the
uterus or after removal of the appendages. It was a
question which could b9 settled by careful inquiri®8 by
all surgeons as to the after-results of their operations.
The conclusion to which he had come was that it was
not simply a question a* to which organs were removed,
but also as to the age of the patient; the nearer to the
age of the natural menopause, the less was the distur¬
bance. He had found that postoperative troubles were
less after oophorectomy for myoma than after the re¬
moval of diseased apjjendages, but it was to be noted
that patients of the latter class were generally older.
He had had no experience of treatment by ovarian
extract, but thought it might be worth a trial.
As regards the treatment of pyosalpinx, he thought
that the results were much better from vaginal
incision and drainage, than from removal of the
appendages through the vagina, not only on account of
the diminished risk of pus in the abdominal cavity, but
also because of the frequent bowel adhesions in these
cases. Moreover, he saw no advantage in removal of
the uterus in these cases; drainage appeared to him to be
sufficient. As he had stated in the paper, he thought
tha* in cases of myoma with much haemorrhage and
blanching it was better to remove the appendages than
to attempt hysterectomy; because, after all, the latter
procedure involved much more shock; and if the
removal of the appendages involved a second operation
later on, the latter was done under conditions of much
greater safety for the patient •, and was rendered all the
easier by the previous oophorectomy.
HARVEIAN SOCIETY OF LONDON.
Clinical Evening.
Meeting held Thursday, October 19th, 1899.
The President.H. E Juler, F.R C.S., in the Chair.
The President exhibited
A CASE OF MICROPHTHALMOS IN A CHILD, .ST SEVEN.
The right eye was very small, only half the size
of the left, and'sunken in the orbit. The cornea was
clear, but only measured 6 m.m in diameter The iris
slate coloured, no reticulum visible, pupil very ill-defined.
The condition was probably congenital. The eye was
quite blind, there being no perception of light. Left eye
was normal and vision good. It was proposed to remove
this eye on account of deformity.
Digitized by GoOglC
Nov. 1, 1899.
1’tt aN^SACTIONS OF SOCIETIES. Thb Medical Piess. 457
In reply to Dr. Felce.Mr. Juler agreed that eviscera¬
tion would be better than enucleation, and in answer to
Dr. Sutherland, said there were no other congenital
defects in this case.
The President also showed an interesting case of
Paresis of both External Recti, notes whereof will be
found under “ Clinical Records.”
Dr. Jaffe thought the symptoms were probably of
unemic origin.
Dr. Cautlet asked if there was further evidence of
chronic interstitial nephritis in the presence of cardio¬
vascular changes. He pointed out that albuminuria
might occur in heavy beer drinkers, apart from renal
changes demonstrable either macroscopicallv or micro¬
scopically. No doubt the explanation put forward was
the correct diagnosis of the case.
The case wa9 also discussed by Dr. Harris, Dr. Felce,
and Dr. Smart, and the President replied.
Mr. Raymond Johnson brought forward a case in
which he had performed so-called arthrodesis of the
knee-joint. The boy, who was a;t. 16, had suffered from
infantile paralysis in infancy, and was left with almost
complete paralysis of the muscles moving the right
knee, and partial paralysis of the muscles of the leg.
The knee-joint was opened, and after the removal of a
thin slice from the femur and tibia the two bones were
pegged together. Bony ankylosis followed, and the
boy was now able to walk with ut the use of any
apparatus beyond a thick-soled boot. In a considerable
number of cases of infantile paralysis |this operation
had been performed with advantage to the knee and j
ankle, j
laparotomy for persistent vomiting. !
Dr. Ewart and Mr. Jaffrey related a case in which |
laparotomy was resorted to for the relief of persistent I
vomiting with exhaustion in a woman, set. 49, in whom
a pulsating swelling, supposed to be connected with the
stomach, could be felt in the left epigastrium. Mr.
Jaffrey found the stomach healthy though much dilated,
th9 pyloric end was flattened and tightly stretched across
the convexity of a fusiform abdominal aneurysm, so that
no fluid could pass through to the duodenum. An inci¬
sion between four and five inches long was made above
the umbilicus, the stomach presented in the wound. It
was quite healthy, and was lying on the left side of the
aneurysm. The flattening was partly due to the weight
of the stomach and its contents, and of the colon and
omentum. By bringing the stomach to the right of
the aneurysm it was seen that the flattening was at once
relieved, and as the stomach did not appear to be inclined
to fall back into its former position it was thought
unnecessary to fix it in any way. Silkworm gut sutures
and dry cyanide gauze were used. With the exception
of some vomiting, due she said, to the smell of brandy,
she recovered quickly, and is now able to take solid food.
She complains still of some burning sensation in the
epigastrium, and has general hyperesthesia of the
abdomen. The pulsating mass is now less easily felt,
no doubt due to the fundus of the stomach being between
the aneurysm and the abdominal wall. The stomach
in this case had been occluded by its own weight, an
unusual and striking instance of the mechanism des¬
cribed in succession by Rokitansky, Glenard, and others,
and recently studied by P. A. Albrecht (Virchow’s
Archives, Bd. 156,Heft 2, 1899), where obstruction is pro¬
duced at the jejuno-duodenal junction by the dragging
weight of the small intestine. His other female patient,
set. 59. who died from pernicious amemia, with exhaustion
and persistant vomiting, exhibited the condition
described by these observers, which Albrecht believes to
be a frequent cause of acute gastric dilatation, and of
death after severe operations, which may lead to
gastric atony, partly as a result of the prolonged admi
nistration of ame3thetics. The empty and contracted
small intestine had dropped entirely into the pelvis,
stretching the mesentery and superior mesenteric artery
tightly across the third portion of the duodenum, which
above the occlusion was inflated and contained feculent
fluid. The stomach in this instance was no* dilated, but
empty and contracted. The possibility of treating this
fatal condition without laparotomy, and by such simple
methods as posture and manipulation, is the practical and
important object of this communication. In all cases of
persistent vomiting not traceable to some obvious cause,
in marasmic and exhausted subjects the effect of the right
lateral posture, of raising the foot of the bed, and of
skilled manipulation of the abdomen by the medical
attendant should be tried. This might, in some cases,
prove successful, and obviate the necessity for surgical
interference.
Dr. Jaffe asked whether the stomach had been washed
out before resorting to operation for the relief of the
vomiting ?
Dr. Ewart replied in the negative, and said the
original diagnosis was carcinoma of the stomach.
Dr. W bitfield showed a case of Linear Lichen Planus
in a married woman, ajt. 34, previously in good health.
The eruption had commenced about 1$ years before on the
skin over the left tibia, immediately above the ankle.
When shown, there was a band of the eruption, about
1 J inches wide, extending from the front of the ankle to
the inner condyle of the left femur. At the edges of the
band typical lichen planus papules, about the size of a
split hempseed, could be seen, but in the centre they had
run together to form a solid raised ridge.
Dr. J. W. Harris exhibited a man, set. 31, who was the
subject of extreme myopathy of the fascio-scapulo-
bumeral type.
OBSCURE CA8E OF EXTENSOR PARALY8I8 OF FOREARM.
Dr. Leonard Guthrie showed a man, iet. 38, suffering
from complete paralysis of the wrist extensors and of the
elbow flexors on both sides, with the exception of the
long Bupinators. The affected muscles were much
atrophied, and did not react to faradism. The intrinsic
muscles of the hands, flexors of the Angers and wrists,
and the shoulder muscles were unaffected. Sensation
was normal, and there was no pain or tenderness of
muscles or nerve tremors. The wrist drop had occurred
two years previously, and both wrists were almost
simultaneously affected Twelve months later the
elbow flexors of the left side had been involved, and
eighteen month3 later those on the right side. The case
was regarded as one of lead palsy. The patient was a
shoemaker. He had never worked with lead, nor
suffered from colic, and there was no defiuite blue line
on the gums. Bat he had been in the habit of taking
four or five pints of 4d. ale daily, and this beverage was
said by some to be productive of lead poisoning, espe¬
cially in gouty subjects like the patient.
CARCINOMA OF TE8TICLE.
Mr. Mower White showed the left testicle, which he
had about two years ago removed from a patient,
set. 37, on the supposition that the globus minor of the
epididymis contained a deposit of “tubercle.” After
removal dissection showed that the nodule, which
measured from 1 m. to ^rd inch in diameter, was situated
in the body of the testicle immediately in front of the
globus minor and entirely within the tunica albuginea
of the gland proper; while the globus minor was to all
appearances quite normal. And the microscope (speci¬
men exhibited) demonstrated the growth to be a
spheroidal-celled carcinoma. The upper end of the
testicle contained a calcareous nodule (discovered before
removal) as large as a hemp seed, and this was attached
to the deep surface of the tunica albuginea. Mr. Mower
White further stated that the patient was now in good
health, and that he showed no evidence of recurrence in
the lumbar glands or elsewhere.
Dr. Cautley referred to a similar instance in a man,
u;t. 28. The case was at first regarded as tuberculous
disease of the globus minor of the epididymis, but, on
operating, a small tumour was found in the lower end
of the testis. This proved to be a columnar-celled
carcinoma. In view of the fact that secondary dis¬
semination occurred in the glands about the cccliac axis
and in other organs, in eight to nine months, he asked
what was the variety of carcinoma in the present care,
and how the variety would influence the prognosis ?
Mr. White replied.
4;>8 The Medical Press.
FRANCE.
Nov. 1, 1899.
NORTH OF ENGLAND OBSTETRICAL AND
GYNAECOLOGICAL SOCIETY.
Meeting at the Liverpool Medical Institution,
Friday, October 20th, 1899.
The President, Dr. Donald, in the Chair.
Specimens.
Dr. Stuart Ross showed the specimen from a case of
retroflexion of the gravid uterus, which terminated
fatally from urtemia. The patient was preg¬
nant 31 months, and had retention of urine for
one week. Six pints of very foetid ammoniacal urine
weie drawn off and the uterus replaced readily. The
patient however, became comatose, and died IS hours
later, of uriemia.
Dr. Gkimsdalk showed the specimen from a case of
uretero-vaginal fistula following vaginal hysterectomy.
Following this operation the patient had incontinence of
urine and attacks of pain and swelling in the left
lumbar region. A papilla could be seen in the vault of
the vagina, and along this a sound was passed which
led into an abscess cavity in the broad ligament, and
iDto this the upper end of the ureter opened. The left
kidney was much enlarged, and the seat of degenerative
change with pyelitis. The exact condition of the parts
was only made out after an exploratory abdominal sec¬
tion and the introduction of an ureteral catheter. While
considering the question of a further curative operation,
tin* patient suddenly sank from uriemia.
Dr. Briggs showed some gynecological specimens.
Cases.
Dr. Buckley read the notes of a case of tubal abortion
associated with a parovarian cyst on the opposite side.
These were successfully removed by abdominal section.
Dr. Davies related a case of ovarian tumour compli¬
cating pregnancy and labour. The patient had a
difficult instrumental delivery, followed by severe
pyrexia and signs of general peritonitis. An ovarian
tumour was diagnosed, and abdominal section performed
a fortnight after delivery. The tumour had undergone
torsion of the pedicle, and was very adherent. The
patient made a good recovery.
Dr. Gemmell related a case of hydatid tumour of the
omentum removed by abdominal section from a patient
who had recently been delivered of a full term child.
The tumour was first discovered during labour when it
occupied Douglas’ pouch and caused obstruction. It was,
however, readily pushed up by manipulation, and the
child delivered naturally.
Dr. William Alexander read a note on “The Treat¬
ment of Adherent Retroflexion of the LTterus by shorten¬
ing the round ligaments.” He pointed out that this
operation was usually considered to lie unsuitable for
cases complicated by adhesions. In these cases he
advised that posterior vaginal section should be per¬
formed and the fundus uteri liberated from its adhesions.
The round ligaments could then be shortened in the
usual way. He related three cases successfully treated
in this manner.
BRITISH BALNEOLOGICAL AND CLIMATOLO¬
GICAL SOCIETY.
Meeting held Thursday, October 2Gth, 1899.
The newly-elected President, Dr. J. Ivor Murray, J.P.,
of Scarborough, having l>een introduced by the retiring
President, took the chair. He referred to the lamented
death of Dr. Sinclair Coghill, of Ventnor, who died a few
weeks after his election as President in June last.
Votes of thanks were passed to the retiring President,
Dr. Fortescue Fox, the Editor of the “ Journal,” Trea¬
surer and Auditors, the Librarian, and the Council and
Secretaries.
The President then delivered an address, entitled :—
a retrospect and forecast.
Dr. Murray took a retrospective survey of the changes
in medical practice during the 55 years of his profes¬
sional career. Looking to the future he considered that
the revival which had taken place in the value ascribed
to the study of balneology and climatology, more espe¬
cially in our own country and to which our Society might
fairly claim to have contributed in no slight degree, was
a matter of congratulation. Much was to be achieved
by hygiene, baths, and mineral waters, and by the
selection of the most suitable health resorts, and in the
majority of cases this could be achieved a3 effec¬
tually in our own country as by exiling patients
to foreign parts, and that with all the home
comforts so imperfectly understood abroad, but which
make all the difference to the invalid and to the
chances of his recovery. The Fellows should bring
before the notice of the society the advantages possessed
by our own health resorts so that our brethren might
become acquainted with the treasures which Nature has
so abundantly supplied in various parts of the kingdom,
and of which, in many cases, they were ignorant. It was
> nly in this way that the prejudice which still existed in
the minds of the great mass of our countrymen could be
overcome. The attention which had recently been directed
to the prevention of tuberculosis by rational outdoor
treatment was peculiarly the province of this Society to
study and encourage, and so with our prophylactics and
means of treatment, of which balneology is not the least
important, we might anticipate the time in the near
future when human life, vastly extended, might be only
limited by natural decay or accident.
Dr. Symes Thompson proposed, and Dr. McClure, of
Cromer, seconded a vote of thanks to the President for
his address.
prance.
[from our own correspondent.]
Paris, October :S'th, 18B9.
Stuttering.
At the Academie de Medicine, M. Jonnesco, of
Bucharest, related the case of a child of thirteen who
was afflicted with pronounced stuttering, in whom
existed also asymmetry of the cranium, with correspond¬
ing flatening of the left side of the head. Hemi-
craniectomy, with resection of a portion of the bone and
incision of the dura mater, was practised. The child got
well at the end of a fortnight, and since then it has no
difficulty in articulating. That fact seemed to prove
that stuttering could originate from cerebral compres¬
sion due to an arrest of development of the cranium.
Cerebral Surgery.
At the Surgical Congress, M. Mondot said he had
removed a bullet which had remained three years and
3even months in the brain, from a man of forty-five
whose mental trouble became so accentuated that he
had to be placed in an asylum. The projectile was
found buried in the brain tissue at a depth of an inch
and a half. The man made a good recovery, and all
mental disturbances completely disappeared.
The speaker practised also with success trephining in
a man of twenty-three who, from a fall on the head
suffered for several years from Jacksonian epilepsy,
having as many as seven or eight attacks daily. The
trepan was placed over the old cicatrix, and the bone
was found to be twice as thick over the seat of the
primary wound as elsewhere. The operator enlarged
the opening to the limit of the abnormal thickness, and
since the operation the epileptic seizures had not
returned.
Resection of the Sympathetic.
M. Vidal spoke on the indications and counter-indi¬
cations of resection of the sympathetic in generalised
Digitized by Google
Nov. 1, 1899. G E RM A N Y. The Medical Press. 459
essential epilepsy. Resection of the sympathetic was
physiologically justified when cerebral anaemia could be
considered as an auxiliary factor in epileptic phenomena.
Certain toxic epilepsies seemed certain to derive benefit
from resection of the sympathetic, for intoxication
too slight to provoke an attack might be aided
by mechanical irritation of the sympathetic. The
operation on the other hand, was absolutely counter
indicated in epilepsy provoked by cerebral compression,
for it incre;ised first the volume of the brain, and
secondly the serious o?dema so frequent in such cases.
The difficulties in the diagnosis of essential epilepsy
rendered necessary, as regards the counter indications
of resections, the use of nitrite of amyl which pro¬
duced temporarily the effects of resection. The opera¬
tion should be reserved for subjects influenced bene¬
ficially by the inhalations made during the prodrotna
of the attack, and it appeared indispensable to abstain
from it if the nitrite of amyl aggravated or provoked
the attack.
Resection ok the Ileus.
Professor Tedenat said that he operated on a man of
lorty suffering from tuberculosis of the intestine. He
lemoved five inches of the last portion of the ileus, and
then united the intestine to the ciecum. The patient
made a rapid recovery. Two other patients were
similarly treated with an equally successful result.
Treatment ok Conjunctivitis.
Dr. Dsrier, of Paris, strongly recommends in the
treatment of conjunctivitis the application of protargol,
which contains only 8 per cent, of silver, while the
nitrate contains 6.1 per cent. Consequently, the solu¬
tions employed for cauterising should be much stronger
than if the latter agent were used.
For instillations the following formula might be recom¬
mended in the majority of cases : Protargol, ten grains,
water oijss. A few drops to be instilled three or four
times daily. For cauterising with a brush, the solu¬
tion should be considerably more active; protargol oj,
water 5'j ss . Insufflation of the powder might be em¬
ployed in grave cases, such as blennorhagic ophthalmia
and trachoma, followed by massage of the lids.
M. Darier treated exclusively with protargol 500 cases
of different varieties of conjunctivitis without the
slightest accident; it is. in fact, an inoffensive agent.
&etrmanp.
[from our own correspondent.]
Berlin, Octolier 21ht 1899.
Elephantoid and Ulcerative Changes in the
External Genitals and Rectums ok Prostitutes.
An article by Victor Baudler in the Arrhir f. Dermat.
v. Syf. h. treats of this subject. The author says that
these changes are not infrequent on the person of older
prostitutes, that they cannot be classed among the
known diseases, and that their etiology is not at present
clear. Such torpid, deep destructions, with hyper plastic
new formation attack by preference the posterior com¬
missure, then the urethra and labia, the anus and rec¬
tum. In the latter-named situation they often lead to
fistulse and strictures, when they do not cause serious
symptoms, are generally only discovered on digital
examination. The author, who has observed a series of
9 uch cases in Prof. Pick’s klinik, is of opinion that these
changes are always due to syphilis ; the favourable effect
of mercury on them is in favour of this view, and also
the circumstance that they can often be traced to a
primary infection. But the syphilis is only the primary
cause for tbeir development, disturbances in the lymph
current, traumata, and irritations, alBO bear a part.
Medical Students in Germany.
The University Calendar recently issued by Professor
Aschirson, shows that in the summer term the numbers
of the medical students at the different universities
were as follows:—Munich heads the list with 1,398,
Vienna, 1,104; Berlin, 1,093; Wurzburg, 623; Leipsic,
617 ; Freiburg, 508; Kiel, 444: Erlangen, 388; Gratz,
376; Zurich, 350: Bonn, 337; Strassburg, 332; Griefs-
wald, 317 : Breslau, 302 ; Heidelberg, 298; Geneva, 277 ;
Giessen, 272; Tubingen, 271; Marburg, 267; K-migs-
berg and Berne, 247 each ; Gottingen, 233 ; Halle, 231.
In Jena the number was 190 ; in Lausanne, 158 ; in
Basle, 12S ; Rostock, 113: and Czernowitz, 4.
The Treatment ok Phosphaturia.
Professor Klemperer treats of this important subject
in the Thera pie d. Oegenuart, 8 99. By phosphaturia is
meant the excretion of a urine that is rendered milky by
precipitation of earthy phosphates. Phosphate of lime is
always deposited when the relations of acid phosphates are
not in proportion to the alkaline, in other words, when
the normal reaction of the urine changes to the alkaline.
Vegetable food makes the urine alkaline, a9 the vegetable
acids become converted into carbon salts It is clear,
therefore, why phosphaturia comes on after free indul¬
gence in vegetables and fruit. When a large quantity
of hydro-chloric acid is secreted in the stomach, there is
less at disposal for the urine ; after a hearty meal, even
if of meat, if urine is passed one or two hours after, slight
phosphatic cloudiness is easily noticeable. As nervous
people pass urine more frequently than others, occasional
phosphaturia will probably be more fiequent with
them than others. Jt is further known that after
violent vomiting and after washing out of the stomach,
when a laige quantity of hydrochloric acid is expelled,
phosphaturia is liable to occur, and also in cases of
dilatation of the stomach and motor insufficiency, when
the acid contents are retained an undue length of time.
All these conditions are met with in neurasthenics, and
it is therefore understood why phosphaturia' is frequent
with this class of patient.
The treatment of phosphaturia must have the aim of
increasing the acidity of the urine. Above all, Minko-
wiski advises albuminous foods (meat, eggs, cheese,
cereals, and legumes), as they render the urine acid, and
objects to potatoes, roots, and green vegetables, as well
as fruit, as they make the urine alkaline. Without
denying the value of dietetic treatment, the author
believes that the treatment must act on the course of
the phosphaturia, and that it can be successful only
when it combats the nerve disease which causes hyper¬
acidity and sleeplessness. The treatment of phospha¬
turia is therefore not easy, and cannot be carried out
according to a rigid scheme. No dietetic and no mt-dicinal
prescription are of unusual ut ility. Theart of the physician
should select a regime that corresponds to the nervous
energy of the patient, and a great deal will be in the
moral treatment. The author has treated his patients
with a free and mixed dietary, and independently of
Digitized by t^.ooQle
460 The Medical Pres?,
AUSTRIA.
Nov. 1, 1899.
meals has recommended them a large quantity of water,
especially frequent acidulated drinks. He has frequently
made nse of electricity and hydrotherapeutics. He has
sent many to the sea-side and some to mountain resi¬
dences. He has impressed upon them that they suffer
from a nerve disorder, the treatment of which will be
materially aided by great regularity of living and self
command.
The same journal contains an article by Professor
Ewald, on
Oboano-thxrapeutics, Arsenic, and Thyroid Pre¬
parations (Iodothykin).
The Professor, who has contributed largely to the
building up of thyroid therapeutics, believes that they
have gained a firm place in our materia medica. The
employment of thyroid preparations would have been
more exten-ive, but for certain bye-effects which act as
a set off. To these belong the nervous disturbances,
sleeplessness, pains in the head and limbs, in the lumbar
region, oppression, palpitation, acceleration of pulse, loss
of appetite, vomiting, diarrhoea, rise of temperature, and
sometimes the appearance of albumen and sugar in the
urine. As the symptoms sometimes exhibited have been
alarming, and as death has actually followed the use of
this preparation, the communication made by Mabille,
of Kheims, that this thyroidism could be avoided, or to a
great extent limited by the simultaneous employment
of arsenic came as a great relief. The author has given
the combination in four cases of idiopathic struma, and
one case of obesity in hospital, one case of infantile myx-
oedema, and one case of struma in private practice. The
iodothyrin tablets (Elberfelder Fabrik, Bayer and Co.)
contain 0 25 grme. each. One or two were given for a
dose at first, and the increase was one daily until eight
or ten were given. The arsenic was given in the form
of Fowler’s solution or arsenious acid pill (1 mgrtn),
the dose of this also being increased daily. The results
were good in the struma cases j that of infantile myx-
oedema was not long enongh under observation for an
opinion to be formed.
Although large doses of iodothyrin were given, no dis¬
agreeable bye-effects were observed in any case, without
arsenic they might have been expected almost with cer¬
tainty. With the exception of slight acceleration of the
pulse (up to 110), neither objectively nor subjectively
were any symptoms of thyroidism observed ; so that the
impression could not be excluded that arsenic was really
a powerful corrective of thyroidism, more certain and
more regular in its action than atropine.
<3lu®tria.
[FROM OUR OWN COKKBBI'ONDKNT.j 1
Vienna, October 28th, 18 W.
Operative Treatment op Tuberculous
Pneumothorax.
At the Gesellschaft der Aerzte, Anton Drasche re¬
lated the history of 230 cases of pneumothorax which
he had recently treated, 32 of which were non-tuber-
culous. Of the 198 tuberculous cases lt>8 were treated
symptomatically, the other 30 surgically by puncture,
aspiration, costo-section and washing out of the pleural
cavity with ordinary saline solution The surgical
treatment gave 12 per cent, of latisfactory re¬
coveries, while the expectant treatment only gave five,
although the latter in no case presented grave symptoms
such as cyanosis, small pulse, laboured breathing, Ac.
The surgical treatment is more important when pro¬
longed suppuration is exhausting the organism, and
leading to the formation of bands of adhesions in
the lung. It is always important, from a surgical point
of view, to know whether the lung fistula is open or
closed. The differential diagnosis of Unverricht and
Weil, who maintain that the open fistula in pneumo¬
thorax gives a water piping sound, is not to be relied
upon as diagnostic, as other large cavities will produce a
similar phenomenon. They think the most distinctive
sign is the analysis of the pent-up gases, as oxygen and
nitrogen are rapidly absorbed, while the quantity of
C0 2 is high. A relative increase of CO a over ten
per cent, points to a closed fistula, while below five per
cent, it may be assumed to be still open. As a general
rule, the fistula remained opened for two or three weeks.
Morbus Basedowii.
At the Versammlung, Sitmann reviewed the history of
Graves’ disease since 1893, a period which he said had
been barren of any therapeutical improvements. Patho¬
logical anatomy showed the thyroid gland to be the
source of the disease, but Askanazy went further and
attributed the disease to an alteration or fatty
atrophy of the striped muscles, which would to some
extent explain the various phenomena of the
disease, but it failed to elucidate the tremor. Physio¬
logical examination showed a more active transformation
of the nitrogenous material which might favour the
muscular change. The sympathetic theory has again
been revived in France, as well as the theory bearing on
the central nerve-system, both of which have their
advocates, but both of these theories fail to throw light
on the exact morbid condition of the thyroid. Again,
we have a compromise in the thyrogenic theory being
combined with the central nervous system, which has
a tendency to lower the nutritive supply. From this
we infer that the battle is between the thyroid and the
central nerve organs, but the question as to which
is the primary lesion, is not yet settled. Sittmann
considers that the clinical features point to a
combination of factors, viz., central nerve organs, con¬
necting links such as the sympathetic, the vagus, and
the end organs which are brought into collateral
sympathy with the nutritive apparatus—the hematic
system. A lesion in aDy one of these three factors
would probably produce a specific alteration in the
thyroid gland. It is therefore necessary to consider
which symptom has been the most prominent in this
complex arrangement m seeking to determine the
primary lesion.
Behn thought the thyiogenic theory was proved by
the results of surgical treatment. The lesion of the
gland was admitted to be the principal change in the
disease, thongh it might not always be out¬
wardly marked. It mattered not if the whole
gland or part of the gland were affected
the characteristic changes are the same. The prognosis
of the disease must be cautiously approached; spoi tane-
ous recovery sometimes takes place quickly, other times
slowly, but this cannot be relied on as constant. The
fatality of operation is due to (a) The severity of an
operation entailing the removal of a large hematic
Digitized by v^ooQle
THE OPERATING THEATRES. The Medical Press. 461
Nov. ,1 1899.
gland ; ( b ) The low resistance of the enfeebled patient;
(<•) The presence of thymus persistent. The operative
treatment not only effects an improvement in all the
symptoms, but often brings about permanent recovery
from the disease. He divided his case into three groups
First resection of the gland 177 cases, ofjwhich 57 6 were
cured, 26 5 per cent, improved, 2 3 per cent, remained
unchanged, while 13 6 per cent. died. Of the second class,
of resection of the sympathetic there were 32 cases in all;
28 - l per cent, were cured, 50 per cent, improved, 12 5 per
cent, remained unchanged, while 9 3 died. The third
class, of arterial ligature comprised 14 cases, 2 4 per
oent. recovered, 53 per cent, were improved, and 28 6 per
cent. died. Of the 319 case3 treated the average results
were 5T8 cured, 27 9 per cent, improved, 4 - l per cent,
unchanged, and 131 per cent. died. The lesson to be
learned from this experience is the great danger of the
method by ligation of arteries.
Every case should be first treated internally with
some of the thyroid preparations. In the cachectic
stage the operation gives little hope of success. Opera¬
tion should bo undertaken whenever the gland pressure
is high or the presence of malignant cysts suspected.
The existence of nodules of hard consistence will decide
any doubt. Operation without narcosis is to be pre¬
ferred.
^he CDperating theatres.
MIDDLESEX HOSPITAL.
Amputation op the Penis pob Epithelioma. —Mr. A.
Clark operated on a man, set. about 50, who was the sub¬
ject of an epithelioma of the penis, which had developed
on the top of a sloughing syphilitio chancre. Mr. Clark
said that the patient had been under his observation
three months ago, when he was admitted to the hospital
on acoount of a rash on his body, and a discharge
from a phimosed foreskin. The rash was obviously
syphilitic, and a cursory examination of the penis
demonstrated the fact of an indurated chancre beneath
the foreskin. There were amygdaloid glands in both
groins, and the lymphatic glands at the back of the
neck were also enlarged. The patient was immediately
put on anti-syphilitic treatment, the foreskin was slit
up,’and the chancre, which was found to be sloughing,
exposed and actively treated. The patient began to im¬
prove at once, and in a month appeared to be on a fair
way to recovery. The sore, however, did not quite
heal, and in about a month and a half the induration
began to recur, and the ulceration to extend to the
tip of the glans. The patient's general health, however,
seemed to improve, and the enlargement of the lymphatic
glands decreased. The induration continuing to spread,
the suspicion of epithelioma was confirmed by micro¬
scopical examination, and the patient was advised to
sacrifice the organ ; to this he consented after a little
delay. Accordingly, nearly four months after his
first admission, the patient was anaesthetised, and the
penis removed by the flap operation. The root of the
penis having been constricted by an india-rubber
tourniquet, a broad dorsal flap, including the skin and
c ubcutaneous tissue, was dissected up on the dorsum of
the penis, and a smaller flap from below, the corpora
cavernosa were then divided, and the tissues
dissected off the urethra for about one-third
of an inch in front of the division of the
corpora cavernosa, and here the urethra was divided.
The tourniquet was taken off, the vessels secured, and
the bleeding stopped with very little trouble. The pro¬
jecting urethra was then slit horizontally, the upper
portion being sewn to the upper flap and the lower to
the lower flap. The skin flaps were then joined over the
rest of the wound and a catheter tied in to the bladder.
Mr Clark said that the development of epithelioma on
the top of a chancre was uncommon, but in this case the
recurrence of the induration which did not yield to
treatment suggested the use of the microscope, which
demonstrated the case to be one of epithelioma. He
pointed out that the prognosis in these cases was more
favourable than in most cases of malignant disease, re¬
currence being the exception rather than the rule, both
in the organ itself and in the lymphatic glands,
especially when the operation was performed at an early
period, as in this patient, before the disease had extended
to the lymphatic glands.
8 T. GEORGE’S HOSPITAL.
Abdominal Tumoub.—8*bousCtbt Behind the Right
Colon.— Mr. Herbert Allingham operated on a woman,
let. 80, who had a fluctuating tumour in the right side of
the abdomen about, but not beneath, the kidney region
The abdomen was opened in the right liuea semilunaris,
when the tumour was found to be behind the colon,
having no connection with the kidney or with the pelvic
organs. The colon and peritoneum were turned over
towards the middle line; the lump was then found to
be a serous cyst; this was tapped find the cyst wall
enucleated. The fluid appeared to be only ordinary
serous fluid; there were no hydatids; it was more like
the fluid of a parovarian cyst. After the cyst had been
removed the colon and peritoneum were replaced,
and the abdominal walls sewn up in the usual way. Mr.
Allingham remarked on the curious fact that the
patient should have such a oyst, not connected with
the pelvic organs, or with the kidney situated behind
the ascending colon. It shelled out easily, he said, like
an ordinary broad ligament cyst. He did not think he
had ever heard of a parovarian cyst being !n such a
region though undoubtedly this tumour was more like a
parovarian cyst than anything else.
Aneurysm of the Upper Third of the Radial
Artery. Removal of the Aneurysm. —Mr. Her¬
bert Allingham operated on a man, set. 45, a
blacksmith, who had noticed about two months before
admission, after a strain, a sudden pain in the upper
part of the forearm fjllowad by swelling. The swell¬
ing increased, and on admission it had all the character
of an aneurysm. An Esmarch bandage having been
applied, a long incision exposed the tumour which was
found to extend deeply into the muscles of the forearm.
The whole aneurysm was dissected out. The interesting
point, Mr. Allingham said, was that, on after dissection,
it appeared that the radial artery had been tom right
across, and the aneurysmal sac had been formed in and
about the muscles of the fo earm. The removal was
very difficult, as it was troublesome to free the to
formed sac from the muscles. Mr Allingham remarked
that it was an uncommon condition, as the aneurysmal
sac was entirely formed in the muscles, no part of the
wall of the vessel entering into the formation of the
aneurysm. He pointed out that during removal the
Digitized by Google
462 The Medical Press. LEADING ARTICLES. Nov. 1 , 1899.
large amount of blood clot made it a possibility that the
tumour might be a pulsating sarcoma, it was, in fact, only
definitely settled it was an aneurysm after it had been
removed and carefully examined.
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“ SALUS POPOLI SUPRF.MA LEX.”
WEDNESDAY, NOVEMBER 1, 1899.
THE FUTURE OF MEDICAL SOCIETIES.
The future of our medical societies is a matter
which nearly concerns all who are interested in the
advancement, as distinct from the practice, of medi¬
cine. It is common knowledge that each year the
task of keeping up the supply of papers for discussion
is becoming more and more onerous, and we can
recall divers occasions on which only the readiness of
speech which characterises the honorary secretaries
lias prevented the collapse of the proceedings. The
blame for this state of things is attributed to the
medical journals which greedily absorb all the literary
work with any pretensions to merit which they can
lay their hands upon, but this process of absorption
is rather a symptom of the disease than the disease
itself. If we compare the prompt publicity which
u medical journal can offer to the author of a commu¬
nication with the limited and tardy publicity which
the average medical society provides, no surprise can
lie felt at the preference which the workers in the field
of medical science display for the former. This is a
point of view which does not appear to have received
the attention it deserves by the managers of these
societies, who blindly adhere to articles of association
which were evolved when medical journalism
occupied a position in the medical world very different
from the predominant place it has acquired during
the last half century. Another cause of the dearth of
papers is the multiplication of societies far beyond
the requirements of any class of practitioners. The
late Sir Andrew Clarke must have had an inkling of
this when some years ago he devoted bis waning, but
still valuable energies, to the creation by federation
of an Academy of Medicine for England. Whether,
if he had been spared, he would have been enabled
to realise his plans we know not, but his disappear¬
ance sounded the knell of the project. Something,
however, lias to be done, and that promptly, if
scientific bankruptcy is to be averted. Existing
societies look upon federation much in the same
light as the British public look upon com¬
pulsory military service— viz, as a thing that
may become unavoidable, but which for the
time being is to be avoided at any price. Short of
this drastic but reasonable measure it ought to be
possible to devise improvements calculated to revive
intei'est in these gatherings. The institution of
clinical evenings, copied from the Clinical society,
has everywhere proved an unqualified success, though
the interest of the living specimens is not always on
a par with their number. But clinical evenings
must necessarily be the exception, and there remains
the difficulty of providing subjects for discussion. It
is really time that those who are responsible for the
conduct of existing medical societies appreciated the
fact that writers of papers resent the general rule
forbidding them to publish their contributions in
the medical journals under penalty of risking exclu¬
sion from the “ Transactions, ’ which are only pub¬
lished after a long interval of time, and when
issued, only come before a comparatively limited
number of readere. Even if the advancement of
science alone lie considered—though this is by no
means the only motive which authors have in view
in laboriously compiling the results of their researches,
it seems absurd that possibly valuable results should
lie held over in deference to a mistaken and narrow
idea of literary property. It may even be asked
whether the interests of the debate would not be
better served by tlie previous publication of important
papers in the journals, for this measure would enable
fellows to think the matter over beforehand, and to
prepare observations and reminiscences worthy cf
the occ&sion. It is not given to everyone to grasp
the tenour of a long paper delivered at break-neck
speed by an amateur reader, nor can the majority of
men prepare and deliver on the spur of the moment
a clear account of what they know on the particular
subject. This difficulty has been so far recognised
by the Royal Medical and Chirurgieal Society that
the papers are printed in advance, so that in¬
tending speakers can take cognisance thereof
beforehand. To publish them in a medical journal
before the date of the meeting would he but a step, and
would certainly fulfil the object in view vastly better
as well as more economically. The so-called abstracts,
which it is the custom to hand round at certain
societies, utterly fail to fulfil their object. Prepared for
the most part by men who have no experience of precis
writing, they are practically worthless, and merely
cumber the society reports published in the journals
with a lot of matter which is not detailed enough to
preface the discussion that follows. Some societies,
like the i phtliamological, do not court publicity, but
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Nov. 1, 1899.
LEADING ARTICLES.
The Medical Tress. 463
in a society of specialists this is not of much impor¬
tance. because the subjects treated there are far too
technical for the ordinary reader
OPERATIONS UPON LUNATICS.
Although of late years cases have been from time
to time recorded of operations upon lunatics, the
series published by Mr. Paul Bush, in the Bristol
Medico- Chiruryical Jo u nui l for September, is interest¬
ing, inasmuch as there was nothing in the nature of
the cases to show that the mental condition of the
patients depended upon the diseases present. In all,
five lunatics were operated upon, and each made
a good recovery, both mentally and physically.
In one a young lady had been under restraint
for three years; Bhe was also suffering from
two bad ingrowing toe-nails. These were removed
and within three months she had quite recovered her
normal mental condition. In another, a lunatic man,
set. 70, was a sufferer from cystitis and dysuria, caused
hy a stone in the bladder. A supra-pubic operation
was performed, and a calculus two inches long and
one inch thick was extracted. After the operation,
his mental state began at once to improve, and in mind
and body the patient was cured within six months.
The third case was that ot a woman, who had been
for two years and a half in an asylum, for
melancholia and severe suicidal impulses. A
year after her admission she had retention of
nrine and intermittent attacks of menorrhagia
which continued for six months. Examination
revealed a large solid growth reaching from the
pubes to the level of the umbilicus. This was
found to be due to a uterine fibroid and was rem oved
per vaginam. The patient made an uninterrupted
recovery, and in less than six months was discharged
from the asylum with her mind quite restored. The
fourth case was also that of a woman who, on
her admission was acutely maniacal. After some
weeks she complained of severe epigastric pain
with temporary collapse; from this attack, how¬
ever, she rallied, and for ten days appeared
better. Then rigors suddenly supervened and a
swelling was made out in the epigastric region. The
swelling proved to be an abscess, from which a pint
of pus was let out, but there were signs of septic
peritonitis, and her recovery seemed almost hopeless.
Nevertheless, despite everything, the patient did well,
and was discharged seven months later, sound in
health, and quite sane. The last case was that of a
woman, set. 32, who had been under treatment for
two years, suffering from severe suicidal and homicidal
impulses. A year before she was operated upon
there was a history of her having swallowed
needles, and complaints had been made by her of
attacks of severe abdominal pain. Ultimately
the pain became persistent, vomiting supervened,
great loss of flesh ensued, and a hard tumour
was made out in the epigastric region. The
stomach was opened, and four hatpins extracted.
Three months after the operation the patient was
discharged from the asylum quite well, both in body
and mind. The brief notes here quoted of these
interesting cases all indicate that the deranged mental
faculties of the patient became manifest long anterior
to the time when the interference of the surgeon was
demanded. That is to say, it is presumable that the con¬
ditions which showed the necessity for surgical relief
were independent of the cause of the madness. In reflect¬
ing upon the fact, then, that the operations undertaken
for the relief of the various conditions present
should have also been followed by the restoration of
the mental faculties, one cannot avoid raisiag the
question as to the etiology of the mania. It is scarcely
possible to believe that the mental disquietude could
have been due to an organic cause, that is to say, to
any gross change of tissue in the nerve centres. On
the other hand, if this hypothesis be admitted, the only
alternative tofall back upon is the assumption that
the mania was functional in character, and only
wanted some sudden outpouring of nerve force
in order to restore the mental equilibrium. One
point in these cases is certain—namely, that the
operation performed not only cured the body but
cured the mind, and, therefore, it is quite possible
that its indirect influence for good was conveyed
through the nerve system. These cases undoubtedly
throw an interesting light upon the practice of sur¬
gery among the insane. Perhaps it may be that at
this moment there are many persons under restraint
in our asylums who only require the counteracting
effect of an operation to restore them to sanity. But
unless the indications for operating happened to be
present it would scarcely do to experimentalise in
this direction in order to test the value of the hypo¬
thesis However, the matter is one which might well
claim the attention of our asylum medical officers.
THE HISTOGENESIS OF NEOPLASMS.
During the last few years evidence has been
accumulating in favour of the view that cancer is a
communicable disease, not only from site to site in
the same individual, but from one individual to
another. Moreover it has been shown to be possible
to induce in animals by direct inoculation, growths
which, clinically and microscopically, must be classed
as malignant. Now that veterinary science is waking
up, and is gradually being placed on a more scientific
footing we may hope that the next few years will
add to our knowledge in this respect. Already one
class of growth formerly included among the
sarcomata, actinomycosis to wit, has been recog¬
nised to be a parasitic disease and the occur¬
rence of malignant growths in the lower
animals, long a matter of doubt, has been
satisfactorily established. These important points
having been cleared up it remains for investigators
to determine the exact nature of the materies merbi t
No particular organism has as yet been identified in
causal relationship to cancer, and all experiments
made in this direction hitherto have been carried out
with cells taken from an infected area in fact this
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464 The Medical Press
NOTES ON CURRENT TOPICS.
Nov. 1, 1899.
transplantation of cells must, for the present,
be regarded as indispensable to infection. Hypo¬
thetically it is assumed that the exact form of
the primary growth, t.e., the original infection,
is determined by the character of the tissues at
the point where the infection gains an entry,
and that the secondary infections, being caused by
the transmission of the actually diseased cells, pre¬
serve the original type though their histological
structure may, in a slight degree, be modified by con¬
ditions of environment. Should this secondary
infection by chance take place apart from the trans¬
mission of the actual cells, there is no theoretical
necessity for the secondary growths to follow the
original type. It is urged that for purposes of
investigation, a distinction should be made between
connective tissue and epithelial growths, but it is
difficult to base a distinction on purely histological
variations in view of the clinical resemblances
which characterise the typical growths of both forms of
tumour. We are quite prepared to learn later that some
of the growth a at present classed as cancer are due
to bacteria, in other words, that in some cases the
hyperplastic process merely represents the reaction
of the tissues to irritation set up by living bacteria.
The tendency to unlimited multiplication of infected
cells, and their ability to maintain their histological
characteristics, even in other situations, constitute a
veiy special pathological feature, for which there is
no parallel in other morbid processes. It is this
peculiarity which has, so far, baffled all attempts at
elucidation.
4totes on Current topics.
A Study of Anger.
In a recent number of the Psychological Review
Mr. G. Stanley Hall gives an interesting account of
what we may call the physiology of anger. Anger
may be defined as the outward and visible manifesta¬
tion of emotions which have escaped control and the
measure of individual civilisation is precisely the
degree to which command over these particular
manifestations has been acquired. The “ gentleman ”
is conventionally one whose nervous system has been
so disciplined as never to elude control in this direc¬
tion. In a state of nature no control of the kind is
practised except in deference to motives of a physical
order, but the further we advance on the path of civili¬
sation the more the ability to command the emotions
is expected and enforced If this be so it is difficult to
avoid the conviction that we have not advanced very
far on that road. Each individual has his weak side,
in other words, everyone is more vulnerable on one
point than on certain others Some people are pecu¬
liarly susceptible to ridicule, while others are more
disposed to jealousy, a sense of injustice or dis¬
appointment. The manifestations of the state of
anger vary according to the temperament of the
individual, but in all there is grave ciiculatory dis¬
turbance, occasionally so marked as of itself to deter¬
mine a fatal issue. Those in whom the heart is
strong and prompt to react, usually flush at the
approach of anger, but the less sanguine, and those
whose hearts respond less readily to stimulation, or
are unequal to the strain thrown upon them, become
pale, though the pallor may be but momentary. In
both the force of the heart beat is markedly
enhanced, the heightened blood pressure accelera-
ates the urinary and salivary secretions, while the
greater demand for oxygen causes active working of
the respiratory muscles. The extraordinary strain
thus thrown on the nervous system is apt for the
time being to disorganise the muscular apparatus,
leading to tremors and unsteadiness of gait, which,
however, may be promptly recovered from. Giddiness,
nausea, and other functional disturbances are directly
attributable to the sudden change of blood pressure.
The sounds emitted by persons under the empire of
anger vary, passing from the monotonous cry of
infancy, through the animdlike noises of childhood,
to the threats and oaths of adult life. In exceptional
cases there is a kind of inhibitory paralysis of
the sound-producing apparatus, but in general the
emission of a noise of some sort seems to be the
necessary accompaniment of this state of pent-up
energy. The state which we call irritability results
from impairment of the inhibitory powers, and is
often due to ill-health or to fatigue and loss of sleep.
The irritability of convalescence is a sign that the
lower reflexes are restored before the higher for the
•‘department of inhibition ” is the controlling power
of the organism and the seat of the highest mani¬
festations of the ego.
The Primate on Medical Training.
The Archbishop of Canterbury, in the address
with which he heralded the distribution of prizes at
St. George’s Hospital Medical School last week,
opportunely insisted on the fact that, although
accident occasionally paves the way to scientific dis¬
covery, the great mass of discoveries come from
hard study. Even in the cases of so-called accidental
discovei’ies the result in a very large number of
instances has turned upon previous knowledge, with¬
out which the significance of the accident, which
proved the starting point of a quasi-revelation,, would
probably have been overlooked. The accident of the
falling apple which startedNewton thiukingof the laws
which govern the universe, was pregnant with
meaning only to him. and so it is with the
many‘accidents ' which clinical experience brings
before us. The uneducated or unobservant
person has eyes yet sees not and the vast majority of
human beings see only, and then imperfectly, what
they have been trained to see, and their mental vision,
stops at the threshold of the unknown. By persistent
study alone can we hope to acquire the knowledge
which shall enable us to recognise the precious stone
when chance throws it in our path. Kuowledge
may be described mathematically as a line, finite at
one end and infinite at the other, so that our course
must be ever onwards under penalty, as His Grace so
pithily put it, of going back. The man, he observed,
who stands still in medicine is losing ground and
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Nov. 1. IH9&. NOTES ON CURRENT TOPICS. The Medical Press. 465
is beginning to go back. The world is moving
onwards, and unless we move with it we are indeed
falling behind. The task is harder for each succeed¬
ing generation, for the new comer has first to master
what has already been accomplised before he can
apply himself to the task of adding to the store.
The life of the medical practitioner is, or ought to
be. one of perpetual study. His training merely
teaches him to observe, and his subsequent experience
should enable him to learn. Experience is not
knowledge, otherwise the oldest among us would be
the wisest quod absurdum est. As long as we practise
medicine and surgery we ought to continue to study
medicine and surgery in gratitude to those who have
laboured on our behalf in the past, and as evidence
of our desire to maintain an exalted conception of
our profession. -
Miscegenation.
Thebe is a general impression, based on wide
experience, that half-castes are necessarily inferior to
the two races which produce them, but on looking
into the matter the impression would seem to be
fundamentally erroneous, although the observation
may, in the main, be correct. The fact probably is
that half-castes are usually the results of illicit con¬
nections, and are consequently brought up under
conditions of environment unfavourable alike to
physical and mental development. A similar
remark might be made concerning illegitimate
children everywhere, and obviously the deteriora¬
tion so frequently observed in them must be
due, not to any inherent incapacity, physi¬
cal or moral, but to the influence of perni¬
cious surroundings. There are many examples
of half-caste races which occupy a high position in
the scale of humanity—not to go further than the
Brahmins and the clans of Rajpootana—races
descended from men who left their homes before the
white invader and intermarried with the dark women
of the plains. The antipathy of white people towards
such unions is, however, readily comprehensible for
it means degradation for the offspring as compared
with their white sires, while, on the other hand, the
readiness with which coloured women ally themselves
with whites is physiologically justified by the prospec¬
tive superiority of the offspring as compared with
the maternal strain.
The Reorganisation of International
Congresses.
The recent congress which took place at Amster¬
dam has given rise to much editorial criticism on
both sides of the Atlantic of the system which prevails
in the organisation of such gatherings. It seems
that it was originally intended to restrict the papers
and discussions to those who had been formally
invited to participate in the proceedings, but this
otherwise admirable idea was overruled in view of
the fact that the financial success of the congress
would thereby have been imperilled. Nevertheless, we
are disposed to believe that some such arrangement
will ultimately come into force or these huge picnics
will fall into discredit. The disproportionate import- i
ance which the festive part of the programme has
assumed of late years tends to minimise the real
object of the gatherings which is, or ought to be, the
advancement of knowledge. But even from a social
point of view a measure which would tend to limit
participation to those whose professional standing
renders them worthy of the honour, need not react
prejudicially. Municipalities and local bodies would
doubtless show themselves much more hospitable if
it were possible for them to keep their hospitality
within reasonable bounds. It is fast becoming
a physical impossibility for individuals, or aggre¬
gations of individuals, however hospitably dis¬
posed, to minister to the appetites of thousands,
whereas if membership implied professional distinc¬
tion, the numbers would be reduced to manageable
proportions. The legitimate expenses attendant upon
an assemblage of scientific men who have met for
purely scientific purposes, need not be great, and the
attractions which have become such a marked feature
of the present-day congress are sought after and
enjoyed more particularly by “everybody who
chooses to attend.” As the New York Medical
Journal observes, the open door policy is the correct
one if the object be to get the profession together and
have a good time, but if the chief motive be to secure
n consensus of opinion of the leading lights of a
specialty, the side-shows should be eliminated and
the membership restricted.
Gum-Paper as a Fatal Sticking-Plaster.
The term, “ stamp lickers ” tongue, which the
Medical Press and Circular was the first to use,
has since become embalmed in the literature of the
land. It is to be hoped that some good, from a preven¬
tive point of view, may result from the general atten -
tion that has been called to the matter, and that
careful folk will, in future, wet their postage stamps
by means of a moistened finger or a mechanical
damper. It is clear that even were the adhesive stuff
above suspicion, which it is not, that there still
remains an abundance of ways in which a stamp miy
become contaminated. For instance, outside a post
box not long ago, the present writer saw a man drop
i on the pavement a postage stamp, which he then
picked up and applied to his tongue before fasten¬
ing to the envelope, as if such things as dangerous
germs were unknown in the dust of a Lon¬
don street. Postage-stamp paper, however, is
not the only source of sticky mischief when applied
to wounds. The gummed edge of an ordinary
envelope may be just as fraught with evil. Only
last week an inquest was held in London on the body
of a clerk who used that substitute for sticking
plaster to a wound in the scalp. The medical testi¬
mony was to the effect that death was due to septi¬
caemia, and the surgeon commented upon the
unwisdom of putting gum-paper on a wound. Of
course, there are various ways in which the wound
may have become septic, but the use of the rough-
and-ready method in question opened up risks that
were no less tenable than unnecessary. Nowadays>
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NOTES ON CURRENT TOPICS.
Nov. 1, 1899.
466 The Medical Press.
in almost every household, it is possible to find some
simple anti-septic, such as weak carbolic acid or
permanganate of potash, that would be available for
the immediate treatment of wounds.
The Carmichael Prize Essay.
In our columns to-day will be found an announce¬
ment by the Royal College of Surgeons, Ireland, that
it will, this time next year, award £'120 for the best
Essay on medical education as specified in the will
of Richard Carmichael. This Prize has been in
abeyance for some years past, because the College
had found that the income of the Fund did not come
near to providing the cost of carrying the trust into
efFect, and in fact, the College had lost heavily by
the effort to do 60 . It was, therefore, decided to
apply to the Master of the Rolls to amend the
scheme for allocation of the income, and the College
was anxious that the money should be applied
to some professional purpose more useful than
the publishing of an Essay on a subject
so thread-bare as medical education, it having been
found by past experience that expenditure on that
object was absolutely useless. The Master of the
Rolls, however, while he modified the scheme so a6 to
make it workable, refused to change the purpose of
the outlay as expressed by the testator, and it is
accordingly now making a fresh endeavour to comply
with a very irksome obligation, and to get some value
for the heavy outlay.
The Death of General Symons.
The nation has received with deep regret the news
of the death of the gallant commander of the British
forces in the battle of Glencoe. General Symons was
originally reported to have been wounded by a bullet
in the abdomen. From the first, the wound was
described as a mortal one, and, therefore, the worst
was anticipated. But reassuring newB arrived
last week that the projectile had been extracted,
and that the wounded officer was beginning
to progress favourably. The improvement, however,
was cnly of temporary duration, and the announce¬
ment of his death was received in London at the end
of last week. Thus another gallant, distinguished
British officer has laid down his life for his country in
the cause of freedom, justice, and humanity. We may
be assured that everything was done for him which
British surgery could effect. So far we are in the
dark as to the exact nature of the lesion, nevertheless,
nothing from the first could have been more wanting
in hope than the announcement conveying the
intelligence that the wound was mortal. The
sympathy of the nation will be with Lady Symons,
whose sad bereavement has been the object of so
much public condolence.
An outbreak of scarlet fever among the men of the
Durham Light Infantry, who were under orders to
sail for South Africa, has led to a change of plans,
and it is probable that the regiment will be struck
out of the list for active service.
The Care of the Sick and Wounded in
South Africa.
Mr. W yndham, in the closing meeting of the
session of the House of Commons last week made
some reassuring remarks concerning the arrange¬
ments for the care of the sick and wounded in South
Africa. At the present moment he stated that there
were in Natal 44 officers and 263 men of the Royal
Army Medical Corps, with five nursing sisters. Eight
more officers and 80 men were due on the 26th ult.,
while there would be a total of 1 10(1 hospital beds in
Natal, and 550 near Cape Town. In addition, two
hospital ships had been sent out for the con¬
veyance of the wounded from Natal to Cape Town.
Moreover, further preparations were in progress in
order to provide for contingencies, such as the
demand which might fall upon the British Medical
department of attending to a large number of
wounded Boers. We are glad to note that the
American ladies in London are raising a fund of
£30,000 to provide a hospital ship to go to South
Africa for the succour of the sick and wounded in
the war. Altogether, so far, satisfaction may be
felt in the arrangements made for the care of the
British troops.
A Skin Hospital for Dublin.
A meeting was held at the Hibernian Hotel,
Dublin, on the 26th ult., for the purpose of promoting
the establishment of a special hospital in Dublin for
the treatment of skin diseases. There was an
influential attendance, mostly of non-medical men,
and resolutions were adopted, with acclamation,
declaring the necessity for such an institution, and
directing steps to be taken to organise it. Dr. C. M.
O’Brien and Dr. George B. White are taking an
active interest in this work.
Rehabilitation of the Ratcatcher.
Dr. Rawlings calls attention in the Times to an
interesting paragraph in Defoe's Journal, written at
the time of the Great Plague in 1664. He says :—
“ An order was published by the Lord Mayor and
the magistrates, according to the advice of the phy¬
sicians, that all dogs and cats should be immediately
killed. ... A prodigious number of these crea¬
tures were destroyed. . . . Forty thousand dogs
and five times as many cats. . . . All possible
endeavours were made use of to destroy the mioe and
rats, especially the latter, by laying rats-bane and
other poisons for them, and a prodigious number of
them were also destroyed.” This is interesting in
view of what is now known concerning the role
played by these rodents in the dissemination of the
plague, and it is important because rats almost in¬
variably form part of the cargoes of ships coming
from infected ports. The occupation of the profes¬
sional ratcatcher bids fair to be rehabilitated in the
near future, and he may even aspire to become a
sanitary official. We would suggest that the time
that can be spared from the hunt after the bacillus
tuberculosis might perhaps be advantageously
devoted to the destruction of rats.
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Nov. 1, 1899.
ftOTES ON CURRENT TOPICS. The Medical Press. 467
The Local Government Board and Boards
of Guardians.
The Local Government Board are having an
exceptionally busy time just now with recalcitrant
local authorities. Their war with the Leicester
Board of Guardians is still raging, and they have in
addition several other important cases in hand.
Among these must be mentioned their dispute with
the St. Olave’s Board of Works. The latter body
recently suspended their Medical Officer of
Health. Dr. W. A. Bond, for having, in con¬
junction with the Suffragan-Bishop of Southwark,
sanctioned the removal of some human remains
from the crypt of the church of St. Thomas's,
Southwark, without obtaining the permission of the
authority of his district. The Local Government
Board, however, having had the facts brought under
their notice, directed the St. Olive’s Board of Works
to reinstate their Medical Officer. But this the latter
peremptorily refused to do. The climax in the
dispute was reached by the central authority in
pursuance of their legal power, giving notice
that they intend to issue an order to remove
Dr. Bond's suspension. However, even this decision
has had no effect upon the obstinate Board of
Works. They have decided to adhere to their deter¬
mined action in the matter, and the result, namely,
their discomfiture, can, therefore, now be only a
question of a few days. Sympathy must be felt for
the Local Govern ment Board that the local authori¬
ties whose action they have to control are not more
generally composed of persons gifted with common
sense and more alive to their duties as public officials.
The Postal Service and Vaccination.
In consequence of many of the Post Office employes
having been called out with the reserves for active
service at the seat of war, the authorities at St.
Martin's-le-Grand have had to deal with a large
number of vacancies, and persons willing to
undertake the duties of auxiliary postmen have
recently been in much demand. It seems, how¬
ever, a good deal of difficulty has been ex¬
perienced in filling up the vacant poets. There
is no lack of applicants — though the payment
is only six shillings a week—and the applicants fulfil
all the requirements of height, character, and educa¬
tion. But they decline, a contemporary asserts,
to submit to the clause requiring vaccination. That
is to say that their misguided conviction
upon this matter prevents them from obtain¬
ing employment for which they are otherwise
quite suited. All that we can say upon this matter
is to express the hope that the authorities will not
give way in the demand for this necessary require¬
ment for public service. If candidates for labour
cannot or will not see that it is to their own interests
to conform to the regulation in regard to vaccination,
it is entirely their own fault if the consequences
thereof are not to their liking. It is the duty of the
State to see that the work of the State is not exposed
to any risk of interruption, such as would be the case
were an epidemic of small-pox to break out among its
servants who had been allowed to remain unprotected by
Jenners valuable prophylactic.
A Fatal Post-Mortem Wound.
Last week an inquest was held upon the body of a
medical man, Mr. W. G. Hull, M.R.C.S., who died at
the London Hospital. From the evidence it appeared
that the deceased scratched his hand accidentally
while making a post-mortem examination fourteen
days previous to his death. At the time, the injury
was immediately treated with antiseptic lotion, but
a fatal acute septicaemia ensued. This sad incident
points to one of the dangers inseparable from the pro¬
fession of medicine. Indeed, the wonder is that it is
not a matter of constant occurrence, for whereas cuts
and scratches are common in the course of post¬
mortem examinations, yet on the other hand general
septic mischief is happily a rare result. For this
fact the powers of individual resistance have no
doubt to be credited to a great extent. There
are certain prompt precautions, however, that
are absolutely essential for the safety of the
individual concerned. The wound had best be
washed under the tap and sucked. It should then
be nibbed with solid caustic, or better still with a
liquid caustic, as pure carbolic acid The wound
should then be dressed with an antiseptic dressing,
such as iodoform or corrosive sublimate until healed.
By such vigorous measures the danger of a poisoned
wound sustained at the post-mortem table will be
reduced to a minimum. To neglect to treat even the
slightest prick under such circumstanoes is the veriest
foolhardiness. A good precaution is to touch all
slight abrasions of skin with lunar caustic.
Smoke Prevention.
The efforts of the world to work out its own salva¬
tion go towards the formation of history, but when
gauged in any one particular direction are apt to
seem hopelessly slow and feeble. Take the question
of smoke prevention, as to the absolute evil of which
to health and to property everyone has been con-
vincoed of for generations past. The volume of
smoke vomited forth into the atmosphere of our
great towns is just as vast as ever it was, if, indeed,
not much greater in these later days of general
prosperity. The causes of this persistence are not
far to seek. Apathy on the part of the local
authorities to prosecute factory owners, want of
supervision by overworked sanitary inspectors, and
the absurd leniency displayed in these cases by
police magistrates. Fortunately for the future well¬
being of our citizens, signs have not been want¬
ing that the days of the offending chimney owner
will soon be numbered, that is to say,
unless he be prepared to put up with a system of
costly fines. Last week one of those hardened trans¬
gressors, the electrical companies, was convicted of
a nuisance, under the Smoke Prevention Act. and
sentenced to pay the substantial sum of £4 r >. After
that experience the County of London and Brush Pro¬
vincial Electric Lighting Company will probably
decide to adopt one of the excellent smoke reven-
Digitized by LjOOQle
468
Thu Medical Press. NOTES ON CURRENT TOPICS.
Nov. 1, 1899.
tion contrivances now on the market. There is no
need for a factory chimney to smoke.
Post-Prandial Frivolity.
At the Colchester Oyster Feast Sir Claude de Cres-
pigny is reported to have made some extraordinary
remarks concerning the unfortunate General Symons,
to the effect that, “unless the general was killed by the
army doctors there was every hope of his recovery.”
Not unnaturally this ill-timed and foolish remark has
been sharply criticised, and while we do not suppose
that the post-prandial orator intended any reflection
on the Army Medical Service, he cannot but see that
his reputation as a gentleman of sense and good
taste must inevitably suffer, especially in view of the
sad termination. ——
The Isolation of Infective Disease
in Dublin.
Progress has been made towards securing
temporary provision for infective disease in
Dublin, and establishing a modus vivendi be¬
tween the Corporation, which desires to possess
a special fever hospital under civic administration,
and the authorities of the existing hospitals
who fear that their institutions will be left
out in the cold if this is done. Cork Street Fever
Hospital has offered to expend £'2,000 on enlarge¬
ments if the Corporation will undertake to pay
2s. 6d. per head per day for all patients more than 40
admitted on the order of the Corporation, and Sir
Charles Cameron, speaking for the Public Health
Committee, has accepted the proposal, but strictly as
a temporary measure, and without prejudice to the
ultimate building of a sufficiently large special
hospital. On the question of expense he stated that,
in his opinion, a commodious hospital could be
erected for £25,000, and he pointed out that the rate¬
payer would be amply recouped for such outlay,
inasmuch as the existing slip-slop system of capitation
subsidies casts him over £4,500 a year. While we
welcome any temporary scheme for enlarging the
available accommodation for infective cases, we cer¬
tainly hope that 6uch an expedient will not interfere
with a permanent and sufficient settlement of the
difficulty. -
The O’Grady Memorial.
The public memorial to the late surgeon Edward
Stamer O’Grady, of Mercer's Hospital, Dublin, has
been erected in Leinster Lawn, the garden in front
of the Royal Dublin Society. It takes the form of a
drinking fountain, the bowl being of marble mounted
upon a base of Caen stone and raised by a granite
foundation. When completed it will be an enduring
and well-deserved testimonial to the public apprecia¬
tion of his sterling qualities and surgical attainments.
New Method of Disinfecting Rooms.
The report of the Public Health Department at
C hicago informs us that an efficient and ready
method of disinfection of hospital wards and other
rooms is adopted in that city. The room having
been prepared as for sulphur disinfection, and all
contained articles exposed as freely as possible, a
sheet, for every 1.000 cubic feet of space, is hung on |
a line, and the operator rapidly sprays each sheet
with a 40 per cent, solution of Formaldehyde, the
room being then locked up for five hours. The
operator must not lose time, as, after three minutes,
the air becomes irrespirable.
A Cyclist's Death from Tetanus.
An inquest was held in London last week on the
body of a young lady, the daughter of a medical man,
who had succumbed to tetanus following a bicycle
accident. The case is of interest in view of the fact
that immediate thorough cleansing of the wound
d:d not prevent infection, and, when the disease had
declared itself, repeated injections of anti-tetanus
serum failed to check the course thereof. This is by
no means the first case during the present year of
death from tetanus as the result of cycling injuries.
A silly paragraph has been going the round of
the Press to the effect that a Judge of the Supreme
Court, of Connecticut, having stated that for a
physician to shorten the life of a person afflicted
with an admittedly incurable disease was not a
criminal offence, a certain doctor, who shall be name¬
less, has made it publicly known that he is willing to
act on this obiter dictum. It is hardly necessary to
point out that such an act would be deliberate
murder, punishable as such in every country in the
world. We are all afflicted with an incurable disease
- life, to wit — and the mere question of the mean
prospect of life does not affect the principle involved.
Mr. J . T. Arlidge, editor of the defunct British and
Foreign Medico-chir. Review and several treatises on
lunacy and hygiene, died at hie residence, at New¬
castle-under-Lyne, on Friday last. The deceased
was a J.P. for Staffordshire, and while medical
inspector of factories in the potteries was the first
person to draw attention to the evils in the lead
processes, and the agitation which followed resulted
in the framing of special rules by the Home Office.
The annual collection for the Dublin hospitals will
be made on Sunday, November 12th.
PERSONAL.
Dr. Duncan Burgess has been elected President of
the Sheffield Medico-Chirurgical Society, which held its
opening meeting of the session on Oct. 19th.
Sir William McCormac has volunteered to go to
South Africa to assist in the organisation of the Army
Medical Service, and his offer has been gratefully
accepted by the Government. He is to be accompanied
by two civil surgeons whose names have not yet been
made public. Sir William will be attached to the head¬
quarters staff as consulting surgeon.
Dr. J. Ivor Murray, of Scarborough, has been e’.ected
President of the Balneological and Climatological
Society, and took the chair at the meeting held on
Thursday last. At the same meeting a vote of sympathy
with Dr. Hyde (Chairman of Council) in his serious ill¬
ness was proposed by Dr. Fortescue Fox, seconded by
Dr. Symes Thompson, and passed unanimously.
Digitized by LjOOQle
Nov. 1, 1800.
The Marquess of Dufferin and the Right Hon. Mr-
Asquith, Q.C., M.P , have been nominated for the Lord
Rectorship of Edinburgh University. The election
takes place on Saturday next.
The Earl of Rosebery was elected Lord Rector of
Glasgow University on Saturday last by a large
majority over Lord Kelvin. Our Glasgow correspondent
informs us that the students carried “horseplay” to
such an excess that it was thought probable at one time
the Principal would declare the election null and void.
Col. G. J. H. Evatt, M.D., Principal Medical Officer
at Hong Kong, has been ordered home at once to suc¬
ceed Surgeon-General W. D. "Wilton as Principal
Medical Officer to the Western District at Devonport.
The Colonel, who joined the Royal Army Medical Corps,
in 1865, has had his full share of fighting. His war
record includes the Perak expedition of 1876. the Afghan
war, the expedition to the Soudan in 1HK5, and the
Zhob Valley expedition of 1890. He has on several
occasions received the distinction of despatch mention.
The following staff surgeons have received appoint¬
ment on the active list in the fleet:—Percy E. Maitland,
to the St. George, on commissioning ; Charles Strickland,
to the Juno, on commissioning; John W. Slaughter, to
the Cambrian, on commissioning ; William W. Pryn, to
the Minerva, on commissioning (all to date October 31st).
8urgeons not on the staff:—William J. Codrington, to
the St. George, on commissioning; William H. Pope, to
the Juno, on commissioning; John W. Bird, to the
Minerva, on commissioning ; Arthur W. B. Livesay, te
the Thunderer; Edwyn R. Grazebrook, to the Impreg¬
nable (all to date October 3lBt).
(EorrcepcmOence
We do not hold ourselves responsible for the oplnioo* of nur
correspondents.
Re I. M. S. AND THE R. A. M. C.
To the Editor of The Medical Press and Circular.
Sir,—Y our admirable paper in the issue of August 30th,
p. 219, under the heading “ Enteric Fever in the
Indian Army,” makes a mistake, perhaps not unnatural,
in attributing to the “Indian Medical Service” the
blame for the prevalence of enteric fever in Indian can¬
tonments The Indian Medical Service has practically
nothing to do with cantonments sanitation l>eyond the
fact that the Director-General of the I.M.S. is the civil
sanitary adviser of Government. The sanitation of
military cantonments where alone enteric prevails, is
entirely in the hands of military medical men, and
chiefly the R. A. M. Corps. The spirit of militarism
which you rightly inveigh against hardly, if at all,
exists in the I.M.S in spite of the titles recently thrust
upon us. Moreover, the cause of the prevalence of
enteric is by no means the easy matter it seems, and the
water-borne theory by no means explains all outbreaks
(e </., the recent Quetta outbreak), but this is too big a
subject to enter upon here. Much has been done, and
much is being done: but difficulties are greater than
appear to critics at home. Please distinguish between
the I.M.S.—two-thirds of whom are in Civil employ,
and which, in Prof. Ogsten’s words, “ still attracts the
best graduates of the medical schools”—and the
R.A.M-C. in India. As a rule we are, and have been
for long, content, andhave comparatively little sympathy
with recent agitation, and as practical surgeons and
physicians (civil) are by no means behind the times, as
anyone who has visited the large medical schools, &c.,
in India can testify. We invite critics to come and
The Medical Press. 469
judge for themselves and see the work done by Indian
medical officers in civil employ—see our hospitals, our
gaols, our medical schools. The “ intellectual sterility,”
the military soul-deadening system of seniority, does not
exist for the civil surgeon, who is usually the sole European
medical man, in charge of a district as large as Tyrone
or Donegal, who is physician, surgeon, consultant,
coroner, jail governor, first medical officer, meteorological
observer, superintendent of vaccination, general prac¬
titioner, and specialist of his district! It is because of
these responsibilities and the early independence that
the I.M.S. still attracts the best men of the house-
surgeon claw to enter it. Please do not follow the
British Medical Journal in confusing the I.M S. with the
R.A.M.C. serving in India. I am, Sir, yours truly,
T. C. D.
j The Royal University of Ireland.
I The ceremonial of capping the new graduates of the
| University took place last Friday, and presented no
I feature of unusual interest. The Marquess of Dufferin,
| who as Chancellor of the University occupied the chair,
| in the course of his address referred to the great
loss which the University had sustained by the recent
death of Sir Christopher Redington, his Vice-Chancellor.
The degree of L.L.D. Hon. Caus. was conferred on the
Right Hon. W. J. Pirrie, in consideration of his valuable
services to the industrial sciences. Mr. Pirrie is one of
the predominant partners in the great shipbuilding firm
of Harland and Wolff, of Belfast.
Westminster Hosnltal Medical School.
At the meeting of the School of Medicine Committee
on October 18th, the following prizes and entrance
scholarships were awarded: — Epsom Scholarship, 110
guineas, to Mr. E. H. Bennett Bailey: Arts Scholar¬
ship, £40, to Mr. L. White; Oxford and Cambridge
Scholarship, £40, to Mr. W. C. Hocken; Arts Scholar¬
ship, £30, to Mr. W. H. France ; “ Fish” Prize, £20, to
Mr. W. Payne; Midwifery Prize, to Mr. W. Payne;
Materia Medica Prize, to Mr. E. R. Carling; Forensic
Medicine Prize, to Mr. W. Payne; Practical Chemistry
Prize, to Messrs. T. B. Hickley and C. Parker; and
Physics Prize, to Mr. O. P. N. Pearn.
Sheffield Medico Chirurglc&l Society.
The session 1899-1900 was opened on October 19th.
The following are the officers for the present
session.-—President, Dr. Duncan Burgess: Vice Presi¬
dents, Dr. Young, Dr. Kay-, members to complete
council, Mr. Leach, Mr. Reckless, Dr. Porter, Dr. White,
Dr. Brown, Mr. H. Lockwood, Dr. McKay. Dr. Thomson
(Retford), Mr. Shea (Chesterfield). Dr. Alfred Robinson
(Rotherham); treasurer, Mr. Snell; librarian. Dr.
Addison ; secretary, Dr. Cocking. The President. Dr.
Burgess, delivered the inaugural address on “ Some
Recollections of Medical Cases.”
Death under Chloroform.
A man died at the Sonthport Infirmary on the 23rd
inst., while undergoing an operation for the relief of
intestinal obstroction, and the usual verdict was
returned. The value of these records is stultified by
the lack of details concerning the method of administra¬
tion and the amount of the drug inhaled.
Bmall-Pox at Hull.
The epidemic of smallpox'at Hull has assumed dis¬
quieting proportions, upwards of 300 cases having, so
far, been admitted to hospital. The problem of provid¬
ing accommodation for this large number has taxed the
resources of the authorities who are now actively
engaged in adding to the beds available. Steps have
been taken to induce people to be revaccinated, so far
with a fair measure of success.
8uldde of a Medical Man.
An inquest was held at Llandudno, on the 26th inst.,
on the body of Lancelot B. Todel, a medical practitioner,
who had died from the effects of a self-administered
dose of carbolic acid. The deceased had shown mental
symptoms of a disquieting nature, but unfortunately it
had not been thought necessary to place him under
restraint. A verdict of “8uicide while temporarily
insane ” was returned.
MEDICAL NEWS.
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T
470 The Medical Press. NOTICES TO CORRESPONDENTS. Nov. 1 ,1899.
Notices to
toresponbcnifi, £hort ^tetters, &c.
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,” &c. Much confusion will be
spared by attention to this rule.
M D.—The Cavendish Lodge (No. 2,620) founded by the staff of
the West London Hospital, in connection with the West London
Medico-Chirurgical Society. The secretary is Dr. P. S. Abraham,
2, Henrietta Street, Cavendish Square, W.
The Public Health Journal is responsible for the following
poetical outburst:—
The Patient Patient !
They sawed off liis arms and his legs,
They took out his jugular vein.
They put fancy frills on his lungs,
And thejr deftly extracted his brain.
'Twas a triumph of surgical skill,
Such as never was heard of till then:
’Twas the subject of lectures before
Conventions of medical men.
The news of this wonderful thing
Was heralded far and wide,
But ns for the patient there's nothing to say,
Excepting, of course, that he died.
Western County.— Our correspondent's memory has failed him.
The facts first appeared iii this journal in the issue of October 4tli,
1899.
A NEW METHOD OP CONVERTING CENTIGRADE INTO
FAHRENHEIT.
Dr. Whiton, of New York, has brought forward a novel method
of converting centigrade scale into Fahrenheit, which he claims is
much simpler and easier to perform as a mental process. To con¬
vert F into C he subtracts 32 and adds one-ninth of the remainder,
dividing the total by two. Thus 104 degs. F. — 32 = 72. Add to
this 8 (the ninth of 72) and we linve 80. Divide by two and we have
40, which is the corresponding figure in the centigrade scale.
BICYCLE SADDLES.
In the course of some remarks by “ a leading cyclist," published
in the New York Sanitarii Record, on bicycle saddles, the writer
condemns the ordinnry makes on the ground that they bruise his
sternum bone. This is utter all a pardonable error in a layman, and
even to medical students it seems nnomalous to put the stern in
front.
Medical Officer of Health. —The Jenner Society (Honorary'
Secretary, Dr. Francis Bond, Gloucester), issues a mass of useful
literature upon the subject of vaccination, to which society our
correspondent should make application.
BEE STINGS.
It is stated by Nature that a solution of cocaine is a perfect cure
for the stings of bees and wasps, being not only an analgesic, but an
antidote.
Dr. Clement R. Sees.—W e are unable to find space for a discus¬
sion on the grounds for belief in baptism and vaccination respec¬
tively, for reasons which are obvious.
Dr. John Hayward.— Samples of the new fish food were ob¬
tained of W. R and W. Smith, 6, Hanover Street, Glasgow.
.THE PATENT MEDICINE TRADE.
Accordinu to the most recent return the trade in patent medi¬
cines is spreading. The number of licences to sell in Great Britain
(excluding Ireland) was, in 1897, 32,473; and in 1898, 33,992. Aguiu,
the revenue from the sale of patent medicine stamps was last year
£266,404, the highest figure ever reached. In ten years last past the
Chancellor of the Exchequer has received uearly two millions and a
half from this source of taxation.
Jfteettngs of the Societies anh lectures.
Wednesday, November 1st.
Obstetrical Society of London.—8 p.m. Specimens will be
shown by Dr. W. Duncan and others. PapersDr. Hermau : Two
Cases in'which life appeared to have b,een saved by Anti-strepto¬
coccic Serum. Dr. P. D. Turner: Notes on Tuberculosis of the
Fallopian Tubes and Uterus in Cases of Phthisis.
St. John's Hospital for Diseases of the Skin (Leicester
Square).—4.30 p.m. Dr. M. Dockrell: Lichen.
Thursday, November 2nd.
Harveian Society of London (Stafford Rooms, Titchborne
Street, Edgware Road).— 8.30 p.m. Dr. J. W. Washbourn : Cases
illustrating the Value of Treatment with Anti streptococcic Serum.
Royal College of Physicians of London.—5 p.m. Dr. W. A.
Foxwell: On the Causation of Functional Heart Murmurs. (Brad¬
shaw Lecture.)
Central London Throat, Nose, and Ear Hospital.—o p.m.
Dr Dun das Grant: Differential Diagnosis of Nasal Discharges.
Friday, November 3rd.
West Kent Medico-Chirurgical Society (Royal Kent Dispen¬
sary, Greenwich). 8 45 p.m. Paper:—Dr. A. P. Luff: Modern
Views as to the Causation and Treatment of Gout.
West London Medico-Chirurgical Society.— Papers Mr.
J. G. Pardoe : Some Modern Methods in the Treatment of Chronic
Urethritis. Mr. S. Edwurds : Urinary Obstruction with Cases. Mr
| Me A dam Eccles will show an Enema Apparatus from . Central
Africa. '" ~.'
Larynooloiiicai. Society of London (20. Hanover Son are,sW.).
—5 p.m Cases and Specimens will be shown by Dr. F. Poller, Dr.
| H. Mackenzie, Dr. St.Clair Thompson, Dr. D. dirant, Dr. W. Hill,
Dr. H. Tilley, Dr. S. Spicer,and Mr. R. Lake.
| Society of Anesthetists (2", Hun •- ;r Square, W.).—8.30'p.m.
Dr. SavHge : The Relationship between the Use of Amesthetics and
Insanity.
ftecattcies.
County Borough of Great Yarmouth.—Medical Officer of Health,
Medical Officer for the Borough Isolation Hospital, and Port
Medical Officer of Health. Salary £400 a year. Applyitofthe
Town Clerk, Town Hall, Great Yarmouth.
County of London, Manor Asylum, Horton, Epsom.—Dispenser.
Salary commencing atfcllO per annum, with dinner daily.
' Cumberland.—Qualified Indoor Assistant. Salary £KK). Apply,
“Cumberland,” Medical Press Office, Dublin. (See Advert.).
Apply to the Clerk to the Asylums Committee, .Office, 6,
Waterloo Place. S.W.
Glamorgan County Council and Cardiff Corporation.—Bacteriologist
to the Joint Committee, and Lecturer on Bacteriology in the
University of Cardiff. Salary, £.100 a year. Apply to the Clerk,
Glamorgan County Offices, Cardiff.
Hospital for the Insane, the C'ppice, Nottingham.—Assistant
Medical Officer, unmarried. Salary £150 per annum, with apart¬
ments, board, attendance, and washing.
Metropolitan Asylums Board.—Four appointments as Assistant
Medical Officers at the Fever Hospitals. Salary £160, rising
to £300, with board, lodging, washing, Ac. Immediate appli¬
cations to the Clerk to the Board. (See Advert.).
Royal Infirmary, Hull.—House Surgeon for two years, unmarried.
Salary, 100 guineas per annum, with board ana furnished apurt-
ments.
Stoke-upon-Trent Union.—Resident Medical Officer for the Work-
house. Salary commencing at £13(, with board, washing, and
furnished aoartments. The Guardians provide the drugs, medi¬
cines, and appliances.—Applications to the Clerk, Union Offices,
Stoke-upon-Trent.
appointments.
Harris, Wilfred J., M.D.Cnntab., M.R.C.P , Assistant Physician
to the City of London Hospital for Diseases of the Chest!
Key, David T., M R.C.S., L.S A., Medical Officer for the Wyke
Regis District of the Weymouth Union.
Martin, E. W., M.B., Cli.B.. Junior House Physician to the City
of London Hospital for Diseases of the Chest.
Moore, E. J. F., L.R.C.P.Lond., M.R.C.S., Medical Officer for the
Workhouse, Bethnal Green, London.
O Farbell, H., L.R.C.P., L.R.C.S., Medical and Sanitary Officer
for the No. 1 Portumna Dispensary District, Co. Galway.
Parsons, C. T., M.D.Lond., Resident Medical Superintendent for
the Fulham Union Infirmary.
Potts, W. J., M.D.Lond., L.R.C.P., M.R.C.S., Medical Superinten-
dentfor the Infirmary, Bethnal Green, London.
Price, F. W., M.B., C.M.Edin., Assistant Resident Medical Officer
to the Brompton Hospital for Consumption.
Reed, Walter Hugo, M.R.C.S., L S.A., Medical Officer of Health
by the Westbury (Wiltshire) Urban Council.
Rorik, G. A., M.B., Ch B.Ed.. Junior Assistant Medical Officer to
the Cumberland and Westmorland Aqylinn, Carlisle.
Rowlands, William Cobden, M B.C.M.Edin., Medical Officer at
the Llynvi Colliery, South Wnles.
Stevens, Bertram, M.B., B.S.Durh., M.R.C.S., L.S. A.. Senior
Assistant House Surgeon to the Huddersfield Infirmary.
Taylor, Henry Young, M.B., C.M.Edin., Senior House Surgeon to
the Huddersfield Infirmary.
Thorne, Mat, M.D.Brux., has been appointed Teacher of Vaccina¬
tion, and empowered to grunt certificates by the Local Govern¬
ment Board. The Vaccination Station is at the New Hospital
for Women, 144, E us ton Hoad, London. N.W.
Williamson, O. K., M.A , M.B., B.C.Cantab., M.R.C.S., Patholo¬
gist to the City of London Hospital for Diseases of the Chest.
girths.
Newton.—O n October 24th, at Balcombe, Sussex, the wife of
Reginald Newton, M.R.C.S. and L.R.C.P., of a daughter.
JJeaths.
Arlidge.— On October 27th, at Newcastle-under-Lyme, John I.
Arlidge, M.D , F.R.C.P.Lond., J.P., ugei 77.
Hooi.e.—O n October 19th, Stephen Hoole, L.D.S.Eng., of 16, Old
Burlington Street, London, W., in his 68th year.
Lewis. —On October 26th, of scarlet fever, Frederick Henry
L^wis, B.A., M.B.Cautab., M.R.C.S.Eng., and L.R.C.P.Lond.,
son of the late Dr. Frederick Lewis, of Gloucester Place, W.,
aged 32.
Livy. • On October 24th, at Birkdale, Southport, John Livy, M.D.,
F.B.C.3., and J.P. of Bolton, aged 73.
Palmer.— On October 21st, at Lancaster House, Lincoln, Edwin
Charles Palmer, M.A., M.B.Cantab,, in his35th year.
Routh.— On October 21st. after a short illness, Alfred Curtis Routh,
M.R.C.S., of 8t. Leouards-on-Sea.
Woodward.— On October 17tli, at Bellary, India, of enteric torer,
Arthur Woodward, M.R.C.S., aged 26 years, only sou of E. H.
and T. J. Woodward, of 13, St. George’s Terrace, Brighton.
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“ 8ALU8 POPULI SUPREMA LEX."
Circular.
Vol. CXIX. WEDNESDAY, NOVEMBER 8, 1899. No. 19.
Clinical Xccture
ON
LEPROSY AND CANCER OF THE
SKIN.
Delivered at the London Hospital.
By'JONATHAN HUTCHINSON. F.R.C.S ., F.R.S.
Gentlemen, —Perhaps you may be somewhat sur¬
prised at my including leprosy in a lecture upon
diseases of the skin, but I have deliberately done so
because I wish to insist that in its earlier stages
leprosy is purely a disease of the skin, and that all
through the course the severest lesions are those
which begin in the skin and extend to the tissues
beneath it or to the superficial nerve trunks. Indeed,
in the macular stage it presents many resemblances
to lupus, occurring in symmetrical patches, spreading
at its edges, and leaving in the centre instead of a
thin pale scar, an aneestnetic area.
Not only is the disease in its earliest stages an
affection of the skin, but it niay remain so for years,
and in mild cases terminate favourably without ever
extending beyond this tissue. I have had under
observation for some time an English leper,
who has had the disease for at least ten years,
and the only lesions he presents are numerous,
patches of dusky erythema from the size of a half-
crown to that of the outspread hand, with pale
oentral area of total anaesthesia. These are scattered
all over his trunk and limbs, especially well-marked
upon the back and buttocks, and he made his own
diagnosis for me by volunteering the statement that
the skin “ in the centre of them was quite dead.”
His general health is perfect, he is actively engaged
in business, and absolutely the only inconvenience
the disease has caused him in ten years’ time is the
patchy pigmentation of the skin for which alone he
consulted me. He has not the slightest suspicion of
the true nature of his malady, nor shall he have if I
can help it.
Next in the normal course of the disease comes the
development of cutaneous tubercles, sometimes firm
circumscribed bossy elevations not unlike a large
urticarial wheal, but more often only a thickening and
oedema of normal folds of the skin, most commonly
those of the brow and forehead. The old division of
leprosy into the anesthetic and tuberculous forms,
was entirely uncalled for, they are simply stages in,
and of, the same disease, and although the anaesthetic
stage may exist for a long time without the develop¬
ment of the tuberculous, wherever tubercles are you
invariably find well-marked anaesthesia also, and
usually thickening of the ulnar nerve, and careful
questioning will generally elicit a history of anaesthesia
in some region of the skin, which began months or
years before. Usually by some apparently accidental
ourn, as in. a boy patient of mine who had a severe
burn-scar across two fingers, due. as he explained, to
his thrusting his hand into the flame of a candle by
his bed side, while yawning and stretching just after
getting up one dark morning.
The relation between leprosy and tuberculosis we
do not as yet clearly understand, but it seems un¬
questionable that one exists. The bacilli found in
the lesions of the two diseases are strikingly similar,
but their identity cannot be proved an account of the
impossibility, so far, of cultivating the lepra bacilli
upon any artificial medium. Dr. Geo. Newman in¬
forms me that the bacilli of leprosy are extremely
similar to those of avian tuberculosis, both in their
shape, in the clumps or masses in which they are
found in the tissues, and in the small amount of re¬
action to or encapsulation of them by the fixed cells.
It is also significant that the actual cause of death in
the great majority of lepers is pulmonary tuber¬
culosis. As to the cause of the localisation of the
bacilli in theskin wearequite in tbe dark. It certainly
is not due to direct local infection, but the virus
must be distributed by means of the circulation, and
probably to some degree under the influence of tbe
nervous system, as the lesions are usually sym¬
metrical.
One of the obstacles to the solution of the problem
is the great difficulty in identifying the bacilli in the
patches of the macular sta^e. But this, of course,
is no more than we find in lupus erythematosus,
which though regarded on that account by many as
non-tuberculous,always occurs in members of families
having a strong tuberculous history.
As for the fear of contagion in leprosy, I regard it
as utterly unfounded. We have abundant evidenoe
to prove that those living in daily and hourly con¬
tact with leprous members of their own families,
contract the disease only in the rarest of instances.
The spread of leprosy by direct personal contagion
is a contingency which must be counted as merely a
remotely possible accident. Cases occurring in the
same household or village are much more probably
due to identical food and surroundings than to
any form of direct infection. Isolation is cruel, a
fearful waste of labour, and leaves the real cause of
the disease entirely untouched. It has never checked
or limited the spread of the disease in the slightest
degree.
As to the port of entry of the disease into the
system it probably lies between tbe lungs and the
alimentary canal. To my mind the balance of pro¬
bability is strongly in favour of the food being the
source of infection. In this it is again parallel with
tuberculosis. The food theory of its causation I have
elaborated so fully elsewhere that it is not necessary
for me to enter into it in detail here. Suffice it to
say that leprosy is not a disease of civilisation, but
just the reverse. It is extremely ancient, und it may
be said that there are few savage tribes living near
large bodies of water in which it has not been preva¬
lent at some time. The disease is singularly identical
in all countries and races, and this uniformity argues
a uniformity of cause. In all countries and conti¬
nents it forms a ring round the sea board,, never
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The Medical Pbess. ORIGINAL COMMUNICATIONS. Nov. 8, 1899.
penetrating more than a few days’ journey into the
interior. It is not the richer and more varied diet
which accompanies civilisation which has caused its
disappearance but the withdrawal of one injurious
food substance, badly cured or partially decayed fish.
"Wherever the use of this as an article of diet occurs,
leprosy is present; wherever it ceases to be used
leprosy disappears. In all probability the bacillus
was conveyed, and found its intermediate home in the
tissues of decaying fish, and was modified in some
way by the “ culture medium.”
There is an especial appropriateness in taking up
cancer as it appears upon the skin, as this is by far
the best situation in which to study it. Here the
very earliest stages can be detected, and every change
which the process undergoes carefully noted.
An admirable illustration of this is found in
epithelioma of the lip or “ pipe cancer.” Here the
lip hardens and cracks under the pressure of the
dirty pipe, the sore becomes warty at its edges, a
cauliflower-like surface is developed, the glands
under the jaw rapidly become involved, and fatal
systemic infection is complete. In this form there
have been two years of precancerous stage, and one
of frank” cancer, before the drama closes.
In striking contrast with this look at cancer (flat-
celled) of the eye-lid or cheek, which may run for
twenty or thirty years, and destroy almost the entire
face without involving a single gland, or threatening
the life of the victim. This is not a matter of region
solely, because we may also have upon the cheek the
“crateriform ulcer,” which, though rare, is rapidly fatal.
In other cases of skin cancer, the disease may make
its appearance in freckles, which, after childhood, are
often to be regarded as abnormal. Their presence
also often coincides with a tuberculous tendency. In
the curious *• Kaposi's disease ” or xeroderma pig¬
mentosum, we have dark and profuse freckles as the
starting point of a disturbance which ultimately ends
in cancer, hence its popular name “ malignant freckle.”
An abnormal deposition of pigment is always to be
regarded with suspicion. Moles are frequently the
starting point of malignant disease, usually sarcoma,
especially those which are not congenital. Curiously
enough, they may be the initial point of a general
metastasis and yet l>e very little affected themselves.
I have seen several cases of sarcomatosis of the
entire skin, which proved rapidly fatal starting from
a mole, which was so little altered that only by
careful questioning could I elicit that it was the first
spot to become swollen or slightly sore.
The character of the skin in which cancer origi¬
nates has a marked influence upon its character.
Rodent ulcer, for instance, is extremely mild and
superficial upon the temple, but much deeper and
more rapid upon the eye-lid or the ala) of the nose.
Xeroderma pigmentosum is a freckle cancer in the
young and in the “ second childhood ” of senility we
find again a tendency to develop freckles in which
malignant disease has its origin. The black patches
which grow around the eyelid in old women are
specially liable to degenerative changes of this
description. Cancer is emphatically a process of
senile tissues, and while a parasitic origin may some
day be demonstrated yet all attempts so far are con¬
spicuous failures, and I personally cannot believe
that there is any probability whatever of such a
causation being discovered. The process is a dis¬
turbance of cell-nutrition, of internal balance, quite
independent of any external cause. It is, in the nature
of it, a self-originating process in the senile period.
Inheritance, though not a very common factor in
cancer, is unquestionably a potent one. Many of the
cases of cancer at an unusually early age that I have
seen have been in the children of cancerous parents.
I have under observation a case of rodent ulcer of
the cheek in a boy of fourteen, whose father had
rodent ulcer for thirty years, and suffered from it a*'
the time the boy was conceived. The disease doe 8
not necessarily attack the same organ when trans¬
mitted, more frequently not. What is inherited is
the tissue-tendency to rebel, and this may take plaoe
in any organ or in connection instead of epithelial
tissues, giving rise to sarcoma instead of carcinoma.
I think the term cancer should cover both of these
processes, the principle is the same in both, a rebellion
of the cells; the particular tissue attacked is a detail.
As to the increase of cancer, of which we hear so
much, I think it is greatly over-stated. Accord ng
to some vital returns, in certain districts, it would
appear to have increased nearly 500 per cent, in the
past fifty years. I have a serious distrust of all
registrars’ reports and statistics as a basis for
scientific deductions as to the frequency of disease.
There are too many changes in nomenclature, in
disease-classification, too many loop holes and
opportunities for mistakes both of diagnosis and of
record in our methods of reporting deaths, to furnish
any really secure btsis. I think there can be little
question that cancer is actually increasing slowly,
but steadily. Simply for the reason that the pro¬
portion of those surviving to middle age, and those
becoming liable to it, is increasing. Paradoxical as
it may sound, cancer is a symptom of improving
health on the part of the community.
Its distribution in the lower animals supports this
position. It is comparatively common in dogs, cats,
and horses, who are permitted to live to lie old,
while in cattle, sheep, and pigs, most of whom are
killed for food before maturity, it is extremely rare.
Another contributory cause of its increase is that
marriages occur later in life than was formerly cus¬
tomary, and I believe, from my own experience, that
the children of middle-aged or senile parents are
more liable to cancer.
FOREIGN BODY IN THE FEMALE
BLADDER.
By J. LAMOND LACKIE, M.D., F.R.C.P.E.,
Gynecological Tutor, Royal Infirmary, Edinburgh.
Many cases of foreign body in the female bladder
are recorded, and in every text-book reference is
made to the subject, but the acci¬
dental introduction of a large tor¬
toiseshell hairpin, as represented in
the diagram, is, I think, sufficiently
rare to justify my recording the fol¬
lowing case.
On July 24th of this year I was
asked by her medical attendant to see
a lady, wt. 25, who gave the history
that that morning at 5 a.m., on waken¬
ing from sleep, she felt a sensation of
great itching in the region of the
vulva. She therefore withdrew from
her hair a tortoiseshell hairpin, and
with the rounded end endeavoured to
relieve her discomfort. Presently,
however, the hairpin slipped from her
fingere and disappeared, and to her
surprise she found she could not re¬
gain it. Later in the day she informed
her mother of the accident and began
to have frequent and painful mictu¬
rition. The lady’s doctor was sent
for, and, as on examination he could
not detect any foreign body in the
vagina, he concluded that it had
passed into the bladder.
The patient being ansesthetised,
the bladder was explored by means of a
sound, when I easily detected the pre¬
sence of a foreign body. The urethra
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Not. 8, 1899.
ORIGINAL COMMUNICATIONS. Th* Mxdical Pbxss. 473
was therefore dilated by means of Hegar’s bougies and
the index finger of the left hand introduced until it
came in contact with the two sharp points of a hair¬
pin of the nature described by the patient. An effort
was first of all made to pass a pair of forceps along¬
side of the finger, and to approximate these ends and
bo withdraw the pin, but tnis proved impossible. I
therefore determined to turn the foreign body so as
to get the rounded end next the urethral canal. This
I accomplished only with great difficulty, sinoe when
the pin came to be lying transversely, the sharp ends
persisted in penetrating the membrane, and remain¬
ing fixed. Ultimately, but only after persevering for
half an hour my object was attained, and then, on
passing along a pair of very finely-bladed forceps the
pin was grasped and easily withdrawn. There was
considerable haemorrhage from rupture of the external
meatus, and one feared that owing to the consider¬
able stretching of the urethra the patient might
suffer from incontinence of urine for some time, but,
fortunately this was not the case, as she never lost
control of the function of micturition, and twenty-
four hours later Beemed perfectly well.
It is surprising to what an extent the female
urethra may be dilated without any permanent
harm. Although at one time the operation was
frequently resorted to for purposes of diagnosis, of
late years it has fallen into disuse, to a large extent
owing to the introduction of improved methods of
cystoscopy. Howard Kelly has especially condemned
the dilatation of the urethra and the introduction of
the finger as a means of diagnosis, and has devised a
method of examining the bladder by direct illumina¬
tion, which obviates much stretching of the urethral
canal. However, in a case such as I now record it
seems to me that the plan adopted was preferable to
the alternative of anterior colpotomy and the removal
of the foreign body per vaginam. In most cases,
even after greater dilatation than that resorted to in
this case, permanent, incontinence of urine does not
result, the patient regaining control of the bladder, if
not at once, at most in the course of a few days.
Further, the operation of colpotomy must always
entail a certain risk of vesico-vaginal fistula.
RELATIVE WORTH 0F ANTISEPTIC
AND
TECHNICAL IMPROVEMENTS
FOR THE
ACTUAL RESULTS OF OPERATIVE
GYNAECOLOGY. («)
By Professor E. BTTMM, M.D.,
Of Basel.
The absolute reliance on the protective power of
antisepsis has been a good deal diminished by exact
investigations, as it has been proved by a whole series
of experiments and observations that elimination of
all micro-organisms during the operation, has not
yet been attained. We can sterilise the instruments
and dressings, but no method has been discovered,
at least up till now', that gives us with certainty the
game result as to the skin of the hands and the part
to be operated on.
A year's bacteriological research made during a
great number of operations from beginning to end
upon the skin of the hands as well as the operation
field, the wound, the instruments, the dressing and
ligature material, have given me the following
results:—
(a) Abstract of i»per read before Congress of Gynecologists'
Amsterdam, August, 1899.
1. There is no way to remove with certainty all
micro-organisms from the hands. The successive
use of soap and hot water, of alcohol, and of a solu¬
tion of lysol or sublimate, for ten minutes each, are
not sufficient to ensure the sterilisation of the skin.
For these experiments rigid precautions, as pre¬
scribed in Higgler's method, are necessary to obtain
satisfactory results. Above all it is not sufficient to
examine only a small part of the skin of the hands,
to remove the adhering remainder of the sublimate,
taking into account the shrivelling of the skin by the
alcohol.
2. The same conclusion is to be drawn with regard
to the skin of the rest of the body and especially for
the external genitals, the perineum, the vagina, Ac.
3. During the course of the operation we find on
the instruments and ligatures and in the wound
principally the micro-organisms originating in the
deeper parts of the epidermis and from the glandular
ducte. In fifty great operations, under exact control,
none were found entirely free from the presence of
micro-organisms.
4. With the ** aseptic ” method, even when the
operation is made in the liest conditions and with the
greatest precautions, the number of micro-organisms
is far higher than that which is found in using the
antiseptic method. At the end of the operation the,
.so-called sterile, salt-solution contains regularly
micro-organisms and sometimes in great number.
5. The micro-organisms of the atmospheric dust,
are but of small importance in the infection of opera¬
tion wounds.
<>. Difficult as it is to operate without giving access
to the micro-organisms, it is still more so to keep
them away from the wound and its surroundings for
a longer amount of time. It is, therefore, illusory to
think that either asepsis or antisepsis can bring
about a sterile condition of the wounds. According
to circumstances there will lie in every wound more
or less bacteria. In spite of this proved presence of
micro-organisms most wounds heal without sup¬
puration or fever. This result is due to the bacteri¬
cidal power of the organism. But this bactericidal
power of the organism can be insufficient, and this
occurs when the wound is brought into contact with
virulent micro-organisms or when it presents bad
conditions for the full development of the bacteri¬
cidal qualities of the tissues and humours.
Formerly the access of virulent micro-organisms
to the wounds was only a question of chance.
Actually antisepsis gives us the means to avoid this
contact. But, as virulent micro-organisms are gene¬
rally found in the secretions of wounds and in the
humours of the infected body, and as, on the other
side, a true disinfection of the hand, impregnated by
these infective secretions, is impossible, the dominat¬
ing clement of every asepsis or antisepsis should be
the avoidance of the contact with septic matter,
abstinence when the contact has taken place, and
isolation of septic patients.
The second possibility of insufficience of the bac¬
tericidal power of the organism brings us to a point
where the territory of technique covers that of anti¬
sepsis. Technique has to remedy the insufficiency of
our antiseptic and aseptic means, it has to arrange
the conditions of the wound in such a way that the
may organism be able to win the struggle against
the never entirely missing bacteria.
In this view it can be said that purely technical
means have a great influence on the aseptic healing
of wounds.
I should like to give some examples to show this
more clearly.
A short and well-conducted operation exposes the
tissues only for a short time to the influence of
exterior surroundings and brings manipulation to a
minimum ; in this way it diminishes the chances of
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ORIGINAL COMMUNICATIONS.
Nov. 8, 1899.
474 THK MlDlCAI- PrB68.
accidental infection. The number of micro-organisms
entering the wound will be a good deal less than in
an operation of long duration, in which the tissues
are lacerated by repeated manipulations.
In addition to this a short operation does not so
much tax the resisting power of the wounded tissues
as well as of the entire organism. To expose the
eritoneal cavity during a long time has a well
nown bad influence on the heart, the intestines
ajid the serosa. Asepsis has delivered us of the
dangerous application of too much concentrated
disinfectants.
The importance of haemostasis for the aseptic
healing of wounds is universally recognised. The
drier the wound, the better are the chances for
primary healing. On the other hand the blood, as
soon as it has left the vessels loses its bactericidal
properties and becomes an excellent medium of
culture for the micro-organisms. This being especi¬
ally the case for the peritoneal cavity, for abdominal
operations exact haemostasis is at least as important
as exact asepsis.
Next in importance comes the choice of the opera¬
tive way. Neither the operation per vaginam or by
laparotomy should be condemned by principle. In
cases when per vaginam the part to be operated can
be better exposed to view, so as to facilitate exact
ha'mostasis and avoid injuries of the surround¬
ings. presenting as it does the least danger, it is
therefore the best. But should it appear that the
employment of this method prevents obtaining a
good view, it would be better to overlook the diffi¬
culties belonging to asepsis and follow the directions
of the technique demanded by laparotomy.
A last point, where antisepsis and technique meet
is drainage, and especially drainage of the peritoneal
cavity. It is an established fact that drainage, even
on the greatest scale, has no effect whatever on diffuse
septic peritonitis. But the case is quite different
when we have local troubles to deal with, as circum¬
scribed abscess, extensive lacerations of the serosa
or contact of the serosa with infectious matter. In
these conditions we ought not to expect more of the
peritoneum than from any other wound, and I then
apply drainage by gauze tampons, from which mode
of treatment, I have never experienced other than
favourable results, and would prefer applying it onoe
too often than omitting it.
From all this the conclusion ought to be that to
obtain an entirely satisfactory result, antisepsis and
improved technics have to go hand in hand. The one
without the other is not sufficient. The history of
intraperitoneal treatment of the stump in myomo-
tomy furnishes a good example of the importance of
technique in relation to antisepsis.
Antisepsis is easily learned and executed. But
technicalities are more difficult to learn ; they repre¬
sent an art, that demands above all things a born
aptitude. It is high time for instruction in surgical
technique, of late much neglected for antisepsis, to
be reinstated in its place of honour.
NOTES ON
POISONING BY PRIMULA OBCONICA. (a)
By E. MACDOWEL COSGRAYE,
MD.Dub., F.R.C.P.I.,
Professor of Bioloyy, Royal College of Surgeons ; Physician to Cork
Street Fever Hospital.
The following notes on poisoning by primula
ODconica were suggested by a case which lately
came under my care. The patient, who came to see me
on September 23rd, 1898, was a lady who was very
(o) Read in the Medical Section, Rovol Academy of Medicine
May l!»th, lKtit.
fond of gardening, and had in her greenhouse some
fine young plants of primula obconica which she
tended daily. For the previous seven weeks she had
had irritable red patches on the wrists and forearms,
with here and there the surface broken.
The eruption came out suddenly, appearing on the
wrists and lower half of the forearms within twenty-
four hours. In a few days it died away from the arms,
and, as it died, came out at the back and sides of the
ankles; in about a month the rash recurred on the
wrists and arms, and had, when I saw her, remained
out for about three weeks, although the plants were
no longer being tended. The rash varied in appear¬
ance—sometimes it was urticarious, sometimes ecze¬
matous, and occasionally papules formed and passed
on into pustules. There were attacks of intolerable
itching, and sometimes of severe neuralgic pain;
and all the time, whether the rash was visible or not,
the patient had epigastric uneasiness and felt sick
and out of sorts.
The progress was slow; bathing the affected
regions with very hot water, and the application of
dilute citrine ointment giving most relief.
On glancing over Neale’s Digest and recent
volumes of the medical journals, and such papers as
The Garden, Gardening, and the Gardeners’ Chronicle
a number of references will be found to toxic sym¬
ptoms following contact with primula plants.
Primula obconica was introduced into this country
about 1880, and as it flowers freely all through the
winter it has rapidly come into favour. It has loose
umbels of pale lavender blossoms and slightly tapered
leaves from whose shape it derives its specific name.
Other varieties of primula also have poisonous pro¬
perties, especially P. Sieboldii (1), which under the
name of Cortusoides amcena was introduced into these
countries about 1864.
As these cases occur among those handling plants
the hands are more generally affected. In my case
short gloves were worn when gardening, so the wrists
were the seat of the disease. With gardeners the parts
of the hand least well-protected by a thickened horny
layer are generally affected. Thus. Dr. Allan Jamie¬
son (2) describes a case where the ball of each thumb
and the back and extending to the palmar surface of
some of the fingers was the seat.
When other parts are affected it may be by con¬
tact, and they are then those parts which are most
easily touched by the hands. Dr. Kingsley Ackland
(3) records the case of a lady who had repeated
attacks on her hands, and on one occasion had her
chin affected.
In Dr. Clark’s (4) case the eye-lids were affected
from rubbing them to remove flies.
Dr. Oldacres (5) describes a case accompanied
with much swelling of the face and much oedema of
the eye-lids.
Dr. Wilson, (6) of St. Andrew's, mentions the case
of a lady who suffered martyrdom with an irritable
rash on her neck and chest. She was veiy fond of
the primula obconica, and always wore its lavender
flowers in the evening. When the favourite flower
was given up the rash disappeared.
There may be extreme sensitiveness to the poison.
A lady (7) at dinner complained of irritation of the
face and nose and of the lxidy generally: four pots
of this primula were on the table, on their removal
the irritation subsided. Next day the irritation re¬
curred when the lady was in the conservatory,
although she was not within six feet of the plant.
Sometimes, however, as in a case of which I have
notes, the rash is general, and so its extension from
the parts which touched the leaves is due not to
external but internal causes.
The rash varies in appearance in accordance with
the intensity of the attack. In its lightest form i
is a simple dermatitis with a more or less abundan
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Nov. 8, 1899. _ORIGINAL COMMUNICATIONS.
crop of small red papules. (11) Dr. Ackland (3) speaks
offit as an intensely irritable papular eruption. Cases
described by Dr. Oldacres (5) have been called by
some eczema, and by others urticaria. Dr. Sym (1)
describee the appearance as that of a moist eczema,
papulous and excoriated.
Dr. Allan Jamieson (2) describes a severe case as
having “ well-defined, hard, red, scaly areas. The
edge was distinctly raised and linear, the horny layer
of the epidermis ragged and undermined. The
general surface of the patches, which were of con¬
siderable extent, was rough to feel, thickened, and
had a tendency to fissure.”
The course of the disease can best be understood
by comparing the descriptions of a light and a severe
case. In the former, (3) in a little more than twelve
hours after contact with the leaves, a broad band of
small papules appeared on a raised base, and gave
rise to almost intolerable itching.
In a severe case as described by Dr. Leighton (9)
the patient was “ suffering from tremendous oedema
of the right hand, with well marked lymphagitis
of right arm and tenderness in axillary glands. Next
day there began a profuse serous discharge from
between the Becond and third fingers. The pain in
the joints was excessive, and the patient was slightly
feverish. The discharge continued for eight days,
gradually decreasing.
In addition to the itching, which is generally
urgent, there is often severe neuralgic pain, and fre¬
quently. as also occurred in my case, there are
dyspeptic symptoms. (- r >)
Tne duration of the rash is variously described.
Dr. Clark's case (I) must have been mild, for desqua¬
mation ending in recovery took place in four or five
days. In my case the skin trouble lasted several
months, and in the case of a gardener, of which I
have notes, it lasted a couple of years.
Tolerance is not easily established, as in a case
published by Dr. Clark where some plants were
brought indoors (their leaves being held aside daily
whilst the roots were watered), the condition of the
owner’s hands became chronic. Several cases have
been reported where handling the flowers after cure
led to repeated attacks which showed no diminution
in severity.
A troublesome symptom is the occurrence of re¬
lapses. My own case affords an example of this, and
Dr. Leighton (9) reports a case with two relapses, the
time between the first and second being eight
months, and between the second and third sixteen
months.
Dr. Pooley (10) reports a very interesting case :—
“ A market-gardener who used primula obconica in
making funeral wreaths did so with impunity until
he got an attack of facial erysipelas (his son. who did
not touch the plants, had erysipelas at the same
time, which confirms this part of the diagnosis), and
got six relapses when working with the primula, the
fingers also being affected.” This susceptibility to
primula poisoning following erysipelas is interesting.
The discovery of the cause of the attack is some¬
times due to the patient being a reader of gardening
papers. In a case reported by Dr. Oldacres (») the
discovery followed indirect experiment—An old lady
who suffered repeatedly from a troublesome rash
and always got relief by going away from home read
a letter in the Gardeners' Chronicle , and suspecting
that her troubles might arise from the same cause
gave up handling the plants, and received the benefit
that had previously followed the change of air.
Direct experiment was made by a lady whose case
is reported by Dr. Ackland (3)—" She bared her arm
and lightly pressed a bunch of its leaves round the
middle of the forearm. Nothing happened until the
next day, more than twelve hours after the experi¬
ment, when a broad band of small papules appeared
Th» Mxpical Press. 475
on a raised base, giving rise to almost intolerable
itching.”
Dr. Wilson, (6) of St. Andrew’s, examined the
lnnt and found glandular hairs on the leaves, wb ich
e suggested as the cause of the trouble. Greenwood
Pirn, F.L.S., has kindly examined the hairs for me
and reports—“ The hairs on the leaf-stalk, flower-
stalk, and mid-rib are of two kinds—one long and
rather slender with six or seven septa and a slightly
glandular tip, apparently, not functionally glandular;
the others short, about two to three septa with a dis¬
tinctly glandular tip, containing a yellowish-brown
material, doubtless the irritant. The hairs are
delicately striated under a high power. Those on
the lamina are few and rather conical, also with
aborted glands.”
It is probable that the young freely growing leaves
have most effect, (11) and possibly some plants are
more virulent than others, as generally when the
disease occurs several people are affected.
Dr. Oldacres (5) records how a lady “ by way of
experiment has handled the plant a few times, which
has always resulted in the return of the rash and the
dyspeptic symptoms. Further, two of her nephews
who have been staying with her have handled the
plant to test its effect upon them, and have suffered
from the rash in the same way.” And a gardener (12)
who tried to infect himself failed, although, sub¬
sequently, when engaged in potting plants, he got a
severe attack.
BlIlI.lOliRAPHT.
il) Dr. Alan C. Sym, “British Medical Journal,’' November 12th'
1898.
(2) W. Allan Jamieson, M.D., ” British Journal of Dermatology,”
1893, page 140.
(:») C. Kingsley Ackland, L.R.C.P.Lond.. “ Lancet,” I ftps, page 28S*.
(4) Fred. H. Clark, M.B., C.M., 11 British Medical Journal,'*
September 20th, 1X90.
(5) Charles E. Oldacres, M.R.C.S., " British Medical Journal.'’
July 3rd. 1XX9.
(rt) “ Lancet." September 2utl», 1890.
(7) “ The Garden, xlix., 195
(8) Dr. Alan C. Sym, “ British Medical Journal,”September20th.
1*90.
(9i Gerald R. Leighton, M.B., C.M., British Medical Journal,"
October 15th. 1*9$.
(10) E. Burdett Pooley. L.R.C.P., “Lancet,’’ July 22nd, 189:1.
HI) James Ferguson, M.B., C'.M.. “ British Medical Journal.”
(12) ” The Garden, ’ xlviii., 195. October 25th, 1890.
DUSTING POWDERS IN DISEASES
OF THE SKIN.
By DAVID WALSH, M.D.Edin.,
Physician, Western Skin Hospital, London, Vv'.
The treatment of diseases of the skin offers, as
regards the application of remedies, certain advan¬
tages that do not as a rule present themselves in
dealing with internal maladies. In other words, the
dermatologist is able to apply his medicaments
directly to the diseased surfaces, and to note results
with accuracy and certainty. He finds lotions, oint¬
ments, wet or dry dressings, dusting powders, plasters,
varnishes, pastes, liniments, and other approved
methods ready to his hands. By these means he may
direct his attack so as to secure short or prolonged
contact af antiseptics, calmatives, stimulants, pro-
tectives, caustics, parasiticide-s, and the rest of his
therapeutic weapons. The use of dusting powders
dates from ancient times. Their function is two-fold,
(1) Cosmetic, to dry up the physiological moisture or
greasiness of the skin, as in the ordinary face powder :
(2) Medicinal, to absorb discharges from inflamed
surfaces, and also to medicate and protect the skin
from contact with irritating material.
1. Cosmetics. Little need here be said under this
heading. The practice of ” powdering ’’ the face was
robably known to primeval woman, and dated from
er first consciousness of the advantages of personal
attraction. That the rubbing of powders into the
D
Digitized by CjOO^Ic
476 i’he Medical Pbess. TRANSACTIONS OF SOCIETIES.
face is bad for the skin cannot be doubted. Some¬
times irritant or poisonous substances, such as arsenic
or lead are contained in the powder. Even when
the ingredients are in themselves harmless, it follows
from the nature of the application that the ducts of
the skin will be more or less obstructed. Clearly, the
finer the powder the more mischief is likely to ensue
from the choking of sweat and sebaceous ducts.
The use of toilet powder in the nursery, however,
is a good and sufficient excuse under the conditions
that rule the rearing of children, whatever may be
said of adult cosmetics. Ite chief function is to
absorb irritating discharges and keep the skin dry.
For that purpose it is freely sprinkled over the
buttocks and genitalia of babies, in whom the exi¬
gencies of civilised up-bringing have decreed that the
evacuations shall be caught and confined in napkins.
The irritant nature of that particular kind of infant j
swathing is shown by the frequency with which |
rashes are confined to what is aptlv termed the
“ napkin area.” As eveiyone knows who is versed in
the skin affections of infantile syphilis, the develop¬
ment of a specific rash is most typical and common
in that particular region of the body. Now and then
there can be no doubt that the toilet powder sold by
the chemist has contained an irritant drug, but the
majority of cases are due to other causes. If good
powders be used for normal and abnormal skins
there will be little difficulty in vindicating the tradi¬
tions of the nursery as to their value and necessity.
The best drying powders for babies are made of
the simplest materials. Where the skin is hcalthv
violet powder, starch, or fuller’s earth, if pure, will
answer the surpose. The addition of a little boracic
acid or other mild antiseptic is desirable. It is hardly
necessary to use the pure boracic acid that forms the
bulk of some toilet powders. Where the surface of
the skin is inflamed the nature of the powder should
be modified. In cases of slight irritation the follow¬
ing formula is excellent:—
R Acid Boracic Pulv. ;
Calamine, aa 5ij ;
Amyli Pulv., ad 5 ij ;
M. ft. pulv.
Where there is weeping or severe inflammation
(especially if syphilitic) two drachms of Europhen
may be added.
2. Medicinal.—Dusting powders are chiefly useful
in all periods of life in the treatment (a) of inflamed
folds of skin, or intertrigo, in groin, armpit, and so
on; ( b ) of excoriated and weeping surfaces; (c) of
open ulcers.
(a) These eczematous inflammations of opposed
folds or areas of skin are often due to 6eborrhcea, or
to parasitic fungi. They are common in the groin,
armpits, bends of arms or legs, perineum, about the
scrotum and buttocks, between the mammae, and
creases of the skin of neck and belly in stout
persons.
The writer has found the best powders for this
condition are made of staroh, with oxide of zinc, or
calamine, and an antiseptic in the shape of boracic
acid (3j or ,~ij to the ounce), salicylic acid (grs. x.
to the ounce) or Europhen (“>8S or 3j to the ounce).
The last-mentioned is an odourless substitute for
iodoform. The addition of a little calomel is often
useful.
( b ) Excoriated surfaces, result from injuiy, or from
an inritant which may attack the skin from with¬
out, or according to the writer's theory of excretory
irritation, either from within (a). A true eczematous
condition, that is, a catarrhal weeping inflammation
of the skin without obvious cause, is probably an
extremely rare condition. In any case the object of
(a) ‘‘Excretory Irritation. ” By D. V ulsli, M.D. London:
Biiliiere, Tindall, & Cox. 1*U7.
Nov. 8, 1899. __
the powder is to protect, to absorb discharge, and
act as an astringent, to provide an antiseptic and
aseptic application, and indirectly to form an arti¬
ficial scab, and thus imitate the natural processes of
healing.
Starch is one of the best drying applications to a
moist inflammatory surface. Another excellent
application is the compound powder of chalk. Slight
astringency is obtained by adding zinc oxide or car¬
bonate (calamine) and antiseptic action by boracic
acid, salicylic acid or Europhen. Calomel is a good
powder for unbroken skin, but is apt to do damage in
a moist or discharging skin, possibly owing to the
formation of a perchloride. Its use is strongly indi¬
cated, however, in syphilitic rashes about the buttocks
of children. Kaolin (a silicate of alumina) is apt to
irritate some skins, but can be used with a tar pre-
aration. Iodoform, besides its unpleasant smell
as the disadvantages of setting up an acute derma¬
titis in some persons who have a predisposition
against the drug, and other vehicles of active agents
are rice, arrowroot, orris root, lycopodium, and talc.
For a simple excoriated surface
Calaminas, 5»j;
Europhen, ;
Amyli, ad. 3j.
M. ft. pulv.
(c) Open ulcers, whether specific or non-specific,
are often greatly benefited with dusting powders.
Certain precautions are needed. Boracic and sali¬
cylic acids often cause great pain. Calomel is rarely
safe to apply to any but the syphilitic sore, whether
hard or soft. Iodoform is excellent for both ulcers,
whether specific or non-specific. Europhen is some¬
what less active as a substitute, but has not the
offensive smell of iodoform. A plan used by the
writer in treating non-specific ulcers is to in¬
corporate a bland powder (e.g., starch and
boracic acid), with a pad of absorbent bor¬
acic wool, applied as a dry dressing.. The
usual wav of applying these external applications is
to dust the material on with a swan’s down pad or a
pledget of cotton wool; or it may be peppered over
the surface from a small dredger. One of the most
satisfactory ways of procuring prolonged contact
with the skin is by Unna’s plan, by which the powder
is sewn up in long flat bags, and bandaged to the
skin.
The use of dusting powders is a point that will
repay the attention of medical men engaged in
practice. The foregoing brief sketch of their essential
features will, it is hoped, prove of some practical
service to the readers of this journal.
^ransactionB of gotietus.
OBSTETRICAL SOCIETY OF LONDON.
Meeting held Wednesday, November 1st, 1899.
Mr. Alban Doran, President, in the Chair.
tuberculosis of the fallopian tubes and uterus
IN PHTHISIS.
Dr. P. D. Turner gave the results of the examination
of the genital organs of twenty-seven consecutive cases
of phthisis in female subjects at the Brompton Hospital.
Tuberculous lesions of an undoubted character, the
bacillus being present, were found in five cases = 18'5
per cent. In one the tubes alone were involved ; in two
the tubes and the body of the uterus ; in one the tubes,
body of uterus and cervix, and in one the tubes, body
of uterus and ovary were affected. All five were
cases of chronic phthisis, and all had intestinal
ulceration. In seven of the remaining cases there
was some evidence of interstitial or catarrhal sal-
Digitized by GoOqIc
TRANSACTIONS OF SOCIETIES. Thb Mbdical Pbess. 477
Nov. 8, 1899.
pingitia, the condition in several suggesting a tuber¬
culous origin. No note had been taken of tuber¬
culosis of the peritoneum merely covering the genital
organs. The results, as far as they went, seemed to
show that tuberculosis of the uterus was more common
than supposed. He pointed out that the typical tuber¬
culous tube was much thickened and distended, and
showed an opaque yellowish-white surface with a swell¬
ing which increased from the uterus to the junction of
the inner and middle thirds, the outer two-thirds being
more or less cylindrical and the thickening ending
abruptly at the fimbriated extremity. The extremity
of the tube was often pervious showing the caseous con¬
tents which sometimes projected through it. The
adherent extremity of the tube often formed part of the
wall of an abscess cavity, more rarely there was hydro¬
salpinx as in a case where the tuberculosis appeared
recent and acute. It was evident that the disease had
advanced from the outer to the inner extremity of the tube.
He described the earliest appearances adding that at
a more advanced stage, giant cells with bacilli were found.
Still later, the mucous membrane was replaced by tubercu¬
lous material, the muscular coat ultimately being invaded.
At this stage, giant cells were still visible, but the bacilli
rarely. In the ultimate stage, the tube was represented
by a caseous mass covered only by peritoneum. He
pointed out that the ovary did not offer the same nidus
for infection, and hence was comparatively rarely
diseased.
Mr. Targett mentioned that out of 2,500 autopsies in
women during 12 years in St. Bartholomew’s, in only
12 was tuberculous disease of the tubes noted, less than
one per cent. In 450 there was old or recent disease of
the lungs, and of these, 45 had tuberculous peritonitis,
and 20, tuberculousdisease of the tubes and ovaries.
The President suggested that the hydrosalpinx was
a source of irritation which sealed the tube. Primary
tuberculous disease of the tube was a very serious con¬
dition, in which the question of removal must be
entertained.
Dr. Turner, in reply, said that none of the patients
presented any symptom referable to the uterus or tube.
The dictum that tuberculosis anywhere in the body
always Bhowed itself in the lungs after puberty was
falsified by one case, in which nothing was found in the
lungs. In the early stage one met with bacilli and no
giant cells, while later the giant cells developed and the
bacilli disappeared.
1WO CA8E8 IN WHICH LIFE APPEARS TO HAVE BEEN
SAVED BY ANTI8TREPTOCOCCIC SERUM.
Dr. G. Ernest Herman began by remarking that
judgment as to the therapeutic value of the anti¬
streptococcic serum iB difficult, because we know not yet
enough about the effects of the streptococcus. 'If the
antistreptococcic serum fails, it may be because
it is used too late, or bemuse the patient has
been poisoned by some microbe other than the strepto¬
coccus. In some cases published as examples of success
from the antistreptococcic serum, it has seemed to the
author, from reading the reports, that some of the
patients were never in danger, and that in oome recovery
was to be attributed to other therapeutic measures (such
as removal of retained plaoenta) used at the same time
as the serum. For these reasons it seems to tho author
impossible at present to draw conclusions as to the value
of the serum from statistical tables. The author sub¬
mitted two cases, in which, in his opinion, the symptoms
were such as to warrant a very unfavourable prognosis,
but nevertheless the patients got quite well after antis¬
treptococcic serum. The first was a case in which a
severe operation was followed by great prostration from
which the patient recovered, but the rally was followed by
renewed prostration, such as in the author’s former experi¬
ence had ended in death. With antistreptococcic serum
the symptoms quickly improved, and the patient got well.
The second was a puerperal case, in which the occur¬
rence of three severe rigors on successive days led the
author to think that the patient was suffering from
pyeemia, and that secondary abscesses, Ac., might be
expected. With antistreptococcic serum the symptoms
improved, and the only development was a small patch
of cellulitis which ended in resolution. He admitted
the difficulty and uncertainty of prognosis in cases such
as those now reported, but he submitted that, in the
present state of our knowledge, it is only by the
consideration of cases such as these that judgment can
be formed.
Dr. Clapham (Wimbledon) referred to a case delivered
by a midwife, in which the patient presented symptoms
of marked septicaemia. There was nothing in the uterus,
but he washed it out with bichloride solution without any
effect on the temperature, which, however, fell during
the next day. High fever with rigors occurred on the
fifth day, and he curetted. Still the temperature
increased, so he gave 15 cc. of serum. The temperature
fell to 102 degs., but rose again to 105 degs., and did so
for five nights. The patient was desperately ill, but on
the tenth day, after five injections, great improvement
took place. A subsequent rise of temperature occurred,
followed by effusion into the knee, and an abscess
formed in the left labium. The blood was examined,
but nothing of interest was found.
Dr. Horrocks said that at first he thought he had
got hold of an unfailing remedy, but subsequent experi¬
ence had qualified this belief even when used at an early
stage. He was afraid that the bad cases did not recover,
and he mentioned several instances in support of this
view. He thought, however, that in bad cases the
serum afforded the only possible chance, and he hoped
that in time it might be made more active.
Dr. A. South said that something ought always to
be done besides giving the serum, therefore one could
never be sure how much of the credit was due to the
seium. He referred to the only case in which he had
used it, in which immediate improvement had followed.
Dr. Cullingworth said nothing was more difficult
than to estimate therapeutical effects, and he related a
case which was rapidly getting worse under ordinary
treatment. A fortnight after admission the interior of
the uterus was examined, but practically nothing was
found to account for the condition. Then serum was
given in 12 injections of 10 cc. in seven days, yet the
temperature that day was 104'8 degs.F. He also referred to
another case of a patient who had been curetted and
some decomposing material removed, but she got worse
instead of better, so serum was injected and the tem¬
perature immediately fell, although before the serum
was used that patient was almost moribund. He urged
that every case in which it was tried should be reoorded.
Dr. Eden observed that their treatment seemed to be
outrunning their pathology. The streptococcal origin of
puerperal fever was by no means proved; indeed, its
etiology appeared to be very varied. He thought it was
of prime importance in all these cases to demonstrate
the presence or absence of the streptococcus. The author
did not seem to attach much importance to bacterio¬
logical examination, but if the streptococcal origin were
not proved, their treatment was empirical. Any future
improvement in the mortality of puerperal fever might
fairly be attributed to the new treatment.
Dr. Cullingworth observed that the object of
“prime importance” was to cure the patient.
Dr. Eden retorted that the search for the bacterium
need not prejudice the cure of the patient.
Dr. Cullingworth said it would if they had to wait.
Dr. Eden replied that it was not indispensable to await
the result of the examination.
Dr. Eobinson said that if they were going to wait
until the bacteriology of puerperal fever had been worked
out they might have to wait a long time. He referred
to a case of his own in which, on the third day, the
patient, who had been attended by a nurse, had a rigor
and became very ill. He saw her on the eleventh day
when she appeared to be dying. He mentioned inci¬
dentally that the whole of the vagina was covered by a
thick whitish-yellow membrane, which contained strep¬
tococci. He advised serum treatment, and. within a day
or two the membrane melted away and the patient
began to recover. With reference to the suggested
bacteriological examination he asked how it was in¬
tended this should be made ?
Dr. Eden said by examining the uterine excretions
and the blood.
Dr. Pollock suggested that the cases which recovered
Digitized by VjOOQ 1C
y y ^
478 The Medical Press. TRANSACTIONS OF SOCIETIES.
Nov. 8, 1899.
were cases of pare infection, and those that did not
recover of mixed infection.
Dr. Maclean insisted on the fact that practically the
same disease was produced by a large variety of
organisms, and the serum which rendered immune to
one germ was perfectly tolerated by another so that the
injection of antistreptococcal serum might be far from a
help.
Dr. A. Booth recalled that on a previous occasion Dr.
Cullingworth had stated that the serum was harmless
even wnen it did no good.
Dr. Horrocks said that if properly sterilised it was
probably absolutely safe, and might even supply a little
nourishment to the patient, and he mentioned that a
dog had been kept alive by injections of serum for three
months without loss of weight. It did not matter if the
terum were a little coloured, but it should not be used if
turbid.
Dr. Spencer said he gathered that the general sense
was in favour of continuing the use of the Bernm in cases
of septicemia. He doubted whether the streptococcus
was as frequent as all the other organisms put together
as a cause of septicemia. It did not seem reasonable
without knowing this to employ the serum. He stated
that the injections were by no means free from danger,
for there were cases in which death had occurred shortly
after them. He had not been struck by the result in the
author’s cases, for he had seen similar cases recover
without the serum, moreover, the injections were some¬
times followed by a rise instead of a fall of temperature.
In short, he looked upon it as an empirical treatment,
the value of which was far from proved.
The President observed that however desirable such
a remedy might be, he was afraid it could not yet be said
that the serum was that remedy.
EDINBURGH MEDICO-CHIRURGICAL SOCIETY.
Meetino held Wednesday, Novembir 1st, 1899.
Sir John Batty Tuke, President, in the Chair.
Db. J ames showed a patient, a-t. 9, the subject of slight
41 cretinism.” Her younger sister, at. 7, was eight inches
taller, and suffered from a cystic goitre.
Dr. James also showed a rare skin affection—kerato-
dermia symmetrica erythematosus.
Dr. Gibson showed a case of slight “ cretinism ” with
cystic goitre.
Dr. Lovell Gulland read a paper on
the importance of the examination of the blood
IN DOUBTFUL CASES OF DISEASE.
The author first emphasised the necessity of examining
the blood in all doubtful cases, a procedure too much
neglected in this country, though its value was fully
recognised in America and Germany. The blood was
the only tissue which could be examined during life,
and this alone was enough to show the importance of
not neglecting it. Cases of blood disorder, pernicious
amemia, leucocythaemia, and the like, did not come
within the scope of the paper. In systematic examina¬
tion of the blood we had to consider the number of the
red corpuscles, and the percentage of hiemoglobin, the
number of the blood plates, the rapidity and amount of
fibrin formation, and most important of all, the number
of leucocytes and the proportions of the different
varieties. The enumeration of the red corpuscles was of
less importance in general disease than in blood dis¬
orders. This was because alterations in them,
secondary anaemia, were more or less the same
in all diseases, depending entirely on the severity
of the cause producing them. At the same
time, the number of red corpuscles present in an
acute or chronic illness had an important bearing on the
prognosis. Ihe number of the blood plates and the
amount of fibrin were difficult to estimate, and, with one
exception, were of little diagnostic value. But in cases
where the diagnosis lay between malignant disease and
suppuration—in both of which a leucocytosis was
present—the amount of fibrin might be of value, as it
wa3 decreased in the former, and increased in the latter.
Far the most information, however, was got from the
leucocytes. Indeed, for clinical work, a leucocyte count
and the preparation of stained films were the essentials.
The amount of the haemoglobin could be roughly
estimated by the colour of the blood, and
from the stained film an approximate idea of
the number of red cells could be obtained. As
regards the leucocytes, we had to consider the total
number and the proportion of the various kinds. The
latter could only be judged of by carefully counting those
on a stained film, and at least five hundred cells should
be counted. The diagnostic results of systematic blood
examinations were illustrated by a number of cases from
Dr. Gulland’s own experience. A patient had been sub¬
jected to a cosmetic operation on the face. The wound
healed well, but on the fourth day the temperature rose
and the man complained of a sore throat. There was an
epidemic of influenza at the time, and the question arose
whether the condition was septic, a simple tonsillitis, or
influenza. The blood count on the sixth day showed
2,000,000 reds, 30 per cent, of hfemogobin, and24,000leuco¬
cytes. Influenza was absolutely excluded by the leucocy¬
tosis, and tonsillitis by the amemia, so that a diagnosis of
septicaemia was made, which subsequent events con¬
firmed. In the case of a woman the temperature rose
about the tenth day of the puerperium, and there was
some amemia; locally, nothing was to be made out. The
examination of the blood showed great diminution of the
red cells and marked leucocytosis. The case had been
thought to be one of pernicious amemia, which some¬
times developed after parturition, but the leucocytosis
put this out of court, and led to the correct diagnosis of
septicaemia. A number of other illustrative cases were
described, the chief points brought out being the absence
of leucocytosis in tuberculosis (unless complicated by a
septic infection), in measles, and in influenza; its
occurrence to a comparatively slight extent in typhoid,
and its constant appearance in pneumonia even from the
initial rigor, and in septic conditions. In septicaemia,
too, a very great and rapid destruction of the red cor¬
puscles was an invariable accompaniment. The study
of the different leucocytes in disease was also well worthy
of attention. The eosinophiles, for instance, were in¬
creased in asthma, thus affording a distinction between
true spasmodic asthma and the dyspnoea of cardiac and
renal disease. They were also increased in certain skin
diseases, such as dermatitis herpetiformis and pem¬
phigus, but the most marked eosinophilia was seen in
trichinosis. This last was a comparatively recent
observation, whose accuracy, however, had been con¬
firmed ; the eosinophiles might form as many as 68 per
cent, of the total leucocytes. In conclusion, Dr. Gulland
pointed out that in drawing conclusions from an
examination of the blood, the other signs must not be
lost sight of, and the possibility of a complication
causing leucocytosis had also to be borne in mind. The
paper was discussed by Drs. Alexander James, Chalmers
Watson, and Foulis.
The retiring President then delivered a short valedic¬
tory address, in which he alluded in suitable terms to
the losses the society had sustained through death during
the past year. Among the thirteen members the society
had lost were Sir William Jenner, John Moir, the
father of the profession in Edinburgh, John Struthers,
William Rutherford, and John Duncan. In passing the
work of the session in review, the President remarked
that they had had no papers bearing on the three great
questions of public health—vaccination, the prevention
of tuberculosis, and the prevalence of venereal disease—
which were at present agitating the public mind.
WEST LONDON MEDICO-CHIRURGICAL
SOCIETY.
Meetino held on November 3rd, 1899.
Dr. J. B. Ball, President, in the Chair.
A native enema apparatus brought from the Upper
Congo River. Central Africa, by Mr. W D. Armstrong,
was shown by Mr. McAdam Eccles. The instrument
Die
oogle
Nov. s, 1899. TRANSACTIONS OF SOCIETIES.
consisted of a medium-sized calabash, together with a
small cane pipe, some three inches in length and the
size of an ordinary lead pencil, fixed into the smaller
end of the calabash, the fluid being allowed to run into
the section by hydrostatic pressure.
Dr. Mansell Mocllin exhibited the ovaries removed
from a patient, set. 40. Both ovaries were enlarged, and
the capsules thickened, one containing a cyst the size
of a walnut.
Mr. Pardoe read a paper entitled
home modern methods ok treatment in chronic
V RETHR1TIS.
He said that great changes had taken place in the
treatment of gleet during the past few years, due to
improved methods of diagnosis, whereby we were enabled
to treat the causes, and not merely the symptoms of this
trouble. Before successful treatment occurred, localisa¬
tion of the seat of the disease was essential. After
explaining the methods in use which were l*est calculated
to attain this object, he proceeded to describe various
modes of treatment which were most likely to cure the
diseased condition of the urethra, causing the gleet.
Tho paper was discussed by I)rs. Bell and Lloyd, and
Messrs. Swinford Edwards, and Bidwell. Mr. Pardoe
replied.
Mr. Swinfobd Edwards read a paper on
URINARY OBSTRUCT ION,
with cases illustrating some of its causes, He
said that obstruction to the free flow of the
urine was due to changes, either in the prepuce,
the urethra, the prostate, or the bladder. The first
case illustrating his remarks was one of stricture and
impacted urethral calculus. The calculus was removed
after urethrotomy with Otis’s instrument, wi+h complete
success, the patient being able to pass water naturally
for the first time for many years. The next case was
that of a patient operated on by the author for stricture
andperimel fistula. The last case narrated was that of a
patient who suffered from obstruction due to an enlarged
prostate ; vaseotomy was performed on one side with
such an excellent result that it was proposed to at once
perform the same operation on the opposite side. The
paper was discussed by Drs. Bell and Lloyd and Messrs.
Bidwell and Pardoe. Mr. Swinford Edwards replied.
BRITISH LARYNGOLOGICAL, RHINO LOG IC A L,
AND OTOLOGICAL ASSOCIATION.
Annual General Meeting, October 27th.
Dr. Barclay Baron, President, in the Chair.
Dr. Dun das Grant read notes of a case of
SUDDEN NERVE DEAFNESS
of the right ear in a woman, a;t. 40. Prior to the attack
she had menorrhagia and diarrh.ea, with passage of blood
from the bowel; and following the deafness, vertigo and
nausea. The loss of hearing was chiefly for tones of the
middle pitch. There was diminution of the pharyngeal
reflex, exaggerated knee-jerk and comparative hemi-ames-
tliesia. The condition might be due to Meniere’s disease,
to anoemia of the auditory nerve or to hysteria, The
hearing soon improved, and is now nearly normal.
Dr. Dundas Grant showed a microscopical section of
an epithelioma from the temporal bone of a male patient,
jet. 45. The symptoms simulated necrosis of the tem¬
poral bone. A mastoid operation was performed with
considerable relief, though the disease is slowly
advancing.
Mr. Bark (Liverpool), remarked that he had lately
seen an almost similar case with rapidly recurring aural
polypi.
Mr. Winoravf. thought that the growth commenced
in an epidermal region.
The President delivered an address upon “ Correla¬
tion of General Medicine and Laryngology, Rhinology
and Otology.”
The President showed a case of double uvula in a
child associated with a curious defect of speech.
Mr. Wingrave considered the case to be one of cleft-
The Medical Pres3. 479
palate, and that the defective articulation was due to a
different condition.
Dr. Abercrombie again showed his case of “ laryngeal
papilloma ” exhibited at the meeting in April. In the
interval the tonsils and adenoids had been removed, and
the growth afterwards treated with astringents; it in
now much diminished in size.
Dr. Whistler showed a useful instrument for gauging
the antero-posterior length of spurs.
Dr. Reid for Dr. Orwin showed a convenient apparatus
for applying continuous heat to different regions of
the body.
Dr. Trekilian showed a case of new growth in the
left maxillary antrum of a child, which produced con¬
siderable swelling of the left cheek. A discussion ensued
as to the seat and the nature of the growth. He also
read notes of (1) a case of “ anosmia ” following head
injury ; (2) a case of severe bilateral “acute otitis’’with
facial erysipelas.
Mr. Noubse showed for Dr. .Takins, a case of
“ malignant growth of the larynx ” in a phthisical
patient.
Mr. Wyatt Wingrave showed a case of “suppuration
of the maxillary antrum.” Persistent pain and dis¬
charge from the left nostril had followed the extraction
of an upper molar twelve months before. On examina¬
tion, a small opening was found at that site through
which a tine probe could be passed into the left nostril.
The opening in the alveolus was enlarged with a drill,
and fo.'tid pus evacuated.
Mr. Wingrave also showed a woman from whose left
ear he had removed an ivory exostosis with a drill
trephine. The deafness from which she previously
suffered was relieved.
SHEFFIELD MEDICO-CHIRURGICAL SOCIETY.
Meeting held on October 20th, 1899.
The President, Dr. Burghsk, in the Chair.
Mr. Pye-Smith showed a case of double coxa vara,
together with a skiagraph, in a boy, set. three. He
was the youngest of seven children. There was evidence
of rickets in him and in two of his brothers. He did
not begin to walk till he was over two years old. He
had a waddling gait and soon got tired. There was
lordosis, slight eversion of the feet, great restriction of
abduction, and some diminution of internal rotation.
The great trochanters were an inch above Ntilaton’s
line, the heads of the femora could not be felt, nor could
the limbs be lengthened by traction. The diagnosis
from morbus coxa*, and from double displacement of the
hips was pointed out.
Mr. Dale James showed an unusually fine example of
tattooing on the chest and forearms.
Dr. Arthur Hall showed (1) u case of lichen planus,
and (2) a case of serpiginous syphilide.
Dr. Burgess showed (1) a case of Addison’s disease;
(2) a case of hemiatrophy resulting from injury to the
skull in infancy ; and (3) a tumour of the pons.
Dr. Sinclair White read a paper on
ASEPTIC surgery.
He s’ated that no one now doubted the germ origin
of septic diseases, but it was open to question whether
in surgical practice the application of Lister's memorable
discovery was as wide as it should be. The fault, if any,
rested with our teachers, who should insist that failure
to resort to measures for securing aseptic healing of
wounds is tantamount to gross professional negligence.
Sterilisation should be the first and, except in opera¬
tions, through septic tissues, the only line of defence
against septic micro-organisms. With efficient sterilisa¬
tion the subsequent use of antiseptics is illogical and
unnecessary. Heat, in the form of boiling water or
steam, should be used for disinfecting instruments,
ligatures, dressings, and towels. The skin, after
thorough cleansing with a nailbrush, soap, and hot
water, should be disinfected by a five minutes’ contact
with a 1 in 500 solution of biniodide of mercury
in methylated spirit. An aqueous solution of the
Digitized by CjOO^Ic
480 The Medical I’rebs.
FRANCE.
Nov. 8, 1899.
same salt, 1 in 1000, should be used for
disinfecting wounds. Ligatures should be of silk¬
worm gut, which in various sizes is applicable to all
kinds of work. Vessels should be twisted rather than
tied. Drainage was unnecessary and a source of
danger in operations through healthy tissues. We do
not drain the non-dependent lacerated wound filled
with blood and bone dust produced in performing
osteotomy, yet logically if drainage were ever required,
in non-septic operations it should be resorted to
here. Aseptic healing was a painless process, and
deviation from this condition should excite suspicion of
something having gone wrong. After operations the
pulse and temperature should be carefully watched. A
slight degree of fever during the first 48 hours wa3
common, and need not cause anxiety; but, generally
speaking, if all were going on well, the pulse and tem¬
perature should be normal on the evening of the third
day, and remain so afterwards.
Jvance.
[from our own correspondent.]
Paris, November 5th, 1899.
Contra-Indications for the Use of Cacodylate of
Soda.
At the Academy of Medicine, M. Gautier spoke on the
preparations of cacodylate of soda, which when
administered, he said, by the mouth or by the rectum,
produced frequently symptoms of intolerance; the
patient complained of cramps in the stomach, and the
breath presented a garlic odour. These symptoms
persisted several days after the suppression of the drug.
He had also remarked that in individuals whose kidneys
were perfectly sound, and a fortiori in those more or less
impermeable, the prolonged injection of cacodylate of soda
produced only temporal ily albuminuria. On account of
this inconvenience, due to an incomplete reduction of the
agent in the intestine, M. Gautier renounced its employ¬
ment by the mouth or the rectum in favour of hypo¬
dermic injections. Not only was the odour of garlic thus
avoided, but also the other troubles. His formula was:—
Cacodylate of Soda, 3i9S-;
Phenicated Alcohol, nix.;
Distilled Water, Jiijss.
Each syringe represented one gra in of cacodylic acid,
that was to say, the average dose for an adult in the
twenty-four hours, but which might be doubled without
danger on the condition that the treatment was
suspended every eight or ten days during a lapse of time
equal to the period the patient was under the treat¬
ment.
Operating Phimosis without Circumcision.
Dr. Lambert, of Dunkirk, operates phymosis without
having recourse to the classical method of circumcision.
His method is based on the principle that the phimosis
comes from atresia of the mucou3 membrane, and that
it suffices to effect a cure by simply increasing the
diameter of the membrane without touching the
cutaneous envelope.
After having prepared the parts by means of anti¬
septic irrigations, and made one or two injections of
cocaine to obtain the necessary degree of anaesthesia,
he seizes the prepuce with three forceps disposed at
equal distances from each other. Taking a pair of scissors;
he makes a small nick in the mucous membrane between
each forceps, through which he introduces the fine poin^
of the scissors, passing between the membrane ani skin
and slits up to the sulcus. The prepuce thus dilated
the glans becomes free. The small incisions are
sutured, and the wound dressed in the usual way. The
prepuce is then drawn over the gland, remaining thus
dilated until the cicatrisation is complete.
Beer Yeast in Vaginal Gonorrhcea.
Dr. Sireday is in the habit of employing in his
hospital service beer yeast in the treatment of blenor-
rhagia in women, according to the method of Dr. Landau,
of Berlin, who employed it in leucorrhcea. A plug of
cotton steeped in a mixture of fresh brewery yeast and
sweetened water is introduced into the vagina and
renewed daily. The treatment brings about a rapid
modification of the mucous membrane, and a notable
decrease of the secretion, although it did not effect a
complete cure.
Erysipelas and Ichthyol.
A confrere publishes a series of 250 cases of erysipelas
treated exclusively by him with ichthyol; the patients
belonged to all grades of society, and their ages varied
from six months to eighty-seven years. After having
cleaned the surface with a plug of cotton wool wet with
alcohol, he applies with the fingers an ointment of
vaseline and ichthyol (13 to 30 per cent.) The treatment
is renewed every four or six hours. Recovery was in
every case rapid.
(Sermang.
[from our own correspondent.]
Berlin, November 4th. 1899.
Six Years' Experience in Koch’s Treatment of
Tuberculosis.
In the Zeitsch f. Hyg. und Infections Krank, Dr. Fr.
Krause records his experience in this department of
therapeutics. The article, which is intended mainly for
practitioners, shows what results can be achieved in the
treatment of tuberculosis, and expresses the wish that
the writer's experience may encourage others to take up
the subject in a practical manner. He does not think it
necessary that the method should only be used in special
centres, and by experts only. He is of opinion that, if
only slowly, the tuberculin treatment will work its way
into general practice. He advises practitioners not to
found extreme opinions regarding it, and not to advise
their patients to decline to allow themselves to be treated
by “ this poison.”
The writer has used tuberculin since 1892, and sinoe
the introduction of the new tuberculin he had used it.
In the present article forty-one cases are recorded, which,
as a basis for an opinion, are the more valuable, as they
were under observation for years. Of the forty-one
cases thirty were without complication, whilst in the
remaining eleven the infection was mixed. In the later
class the secondary infection was overcome in four cases,
in seven it persisted in spite of all treatment. Of the
patients in the first category three acquired a mixed
infection that could not be overcome. In addition to
the thirty cases of the first class there were the four of
the second in whom the secondary infection was over¬
come, who were submitted to the tuberculin treatment.
Of these thirty-four, twelve were at the time of writing
temporarily cured, three were improved, two were still
under treatment, three did improve but succumbed with
second infection, one was improved but became second-
Digitized by v^ooQle
Nov. H. 1899.
A U STRIA. Ihe Medical Press. 481
arily infected but was still living, three showed them¬
selves unsuitable for tuberculin, in three the tuberculin
was used for diagnostic purposes only, and one
case got worse under the treatment. There remain
twenty-seven cases in which the tuberculin was
used therapeutically. Of these twelve were tem¬
porarily cured, thirteen improved, in one no change
was observed after some weeks of the treatment,
and one got worse. In this case the condition was due
to excess of toxin, but the remedy itself was not the
cause of this, but only its faulty administration. The
writer concludes that when properly used tuberculin
gives exclusively good results. He ha3 formed no
opinion as to which of the tuberculins is the better, the
old or the new, but he records some observations on the
point. Eleven patients had the new tuberculin, six of
them exclusively. At first the writer thought that
the T.E. had a more lasting effect, and protected the
-organism for a longer time than the other. Later on
the new preparation appeared to affect the tem¬
perature less than the old, and whea caution was used
it set up no distinct reaction. On the other hand, the
old preparation was such a powerful tonic with
a moderate state of health and not far advanced
phthisis, as to be second to none in the whole
therapeutical armamentarium. For the future. Dr.
Krause has decided to first of all treat all suitable
cases with the old preparation, and then if the
expected general effect has taken place, to at once go
on with the new. He expressly remarks that the
new preparation is not as harmless a remedy as has
been believed by many. The greatest caution mii3t be
used to avoid intoxication.
Upon the whole, the writer’s opinion is that with
both tuberculins we have a specific remedy for the
treatment of the disease. No further specific is needed
at present, and efforts for the discovery of one would be
better employed in discovering one for the prevention or
treatment of mixed infection.
The remedy was given at long and short intervals.
Twice within 34 hours, and at intervals of days, the
dose sometimes was large, in one patient 500 mgrm.,
and several Dthers received 300 mgrm. twice within 24
hours. From his own observation Dr. Krause con¬
cludes that the best method of tuberculin treatment
is to keep to minimal reaction* It is quite enough if
the thermometer goe3 a few points over 37 degs. C.,
provided, of course, that the previous temperature was
below that figure, This limit can be adhered to with
care and some experience. The pauses between two
doses should be at least three days, generally more.
All patients have slight pain at first in the injection
punctures, and a little dragging in the limb3 and slight
malaise. If these symptoms do not disappear, or at least
distinctly diminish after the fifth or sixth injection, and
also if patients who have hitherto borne the treatment
well present these symptoms, the syringe should be laid
aside for a time.
The author concludes by discussing the method by
which tuberculin acts beneficially. It is well known that
tuberculin has a special affinity for the newly formed
granulation tissue thrown up around tubercle centres. An
inflammation is excited in the tissue, which finally ends
by destroying it. If this dose is so accurately measured
that only a local inflammation is excited, a strong
leucocytoiis is set up. If the process is repeated time
after time, the granulation tissue loaded with leucocytes
becomes gradually converted into connective tissue. The
tuberculous centre surrounded at first by a wall of
leucocytes is gradually penetrated by connective tissue
which, in further course, is converted into cicatricial
bands. The enclosed products of cell decomposition
along with the virulent tubercle bacilli are shut off by
a strong wall of healthy lung tissue, and in the course
of yea/s the tubercle bacilli, so tenacious of life,
gradually die off. A definite cure in the present instance,
even if brought about by a specific remedy, is not the
consequence of any acquired specific immunity, but is
the result of an anatomical process.
Aspirin.
A new salicylic preparation (acetyl salicylate) has been
recently introduced under the name of aspirin. It is in the
form of crystalline needles, soluble in water at 37 degs. C.
at the rate of 1 percent. In alcohol, ether, Ac , it is about
as soluble a3 other salicylic preparations. The most
important distinction between aspirin and other salicylic
preparations lies in the fact that it does not irritate the
mucous surface of the stomach; further, it split3 up so
slowly in the gastric juice that it passes out of the
stomach undecomposed and undergoes this process only in
the alkaline intestinal juices, the blood, and in the tissue
lymphs. It is useful in all diseases in which salicylic
acid and sodium salicylate have been employed, especially
in gout, articular and muscular rheumatism, sciatica, dry
pleurisy, &o. An agreeable form of administration is
aspirin (one grain), Bugar (three to four grains), stirred
round in a little water and taken three or four times a
day.
From the advantages it possesses over the crude sali-
cylin preparation, its agreeable slightly acid taste, the
absence of noises in the ears, irritation of the stomach
when taken, aspirin is likely to come rapidly into
favour.
Austria.
[from our own correspondent.]
Vienna, November 4th, 18W>.
Morbus Basedowii.
In the discussion that followed Sittraann’s paper on the
subject of Basedowii’s treatment. Mikulicz’s eighteen
operations for the radical relief of the disease were ad¬
vanced. To vouch for the genuineness of the cases it
was stated that Kast had diagnosed and previously
treated them for such. These cases proved that the
morbid changes of the gland were not constant in their
anatomy, as different forms of the disease were met with
which anatomists would divide into (i) diffuse hyper¬
plasia, nodular, cystic, and composite. Macroscopically
and microscopically, these changes are easily observed
in the uncomplicated gland. All these cases bad been
treated internally for years before the operation, and 17
out of the 18 bore the operation well, one having post-
ha-morrhage from the four cut arteries that greatly
endangered the life of the patient at the time, and
which subsequently died. The hyperplasia of the
arteries in this case was extreme.
Ten of the cases may be considered permanently cured,
in eight of them it is four years since the operation
was performed, and they are now well; while all of them
were certainly improved by the operation.
Digitized by LjOoq le
482 The Medical Press.
SPECIAL ARTICLES.
Nov. 8,1899.
In mild cases, where isolated nodules were present,
enucleation was practised with tying of the arteries,
but in very severe cases with double struma the resec¬
tion can be performed with less danger.
Mobius could not conceive how the theory of the
nerve system could be connected with a glandular
adenoma.
He thought the greatest danger to the operation was
the enfeebled heart, which often suddenly stopped with
out the least provocation. To obviate the danger of bleed¬
ing and prevent the sudden abstraction of fluid from the
body, Miibius prefers the bloodless operation of thermo¬
cautery.
Zabludowski thinks operating quite unnecessary, as
bimanual massage will remove the fluid and thickening
from the gland.
Kummell was in favour of operating in the treatment
of the disease, as two-thirds of all the cases were usually
cured, while the others were certainly improved.
Biiumler asked if the enlarged heart met with in
Basedowii was observed to constantly diminish after the
operation ? To which Reinbach instantly answered in
the affirmative.
Ziemssen said he had often seen Ihe disease cured
by years of vegetable diet in elevated climates.
Rumpf said that all his operations showed gradually a
normal heart, which was confirmed by Rehn.
The Linb oe Demarcation between Medical and
Surgical Treatment.
At the opening meeting of the “ Doctoren-Collegium ”
tiersuny read a long paper on the line of demarcation
between medical and surgical treatment. Diagnosis
was the fundamental element in the treatment of all
diseases, although we had, even in the present time,
Nature’s therapeutic physician who could cure without
our scientific diagnosis. Having diagnosed a case the
prognosis has still to be considered. If a surgical case
we should be able to forecast the course and result of
the morbid process as well as the future results of an
operation, giving also the chances of expectant treatment
along with operative interference.
The latter implies a wide knowledge of surgery as
practised at the present day. Not long ago an ovarian cyst
was a perfect noli me tang ere, till Spencer Wells proved
it to be a fallacy. Carcinoma was another disease never
to be touched, unless as an ultimum re/ugium, and to
explore the abdomen would have incurred criminal
censure; to-day, enterostomy for cancer of the bowel is a
radical cure.
Surgical operations are often necessary as a prophy¬
lactic, such as hernia, when the so-called radical cures
are performed, to avoid the use of a hernia belt, or where
the patient is too poor to purchase one. The hernia may
be safe enough of itself, but one day it may unexpectedly
become irreducible and, subsequently, dangerous to life.
The contra-indication for all these advantages from
surgical treatment is valvular disease of the heart as
well as myo-degeneration.
Physiological Institute.
Vienna has now added to her large buildings another
convenience to medicine. The M inister of Kducation, in
opening the institution, said that Hyrtl and Rokitansky
had made Vienna famous in medicine with few advan¬
tages compared with the present, which he hoped would
stimulate the young to emulation. The rector next
praised the works of Bruke; while Exner closed with
a general description of the new building.
Special Articles.
THE LAWS OF WAR RELATING TO MEDICAL
MEN AND WOUNDED.
The piactices of the ancient world, and even the
opinion of some modern writers on public law, made no
distinction as to the means to be employed to aocomplish
the end for which arms had been taken up. Even
Bynkershoek and Wolff, who lived at the beginning of
the eighteenth century, assert the broad principle that
anything done against an enemy is lawful; that he may
lie destroyed, though unarmed and defenceless; that
fraud, and even poison, may be employed against him ;
and that an unlimited right is acquired by the victor to
his person and property. Such, however, was not the
sentiment and practice of enlightened Europe at the
period when they wrote, since Hugo Grotiu3 had l^ng
before inculcated milder and more humane principles,
which Vattel subsequently enforced and illustrated, and
which are adopted by the unanimous concurrence of all
the public jurists of the present age.
Formerly, when nation attacked nation, the whole
inhabitants of the hostile State were regarded as liable
to the rigours of warfare; but at the present day not
only old people, women and children are regarded
as exempt from the violence of warfare, but also in
general all those subjects of the hostile State who do not
bear arms or who Lake no active part in hostilities, and
even those who follow the enemy’s camp, but take no
part in hostilities—such as medical men, commissaries,
and all who can be strictly classed as non-combatants.
In the case of enemies rendered harmless by wounds or
disease, the growth of humane feeling has long passed
the simple requirement that they shall not be killed or
ill-used, and has cast upon belligerents the duty of tend¬
ing them so far as is consistent with the primary duty
to their own wounded. But the care which the wounded
of a defeated army thus obtain is necessarily inadequate
to their wants, and the usefulness of surgeons on both
sides is hampered by their liability to be detained a 8
prisoners. A step of which the value in mitigating the
unnecessary horrors of war cannot be over-estimated
would therefore be made if a general and sufficiently
full understanding were arrived at as to the treatment
of sick and wounded, and of persons and things engaged
in their service, which should give free scope, as far as
the exigencies of war permit, to the action of everyone
whom duty or charity may enlist in the mitigation of
suffering.
Under the Convention of Geneva of 18(54 the greater
part of the European States bound themselves to observe
a code framed with this object, and the accession of
nearly all the civilised States of the world has converted
its provisions into rules of overwhelming authority
This Convention was signed on behalf of Switzerland,
Baden, Belgium, Denmark, Spain, France, Hesse-Darm-
stadt, Italy, Netherlands, Portugal, Russia, and Wur-
temburg. The following Powers have also acceded to
it:—Argentine Republic, Austria, Bavaria, Bolivia,
Bulgaria, Chili, Great Britain, Greece, Japan, Mecklen-
burg-Schueren, Montenegro, Persia, Peru, the Pope,
Roumania, Russia, Salvador, Saxony, Servia, Sweden and
Norway, Turkey, United States. The articles are as
follows:—
“ Art. I.—Ambulances and military hospitals shall be
acknowledged to be neuter, and as such shall be pro-
Digitized by CjOO^Ic
Nov. 8, 1899.
SPECIAL ARTICLES.
Thk Medical Pkk>s 483
tected and respected by belligerents so long as any sick
or wounded may be therein. Such neutrality shall cease
if the ambulances or hospitals should be held by a
military force.
“Art. II.—Persons employed in hospital and ambu¬
lances, comprising the staff for superintendence, medical
service administration, transport of wounded, as well as
chaplains, shall participate in the benefit of neutrality
whilst so employed, and so long as there remain any
wounded to bring in or to succour.
“Art. III.—The above persons may even, after
occupation by the enemy, continue to fulfil their duties
in the hospital or ambulance which they serve, or may
withdraw in order to rejoin the corps to which they
belong. Under such circumstances, when these persons
shall cease from their functions, they shall be delivered
by the occupying army to the outposts of the enemy.
“ Art. IV.—As the equipment of military hospitals re¬
mains subject to the laws of war, persons attached to such
hospitals cannot, in withdrawing, carry away any articles
but such as are their private property. Under the same
circumstances, an ambulance shall, on the contrary,
retain its equipment.
“Art. V.— Inhabitants of the country who may bring
help to the wounded shall be respected, and shall
remain free. The generals of the belligerent powers
shall make it their care to inform the inhabitants of the
appeal addressed to their humanity, and of the neutrality
which will be the consequence of it. Any wounded man
entertained and taken care of in a house shall be con-
dered as a protection thereto. Any inhabitant who
shall have entertained wounded men in his house shall
be exempt from the quartering of troops, as well as from
a part of the contributions of the war which may be
imposed.
“Art. VI.—Wounded or sick soldiers shall be enter¬
tained and taken care of, to whatever nation they may
belong. Commanders-in-chief shall have the power to
deliver immediately to the outposts of the enemy, soldiers
who have been wounded in an engagement, when
circumstances permit this to be done, and with the con¬
sent of both parties. Those who are recognised
after their wounds are healed as incapable of
serving, shall be sent back to their country.
The others may also be sent back on condition
of not again bearing arms during the continuance of
war. Evacuations, together with the persons under
whose directions they take place, shall be protected by
an absolute neutrality.
“Art. VII.—A distinctive and uniform flag shall be
adopted for hospitals, ambulances, and evacuations. It
must on every occasion be accompanied by the national
flag. An arm badge shall also be allowed for individuals
neutralised, but the delivery thereof shall be left to
military authority. The flag and the arm badge shall
bear a red cross on a white ground. (Turkey uses a
red crescent.) ”
The following additional articles were signed at
Geneva on October 26th, 1868. The chief articles are
as follows :—
“ Art. I.—The persons designated in Article II. of
the Convention shall, after the occupation by the
enemy, continue to fulfil their duties, according to
their wants, to the sick and wounded in the ambulance
or the hospital which they serve. When they request
to withdraw, the commander of the occupying troops
shall fix the time of departure, which he shall only
be allowed to delay for a short time in case of militiry
necessity.
“ Art. III.—Under the conditions provided for in
Articles I. and IV. of the Convention the name
(ambulances) applies to field hospitals and other tem¬
porary establishments which follow troops on the field
of battle to receive the sick and wounded.
“Art. V.—In addition to Article VI. of the Convention,
it is stipulated that, with the reservation of oflicers,
whose detention might be important to the fate of arms
and within the limits fixed by the second paragraph of
that article ; the wounded fallen into the hands of the
enemy shall be sent back to their country, after they are j
cured, or sooner if possible, on condition, nevertheless, '
of not again bearing arms during the continuance of the
war.
“ Art. VI.—The boats which, at their own risk and
peril, during and after engagement, pick up the ship¬
wrecked or wounded, or which, having picked them up,
convey them on board a neutral or hospital ship, shall
enjoy, until the accomplishment of their mission, the
character of neutrality as far as the circumstances of
the engagement and the position of the ships engaged
will permit. The appreciation of these circumstances is
entrusted to the humanity of all the combatants. The
wrecked and wounded thus picked up and saved must
not serve again during the continuance of the war.
“ Art. Vll.—The religious, medical, and hospital staff
*•- any captured vessel are declared neutral, and on
leaving the ship may remove the articles and surgical
instruments which are their private property.
“Art. VIII.—The staff designated in the preceding
article must continue to fulfil their functions in the
captured ships, assisting in the removal of wounded
made by the victorious party; they will then be at
liberty to return to their country in conformity with the
second paragraph of the ffrst additional article.
“ Art. IX.—The military hospital ships remain under
martial law in all that concerns their stores ; they be¬
come the property of the captor, but the latter must not
divert them from their special appropriation during the
continuance of the war. The vessels not equipped for
fighting which during peace the Government shall have
officially declared to be intended to serve as floating
hospital ships, shall, however, enjoy during the war,
complete neutrality both as regards stores, and also as
regards their staff, provided their equipment is exclu¬
sively appropriated to the special serv ce on which they
are employed.
“ Art. X I.—Wounded or sick sailors, and sailors when
embarked, to whatever nation they may belong, shall be
protected and taken care of by their captors. Their
return to their own country is subjected to the provi¬
sions of Art. VI. of the Convention, and of the additional
Art. V.
“Art. XII.—The distinctive flag to be used with the
national flag, in order to indicate any vessel, or boat
which may claim the benefits of neutrality in virtue of
the principles of this Convention, is a white flag with a
red cross Military hospital ships shall be distinguished
by being painted white outside with green streak*.
Art. XIII.—The hospital ships which are equipped at
the expense of the aid societies recognised by the
Governments signing this Convention, and which are
furnished with a commission emanating from the
Sovereign, who shall have given express authority for
their being fitted out, and with a certificate from the
proper naval authority that they have been placed
under his control during their fittiDg-out, and on their
final departure, and that they were then appropriated
solely to the purpose of their mission, shall be con¬
sidered neutral, as well as the whole of their staff. They
shall be recognised and protected by the belligerents.
They shall make themselves known by hoisting, together
with their national flag, the white flag with a red cross.
The distinctive mark of their staff, while performing
their duties, shall be ah armlet of the same colours.
The outer painting of these hospital ships shall be white
with red streaks. These ships shall bear aid and assist¬
ance to the wounded and wrecked belligerents without
distinction of nationality. They mu3t take care not to
interfere in any way with the movements of the com¬
batants. During and after the battle they must do
their duty at their own risk and peril. The belligerents
shall have the right of controlling and visitiDg them ;
they will be at liberty to refuse their assistance, to order
them to depart, and to detain them if the exigencies of
the case require such a step. The wounded and wrecked
picked up by these ships cannot be reclaimed by either
of the combatants, and they will be required not to serve
during the continuance of the war.”
The Convention of St. Petersburgh condemned the
use of explosive bullets, and other Conventions have
attempted to alleviate, as far as possible, the frightful
horrors of war.
Digitized by GoOglC
484 The Medical Press.
LEADING ARTICLES.
Nov. 8, 1899
^The (Dictating theatres.
EOYAL WESTMINSTER OPHTHALMIC
HOSPITAL.
Operation for Cataract. —Mr. H. Work Dodd
operated on a min, let. 58, who wa3 admitted for im¬
perfect vision. On examination of the right eye with
oblique illumination (the pupil having been dilated
with gutta; homatropime et c >cainx, which is found to
be the quickest mydriatic), there was found to be
complete opacity of the crystalline lens, so com¬
plete that there was no shadow thrown on to the
opacity of the lens by the iris. The opacity also
precluded any of the normal red reflex of the fundus
being seen with the ophthalmoscope at a distance.
Perception of light was good. The other eye on being
examined by the same method was discovered to be
cataractous, but not advanced sufficiently for operation,
though vision was much depreciated. Operation on the
right eye wa3 therefore determined upon, though Mr.
Dodd pointed out at the moment of operation that
some departure from the normal might be expected be¬
cause of the appearance of isolated dot3 of denser opacity
in the cataract indicating probably calcareous degenera¬
tion. The patient having been cocainised with drops of
cocaine solution (gr. 4 to 3) applied 3 or 4 times, the eye
was first thoroughly disinfected with perchloride lotion
(1 in 5,000) from a douche, particular attention being
paid to the caruncular region, the lids and
surrounding skin were also thoroughly washed; the
patient having a very deep orbit and the speculum not
lying well in position, Mr. Dodd determined to do the
operation using only Mr. Critchett’s nature’s speculum
(that being the retraction of the upper lid by the third
finger of the forceps hand, which is sufficient to expose
the eye for operation, and which has also the advantage
of immediate and sudden relaxation incase of necessity).
Yon Graefe’s knife was employed, the point of punc¬
ture was a modification of what is known as
the 3 m.m. operation, being made at the corneo¬
scleral junction, the counter puncture being at a
corresponding point on the opposite side of the cornea.
With slow quiet strokes the knife wa3 carried upwards
to within about a mm. of the superior part of the cornea
when the edge was turned forwards and the incision
completely finished, with the edge to the front. Iridec¬
tomy forceps were then introduced, and some little
difficulty was experienced in withdrawing the pupillary
margin of the iris through the corneal wound owing to
adhesions between the iris and the anterior capsule of
the lens due to old inflammation; ultimately a sufficient
iridectomy for the passage of the lens was attained,
the anterior capsule of the cataract was lacerated
in a T-shaped manner, and then, the lids being retracted
now by an assistant, the operator placing one tortoise¬
shell scoop below the cornea and another behind the
wound of the cornea above, endeavoured with carefully
graduated pressure to cause the lens to leave its capsule
and the eye. Owing to past inflammatory adhesions
(above mentioned) this was attended with much difficulty.
An instrument was, therefore, passed in to separate the
iris and the lens, and then again pressure was tried as
before; the lens with difficulty came out enclosed in its
capsule, and this with no escape of vitreous
humour, though the operator pointed out how
near this structure wa3 to the mouth of the
wound. The ocular region having been now again
thoroughly cleansed with perchloride solution, both
eyes were closed by a light pad of cyanide lint held
in position with two strips of sticking plaster, and the
patient removed to bed. Mr. Dodd pointed out that the
partial loss of vitreous humour, though apparently
regarded by the older ophthalmic surgeons with equa¬
nimity, was in reality a serious matter, as eyes from
which the vitreous humour had been lost, though they
might heal well and plump out with fluid secre¬
tion to almost a normal tension and recover very
good vision, yet persistent inflammatory irritation,
shrinking of the globe, and after a time loss of vision
were common results. He said that by keeping the
incision rather on the corneal side of the corneo-sderal
junction, and taking care that the counter puncture was
in the same region, and not too far back into the sclera,
as is often the case, opening of the vitreous chamber
might generally be avoided, though it ought to be said
thatinsome degenerated eyes the vitreous wa3 so ex¬
tremely fluid that it was lo3t even when the greatest
skill and care were exhibited.
It is satisfactory to state that the patient has done
extremely well, and, as far as can be seen three weeks
after the operation, has recovered comparatively good
vision.
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“ SALUS POPCLI SCPREMA LEX.”
WEDNESDAY, NOVEMBER 8, 1899.
PUBLIC ANALYSTS AND PLURALITIES.
In a recent article we commented upon the rejec¬
tion in a magistrate a court of the evidence of a
well-known public analyst on the ground of his not
having based his testimony upon a personal analysis.
Amongst other things we freely criticised the system
of pluralities that has become the rule rather than
the exception as regards public analysts. As the
opinions then advanced appear to have given rise to
more or less misconception in certain quarters it may
Digitized by ^ooQle
Nov. 8, 1899.
LEADING ARTICLES.
The Medical Press. 485
be well to add a supplementary statement deal*
ing with some aspects of the functions and tenure
of those important official posts. First of all
it would be highly desirable to define the posi¬
tion of a public analyst. Is he simply a chemist,
or is he also a bacteriologist? In the case
alluded to above, the disallowed evidence bore upon a
bacteriological analysis. If the position of public
analyst does not include that special and highly
technical branch of biological research, than our
friends the lawyers will probably have something to
say in the matter. This point is of considerable
importance, because the time and special skill
required in bacteriological examinations are most
exacting elements, and would have to be added to
complicated chemical processes already demand¬
ing patient accuracy and thoroughness on the
part of the operator. In any case it is interest¬
ing to inquire on what footing the analyst ap¬
pears in Court. A gentleman who is entitled
to speak with authority has sent us a communica¬
tion in which he says emphatically that public
analysts have nothing to do officially with medico¬
legal work. If that proposition be accepted it is
clear that any such analyst gives court evidence
merely as a private oxpert. But the position is by
no means so simple as our correspondent would have
us believe. It is true that a public analyst may be
called in to give evidence in a case outside his own
district, in which event he appears in the witness box
as an expert pure and simple, to give either
corroborative or rebutting testimony. The analyst
is an officer of the Local Government Board
in the restricted sense of the condition laid down in
the Sale of Food and Drugs Act, 1875, that all
appointments and re appointments are subject to.
the approval of the Local Government Board.
The Act lays down that in every district a competent
person may be, and if required by the Local Govern¬
ment Board, must be, appointed public analyst.
The appointment is made by the Town Council of
any borough having a separate Court of Quarter
Sessions, or a separate police establishment, while all
parts of the country not included in the foregoing are
provided for by the County Council. The salary, wholly
or in part, is paid by the local authority, and it
appears to us to be an untenable position to claim
that if a public analyst goes into court to sustain a
prosecution undertaken by the authority by whom
he has been appointed that he does not give evidence
in an official capacity. With regard to the co-tenure
of the post of public analyst with that of the medical
officership, it is open to grave doubt whether such a
dual appointment is not against the interests of the
community. A Medical Officer of Health, to be
efficient, should be fully occupied with the sanitary
supervision of his district, and in that case could not
spare the time for laborious analyses. It is physic¬
ally impossible for a man, conscientiously and ade¬
quately to do his duty as public analyst to half-a-dozen
districts, while at the same time he is acting as
Medical Officer of Health, lecturer at a medical school,
medical adviser to various boards, and as holder of
a number of minor paid or honorary positions. The
Local Government Board discourages this species of
co-tenure, but we would go further, and render them
illegal. Plurality in the posts of public analyst in
extreme instances amounts to a hardly less abuse. It
is readily to be understood why the holding of more
than one appointment as public analyst should be
countenanced by the Local Government Board,
inasmuch as by the combination of two or three
districts laboratory expenses could be lessened,
and a better salary could be offered as an
inducement to a competent man When a single
chemist, however, undertakes the duties of public
analyst to five, six, eight, or any number
up to thirty boroughs or counties, we hold that the
whole thing degenerates into a farce. Personal
supervision is impossible, and efficiency is tossed on
the horns of a dilemma, for either the public analyst
or the counties and districts for which he acts must
be neglecting his duty. In any single borough or
county of moderate size the proper enforcement of
the Food and Drugs Act, would imply a number of
analyses more than enough to occupy the whole time
of any man, however diligent. It is enough to
make any plain man gasp and stare with astonish¬
ment to find that a busy and distinguished Irish
Medical Officer of Health holds the post of public
analyst to six boroughs and twenty-four counties.
In London another Medical Officer of Health,
who is lecturer to a medical school, acts as
analyst to two counties, two boroughs, and
four large and crowded Metropolitan parishes. It
will be interesting to hear any defence that may be
forthcoming to pluralities of that kind. Of course, the
convenience and economy of using one laboratory
and staff for several districts is obvious. Then there
is the question of evidence. It seems abundantly
clear that the lawyers will, in future, insist on all
such medico-legal evidence given in court being the
result of a personally conducted analysis. At least,
any legal adviser who neglected to take that line, after
a recent decision, would be neglecting the interests
of the client whom he was defending. The phases
of this important subject are by no means exhausted,
and we propose to deal further with the matter at
some future time.
THE NEW CHARTER OF THE ROYAL
COLLEGE OF SURGEONS, ENGLAND.
It is not to be disputed, of course, that the New
Charter applied for by the Royal College of Surgeons,
England, will, if granted, confer distinct advantages
upon the College. In brief, it will enable the Council
to endow distinguished persons, worthy of honours,
with an honour which, under the circumstances of
the case, could not fail to be highly prized. Again
in making application for powers in this direction,
the Council have merely endeavoured to fall into line
with other corporations and institutions, whose char¬
ters enable them to confer honorary distinctions. All
those Fellows and members of the College, then, who
Digitized by Vj ooQle
486 The Medical Press. LEADING ARTICLES. Nov. 8, 1899.
have the interests of their College at heart, will un¬
doubtedly hope that the Privy Council will accede to
the petition for the New Charter which has been
made. Practically the draft charter consists of six
clauses. The first deals with the main object thereof,
namely, the power to confer honorary fellowships
which shall not, at one and the same time, exceed
fifty in number. The second determines that the
election of a honorary Fellow shall be by a majority
of votes in the Council. The third, that no fee
Bhall be payable by any honorary Fellow in
respect to his election or diploma. The fourth
that no honorary Fellow shall be eligible as
a member of the Council or Court of Examiners,
or be entitled to vote at any election of a
member or members of the Council, but that he shall
have and enjoy other such of the other corporate
rights and privileges attaching to the Fellowship of
the College. The fifth, that no honorary Fellow shall
thus acquire any right to practice surgery, or to be
registered as a registered medical practitioner, and
sixthly and last that in so far as concerns the election
admission rights and privileges of Honorary Fellows,
and all matters relating thereto, these will be regu¬
lated by the existing, bye-laws, charters, and regula¬
tions of the College. Thus it will be gathered from
this brief statement of the objects and details of the
New Charter that there is nothing which can be
regarded as detrimental to the interests, either of the
“ body corporate/’ or the College itself. All the
Council desire to attain is the power to confer an
honour upon distinguished individuals who have been
honoured by other corporations. It is more than
likely that they have been inspired to embark upon
this undertaking by the fact that the Royal College
of Physicians, London, are empowered by their
charters to confer an Honorary Fellowship of their
college upon distinguished persons. The latest to
receive this honour was the Prince of Wales.
We may safely conclude, then, that as soon as
the Royal College of Surgeons are in the position to
endow a liege subject of the Queen with an
Honorary Fellowship of the College, no time will be
lost in following the example of the sister college, and
in presenting the Heir-Apparent with a diploma
enabling him to sign himself F.R.C.S. We cannot
suppose that any difficulties will be raised against the
petition which has been made for the Charter.
Practically, no contentious matter is involved in it,
and it has received the unanimous support of the
“ body corporate.” It is true that a section of the mem¬
bers were desirous of introducing extraneous questions
into the Charter, with a view to settling points in con¬
nection with college politics, which are annually
paraded at the November meeting of the College, but
the Council wisely and firmly intimated that the
occasion would be an inopportune one for following
such a course. Obviously, if any contentious matters
had been incorporated in the application for the
Charter grave difficulties would have been introduced
into the case.
THE PSYCHOLOGY OF JURORS.
The confidence which trial by jury inspires in the
breast of the average citizen is doubtless based on
the assumption that the verdict of twelve men r
honest and true, stands a good chance of being free
from fear, favour, and affection, as well as from the
whims, cranks, and oddities of the individual juror,
especially as care is taken to exclude the better-
educated classes of the community from the jury
panel, presumably in order to prevent their exercising
too predominant an influence over their less-educated
colleagues. If, however, we inquire into the mental
condition of the average juror one cannot but be
struck by the fact that he is fitted neither by occupa¬
tion nor training to discharge the highly responsible
duties entrusted to him. As Dr. Crothers observed
in an address recently delivered before the New York
Medico-Legal Society, while none would question
the motive and intent of the average juror to be
just and fair in his conclusions it would seem that
certain conditions and surroundings make it impos¬
sible in most cases, either to understand the case
liefore them or the principles of equity involved.
The assumption that the twelve men set apart for this
duty are endowed with a large and sufficient mental
capacity for the discernment of truth and justice is
far from being true in reality. On the contrary,
they are, oftener than not, naturally incompetent, and
they are. moreover, generally placed in the worst
possible conditions and surroundings to exercise even
average common sense in any disputed case. Take
a typical trial in which twelve men, many of them
recruited from the out-door labouring class, unaccus¬
tomed to any form of continuous mental work,
obliged to remain sedentary in a stuffy court-house,
and constrained to listen to a lot of conflicting expert
evidence wholly beyond their ken. What little gleam of
light enters their mind as the result of perfunctory
attention to the evidence is ruthlessly destroyed by the
interested ex parte pleading of the advocates. Let us
remember that in all probability not one of these
twelve men would have been chosen to take charge of
any trust or to decide on any matter outside of his
every day life, simply because, on general principles
and from common sense observations, he would have
been clearly incompetent. Let us bear in mind also
the difficulty which most of us experience when called
upon to concentrate the mind for any length of time
on a lecture or discourse, and we shall form a faint
idea of the hopeless confusion into which the minds
of the average jury must fall after a few hours of
suck an unaccustomed strain. Suppose the case to
be prolonged for several days, ere which time the
body begins to suffer from change of habits and
enforced inaction and more than shares in the
mental lassitude. Let us ask ourselves then
what probability there is of the twelve arriving
at a clear and impartial opinion on the ques¬
tions put to them by the judge. Having done
tliis we shall not be surprised at the generally
received opinion that a law suit is largely a matter
of chance—a “ toss up,” as a sporting lawyer would
Digitized by VjOOQlC
Nov. 8. 18fH>.
NOTES ON CURRENT TOPICS.
Thb Medical Press. 487
say. In a technical civil action, assessors might
assist the jury in arriving at an approximately
correct conclusion, but in criminal cases—the most
important from a social point of view—the inter¬
vention of assessors would not be tolerated except in
the person of the judge, who, indeed, finds himself in
most instances obliged to come to the assistance of
the jury. Dr. Crothers’ description of the jury during
a prolonged trial, ought to rank high as a study of
physiognomy. As the case goes on, he observes, the
faces of the jurors become pale or unduly flushed, the
eyes lose their intelligence, and become vacant and
watery. Some show restlessness by frequent changes
of position, others become somnolent and inclined to
stolidity, others, again, are constrained and seem to
be struggling to keep up some degree of dignity, and
all show signs of that confusion of mind which comes
from changed surroundings and functional disturb¬
ances resulting from confinement and mental
exhaustion. Thip, he remarks, is the natural outcome
of placing untrained men in positions which they can¬
not fill, and requiring of them clear judgment under
circumstances in which it is almost impossible to act
normally.
4lotc0 on Current topics.
Consultants at the Seat of War.
Surprise has been expressed in certain quar¬
ters that Mr. Frederick Treves should have decided
to proceed to the seat of war in South Africa. But
we understand that the “ offer for his services made
to him by the Government was such that he could not
possibly refuse.” Possibly, it would be no monetary
consideration which could induce Mr. Treves to trans¬
fer himself for an indefinite period from his active
surroundings, nor can a surgeon in his position
afford to act merely upon the dictates of patriotism.
Possibly, therefore, the intimation of an honour
as a reward for services rendered in the war,
has made the offer of the Government
under these circumstances, an impossible one
to reject. If this be so, we may assume
at once that any such recognition of Mr.
Treves' position as a representative British surgeon
will be warmly welcomed by the profession generally.
Meanwhile a correspondent is anxious to know how
the presence of Mr. Treves in South Africa will affect
the appointment of Sir William MacCormac. The
latter surgeon is proceeding to the Cape as consulting
surgeon to Her Majesty’s Forces at the seat of war.
But this appears to be the official title which lias
also been conferred upon Mr. Treves. Hence it has
naturally been asked, will the President of the Royal
College of Surgeons take precedence to his younger
colleague, or will the two appointments be on an
equal footing from an official point of view ? The
War Office have made no statement upon this
point, und, therefore, it is only possible to speculate
concerning their intention in the matter. We learn
that the President of the Royal College of Surgeons,
Ireland, Mr. R. L. Swan, has also placed his services
at the disposal of the Government. This action
on the part of the Government must not be
construed as indicating any want of confi¬
dence in the Army Medical Staff, but it is
a matter of public notoriety that this depart¬
ment is greatly under-manned, and in any event
is sure to be greatly overworked.
Lesions of the Skin and Carcinoma.
The eczematous condition of the nipple, which,
since Sir J. Paget drew attention to it, is admitted to
precede carcinoma of the breast, has raised the
question of the possibility of the existence of a pre-
cancerous stage of cancer, and the theory receives a
good deal of support from the connection which
appears to exist between the two diseases
in this instance. But further confirmation in this
regard has lately been brought forward, curiously
enough, also in connection with a lesion of the skin.
Hartzell has collected a series of cases of psoriasis,
treated by arsenic, in which epithelioma ultimately
developed. So far the series consists of eleven, and
the interest of the cases is naturally centred in the
etiology of the malignant degeneration. Is the
disease caused by the arsenic, or i6 it only another
proof of the existence of a precancerous stage ?
As workers in arsenic have been prc ved to possess
no special predilection for cancer, it is possible that
the reasonable theory as to the existence of a pre¬
cancerous stage of cancer is, in this instance, as in
the former one, correct. The belief that cancer is a
parasite disease would in no sense be lessened by the
adoption of this theory, tor the natural conclusion is
that there must be some special preparation of the
soil before it can become a cultivation medium for
the development of cancer micro-organisms.
Paralyses following Anaesthesia.
Paralyses supervening after general anaesthesia,
the so-called post-anmsthestic, or post-operative
paralyses, of which numerous instances have been
placed on record, belong to several distinct categories,
but none of them can reasonably be attributed to any
toxic action on the part of the anaesthetic itself.
First, among these strictly peripheral paraylses are
those which may be dismissed as mere coincidences
such for instance as hemiplegia from rupture of a
cerebral blood-vessel, or mere functional paralysis,
mono or hemiplegic. Excluding cases in which a
nerve, or several nerves, have been cut. or otherwise
injured in the course of the operation, the most
common variety of post-operative paralysis is that
due to stretching of or pressure upon a nerve trunk,
brought about in some instances, by prolonged decu¬
bitus in a faulty position, as for instance
elevation and extension of the humerus which
then presses upon the brachial plexus, or allowing a
limb to hang over the edge of the table, and
so on. Then, too, injurious pressure may be
exerted by clamps or tight straps over the shoulders
or lower extremities. It is important that the atten¬
tion of surgeons should be called to these accidents
in order that attention may be paid to the question
Digitized by
Google
488 The Medical .Press.
NOTES ON CURRENT TOPICS.
Nov. 8, 1899.
of posture during anaesthesia. While these pressure
paralyses are usually recovered from in a short time
it must not be forgotten that in some cases they have
been known to persist for months and even years,
indeed the disability may even be permanent The
duration of the paralysis depends, of course, upon the
amount of injury inflicted upon the nerve trunk and
upon the recuperative power of the individual. Inas¬
much as there are no means of estimating these
factors in any given case it behoves us to bear this
contingency in mind when preparing a patient for
operation.
rities have devised better and simpler methods than
the one for which M. Bertillon enjoys the credit.
We do not know what M. Bertillon would have to say
to this criticism, but no one, we suppose, has yet
forgotten the sorry figure which this anthropometric
authority cut at the Rennes trial of the unfortunate
Captain Dreyfus. If, however, there are “simpler
and better methods ” than the one known as
“ Bertillon’s : ’ for the detection of criminals, we would
urge that the authors of them would be conferring a
favour upon the police authorities of the world by
making them known.
The Health of Cornwall.
We learn from the Western Morning News that for
the firet time since 1892 the Sanitary Committee of
the County Council have issued a report on the
health of the county for a complete year. Though
somewhat belated the report is none the less
welcome, for it will direct attention to a condition
of things which should attract more than passing
notice. The birth rate for the county is low,
nearly five per thousand below that for the
whole country, but the death rate of infants under
twelve months is as high as 15 6 per cent, in the rural,
and 19 3 in the urban, districts, rates which are
notably higher than those of large towns, such as
Plymouth, Manchester, Birmingham, &c. Diarrhoea
and whooping-cough contributed largely to this
abnormally high death rate, due in large measure to
improper feeding. It is a sad commentary on our
present attitude towards phthisis that no less than
437 deaths, or one in thirteen, were ascribed to this
disease, the death rate from this cause in the towns
being exactly double that for the country. We are
promised that in future the reports will be made
annually at an earlier date, and there can be no
question that these reports, when explained and com¬
mented on by the local press, constitute a valuable
means of educating the public on matters in which
they are deeply interested.
The Northampton Guardians.
The Northampton Guaidians, who had the good
sense to “climb down ” when the Local Government
Board applied for a writ of mandamus in respect of
their refusal to appoint a vaccination officer, made an
unsuccessful endeavour last week to evade payment
of the costs on the ground that they had only wished
to raise a constitutional question without any inten¬
tion of being contumacious. The judges, however,
decided the case against them, and it is quite possible
that the law-abiding citizens of Northampton may
resent being called upon to paj a large bill of costs in
addition to their own legal expense for the doubtful
privilege of fighting a government department.
The Bertillon System.
The honour of having introduced the anthro¬
pometric system known under the above name is
apparently not rightly attributed to M. Bertillon.
According to a correspondent in an American con¬
temporary, the system in question is really that
designed by Broca, and it is added that other autho¬
Sleeping in Corsets.
To describe the vagaries of fashion in woman’s
dress from a physiological point of view would be to
pen a scathing satire on the foibles of the sex. From
recent letters published in a public journal we learn
that one of the chief causes why a woman cannot take
the short, smart little steps that mark the progress
of a tightly-shod and high-heeled boot, is because she
has not worn them from youth upwards. Anyone
who prefers cramped artificial gait of that kind, to
say nothing of the associated internal organic com¬
plaints, would probably defend the dyeing of hair,
the rougeing of cheeks, and all other methods of im¬
proving Nature's work, and would defend their use
in the nursery or at the boarding-school. Heaven
defend our school girls from such a fate.
So far their most serious physical handicap
consists in the corsets that a distorted feminine
judgment still generally insists upon their wearing.
About that extraordinary implement of attire—for
that is what it amounts to—the one thing that pre¬
vents it killing off a considerable proportion of the
female population of the United Kingdom lies in the
fact that during sleep the body is allowed to resume
the shape and movements with which that most perfect
product of Nature has been endowed. It will come as a
shock to most of the sterner sex to learn that the
practice of sleeping in stays is discussed in some
quarters as an accepted fact. In the directions given
by one foolish dame the lady is directed to stand up¬
right and hold an old-fashioned backboard, bracing
back the shoulders while being laced. This method
is said to obviate entirely the necessity of sleeping in
corsets. The picture thus raised reminds one forcibly
of the mediaeval rack, with an innocent schoolgirl as
the victim instead of a Christian martyr or a
criminal.
Premature Burial.
The Society that boasts the somewhat high-
sounding title of the London Association for the
Prevention of Premature Burial has passed a number
of resolutions which have been duly published for
the behoof and guidance of the public. It seems that
a draft bill for the better prevention of premature
burial was prepared by this society some two
years ago, and the executive have not yet given
up hope that the Legislature will give prac¬
tical shape to their recommendations. One of
their resolutions states that “ notwithstanding
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Nov. s, 1899. NOTES ON CURRENT TOPICS Tkb Mvdical Press. 489
the indifference shown to the question by a portion of
the public and of the medical profession, the dangers
of premature burial are sufficiently great to warrant
the attention of every thoughtful person." Quite so.
but can the Association with the long name mention
any scientific man of unquestioned reputation and
standing who is convinced that the existence of any
case of live burial has ever been proved by posi¬
tive and unquestionable evi dence ? The final
resolution says that “ the cases that have
been indisputably proved to have taken place
warrant the conclusion that the danger is far
greater than many persons are disposed to think.”
The whole question was discussed some years ago in
a series of articles that appeared in the columns of The
Medical Press and Circular, and that have since
been reproduced in book form under the title
“ Premature Burial, Fact or Fiction ?” The logical
weakness of the Society for the Prevention of Pre¬
mature Burial lies in the fact that they have omitted
to prove in the first place that such an occurrence
has ever taken place. Of assertions and vague
stories there is a multitude; of sane and exact evi¬
dence and reasoning none.
Death under Chloroform.
A death under chloroform occurred last week at
the Birmingham Children’s Hospital, the victim being
a child, cet. nine, who was about to undergo the
removal of post-nasal adenoids. We were under the
impression that laryngologists in solemn conclave
assembled had more than once declared the use of
chloroform for this purpose to be attended by
unavoidable and unnecessary risk. Certain is it
that if curried out by skilled hands the operation is
one which can be accomplished satisfactorily under
nitrous oxide, and this prompts the question why the
more lethal anaesthetic should be employed instead
of the comparatively harmless gas.
Port Sanitary Work.
The half-yearly report of the medical officer of the
Port of London may be taken as a fair type of
the activity and thoroughness of the preventive
sanitary service carried on at the ports of the United
Kingdom. During the period under review no less
than 17,232 vessels were inspected. In 1,431 it was
found necessary to enforce cleansing operations.
Three hundred and forty structural alterations were
carried out in 315 vessels with a view to improve¬
ment of ventilation, lighting, heating, and the
storage of drinking water. During the half-
year the medical officers visited 5,061 vessels at
Gravesend in conjunction with Her Majesty's
Customs, and examined 7,626 passengers and 16,141
members of crews. At Sheerness a further 128
vessels were medically inspected. Sixty-four cases
of infectious disease were dealt with, including
small-pox, scarlet fever, diphtheria, and enteric fever.
Dr. Collingridge reports a gross case of overcrowding
on board a Danish steamer, which arrived with 176
foreign immigrants, all of whom were berthed together
in a scandalously small space. The rational system of
port sanitary prevention that has gradually been
evolved in England is oneof which we may well be proud.
The arrival of cases of such deadly infection as
cholera and plague can now be viewed with com¬
placency, a statement that could be made of no other
country in the world. The absurdity of the old order
of things which depended on fetish fumigations and
quarantine and military cordons has been lately de¬
monstrated at Oporto. Dr. Collingridge is to l>e
congratulated on the success with which he admin¬
isters a vast and laborious organisation.
Lyddite as a Logical War Material.
If the object of war be to destroy as many of the
enemy as possible then it follows that the more
effective the means of destruction employed the
sooner will that object be obtained. There is some¬
thing to be said in favour of the contention that
fewer men are killed nowadays in a big action than in
the old times of hand-to-hand fighting. In the
present war at the Cape the tenable devastation
caused by lyddite shells has been brought into
evil prominence. The lyddite is packed in a
shell and fired by a percussion fuze. It is
obtained by the fusion of picric acid, which is in
turn manufactured by the action of nitric acid
upon phenol. Its explosion creates an area of
havoc far wider than that due to the ordinary shell
charged with powder and shot. In the case of lyddite
the resulting deaths are for the most part due to the
terrific concussion of air, which has been known to
kill a man at a distance of two hundred yards. To
a limited extent, therefore, the lyddite is less bar¬
barous than the ordinary shrapnell shell inasmuch
as its victims are killed outright. Beyond a doubt
in this explosive we have one of the most terrible war
materials yet introduced into warfare. Yet its use
has not been forbidden by the usages of civilised
nations, who appear to have drawn the line us yet
simply against the explosive bullet. It is quite pos¬
sible. as some folk maintain, from a philosophic
point of view that developments of the lyddite type
advance the day of the millennium of universal peace
simply because they will sooner or later render war
impossible.
The Two Medical Defence Unions.
Several efforts have been made to bring
about the amalgamation of the two societies
which undertake the duties of medical
defence, but in each case nothing has come
of the proceedings. The failure of the last attempt,
however, rather tends to show that so far as the
Medical Defence Union is concerned, the amalgama¬
tion will never be carried out. The London Counties
Medical Protection Society wrote in August last
suggesting that an amalgamation should take place,
and the reply of the Council of the Union was that
they could not accede to the request. No reasons
for this decision were given, nor was there any
opportunity afforded for further discussing the ques¬
tion. Thus it would seem that the Medical Defence
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Union have reasons of their own for maintaining
their autonomy, and for refusing to be identified
with any other similar organisation. We should,
nevertheless, have thonght that an amalgamation
scheme could have been arranged whereby a mutual
adjustment of the affairs of each undertaking could
have been satisfactorily effected. Moreover, we can¬
not quite see the advantage of two societies existing
6ide by side, working for the same ends, and incurring
two administrative expenses where one would be
amply sufficient. On the other hand the Protection
Society is apparently in a very flourishing condition,
both as regards finances and membership, and is, there¬
fore, quite able to continue to fulfil its mission
independently of its sister organistation.
The Death of an Officer of the Royal Army
Medical Corps on the Field of Battle.
We regret to say that the official list of the killed
and wounded published in the press on the 3rd inst.
contained the name of Major Edward G. Grey, of the
Royal Army Medical Coi-ps. Thus, doubtless, while
attending to the wounded on the field of battle
he was shot by the enemy. This sad incident again
forcibly recalls the risks rnnby our non-combatantcon-
fvires in the discharge of their duties, and it emphasises
the little-mindedness of those who make a point
of taunting the officers of the Army Medical Corps
with the fact that they do not belong to the combatant
branch of the Service. It was the Duke of Cambridge
who described Sir George Robertson, the defender of
Chitral, as “a brave civilian.” A great deal of
notice was tak en of this sneer at the time, and it is
never likely to be forgotten. Such repeated
exhibitions of official bad taste and jealousy are
answerable for the medically undermanned con¬
dition of the Army at the present time. It was
pointed out last week that the Medical sen-ice of the
Army is in need of nearly 500 officers in order to place
it upon a proper footing as to efficiency. If this be
the real state of affairs, it is an astounding revelation
of what the trifling with the Medical Department by
the War Office has led to. There is nothing which
can compel young medical men to join the Army, and
until the War Office make up their minds to treat
the Department properly, the Army will have to do
without medical officers.
Anti-Streptococcal Serum in Puerperal
Septicaemia.
The value of the anti-streptoicoccal serum in
modifying the course of puerperal septicaemia must
still be regarded as a moot question in spite of the
very large number of observations of its use already
recorded. Judging from the recent discussion on the
subject at the Obstetrical Society of London, the
most then can be said of it is that the injections have
appeared to exert a marked effect in certain cases,
but per contra, at least, an equal proportion of case3
have proved absolutely refractory thereto. It is sug¬
gested, of course, that it is efficacious only in cases of
pure streptococcal infection, and unfortunately,
neither clinically or bacteriologically, are we in a
position to state what proportion of cases of
puerperal septicaemia are due to pure, and
what to, mixed infections. Unless the presence of
the streptococcus has been formally established
the use of the serum is, to say the least of it, empirical
but, on the other hand, if we are to await the results
of careful bacteriological examination before pro¬
ceeding to treatment the chances of a successful
intervention must necessarily be vastly diminished.
The peculiar difficulties in the way of trustworthy
bacteriological examination in these cases are Buch
that if we are to wait until the question has
been settled we may have to wait a long time. The
treatment is on its trial, but the consensus of opinion
appeared to be decidedly in favour of continuing its
experimental use. It would perhaps be too much to
hope for the production of a really efficacious serum
until the bacteriology of the various forms of
septicaemia has been placed od a sound scientific
basis, and for this much further study will be
necessary.
The Employment of Civilian Surgeons in
the War.
It is stated that some resentment i3 be¬
ing expressed by certain officers of the Royal Army
Medical Corps at the employment of a large
body of civilian practitioners with the force in
South Africa, and the editor adds that his
sympathy is with the retired medical officers liable
to further service whose services are not being
utilised in the emergency. However, our contem¬
porary assumes that the War Office want men for
the most part who are young and strong, or men who
have exceptional qualifications to recommend them
This is probably the case, inasmuch as the sixty or 60
surgeons whom the Government have already des¬
patched to the Cape are, in the majority of instances,
young qualified men who have recently held the
post of house-physician or house-surgeon at some
large hospital. Undoubtedly these are ju6t the kind of
men who would be most calculated to meet the
requirements of the position—strong and active :n
mind and body; and, moreover, equipped with the
knowledge of all the newest methods cf surgical
treatment, resourceful, self-reliant, and eager, above
all things, to practise their newly-acquired knowledge
—we do not doubt for a moment that the Govern¬
ment have done well to avail themselves of such
readily-acquired and efficient aid.
* Hepatic Abnormalities in Infants and
Children.
The liver is not an organ in which pathological
changes are expected to be met with in infants and
children, and yet, j udging from some observations upon
the subject brought before the American Pediatric
Society by Dr. R. G. Freeman, of New York, changes
of the kind are not infrequent. Special note »va3
made of the condition of the liver in 5UU cases of
children dying in the New York Foundling Hospital,
and it was found that that in about 41 per cent, of
all these the organ was fatty. This condition was
Nov. 8, 1899.
most often present in connection with acute meni-
gitis, gastro-intestinal disorders, measles, and
diphtheria, while it was rarely associated with
chronic wasting diseases, such as marasmus, mal¬
nutrition, rachitis, and syphilis. Again, there
was nothing to show that the fatty condition
of the liver depended at all upon the nutrition
of the child. Another point brought out by the
inquiry was that cirrhosis and lardaceous disease of
the liver were extremely rare in childhood. These
observations are of much interest, and will have to be
borne in mind by the authors of text-books, whose
teaching upon the subject has hitherto not been in
accordance with the facts.
A Congress of Spiritualists.
The Paris Universal Exhibition of next year—if no
international contretemps interferes with its celebra¬
tion—is to be “ honoured ” by a congress of
spiritualists. That is to say, the opportunity of the
great gathering will be taken by the spiritualistic
community to hold a conference in order to discuss vital
matters concerning their faith. There appears to be two
schools of spiritualists, one which maintains that men
have successive lives on earth—rather hard on those
who have found that one life was enough—and the
other that holds that their successive lives ran their
appointed span in other worlds. Of course this metem-
psychosical question must be a very important
one to spiritualists; on the other hand, there is
no reason for supposing that it affords the least
interest to anyone else. As long, therefore, as the
spiritualists do not come to blows when discussing this
question in their congress, probably no one will inter¬
fere with them, not even the shades of Blavatsky or the
Mahatmas of India. Meanwhile, as a preliminary
measure to their proceedings, the spiritualists might
inform the world as to the chance of the exhibition
ever taking place.
Ships’ Medicine Chests.
No doubt a report on the condition of the indi¬
spensable medicine chests carried by cargo and other
non-passenger vesseIs would prove interesting reading.
We have it on very good authority that they leave
much to be desired from a pharmaceutical point of
view, but whether the crew are any the worse off by
reason of the inability of the captains to administer
medicines, is a debatable question. One can under¬
stand the necessity for surgical dressing because, even
if clumsily applied, they answer to some extent the
purpose for which they are intended, viz., protection
of wounded surfaces. The same remark applies to
splints and bandages which secure more or less
immobility in the event of fractures, and tend to
relieve the victim’s sufferings. When, however, we
consider the likelihood of any good resulting from
the haphazard administration of medicaments
hy the captain’s untutored hands we feel com¬
pelled to make certain reservations. The cap¬
tain may doubtless be trusted to administer purgative
medicines if put up in suitable doses, and he will not
incur much responsibility by giving diarrhoea mixture
The M edical Press. 491
ipecacuanha wine, or syiup of ginger. Even the
administration of quinine might not prove beyond
his capacity, but there we must draw the line, for we
cannot regard with equanimity the prospect of his
administering morphia, or mercury, or even pilo¬
carpine for the purpose of making the hair grow or
otherwise. Marine therapeutics, therefore, in the
absence of a qualified adviser, must necessarily be a
simple matter, so simple, indeed, that it hardly seems
worth while to oblige vessels to carry a medicine
chest at all. On the whole, we should, perhaps,
better serve the interests of those who go down to
the sea in ships if we limited the therapsutical
armamentarium to the two or three simple remedies
aforesaid, and under these circumstances we think it
may possibly be unnecessary to urge the Board of
Trade to take steps to verify the contents of the
chests at pre8e n t in use.
Dublin Insalubrity.
The records of the mortality in the second city of
the Empire for the past four months is positively
appalling. The death rate for the quarter, from all
causes, was 30 4 per 1,000 of the population, or 7*3
over average, and the week ending October 28th re¬
corded the largely increased mortality of 36'4, which
compares with 20'8 for London and 185 for Edin¬
burgh. It is, however, in the deaths from zymotics
that the most alarming increase is manifested. From
these diseases the deaths numbered 773. being no less
than 527 over previous quarter, and 422 over average,
the rate being 8 8 per 1.000. This terrible slaughter
was the result, chiefly, of epidemics of measles and
diarrhoea. The deaths from the latter ailment
during the quarter were 372, being more than double
the average (180). From measles the deaths numbered
189—as against the ten years’ average of 15—and the
prevalence appears to be increasing by leaps and
bounds, the admission to hospital for measles having
advanced within a fortnight from 43 to 60. It is in
view of this appalling state of things that the
Hospitals, the Poor-Law Guardians, and the Corpora¬
tion are engaged in recriminations and discussions as
to whether something or nothing shall be done to
provide for the infected sick, the existing
accommodation having collapsed under the strain.
The Army Medical Service and Its Critics.
We note that two individuals, Sir Arthur Grant
and Sir Claude de Crespigny, whose utterances are,
if not important, at least amusing, hare favoured
the public with unmeasured abuse of the Army
Medical Corps, both such utterances being after
hearty public luncheons, and one of them after a
phenomenal feast of oysters at Colchester. Our
military confreres must accept the rebukes of there
orators “ with bated breath and whispering humble¬
ness,” considering that the intellectual qualities of
both are guaranteed by the fact that they are bucolio
baronets. They have also been at some time soldiers
longo intervallo, the first-named being a captain of
yeomanry and the other a naval man who is also a cap¬
tain of the Limerick Militia. The Army Gazette, by a
NOTES ON CURRENT TOPICS.
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492 The Medical Press.
personal.
Nov. 8. 1899-
reprehensible omission, does not state the war
services of either of them. Tt seems to us that the
most effective luncheon critics are those who combine
total ignorance of the subject and bitter prejudice be¬
gotten of that ignorance, and therefore the Royal Army
Medical Corps must rest content under the censure of
these speakers. Major-General Abadie, who presided
at the oyster lunch, cannot be so excused, considering
that he sat complacently to hear his brother officers
abused in terms alike false and vulgar. But what is
to be expected when it is recollected that he is
obliged to keep himself in the fashion of depreciation
set by the Commander-in-Chief and Sir Redvers
Buller.
Reciprocity of Medical Practice with Italy.
We are informed that the Italian Prime Minister
has promised a deputation of Italian practitioners
that he will introduce in the session of his Parlia¬
ment which is to open next week a Bill to prohibit
practice, even among their own countrymen, by
medical men who do not hold Italian degrees unless
the country of their qualification concedes reciprocal
rights of practice to Italian graduates. This is a
very serious matter, inasmuch as the medical care of
English and American visitors throughout the
Riviera and other health resorts is almost entirely in
theliands of English practitioners. It is also a question
difficult to settle, because the law of practice is differ¬
ent in the two countries. In Great Britain an Italian
can practise as every other non-registered person
can, as he pleases, but this is not much of a concession
considering that every unregistered person can do the
same. He can, also, have his qualification entered
in the register if he has acquired a British medical
qualification, but not otherwise. In Italy, on the con¬
trary, a British registree cannot practice without the
tolerance of the Government, but many have done so
by virtue of that tolerance. Thus it appears that
Great Britain cannot conform to the wishes of Italy
unless it admits all Italian medical degrees to the
register, an impossible alternative. The dispute*
therefore, seems to be impossible of adjustment, but
the Italians ought, before proceeding to disfran¬
chise the British graduates, to recollect that, if they
do so, they will assuredly cut off from their health
resorts the numerous and liberal cash-paying English
speaking visitors who now frequent these places.
For such customers an Italian general practitioner
is an absolute impossibility.
We regret to have to announce the death of Mr.
W. C. Arnison, Professor of Surgery in the University
of Durham, who died on Saturday last at his resi¬
dence at Newcastle-on-Tyne, from pleuro-pneumonia. !
Mr. Arnison succeeded Dr. Heath in the professor- ;
ship, and was president of the British Medical 1
Association some years since when it met at J
Newcastle. Mr. Arnison rejoiced in a high repu¬
tation as a surgeon, and though of a retiring ;
disposition his loss is mourned by a large circle of j
friends. i
Forty officers and men belonging to the Royal
Army Medical Corps are leaving Plymouth to-day
for the seat of war.
PERSONAL.
Dr. Theodore Williams haB presented .£1,000 to the
Endowment Fund of the Royal College of Physicians
London.
Lord Dufferin was elected Lard Rector of the Uni¬
versity of Edinburgh on Saturday last by a large
majority over his opponent, Mr. Asquith.
Mr. Frank Parish, Mayor of Worthing, has been
appointed to the Commission of the Peace for the county
of Sussex by the Lord Chancellor.
Deputy Inspector-General of Hospitals and Fleets,
Henry Harkan, R.N., has been awarded the Greenwich
Hospital pension of .£50 a year, rendered vacant by the
death of Fleet Surgeon Robert Willcox, R.N.
We regret to learn that Dr. Charles Bent Ball*
Surgeon to Sir Patrick Dun’s Hospital, is laid up with an
enteric attack. His progress is reported to be quite
1 satisfactory, and it is hoped that he will soon be able to
resume practice.
Resulting from an inquiry by the Local Government
Board into the alleged misconduct of Dr. Burns, Poor-
law Medical Officer of Sunderland, that gentleman was
: requested to resign his office last week, fle completed
his deposition by suicide with prussic acid.
J The “ call of duty ” to the Transvaal Government has
just been responded to by Dr. Neethling, a native of
that country, by resigning the office of house surgeon to
the Bradford Royal Infirmary, to which he had recently
been appointed, for medical service during the war.
' Mr. Robert D. Joyce has been appointed Assistant
Ophthalmic Surgeon to the Richmond, Whitworth, and
j Hardwicke Hospitals, Dublin. Mr. Joyce had a distin.
guished career in the Catholic University, and served
as house-surgeon of the National Eye and Ear Hospital,
j Dublin.
| Sir Wm. MacCormac and Mr. Makins, of St. Thomas’s
I Hospital, were the subjects of an enthusiastic send off to
i the war on Saturday by about 3t>0 medical students *
Mr. Makins was shouldered to his carriage. The
Director-General of the Army Medical Department,
! Surgeon-General Reade, Dr. Ord of St. Thomas’s Hos-
j pital, Mr. Butlin of St. Bartholomew’s, Dr. Frank of
| Nice, and Mr. R. O’Callaghan were among the members
| of the profession to bid them adien on the platform.
The honorary Freedom and Livery of the Salters’
Company will be bestowed on Sir W’illiam MacCormac
on his return from the South African campaign, as a
mark of appreciation of his conduct in placing his
services at the command of Her Majesty’s Government.
Among othsr members of the profession on whom this
distinction has been conferred, were the late Baronets
Sir William Fergusson, Sir William Gull, and Sir
William Savory.
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CORRESPONDENCE.
_Nov. _ 8 . 1899.
Dr. W. J. Ansoruv, of the Colonial Medical Service,
is on his way to Old Calabar to take up his post as
District Medical Officer in the Niger Coast Protectorate.
Dr. Ansorge is a traveller hors conrours, and is. moreover,
an enthusiastic student of natural history, to which he
has made numerous contributions.
A meeting of the members of the profession prac
tising in Limerick and its vicinity was held on Saturday
last for the purpose of setting on fvX>t a movement for
presenting an address to Dr. Thomas Myles, Vice-Pre¬
sident of the Irish College of Surgeons, on 1 he occasion
of his elevation to the Presidency next June. Dr.
Myles is a native of Limerick, and there was a large
attendance of his confreres on the occasion. The chair
was occupied by Dr. O’Shaughnessy, D.L , who expressed
his high appreciation of Dr. Myles. The necessary
resolutions having been passed the meeting adjourned.
Scotlanb.
[From Our Special Correspondent.'
Rectorial Elections. — At regular intervals the
students of the Scottish Universities are granted a
certain amount of license towards the exhibition of
animal spirits in a physical manner, in direct association
with their academic environment. These occasions
arise as the time for the election of new Lord Rectors of
the Universities comes round. Pease meal and explosive |
hand-grenades of parti-coloured ochre play a prominent
part in what is really a mimic political fight. Edin¬
burgh students have just passed through such a satur¬
nalia ; those of Unionist tendencies —imperialistic they
called them—supporting Lord Dufferin ; their opponents
the Right Hon. Mr. Asquith. Lord Dufferin was elected
by a majority of 257 in a poll of 1,629 over Mr. Asquith ;
friends and foes of the successful candidate participating
later in the day in a fancy dress torch-light procession
through the main streets of the city. The excitement of
the contest was marred by one regrettable incident; for,
during what can only be characterised as a free rough-
and-tumble fight in the physiological class-room, one of
the combatants fell and broke his leg. Although the
withdrawal of Sir Edward Grey from the lists at Aber¬
deen left Lord Strathcona and Mount Royal the un¬
opposed candidate, the proceedings of election were
marked by an organised nomination fight, followed by a
combined attack on the citizens who had assembled to
watch the proceedings, and ended by a baton charge by
the police, the arrest of several students, and the
wounding of others.
The Medical Press. 493
of the Corporation have now passed a resolution to the
effect that negotiations are at an end so far as they are
concerned. It, therefore, remains for the Infirmary
Board to arrange its own scheme for representation to
the trustees of the institution. After so much waste of
time and energy, it is to be hoped that Manchester will
at last take effectual steps for the immediate establish¬
ment of a thoroughly modern hospital.
Pathological Society.— This, the largest of the
Manchester Medical Societies, has just issued its annual
report. It was originally established in 1885. At the
present time it has a membership of 417. It has also 7
Honorary Members, gentlemen distinguished in Medi¬
cine, and the allied sciences. The Society has com¬
pleted arrangements, whereby its Members may have
Examinations of Morbid Products conduc ted for them
at the Owens College.
Pure Mils Supply.— Thanks to the scientifically-
directed energy and public spirit of a number of leading
citizens, a company has been formed for the supply of
non-tuberculous and absolutely pure milk, butter and
cheese. Elaborate buildings have been erected and
fitted with the most approved apparatus. The farms
supplying the milk are under rigorous inspection, and
thorough precautions are taken for insuring a perfect
collection, storage and delivery of the milk to the
individual consumer. Such prophylactic measures
deserve support, and must eventually influence for good
the, at present, unscientific and negligent procedures of
the average dairyman.
Small- Pox Hospital.— Considerable opposition is
being raised to the proposal of the Corporation to erect
a new small-pox hospital at Carrington Moss, at an
estimated cost of .£ 60 ,(XH). It is said that within the
last four years less than a score cases of variola have
occurred. In the three years, 1892-3-4, 993 cases had to
lie dealt with. It is contended that the present Hospital
is quite adequate, and that the new one, if erected on the
proposed site some dozen miles distant and situated in a
water-logged, low-lying district, would be both
inconvenient ant unhealthy.
Victoria University.— Students will be interested
to learn who me the new external examiners in the
Faculty of Medicine. The following have just been
appointed: —External examiner in physiology, J G.
M'Kendrick. M.D., F.R.9., professor of physiology, Glas¬
gow University; external examiner in forensic medi¬
cine, A. P. Luff M.D , lecturer in St. Mary’s Hospital,
London ; external examiner in public health. Arthur
Ransome. M.D., F.RS.: external examiner in surgery,
A. Ernest Maylard, M.B.; external examiner in medi¬
cine, David Bridge Lees, B Sc, M.D., lecturer in St.
Mary's Hospital, London.
Comsponbcncc.
We (In net hold ourselves responsible for the opinions of our
corresj>ondeiit8.
Manchester.
[from our own correspondent.]
Another Abortive Attempt t<> Settle the Royal
Infirmary (Question. —The long extended conference
between the Special Committee of the City Council and
representatives of the Infirmary Board, with a view to
the purchase of the present site and the provision of a
new hospital, has come to nought. The Special Com¬
mittee proposed the payment of £350.000 for the site
and buildings and the erection of an emergency hospital
and out patients’ department in a central position at a
cost of ^£50. The Infirmary authorities suggested the
acceptance of the £350,000, on the condition that the
central emergency hospital should he built on the present
site, and that the Corporation should not cover more than
4,200 sq. yds. of the remaining area. The represen'atives
REVOCATION OF THE MUZZLING ORDER.
To the Editor oi The Medical Press and Circular.
Sir —The muzzling order has been withdrawn in
London and Lancashire, and, as yon correctly remark,
only in South Wales and in Ireland is it now in force.
This withdrawal of the order is stated to be the result
of the cessation of rabies in England, but before we can
acknowledge the sufficiency of this reason we must
admit the prevalence of hydrophobia therein, which j
for one do not and never have done, because the method
of investigat ion, or the evidence upon which the Govern¬
ment has acted in deciding the question has never been
ascertained. We know that in Ireland, where the order
still remains in force, every sick cur which a peasant
kills by a blow of a stone, or a policeman batons to death,
is gazetted as rabid, and, in not one case out of fifty, is
| any reliable means of confirmation of the diagnosis
I resorted to. Unless some more effective method has
been adopted in England, I am prepared to believe that
‘ hydrophobia in either man or beast is, to a great extent
Digitized by
lOogle
494 The Medical Press
LABORATORY NOTES.
Nov. 8, 1899.
imaginary, that a muzzling order was never required at The question of enteric fever in India is too large for
all, and that the cessation of a disease which existed only present discussion, except in so far as to protest against
to a very inappreciable extent does no special credit to the inference which must be drawn from the earlier
such order, and which, in fact, might have been avoided remarks in the letter at present referred to. These
altogether if instructions had been promulgated that all remarks must, however, from their nature go some way
cases should be investigated by an expert before they towards discounting the value of the writer’s remaining
were reported as cases of rabies. I note that the Govern- statements.
ment prides itself upon the fact that in the London it would be interesting to know how far an extremely
district alone, it slaughtered 24,000 dogs in five months, offensive and equally foolish letter will be appreciated
and I offer no complaint of its having done so, inasmuch by the author’s brother officers in a distinguished and
as it is necessarily obviously to combat, in some way, the honourable service.
continually growing excess of stray curs, and, by so
doing, the risk of hydrophobia must be necessarily
diminished. But all this slaughter neither proves the
extinction of that disease, nor justifies the statements as
to its prevalence. I trust, however, that Mr. Walter
Long, M.P., will, by this time, be persuaded that it is a
mistake to introduce legislation which cannot be war¬
ranted by facts and proofs.
I am, Sir, yours truly,
A Sceptic.
THE INDIAN MEDICAL SERVICE AND TBE *
ROYAL ARMY MEDICAL CORPS
To the Editor of The Medical Press and Circular.
Sir, —Will you permit me to offer a reply to the
letter signed T. C. D., which appeared in your issue of
November 1st. I consider that, apart from its per¬
sonally offensive nature, the lucubration referred to is
essentially a foolish one, as the writer gives away the
greater part of his case by stating that he is a civilian
(which, by the way, seems scarcely correct, but this is a
digression) (a) and, as such, has no sympa'hy with the
spirit of militarism in the R.A.M.C. If the civilian
status of the writer is admitted, he has no right to criti¬
cise the views relating to military rank and position,
which are held by officers of H.M. Army serving under
conditions with which he can have no practical acquaint¬
ance whatever. His criticism therefore, so far as it
concerns a spirit of militarism, is simply a gratuitous
impertinence; it re-echoes also a common mistake as to
the essential nature of the phrase “ military duty.”
There is no greater error nor one more productive of
mischievous consequences, as far as the status of medical
officers of the army is concerned, than to regard
as military duties, only such duties, as are of a
purely combative nature, such as field firing, bayonet
exercise, &c. All duties in the Army are designed
for the maintenance of efficiency in H.M. forces and by
inference for the destruction of H.M. enemies. If the
above statement is correct the care and treatment of the
sick in military hospitals will possess something besides
a professional interest; in other words, the successful
performance of professional work will be attended by a j
feeling of justifiable pride at the efficient performance
of military duty. The latter, it is presumed, is a matter
in which your “ civil ” correspondent will take no par¬
ticular interest. There is also another point in this
connection which is worthy of attention. Warfare is no
longer what our American brethren would denominate
“ a brain busting match ” with battle-axes, but is an
art demanding for its successful accomplishment the
application of many sciences, and, among these, the
sciences of medicine, surgery, and sanitation, and it is
only reasonable that men who have been specially
trained in the purely military application of the
sciences which they profess, and who are called
upon to face the risks and hardships of war, should
be rightly regarded as “ soldiers,” should take
pride in an honourable title, and should be animated
with that spirit of militarism which your correspondent
considers himself called upon to decry. There is no
inconsistency between professional efficiency and soldier¬
like zeal, and among medical officers he is the best soldier
who places the highest professional gifts at the service
of his country.
It is impossible at present to be sure whether the best
professional men enter the I.M.S. or the R.A.M.C., and
the ex parte statement of T. C. D. proves nothing.
(al I presume that the writer is an officer of the Indian Medical
Service, and he uses apparently the word " civil ’ in the same sense
as “ civilian."
I am, Sir, yours truly,
R.A.M.C.
JCaboratorp ^otce.
SOME NEW SOLOIDS.
Among recent additions to the apparently inex¬
haustible list of ready-made formula; prepared in
“ soloid ” and “ tabloid ” form by Messrs. Burroughs,
Wellcome and Co., we note with satisfaction the soloids
(1) of Lead 8ubcu-etate, and (2) of Lead Subacetate and
Opium. The convenience of being able at a minute's
notice to prepare these commonly-used applications will
doubtless be adequately appreciated.
Equally convenient for immediate use in urgent cases
are the soloids (1) of Sodium Chloride ; (2) of Sodium
Chloride Compound ; and (3) of Sodium Chloride and
Sodium Sulphate. In preparing saline solutions of the
proper strength for intravenous injections these will be
found invaluable.
NEW TABLOID3.
Holocaine Hydrochloride is a substitute for cocaine in
ophthalmic practice. The anaesthesia which it produces
is claimed to be more rapid and complete than that pro¬
duced by cocaine, and being more superficial it is
specially indicated in preparing for the removal of
foreign bodies and in operations on the conjunctiva.
Unlike cocaine, its effects are produced even in presence of
inflammation. It is devoid of any action on the
pupil and does not modify accommodation or ocular
tension. The tabloidsof Holocaine contain 150 grain each.
The two-grain tabloids of extract of Cascara Sagrada
not having been found to allow sufficient margin for
the idiosyncrasy of some patients and the acquired
tolerance of others, one grain and three-grain tabloids
are now prepared. The larger dose may be taken to
overcome existing constipation, and then the smaller
dose will serve to maintain intestinal regularity. These
tabloids can be had either plain or sugar-coated.
Lastly, we are introduced to the five-grain tabloids of
Guaiacol Camphorate. a convenient means of exhibiting
this base in the treatment of tuberculosis, chronic bron¬
chitis, &c.
EFFERVESCENT TABLOID SERIES.
Messrs. Burroughs, Wellcome and Co., have sub¬
mitted to us various samples of the new series of
effervescent tabloids. The Beries comprises tabloids of
artificial Carlsbad salt, of artificial Vichy salt, of
citrate of caffein, bitartrate of lithium, citrate of
lithium, citrate and sulphate of sodium, &c. The
effervescent form which is thus rendered readily
available will certainly be greatly appreciated. Less
bulky than the ordinary effervescent products, these
tabloids secure greater accuracy of dosage, and, in
general, greater facility of administration. It is
sufficient to place one or more of the tabloids in a
suitable quantity of water, and in a short time we have
a clear solution, refreshing to the palate, and well
adapted to secure the maximum and immediate effects
of the active ingredient or ingredients. The effervescent
magnesium sulphate compound tabloid will be found a
very agreeable and effectual laxative at all seasons.
Among the recent additions to the list of products
issued by Messrs. Burroughs, Wellcome and Co., we may
note the tabloids of Bismuth and Dover’s powder aa
2 - 5 grains,'the tabloids of Krameria and Cocaine, and a
. new series of tabloids corresponding in dosage and
Digitized by GoOgle
Nov. 8, 1899.
LITERATURE.
The Medical Press. 495
active ingredients to the B. P. pills, among others aloes
and iron, compound colocynth, aloes and myrrh, blue
pill, colocynth and hyoscyamus, lead and opium,
ipecacuanha, and squills, &c. It is unnecessary to
insist on the uses to which these various tabloids may be
applied, as they are obvious.
SOLID MICROSCOPIC STAINS.
The introduction of stains for microscopic work in
“ Soloid ” form is a new departure which needs no
justification in view of the tendency of aniline dyes to
undeigo decomposition—a fertile source of disappoint¬
ment and wasted labour in the laboratory. The series
comprises (1) Gentian violet, (2) Methylene blue, (3)
Eosin, (4) Bismarck brown,and (5) Fuchsine, and direc¬
tions for their use are given in an ^ocompanying leaflet.
Theeo “ Soloids ” will specially prove a boon to travelling
investigators and those whose laboratory work is dis¬
continuous, inasmuch as by their aid the requisite
solutions can be prepared as required, accurately dosed,
and with a minimum of trouble.
literature.
ROTH ON LATERAL CURVATURE (a).
Ten years have passed since Mr. Roth brought out his
first edition of this work, an edition that might fairly be
looked on as an enlarged edition of his excellent article
on the subject in Mr. C. Heath’s “ Dictionary of Practical
Surgery,” in 18K6.
We mention these facts to show that from its incep¬
tion Mr. Roth wrote as a pract'cal surgeon, one who in
his own experience has felt the inadequacy of the
mechanical cages, metallic and poroplastic, which instru¬
ment makers delight to see, and which remain on the
poor patient as instruments of torture and nothing more.
Again and again we have been pained by seeing poor
children tormented and weighed down with a poro-plastic
or other cage that but added to their sufferings and
promoted that muscular degeneration which intensified
their agony and cut off the last hope of health.
The conservatism of the medical profession is well
marked by our adherence to existing methods of treat¬
ment of spinal curvature. Apparatus came to be adopted,
and as a result every form of spinal curvature was
deemed a fitting case for the apparatus without any
thought being given to the cause of the curvature and
to preventive measures.
If Mr. Roth’s book has any value greater than another
in surgery it is that it calls on the reader to think, to
ponder on the causes of the deformity, that the defor¬
mity may be prevented, and when it has been established
it may be got rid of.
The success of the treatment is well shown by the
series of 1,20.) (twelve hundred) cases found in the
appendix, a number that justifies the author m hoping
that his book will ultimately banish the mechanical
apparatus, metallic and poroplastic, to their proper place,
the instrumental museum. The book is a valuable and
original contribution to medical literature, of lasting
value as the work of a practical surgeon and withal pro¬
found thinker.
MITCHELL BRUCE’S THERAPEUTICS. (6)
The fact that the latest edition of this well-known
work registers its thirty-eighth thousand is sufficient to
attest its merits and its popularity. At the risk of
appearing somewhat hypercritical, however, we ven¬
ture to draw attention to a few points the alteration
of which would in our opinion enhance the value of
this work. For instance, there is no mention of a
“ dusting powder ” in the index, and we have failed to
(a) " The Treatment of Lateral Curvature of the Spine, with
Appendix, (firing an analysis of 1,000 consecutive cases treated by
S tature and exercises exclusively (without mechanical supports).”
y Bernard Roth, F.R.C.S. Second edition. London: H. K.
Lewis. 189P.
(6) “ Materia Medicn and Therapeutics.” By J. Mitchell Bruce.
M.D., Physician and Lecturer, Charing Cross Hospital, Ac. London
and New York : Cassell and Co. 1$K*.
find any passage dealing with the varied uses of that
commonly used method of applying soothing, astringent,
drying, and antiseptic remedies to the skin. Indeed,
that organ appears to have been not a little neglected,
for we find no mention of the therapeutic action of light,
both solar and electrical, and of the focus-tube used in
X-ray photography. Even if these actions are to be
looked upon as in their tentative stage so far
as practioe is concerned they are nevertheless
worthy of mention in a book of this importance and
width of range. The indelible staining due to the pro¬
longed use of silver salts is dismissed with a few
words, and no mention made of the anatomical elements
in which the deposit occurs. The important practical
point of lead deposits, leading to lead “ opacities ” in the
cornea, is not alluded to. Nor do we find any mention of
super-heated air baths, such as Tallerman 8, under the
heading of “ Baths and Allied Measures,” which deals only
with Turkish and compressed air under the sub-section
“ Air Baths." This omission in the year 1899 mars the
symmetry of a standard work on therapeutics, consider¬
ing that this method of treatment has been before the
profession for several years past. Turning to the
many alterations, additions and omissions made in the
British Pharmacopoeia of 1898 we find, so far as we
have tested them, they are accurately recorded. Emplas-
trum Belladonna', however, given on page 349 as con¬
taining 5 per cent, of alkaloids should be obviously 0 5
per oent. While offering these few criticisms, it must
not be thought for a moment that we are detracting
from the general excellence of the book, which de¬
servedly holds a foremost place upon the shelves of
the student and of the practitioner. Both author and
publishers are to be congratulated on the perennial
vigour of their production.
REID ON PRACTICAL SANITATION, (a)
The appearance of the fifth edition of this excellent hand¬
book is marked with additional in teres r . from the fact that
the book has been completely revised, and to a great
extent rewritten. The chief feature in this work, if one
may generalise, is its practical nature, which stamps
every page of the contents with a character that cannot
be derived from study-chair cogitations. An excellent
illustration of this tendency is the chapter on plumber’s
work, whioh gives just the sort of information that is
wanted in sanitary administration. Most house¬
holders of experience will agree with the general
proposition that “ all cheap plumbing is bad,
and good plumbing must be paid for.” Unfortunately,
the length of the tradesmen’s bill is not, in this instance,
an invariable guarantee that an adequate amount of
good work has been performed in return for the money
payment. Although this book was written in the first
place for the use of sanitary inspectors, it is of great
value to medical officers of health and to students of
sanitary subjects. Nor, should we imagine, does it fail
to find a large number of readers among architects and
builders. Tbe subject of the closure of schools has
hard y been given the prominence it deserves. Not only
is the agency in question undoubtedly answerable for
the enormous increase in diphtheria of late years, but
is concerned in other conditions, such as measles,
whooping-cough, and quite likely diarrhoea. The book
ends with an excellent abstract of the principal Acts
relating to Public Health.
WHITELEGGE’S PUBLIC HEALTH, (b)
This volume ushers in the seventh thousand of
Dr. Whitelegge’s well-known work. He has incorporated
in the text the more important recent developments in
many branches of hygiene. The Vaccination Act of 1898
will be ever memorable in the history of preventive
medicine. As the author remarks, it has “introduced
a momentous change in the administration of a depart¬
ment which has rendered incalculable benefit to the
(ai “Prac'ical 8initatlon.” By Oeorga Reid. M.D. Filth
Edition. London: Griffln and Co. IS!*'.
16 ) “Hygiene and Public Health.’ By B. Arthur Whitelegge,
M.D. London : Cassell and Co. IS!*!*. Seventh Thousand.
Digitized by GoOglC
496 T he Medical Press.
MEDICAL NEWS.
Nov. 8. 1899.
community, in a form which lends itself to statistical
demonstration.” A summary of the results of vaccination
is given, together with many tables and figures,
whereby the investigator is furnished with a veritable
mine of facts on which to found his conclusions. The
standard nature of this work need not be
enlarged upon. The reader will find a good illustration
of the author’s power of sifting out salient points and
of setting them forth in a clear condensed form if he
turns to the section dealing with the all-important
subject of school infection. A careful perusal of the
pages devoted to this point will place him in possession
of a key to all that is known about it. There is no need
to say that this book should be in the hands of all stu¬
dents of hygiene, because that advice is already anti¬
cipated. It should, however, also be on the bookshelf
of every well-educated medical pi-actitioner, for the
subject is one with which every branch of medical
practice is at one time or another intimately concerned.
The Universal Illusion of Free Will and Criminal Responsibility.
By A. Hamon. Pp. 138. Price 3s. 6d. net.
Darwin on Trial at the Old Bailey. By Democritus. Pp. 107.
Price 2s.
NEW BOOKS AND NEW EDITIONS.
The following have been received for Review since
the publication of our last monthly list:—
Baillieke, Tindall and Cox (London and Paris).
A Manual of Surgery for Students and Practitioners. By
William Rose, M.B., B.S., Lond. F.R.C.S., and AU«?rt Carless,
M.S., Lond., F.R.C.S. Second Edition. Pp. 1190. Price 21s.
An Introduction to Diseases of the Nervous System. By H.
Cnmpbell Thomson, M.D., M.B.C.P.. Lond. Pp. 124. Price
4s.
Difficult Digestion due to Displacements. By A. Symons Eccles,
M.B., M.R.C.S. Pp. 138. Price 4s.
Bale, Sons and Danielson, Ltd. (London).
On the Prevention of Eye Accidents Occurring in Trudes. By
Simeon Snell, F.R.C.S.Ed. Pp. 32. Pricels.net.
J. and A. Churchill (London).
Open-Air Treatment of Consumption. By Jane Walker, L.R.C.P.,
M.R.C S., M.D. (Brux). Pp. 15. Price Is.
Year-l>ook of Pharmacy, from July 1st, 1898, to June 30th, 1899,
with the Transactions of the Pharmaceutical Conference held
at Plymouth. Pp. 548.
H. J. Olaishf.r (London).
Cancer. By Thos. Wm. Nunn, F.R.C.S. Pp. 90. Price 2s.
P. S. Kino and Son i London).
Archives of Neurology from the Pathological Lul-oratory of the
London County Asylum. Edited by F. W. Mott, F.R S., M.D.,
F.R.C.P , Lond. Pp. 552. Price 15s.
Henri Lamkrtin iB ruxelles).
L'Annie Chirurgicale. Par le Docteur A. Depage. Premiere
Annee. Pp. 1,970.
H K. Lewis (London).
A Contribution to the Surgery of Fractures and Dislocations of
the Upper Extremity. By J. E. Platt, M.S., F.R C.S. Pp. 228.
Price 10s.
Rough Notes on Remedies. By Wm. Murray, M.D , F.B.C. P.
Lond. Third Edition. Pp. 142. Price 3s. 6d.
Text-Book of Ophthalmology. By Dr. Ernest Fuchs. Translated
by A. Duane, M D. Pp. 876. Price 21s.
The Anatomy of the Central Nervous System in Man and
Vertebrates in General. By Professor Ludwig Edinger. M.D.
Translated by Drs. W. S. Hail, P. L. Holland, and Edward P.
Carlton. Pp. 457. Pricel5s.net.
E and S. Livingstone (Edinburgh).
Materia Medica. Parti. Catechism Scries. (Author’s name not
given). Pp.72. Price Is.
Longmans, Green and Co. (London and Bombay).
Surgery, a Treatise for Students and Practitioners. By Thos. I*
Pick, Consulting Surgeon to St. George s Hospital. Pp. 1170
Price 25s.
Macmillan and Co. (London).
Differential Diagnosis with Clinical Memoranda. By Fred J
Smith, M.D.Oxon., F.R.C.P.Lond. Pp. 352. Price 7s. r„L net.'
Transactions of the .Tenner Institute of Preventive Medicine
Second Series. Pp. 253.
James Maclehose and Soxs (Glasgow).
Raynaud’s Disease; its History, Causes, and Treatment. Bv '
Thos. K. Monro, M.A., M.D. Pp. 230. J |
Oliver and Botd (Edinburgh). |
A , Manual of Modern Gastric Methods. Bv A. Lockhart
Gillespie, M.D F.R.C.P., F.R.S.Ed , with a Chapter on 1
Mechanical Methods in Young Children. By John Thomson,
in.i/., x P]>. !/.•>.
The University Press, Limited (Watford). J
The Pathology of Emotions. By Ch. Fir*. M. D., Paris. Trans- 1
lateil by Robert Park, M.D. Pp. 542. Price 15s.
4ttebical ^etoe.
The Medicine Sickness and Accident Society
The usual monthly meeting of the executive com-
1 mittee of the Medicine Sickness Annuity and Life
Assurance Society was held at 429, Strand. London.
W.C., on 27th ult. There were present Dr. de Havilland
Hall in the chair. Dr. J. B. Ball, Dr J. W. Hunt, Mr.
i F. S. Edwards, Dr. W. Knowsley 3ibley, Dr. M. Green¬
wood, Dr. Walter Smith, and Dr. Alfred S. Gubb. The
sickness experience of the Society during the summer
months has been much lighter than that of the early
| spring and is well under the amount expected.
I The list of those members who are permanently disabled
from professional work still grows and the amount of sick¬
ness benefit paid to them is one of the most important of the
Society’s disbursements. During August and September
a cash bonus was paid to the sickness benefit members
1 of over three years' standing at December 31st last. The
total amount so paid was a little over £5,000, and a few
cheques are still outstanding. The account will he
closed at the end of this month, and the balance trans¬
ferred to the Sickness Benefit Fund. Prospectuses and
all particulars on application to Mr. F. Addiscott, 8ec.
Medical 8ickness and Accident Society, 33, Chancery
Lane, London, W.C.
The Infectious Disease (Notification) Extension Act, 1899 .
A circular has been addressed from the Local Go¬
vernment Board to local authorities for whose districts
the Infections Disease (Notification) Act, 1899, has not
been adopted. The attention of the local authorities is
drawn to the effect which the Infectious Disease (Notifi¬
cation Extension Act, 1899), will have in extending the
operation of the Infectious Disease (Notification) Act,
1889. At present the provisions of the Act of 1889 are
in force in those urban, rural, or port sanitary districts
where that Act has been adopted by local authorities in
the prescribed manner. The effect, hewever, of section
1 (1) of the new Act, which comes into operation on
January 1st, 1900, will be to extend as from that date
those provisions to every urban, rural, and port sanitary
district in England and Wales, whether the principal
Act has or has not been previously adopted therein. The
circular is accompaniod by a memorandum of instruction,
to medical officers and a form of certificate.
The Transvaal and the R. A. M C.
Referring to the strain thrown by the outbreak of
hostilities in South Africa on the Royal Army Medical
Corps, the Civil and Military Gazette points out that the
strength of the corps is about 20 per cent, lower than
what it was thirty or forty years ago, and this notwith¬
standing an increase of the Army and a great extension
of its foreign duties. The present strength is about
840, or 50 below the figure (viz. 890) which the late
Sir Thomas Crawford, Director-General of the Army
Medical Department, fixed some fifteen years ago
as the absolute minimum, and that “ danger¬
ously low.” The consequence is that at present
about 90 officers on the retired list and a good number
of civilian practitioners are being employed in the home
military districts to discharge duties which should fall
to medical officers on the active list. Indeed, matters
are so bad that in one military district in England there
were lately only seven medical officers on the active list,
the proper complement being fixed at 19. There has
necessarily been for some time considerable difficulty in
granting army medical officers adequate leave ; and the
strain of a war in South Africa can only serve to
augment the difficulties of the authorities. It is
urged that the strength of the corps should be raised
to 1,000, but since candidates are not forthcoming in
sufficient numbers to fulfil the existing vacancies and
the concession of military titles has failed to attract
young doctors into the army, it is clear that some more
practical measures must be adopted. The authorities
Digitized by V
■oogle
Nov. 8, 1899. MEDICAL
have now made t wo attempts to work the reform § the
cheap by ringing the changes on ranks and titles in the
somewhat simple belief that sentimental marks of
esteem would be accepted in place of practical conces¬
sions. Their sanguine expectations have been' disap¬
pointed, and they must now face the unwelcome fact
that the market price must be paid in hard cash, and
not in fancy names or meaningless titles. At all events,
if the South African trouble develops into a big thing,
the demand for army doctors will so far exceed the
supply as to convince the War Office that the question
cannot be played with any longer.
Boyal College of Burgeons in Ireland.
At the opening of the Winter Session the following
prizes were awarded:—
Carmichael Scholarship—Miss M. J. Shire, £15.
Mayne Scholarship— D. A. Fitzgerald, .£15. Gold and
Silver Medals in Operative Surgery—C. R. Boyce,
gold medal; C. Myles and J. F. Peart (equal) silver
medal. Practical Histology—E. Evatt, first prize (£3)
and medal: A. Charles, second prize (£1) and certificate.
Practical Chemistry—E. C. Byrne and J. R. H. M‘Manus
(equal), first prize (2) and medal. Public Health and
Forensic Medicine—J. P. Byrne, first prize (£3) and
medal; E. Evatt. second prize (£1) and certificate.
Materia Medica—J. 8. Ashe, first prize (£3) and medal;
T. A. Dillon, second prize (£1) and certificate. Practical
Pharmacy—Miss J. C. Hargrave, first prize (£3). and
medal; W. Ormsby. second prize (£1) and certificate.
Biology—J. E- B. Buchanan and Miss J. C.
Hargrave (equal), first prize (£2) and medal.
Descriptive Anatomy—Junior, J. Cockburn. first prize
(£3) and medal; R. G. Allen, second prize (£1) and
certificate. Senior, A. Charles, first prize (£3) and
medal; T. A. Dillon, second prize (£1) and certificate.
Practical Anatomy—First year, R. G. Allen, first prize
(£3) and medal; R. W. Burkitt, second prize (£1) and
certificate. Second Year, A. Charles, first prize (£3)
and medal; C. W. Ewing, second prize (£1) and certi¬
ficate. Third Year, C. R. Boyce, first prize (£3) and
medal; J. F. Peart, second prize (£1) and certificate.
Practice of Medicine—J. P. Byrne, first prize (£3) and
medal; T. J. Tallon, second prize (£1) and certificate.
Surgery—J. S. P. Stewart, first prize (£3) and medal;
J. P. Byrne and W. R. Meredith (equal), second prize
(£1) and certificate. Midwifery—Mrs. H. L. Hennessy,
first prize (£3) and medal ; J. S. P. Stewart, second
prize (£1) and certificate. Physiology—Miss M. J.
Shire, first prize (£3) and medal; A. Charles, second
prize (£1) and certificate. Chemistry—T. Keogh, first
prize (£3) and medal; G. G. Tabuteau, second prize
(£1, and certificate. Pathology—J. F. Peart, first prize
(£3) and medal; H. Graff, second prize (£1) and certi-
fcate; and Physics—W. Ormsby, first prize (£3) and
medal; A. Ellenbogan, second prize (£1) and certificate.
The West London Hospital.
The annual dinner of the staff of the West London
Hospital took place at the Great Central Hotel on Wed¬
nesday, October 25tb, 1899, Mr. Percy Dunn being in
the chair. Out of twenty acceptances, seventeen mem¬
bers of the sts ff were present. After the usual loyal
toasts had been duly honoured, the chairman proposed
the toast of the “ West London Hospital,” in the course
of which he referred to the gratifying progress which
had been made in the organisation of the post-graduate
college in connection with the hospital, and to the bene¬
fits that were likely to accrue from the enlargement and
improvements now being effected in the out-patient
department. Afterwards the remiion resolved itself into
a committee, in which many matters were discussed
relative to the well-being of the hospital, and resolutions
passed thereupon. The toast of ‘ The Health of the
Chairman,” proposed by Mr. Keetley, brought the pro¬
ceedings to a close.
East Suburban Medical Protection and Medico-Ethical
Society, The West Ham Hospital, Stratford, E.
A general meeting of the above Society was held
at the Town Hall, Stratford, E., on November 7th, at
3‘15 p.m., when Mr. C. 8. Loch, the Secretary of the
NEWS. The Medical Press.
Charity ' Organisation Society, gave an address and
opened a discussion upon “ The Use of Medical Chari¬
ties,” the chair was taken by Fred. J. Smith, Esq.,
M.D., Physician to the London Hospital. The) follow¬
ing resolution was carried:—“That this meeting of
the East-Suburban .... Society and other Medical
Practitioners is of opinion that as a means of prevent¬
ing the misuse of medical charities—supported wholly
or in part by voluntary contributions—medical men
should be elected on the governing ami executive bodies
of such charities in a proportion of not less than 25 per
cent., such representatives to be periodically elected by
the medical practitioners in the vicinity, and hereby
invite the medical profession as a whole to support this
policy. That cop : es of this resolution be sent to the
various medical societies requesting their support; and
to the Press.” This was proposed by Murtaugh Hough¬
ton, Esq.
The Paris International Congress of Medicine, August, 1900.
The French Executive Committee have issued a notice
that every member of the Congress who desires to rhad
a paper at the forthcoming meeting must send the title
and an abstract of his paper to the proper sectional
secretary on or before May 1st, 1900. To facilitate this
f iroceeding the Executive Committee gives the following
ist of the secretaries with their addresses :—1. Compara¬
tive anatomy: Dr. Auguste Petit, 6, Rue Saint Andr(5
des Arts ; 2. Descriptive anatomy : Dr. Rieffel, 7, Rue de
l’Ecole de Medecine; 3. Histology and embryology : Dr.
Retterer and Dr. Loisel, 15, Rue de l’Ecole de Medecine ;
4. Physiology, with biological physics and chemistry : Dr.
Dastre at the Sorbonne : Dr. Gley, 14, Rue Monsieur le
Prince: Dr. Weiss, 20, Avenue Jules Janin ; 5. General and
experimental pathology: Dr.Charrin.ll, Avenue del'Opera,
Dr. Roger, 4, Rue Perrault; 6. Pathological anatomy:
Dr. Letulle, 7, Rue de Magdebourg: 7. Internal patho¬
logy, corresponding to our Section of Medicine in part:
Dr. Rendu, 23, Rue de l’Universit^, Dr. F. Widal,
155, Boulevard Haussmann; 8. The medical diseases
of childhood : Dr. Marfan. 30, Rue la Boetie; 9. Thera¬
peutics : Dr. Gilbert, 27, Rue de Rome ; 10. Pharmaco¬
logy : Dr. Chassevant, 70, Rue de Rennes; 11. Materia
Medica: Dr. Chassevant, 70, Rue de Rennes. 12. Neur¬
ology : Dr. P. Marie, 3, Rue < 'ambaceres; 13.
Psychiatry: Dr. Ant. Ritti, The Cliarenton Asylum,
Seine; 14. Dermatology and Svphilograpy: Dr. G.
Thibierge, 7, Rue do Suresne; 15. General surgery : Dr.
Walther, 21, Boulevard Haussmann; 16. Surgery of
children: Dr. A. Broca, 5, Rue de l’Universite—Dr.
Villemin, 58, Rue Rue Notre Dame des Champs; 17.
Urinary 6urgery: Dr. Desnos, 31, Rue de Rome; 18.
Ophthalmology: Dr. Parent, 20, Avenue de l’Opera ; 19.
Laryngology and Rhinology ; Dr. Lermoyez, 20 bis, Rue
la Boctie; 20 Otology: Dr. Castex, 30, Avenue de
Messine; 21. Stomatology, including certain dental
diseases: Dr. Ferrier, 39. Rue Boissy d’Anglas;
, 22. Obstetrics: Dr. A. Bar, 122 Rue La Boetie;
Dr. Champetier de Ribes, 28, Rue de TUniversite;
23. Gynaecology: Dr. Hartmann, 4, Place Males-
herbes: 24. Forensic medicine: Dr. Motet, 161,
Rue de Charonne; Dr. Thoinot, 8. P.ue de l'Odeon ; 25.
Military medicine and surgery: Dr. the Minister of
War, Paris; 26. Naval medicine: Dr Laugier, the
Minister of the Marine, Paris ; 27. Colonial medicine:
Mons. Kermorgant. the Colonial Ministry, Paris. The
names of those duly qualified medical men who desire
to attend the Congress, with a visiting card and the
subscription of £1. should he sent to either of the
Honorary Secretaries of the International Committee
for the United Kingdom—Dr. Garrod, 9. Chandos
Street, London, W.; or to Mr. D’Arcy Power, 10a,
Chandos Street, London, W.
The Medico Psychological Association.
The date of examination for the certificate of this
Association will be December 14th. The examination
will be held simultaneously in London, Edinburgh,
Glasgow, Dublin, Aberdeen, and Cork. Candidates
intending to present themselves mu9t give fourteen
dajs’ notice to the Registrar, Dr. Benham, Fishponds
Asylum, Bristol. Fuller particulars will be found in our
advertising columns.
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Reading Cases.— Cloth board cases, gilt lettered, containing
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akd Circular, may now be had at either office of this journal,
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the post.
Reprints.—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 l>efore the type is
broken up.
A PHILANTHROPIC ADVERTISEMENT.
We have been asked to give publicity to the offer of a certain firm
of dentists, who shall be nameless, to supply a hundred sets of teeth
every year gratis to tne poor. For reasons which our readers would
appreciated we disclosed the identity of these peeudo-pb ilanthro-
pists, we find ourselves unable to comply with the request, the
more so seeing that none of our readers are likely to wish to avail
themselves of this largtue.
H. S.—No one heeds the vapourings of the little journal referred
to, and the publication of your letter would do it unappreciated
honour.
ALIMENTARY VIVISECTION.
A correspondent calls attention to the advertisement of Benoist's
Real Turtle Soun which is “ guaranteed to be made from the live
turtle only," and he suggests that if this claim be authentic the
Society for the Prevention of Cruelty to Animals, or the Anti-Vivi¬
section Society, ought to take action. It may be surmised that the
sentence in question is not really intended to bear the construction
which our correspondent puts upon it, but the manufacturer will
doubtless enlighten our readers on this point.
M. L. S.-The renovation of the drains is an expense the incidence
whereof will depend upon the terms on which you hold the
premises. If you have subscribed to a repairing lease, the cost, we
imagine, would fall upon the tenant, e.g., yourself.
ANTI-FLEA MEDICATION.
A correspondent writes: -The suggestion to take sulphur dragus
as a protection against the bites of fleas, ef hoc genui omne, though
original, will, I fear, not commend itself for general adoption by
those who suffer from the close attention of the lively flea. The
cure would, I fancy, be found worse than the disease, as those using
the sulphur would (to say the least) be in “ bad odour ” with their
acquaintances, and at once convey the information to those who
had heard of the sulphur "preventive" that the users evidently
suffered from “ Phlebitis " !
Anti-Boer.— 1 The initial velocity of the ballets of the service rifles
of various European armies differs. That of the Lee-Metford is
2,000 feet per second, that of the French Lebel 2,073, tliat of the
German Mjumlicher 2,034, of the Spanish Mauser 2,285, of the Italian
Carcano 2,329. The Boers are said to be armed principally with the
Mauser, which, so far as penetrating power is concerned, judging
from the initial velocity of its projectile, is a very serviceable
weapon.
A. T. Y.-We have considered the subject of our correspondent's
complaint, and will send him a private note.
J. R. (Coluhrook).—You are certainly entitled to charge for the
visit, even though you were unable, under the circumstances, to
take j>art in the treatment. It would, however, be wise to bear this
fact in mind in estimating the value of the time occupied in going
to and fro.
Jfteetings of the Societies anil lectures.
Wednesday, November 8th.
Hunterian Society.— 8.30 p.m. Discussion on the Treatment of
Typhoid Fever (opeued by Dr. N. Pitt).
St. John's Hospital for Diseases of the Skin.—*. 30 p.m. Dr.
T. D. Savill: Prurigo and Pruritus. (Post-graduate Course.)
Thursday, November 9th.
Ophthalmolooical Societt of the United Kingdom.-8 p.m.
Card Specimens. 8.30 p.m. Papers:—Mr. A. Lawson: Corneal
Horns.—Mr. E. T. Collins and Mr. C. D. Marshall : Two Cases of
Primary Tumour of the Optic Nerve.—Mr. J. Griffith: Iritis a
sequel of Gonorrlicea. .
British Gynecological Society (20, Hanover Square,
8 p.m. Specimens will be shown by I>r. Purcell, Dr. H. Snow, and
>lr. Bowreinnn Jessett. Papers : Dr. K. H. Hodgsou : A Case of
Tuberculous Peritonitis simulating Abdominal Tumour, Operation,
Recovery.—Dr. J. Oliver: On the PhysicoChemical Conditions con¬
cerned in the production of Version of the Uterus. .
Central London Throat, Nose, and Ear Hospital— 5 p.m.
Dr. D. Grant: Differential Diagnosis of Nasal Obstructions.
Friday, November 10th.
* Clinical Society of London (20, Hanover Square, W.).—8.30
.m. Papers :— Mr. H. B. Robinson : Acute Intestinal Obstruction
ue to an Intussusception of Meckel's Diverticulum.—Mr. J. Bland
Sutton: On a Case in which Primary Nephrectomy was performed
for complete Rupture of a Kidney.—Dr. N. Dalton: A Case of
Enlarged Spleen due to Congenital Volvulus of the Stomach and
Tranverse Colon and simulating Splenic Anaemia.
Bacaraue.
Bracebridge Asylum, Lincoln.—Junior Assistant Medical Officer*
unmarried. Salary £125 per annum, with furnished apartments*
board, attendance, 4c.
Cumberland.—Qualified Indoor Assistant. Salary £100. Apply,
“Cumberland,” Medical Press Office, Dublin. (See Advert.).
Infirmary of the City of London Union.—Assistant Medical Super¬
intendent at the Infirmary of the Union, Bow. Salary £150 per
annum, with furnished aoartments at the Infirmary, rations,
and washing. Apply to the Clerk to the Guardians, 61, Bortho-
mew-close, E.C.
Preston Royal Infirmary.—Assistant House Surgeon. Salary £50
per annum, with boom, lodging, au J washing, 4c.
Royal Infirmary, Hull.—House Surgeon for two years, unmarried.
Salary, 100 guineas per annum, with board and furnished apart¬
ments.
Suffolk General Hospital.—House Surgeon. 8alary, £100 a year,
with board, lodging, and washing. Apply to the Secretary, Bury
St. Edmunds.
Three Counties Asylum.—Assistant Medical Officer, unmarried.
Salary commencing at £124 per annum, with board, apartments,
washing, and attendance. Apply to the Clerk to the Visiting
Committee, St. Neots, Hunts.
r&ppomtmentfi.
Barker, W. H., L.R.C.P.Edin., M.R.C.S., Medical Superintendent
for the Ararat Lunatic Asylum, Victoria, Australia.
Boon, J. G., L.B.C.P., L.R.C.S.,Irel., Medical Officer for theBroseley
Sanitary District of Shropshire.
Bradford, P. P , L.R.C.P., M R.C.S., Medical Officer for the Brack¬
nell Sanitary District of the EasthampBtead Union.
Bunbury, Edward Garrett, L.R.C.P.Lond., M.R.C.S., Civil Sur¬
geon, has been appointed to the temporary medical charge of
the troops at Bristol in the medical staff of the district.
Butterworth, J. J., M.B., B.Cli., Junior House Surgeou to the
Manchester Royal Eye Hospital.
Church, B. E , L.S.A.Lond., Medical Officer for the Fourth Sani¬
tary District of the Stroud Union.
Clegg, J. Gray, M.D , B.8., F.B.C.S., Honorary Assistant Surgeon
to the Manchester Royal Eve Hospital.
Dunwoody, W. G., M.D., B.Ch Dub., Medical Officer of the Ely
Workhouse.
Harris, 8 . C., L.F.P.S.Glasg., Medical Officer for St. Mary’s Parish,
Ely.
McLaren, J. B., M.B., B.Ch.Irel., Medical Officer for the Work-
house of the Salford Union.
Middlemist, R. C., L.R.C.P.Lond., M.R.C.S., Medical Officer for the
Ryhall Sanitary District of the Stamford Union.
Sanford, J. C., Civil Surgeon, to the medical charge of the troops
at Bodmin.
8tanwell, St. John, M.B., C.M.Ed., M.R.C.S., Medical Officer for
the B&raack Sanitary District of the Stamford Union.
Whitblaw, F., LK.C.P.Lond., M.R.C.S., Medical Officer for the
Second Sanitary District of the Holsworthy Union.
girths.
Best. - On October 31st, at 1, Cambridge Terrace, Dover, the wife of
W. J. Duncan Best, M.B.C.S.Eng., L.S.A.Lond., of a daughter.
Blomfield.— On November 1st, the wife of Geo. Wills Blomfield,
M.B.C.S.Eng., L.R.C.P.Lond., and L.S.A.Lond., Horsefair,
Pontefract, of a son.
Galletly.—O n November 2nd, at Sycamore House, Northwold,
Norfolk, the wife of Wm. Gloag Galletly, M.B., C M., of a son.
Holden.—O n November 6th, at 168, Castle-hill, Beading, the wife of
George Herbert Rose Holden, M.A., M.D., Cantab, of a son.
Jterri ages.
Black—Anderson— On November 2nd, at Trinity Church, Hamp¬
stead, Cuptain W. C. Black, Indian Staff Corps, son of the late
Robert J. Black, M.D., to Hope Gordon, youngest daughter of
the late John Anderson, Esq.
Home-Boss— Harrel. —On November 2nd, at St. George’s, Hanover
Square, London, J. Houie-Ross, F.B.C.P.Ed., only son of
Major Hamilton Robb (lute I.M.S.), Ballynacreena House, Co.
.T Antrim, to Maude, elder daughter of Sir David Harrel, K.C.B.,
Dublin.
Scathe.
Mackey.— October 24th, nt 85, Finborougli Rond, South Kensington,
after a protracted illness, of typhoid fever, Stephen William
Mnckey, L.K.C.S.I., L.R.C.P., L.M , aged 49 years.
McCarthy. —October 24th, at Wingfield, St. Mary Church, Torquay,
Michael Joseph McCarthy, late Fleet-Surgeon, B.N., aged 45.
Digitized by Google
ms and ffiirrular.
“BALU8 POPULI 8UPREMA LEX.*
Vol. CXIX. WEDNESDAY, NOVEMBER 15, 1899. No. 20.
Vienna Clinical lecture.
ALIMENTARY GLYCOSURIA. IN
PREGNANCY.
By Db. HOFBAUER,
Of Prof. Schauta'i Clinic of Gyna’coIoKy. Vienna.
The glycosuria tsi .pregnancy has recently become
one of the most important subjects for investigation
in gynaecology that modern science has to solve, and
may probably result in the establishment of another
diagnostic sign of that physiological condition that
has puzzled clinicians in the past when a forensic
test has to be applied. It is not long since Strumpell
and Strauss Btartled us with the announcement that
sugar in the urine of a pregnant woman was a
normal physiological condition. Why it should
appear in pregnancy in a healthy state and dis¬
appear after parturition was on the first glance
easily explained by pressure, reflex, Ac., Ac.; but when
it was discovered that other pathological pressures
such as tumours, moles, Ac., did not produce this
saccharine condition, the wonder began to increase
where the limit ceased.
In the normal healthy organism large quantities
of saccharine matter can be absorbed, assimilated,
and burned in the body without any appearanoe of
glycosuria, but in the case of pregnancy commencing
in the second month some defect occurs in the as¬
similation as the blood soon becomes hyper-glucffimic
which is thereafter rapidly eliminated by the renal
organa Various theories have been propounded for
this phenomenon, and among the firmist offered is
an alteration of the nerve system giving rise to the
term neurogenic glyoosuria. Another views this
with soepticism, and advocates a toxic condition as
the proximate cause of the disorder of which we have
testimony in alcoholic, lead, and opium poisoning,
giving rise to the term toxigenic glycosuria. Noorden
has still another form, which he has demonstrated
in acute fevers, and to which he has applied the term
febrile glyoosuria.
Among the first to put these theories in some
measure to the test in pregnancy were Lanz and
Jacksch, but feeling dissatisfied with some of the
results commenced, under the guidance of my chief,
Professor Schauta, to oonfirm or disprove some of the
anomalies in the records that lead by inference to
different conclusions. The first step was to discover
the earliest period that sugar appeared, which was
found to be the seoond month of pregnancy.
The next point was to discover how much sugar could
be taken in without interfering with this assimulative
disorder. The first step was to keep a register of the
urine for several days before commencing the experi¬
ment. After this one hundred grammes of chemically
pure grape sugar were given lasting every morning
in coffee or brandy and water, and after an interval
of one-and-a-half to two hours, the urine was drawn
off by means of a catheter and carefully analysed.
This arrangement had no perceptible effect on that
e atient's appetite as she took her breakfast as
eartily as ii no experiment were carried on. Carbo¬
hydrates, it may De noted, were not allowed to be
used during the periods of examination.
Forty-five cases in different stages of pregnancy
were thus treated, at the same time keeping as near
the examples of Lanz, so thus any discrepancy might
be instantly observed in the corresponding epochs.
Thirty-nine of the cases gave positive results, the
other being before the end of tne second month of
pregnancy, when the saccharine condition of the
urine commences and is found to gradually increase
till the end of pregnancy, thus confirming the
assumption that toe assimilation limit is gradually
reduced as the uterus increases.
With this recent knowledge before us it might be
expected, from a forensic point of view, that the
preeenoe of sugar in the urine would be an infallible
confirmation of the pregnant state. That, as far as
we know at present, is a faithful diagnostic symptom
in the normal physiological condition, but, unhappily
for us, the pathological gravid state gives negative
results, and for what reason cannot yet be clearly
elucidated.
In ectopic pregnancy, for instance, I find that out
of eight cases none of them had glyoosuria, although
all snorted, with hsematocele forming in some. The
formation, growth, and expulsion of moles had an
equally negative result. There is another particular
worthy of note where intra-uterine life goes all right
till the death of the foetus, when sugar disappears in
the urine as if no pregnancy had occurred.
These facts inevitably force us to the conclusion
that glyoosuria is a normal physiological condition
where the growth and development of the ovum is
undisturbed; that the presence of alimentary glyco¬
suria is due to some alteration caused by the retention
of the fructifying germ in the uterus. Lanz
attempted to prove from his experiments that this
alimentary glyoosuria in pregnancy was analogous to
Bunge’s, who found that the glycosuria was due to
an absence of iron in the food taken by the pregnant
female. This idea has happily been abandoned for
changes in the nerve system; alterations in the
circulation of the blood which may affect the internal
organs of the abdomen, and thus modify the meta¬
morphosis during the gravid period.
From the inference obtained by animal experiments
a this transitory form of, glycosuria is due to injury of
the glycogenic apparatus which first produces hyper¬
glycemia, and subsequently glyoosuria. Nothing,
however, can be traced to any lesion to account for
the temporary preeenoe of sugar; indeed, the
opposite exists as we have seen in pathological condi¬
tions where no sugar is to be found.
This phenomenon has led investigators to.pxplore,
the blood with no more satisfactory results. No
pathological product of any note except the gluooee
can be discovered. Livievato who has spent a
Digitized by
ORIGINAL COMMUNICATIONS.
Nov. 15, 1899.
500 The Medical Press.
considerable portion of his life at the subject, affirms
that the glycogen is easily demonstrated, and that a
form of leucocytosis coincides with the terminal part
of pregnancy when the glycogen can be found both
intra- and extra- cellular. On the first day after
parturition the cells begin to lose this glycogen yrhich
rapidly disappears from the blood altogether in'a few
days after.
I have made repeated examination of the colostrum
in the gravid state with Ehrlich iodine—mucilage—
solution, which is composed of pure iodine 1*0 gramme,
potassium iodide 3 0 grammes, and mucilage of
gum acacia 100’0 grammes. Under the microscope
the oellular element had the characteristic brown
colouring; some had dark granular nuclei and
flukes; others with diffuse colouring of the cell
plasma. My results might be considered nega¬
tive, as no differentiation from other diseases
in gynaecology could be deduced. I have been
unable to throw any light on the controversy
which still rages concerning these micro-chemical
reactions in the presence of iodine which Ehrlich
affirms proves the presence of glycogen, while Kuhz
positively affirms the contrary. There is no doubt of
the iodine reaction, but how it is to be interpreted we
cannot determine with any amount of accuracy;
possibly it iB due to some deep structural changes
in the blood and colostrum during pregnancy that
we are not yet able, chemically, to follow with
precision.
THE TREATMENT OF ACUTE
PSYCHOSES BY REST IN BED.
By Dr. P. SERIEUX,
Physician to the Asylum for the Insane for the Department of
the Seine.
[Specially Translated fob The Medical Press and
Circular.]
Treatises -and special reviews of therapeutics
usually deal very briefly with the treatment of
mental disease. This domain is for many terra
incognita, and in the absence of facts mere sur¬
mises are accepted. It is generally believed that
all psychoses are incurable, though in reality a
cure is effected in 60 per cent, of the cases.
The douche, the strait jacket, and the padded
cell are still held by ’ many to be the only things
to which lunatics are amenable, though these
methods of treatment have been rejected by
modern psychologists. It is quite unnecessary to
insist on the disastrous consequences of such
prejudices. On the one hand, cases are not altogether
rare in which the doctor, called to a patient with
an attack of acute mental di«order—a disease emi¬
nently curable—can, and ought to resort forthwith
to active measures ; on the other hand the beginning
of mental disorders is a critical phase, as regards the
efficacity of medical intervention. The future of the
patient often depends on the treatment adopted at
the very outset of the mischief.
We propose to describe here a method employed
with great success in acute cases of mental disease,
viz., rest in bed. This treatment is quite easy of
application either for private patients or in special
institutions. Moreover, its immediate results in the
cure of diseases of the brain as well as its indirect
consequences in respect of the organisation of lunatic
asylumB, render treatment by rest in bed an
innovation of the greatest importance. It is
the commencement of a new era in the history of
mental therapeutics. This very simple method will
certainly transform the therapeutics of mental
diseases and give us a fresh idea of how best to
ameliorate the condition of the insane.
Before entering upon the subject of the physio¬
logical effect of this treatment, its results and its
drawbacks, we must briefly discuss the means of
carrying it out—the technique, in fact. One of the
chief advantages is its simplicity; it does not require
any special appliances and is applicable under all
circumstances. Moreover,- it dees not oblige the
patient to enter an asylum. •-..
According to Schmidt, women are more refractory
to the treatment than men. In certain cases (acute
mania, restless melancholia, and pronounced halluci¬
natory confusion of ideas) the patients are with
difficulty kept continuously in bed, but even when
this is the case mechanical restraint by means of
strait-jackets, Ac., should be absolutely discarded.
If the patient resents being kept in bed, we must
imitate M. Magnan, who persuades them that they
are ill, that they are feverish, and that rest in bed is
necessary. For certain patients (paralytics, Ac.), it
is often sufficient to feed them, to supply them with
newspapers, Ac., for their objection to vanish. Often
the mere presence of a nurse seated by the bedside
and talking to the patient, holding his hand, apart
from any more active measures, will obviate their
desire to get up, even if markedly agitated. In
cases of great and persistent excitement we may
advantageously employ a bed on the floor, with
the walls padded to a height of a yard or so;
prolonged oaths and hjrpnotics may also render
service. Should these various measures prove in¬
adequate, which is exceptional, and if the gentle
suasion of one or two attendants has not the desired
effect of inducing the patient to remain in bed,
we must, nevertheless, avoid all struggling and all
violence.
The patient is allowed to give the rein to his desire
for movement, either in the ward, in the garden,
or in an isolated room in which he should only be left
for a short time, under close observation. When the
crisis is over, an attempt should be made to exercise
persuasion. The excitement is never permanent tn
the same patient, and it soon subsides. One important
point to which attention must be called is that the
treatment by rest in bed can be practised in our
asylums without necessitating any costly appliances.
There are, however, sundry dispositions which may
prove advantageous, though by no means indispen¬
sable. The ward should be on the ground floor on a
level with a conservatory, and looking on to a garden.
Special attention should be paid to the ventilation
and heating of this room. It is unnecessary to insist
upon the obvious importance of perfect aeration
and light in a place inhabited day and night by the
patients. The most useful accessories are hinged panes,
Hitsig’s windows, the use of perforated panes of
glass, blinds, Ac., and the room should be rendered
cheerful by flowers and other ornaments. The bath¬
room should be adjacent to the ward, and in some Ger¬
man institutions the bathroom and w..c. are combined.
It has been found convenient to provide two wards,
one being reserved for turbulent patients, having
attached to it isolation rooms. The bed should, for
hygienic reasons, be tolerably hard and rather low,
in order to facilitate restraint should this be neces¬
sary, and also to minimise the ever-present risk of
injury from a fall. The beds, or some of them,
should be readily movable, so as to allow of their
being wheeled into the verandah. There must be an
adequate supply of blankets, and special attention
must be paid to the temperature of the bed, especially
in cases where there is oedema or cyanosis of the
extremities (melancholia). The temperature of the
ward should be the same night and day, and high
enough not to expose the patient to the risk of taking
cold even if he throws off the bedclothes.
Needless to add that the sheets should be kept
irreproachably clean, and that folds and crumbs are
Digitized by G00gk
Nov. 15. 1899.
ORIGINAL COMMUNICATIONS. Tbi Mxdical Pause. 501
to be avoided. The bed should be made twice a day.
Among other devices employed in this treatment
are screens, in order to give the impression of isola¬
tion, mattresses, of which the part corresponding to
the patient's head can be raised to serve as a support
for the back, and to enable the patient to sit up in
bed without fatigue, a table by the side of the bed to
facilitate the taking of meals, and lastly beds on the
floor as already described.
At the commencement of the treatment, at any
rate, the patient should be kept continuously in bed.
He should lie flat in bed, u it is only in the horizontal
position that oomplete rest is secured. Weir-
Mitchell's method need not be too closely followed ;
indeed, we are of opinion that in the majority of
cases it is preferable to relax the strict rules laid
down by him for the treatment of neurasthenia. The
patient may therefore be allowed to get up in order
to discharge his natural functions, to take his baths,
and even in some cases to breathe a more invigorat¬
ing air in the garden. He should also be authorised
to read and write, but meals must be taken in bed.
It is quite impossible to lay down any general rules,
but the patient should leave his bed as seldom as
possible at the beginning of the treatment. In
asylums our practice is to allow most of the inmates
to get up for naif an hour during the morning, and this :
interval should be devoted to discharging the bodily
functions (assisted, if need be, by an enema), washing,
douches, and baths, which should be employed daily.
During this interval, moreover, the ward should be
thoroughly ventilated, the beds aired, the windows
cleaned, and the beds carefully made.
Later on, as the patient improves, and the psycbi-
cal symptoms subside, the treatment may be
gradually modified by allowing the patient to lie on a
sofa in the verandah, and to sit at table for his meals.
Later on still he may get up for two or three hours
in the afternoon, and finally, when he is well on the
road to recovery, the patient may be allowed to get
up daily after lunch.
The duration of the treatment naturally varies with¬
in wide limits. In certain acute cases, such as alcoho¬
lic, hysterical, and epileptic mania, the patient may
become calm and sensible within a few days, some¬
times even within a few hours. In neurasthenia,
Weir-Mitchell enjoins complete rest in bed for a
period of from six weeks to two months, and he
asserts that to allow the patient to get up too soon
is to risk his forfeiting any gain in weight that he
has acquired, and to cause the reappearance of
symptoms of exhaustion.
In the majority of cases of the acute psychoses, the
treatment by rest in bed should be enjoined for at least
six weeks. Guislain advises rest for the first two
or three months of the disease. If the malady per¬
sists for several months, if the appetite is satisfactory,
and the mental symptoms have become less acute, it
is hardly necessary to say that the patient need not
be kept in bed continuously. The bed-treatment
should only be applied iq all its rigour during periods
of exacerbation, the patient passing only the forenoon
in bed during the intervals. As a general rule, in the
absence of special indications, it does not appear
advisable for a patient to be kept constantly in Ded
for more than-two months.
We may add that the treatment by rest in bed does
not constitute the Alpha and the Omega of the
therapeutics of the acute psychoses. Although this
treatment, as we shall presently show, is one of the
most valuable acquisitions of modem psychiatry, it
must not be loosed upon as a universal panacea.
According to the indications, it will require to be
associated with various other therapeutical measures,
such as hyper-alimentation, hydrotherapy, massage,
Swedish gymnastics, electro-therapy, the opium cure,
hypnotics, strychnine, Ac., Ac.
I f the physiological effects of exercise are well
known, the same cannot be said of the physiological
effects of absolute rest in bed. This aspect oi the
question doee not as yet repose on precise data
gleaned from the results of prolonged bed treatment,
and so far our investigations have been conducted
on a purely empirical basis.
Dr. Guy, an English physician, found that rest in
bed had a marked effect on the pulse, and that the
average pulse rate in men between 25 and 50 years of
age was <0 05 pulsations in the sitting position, whilst
in the horizontal position it was only 6662. In
women of the same age it varied from 81'98 to 80 - 24,
while in children between 11 and 15 years old, the
rate was from 91 to 90. Fonssagrives always re¬
corded five or six pulsations less in the horizontal
than in the erect position. The moderating action of
the dorsal decubitus with respect to the heart beat,
is, indeed, well recognised; Weir-Mitchell states that
the diminution of arterial pulsation is equal to twenty
per minute; Roehrich, however, only recorded a loss
of from four to eight pulsations.
Rest in bed does not act only on the heart, but also
on the peripheral circulation. The horizontal posi¬
tion suppresses the influence of gravity, and it there¬
fore favours hypersemia of the brain and a readier
return of the venous blood from the lower limbs to
the heart. This influence is far from being
insignificant, especially in certain diseases, such as
melancholia, in which the force of cardiac contrac¬
tion is markedly decreased. From another point of
view, the peripheral circulation is modified by the
more or less complete suppression of muscular con¬
traction. Lagrange describes the muscles as the
organs of the circulation (the peripheral heart). This
contraction accelerates the flow of blood in the veins,
and if this contraction is wanting, there is a tendency
to blood stasis in the limbs. With patients who
remain standing and motionless for long periods of
time, the fact that rest in bed exerts a satisfactory
influence on oedema and cyanosis is easily explained.
All authorities recognise that the horizontal
position produces a marked slowing of the respiratory
movements. According to Viault and Jolyet, the 23
respirations, which is the average in a standing adult,
falls to 19 in a sitting position, and to 13 in the
horizontal position:
Looking at the question from the point - of view
of general therapeutics, Manquat concludes that rest in
bed is a valuable means of treatment in acute disease,
in that it leaves all the strength of the organism free
to assist in recovery; it moderates the movement of
the heart and’respiration, and checks metabolism.
Quite recently experiments have been carried out
under M. Toulouse with the object of ascertaining
the physiological effects of rest in bed. Mr. Lacombe
noted the slowing of the pulse and of the respiratory
movements, the fall of the central temperature, and
an increase of arterial tension.
Drs. Toulouse and Marchand- recently published
the result of their observations on the variations in
weight produced by this treatment. Rest in bed,
according to these authors, atfirst reduces the weight,
it accentuates the process of emaciation in per¬
sons with a tendency to cachexia, such as general
paralytics, and in those whose tendency is to put on
flesh, in convalescents, for example, it tends to oheck
any further increase in weight.
These conclusions must be received with some hesi¬
tation, they can only be explained by the loss of appe¬
tite, which results from prolonged rest in bed ana by
the absence of all muscular exercise. Moreover, Weir-
Mitchell observed an actual increase of weight among
neurasthenic patients kept in bed, and Neisser re¬
cords the same effect in epileptics. Roedrioh lias
also observed a rapid rise in the weight curve in cases
of acute mania, melancholia, primary mental con-
D
lO
°g
Nov. 15, 1899.
502 The Medical Fiess. ORIGINAL COMMUNICATIONS.
fusion, and acute hallucinations treated by rest in
bed, the increasing varying from 300 to 400 grs. a
day. We must also bear in mind that for several
years past Professor Hayem and other therapeutists
(Ewala, Yon Ziemssen, Nothnagel, Quincke, and A.
Robin) have adopted the treatment by rest in bed
for chlorotic and aneemic patients. The application
of the method has a marked effect in ohecking the
destruction of red corpuscles which the least mus¬
cular exertion causes m chlorotic patients, and, in
addition it indirectly assists digestion by obliging
the patient to quit wearing stays.
In short, rest in bed modifies and regulates both
the cardiac function and respiratory movement,
increasing arterial tension and lowering the central
temperature. It checks the destruction of red blood
corpuscles, and lastly it slows the process of intra¬
cellular oxidation, and consequently retards dis-
assimilation, thereby favouring a gain of weight. In
certain cases this economy in tn» matter of com¬
bustibles may be compensated by loss of appetite,
followed by loss of weight (Toulouse and Marchand).
(7o be continued.)
NOTES ON THE
BACTERIOLOGY OF THE RHEU¬
MATIC AND ALLIED DISEASES.
By ARTHUR S. WOHLMANN, M.D., B.S. Lond.,
Bath.
During the last ten years the belief has been
gradually gaining ground that the rheumatic diseases
are of microbial origin. Clinical evidence and analogy
point so strongly in this direction that, even with¬
out bacteriological confirmation, the presumption
amounts almost to a certainty.
It must be admitted, however, that the bacterio¬
logical proofs of the belief have been somewhat
unsatisfactory, there being considerable discrepancy
in the results of different observers. This is attribut¬
able, in part at least, to the unfortunate nomen¬
clature adopted in regard to the “rheumatic”
diseases, and before discussing the microbes described
I would clear the ground by the adoption of a definite
and reasonable classification. I would divide these
diseases provisionally into four main groups.
1. Rheumatism. —(a) Acute rheumatism, and when
this passes into a chronic subacute form (b) chronic
rheumatism, which I would distinguish absolutely
from “ rheumatic gout ” or “ rheumatoid arthritis.”
2. Gout.—(a) Acute gout, (ft) Chronic gout with
the same remarks.
3. Pernicious Arthritis whioh I would substitute for
rheumatoid arthritis, a term which has been so loosely
applied as to have lost all significance. Abroad the
tenn “multiple arthritis deformans” has been largely
used. By pernicious arthritis I mean a disease with the
most pronounced and defiinite characteristics: a
subacute painful polyarthritis, affecting mostly
women, symmetrical, causing spindle-shaped swellings
of the joints, and no osteophytic thickening or
lipping of bone. In addition there are various
trophic and toxic symptoms, such as muscular
atrophies, glossy skin, cold, dripping-wet palms, pig¬
mentation, anaemia, Ac., the whole forming a perfectly
definite clinical picture. (The points in diagnosis
were illustrated by casts painted from life.)
4. Osteo-Arthritis, a chronic condition characterised
by osteophytic formation and eburnation of bone. It
may oocur as the result of wear and tear, or as the
final stage of rheumatism, pernicious arthritis, or
gout, modified as to details of shape by the preced¬
ing diseases, but as distinct from these as is the
dense envelope of connective tissue round an em¬
bedded bullet from the initial lesion.
It is obvious that in this disease one would not
look for a microbial origin, while in acute rheumatism
and in pernicious arthritis such an origin might
reasonably be inferred.
Bacterwloay of Acute Rheumatism —The work of
the principal English and foreign investigators was
passed in review from Mantle in 1887 to Singer in
1897. . Guttmann, Birch Hirscbfield, Bouchard and
Charrin, Triboulet, Sahli, S&caze, Grim, and Singer
found various cocci, either staphylococci or strepto¬
cocci, while Achalme, LucateUo, Leyden, and Riva
found special organisms. The results of Achalme
were confirmed by Thiroloix and by Treboulet and
Coyon. These latter observers, however, found that
Achalim’s bacillus was frequently associated with a
diplocoocus, and was only present alone in severe
cases.
Examining the heart-blood and the cerebro-spinal
fluid in two cases of acute rheumatism immediately
after death, Achalme found in enormous numbers,
and in pure culture, a large bacillus resembling that
of anthrax Examining the blood of six living cases
he found the same bacillus in pure culture m four
cases, and associated with microoocc in two. The
bacillus stained easily with aniline dyes, or by
Weigert’s or Gram’s method, but best with feebly
alkaline methylene blue. It was absolutely anaerobic,
and grew best in liquid media, horse bouillon with a
little glycerine being best of all, at a temperature of
30 degs. to 38 degs. C.
Sporulation was best observed in the amniotic fluid
of a rabbit killed by inoculation. On the third or
fourth day a spore appeared at the end of the bacillus,
whioh assumed a bell-clapper form. The results of
animal innoculation were described, and some
interesting observations made with regard to its
reaction to salicylates and its precipitating effect on
urates in urine. A number of microscopic specimens
were exhibited showing the bacillus.
Achalme concluded that the bacillus in pure cul¬
ture at first caused acute rheumatism, but that it
seemed to “ open the door to the microbes of secon¬
dary infection, which may persist alone at the decline
of the disease, and this would explain the numerous
cases in which they have appeared to be the patho¬
genic agents of rheumatism.
Pernicious Arthritis.— Schiiller'8 bacillus was
described, and a short account followed of the diplo-
bacillus, which the author, Dr. Bannatyue, and Dr.
Blaxall found in the synovial fluid of patients
suffering from this disease, and which the} look upon
as pathogenic.
A dehoate diploooccoid organism staining with
difficulty, and forming on the fourth day “ gold-dust ”
floating colonies in flasks of clear peptone beef-
broth at 98 degs. F.
Chauffard and Ramon have since described an
organism in this disease apparently identical with
the above.
SOME CLINICAL FEATURES
PERSONALLY OBSERVED DURING
AN EPIDEMIC OF DIPHTHERIA,
WITH ESPECIAL REFERENCE TO
THE EFFECTS OF THE ANTITOXIN
TREATMENT.
By PEERS MACLULICH, B.A., M.D. (Dubl. Univ),
A—infant Medical Officer to the Joint Counties Asylum,
Carmarthen, South Wales.
As early as April of 1893 Professor Behring pub¬
lished a record of recoveries amounting to 80 per
cent, from diphtheria by injecting 5 cc. of his own
anti-toxic serum, this amount then containing 1,500
Diqiti.
■oogle
Not. 16, 1890.
ORIGINAL COMMUNICATIONS. The Medical Pbms. 603
standard unite. Dr. Aronson in the same year also
discovered the value of the antitoxin treatment in
similar cases; but it was not until Roux read bis
paper on the subject at the Eighth International
Congress of Hygiene at Buda-Pest, in 1894, that this
new treatment for an old and terrible disease could be
said, by its astounding efficacy, to be really grasped
by medical men all over the civilised world. The
first recorded case of its use in England was that of
Dr. Eastes’, in July of 1894, in which he used
Aronson’s serum ; and the following spring saw it
employed by many medical practitioners throughout
the United Kingdom.
But then, as even now, it was often only used as a
last resource in tevere cases, instead of being
administered at the very beginning of the disease in
all oases. Perhaps one reason why antitoxin is not
used, and why diphtheria usually tends to spread so
rapidly in any one locality, U that its early diagnosis
is not always properly made; I refer, of course, to
mild cases of the disease. There seems to be an un¬
accountable confusion as to diphtheria in the minds
of some. I have seen typical cases of a mild form
termed “ diphtheritic sore throats ’’; such cases are
not considered to be true diphtheria, and therefore
are not notified, and consequently are a fruitful
source of the spread of this disease, especially among
school children. The reason for this distinction
seems to be due to the apparent mildness of the
attack. Yet these cases are as certainly diphtheritic
as are those accompanied by graver constitutional
symptoms and severer local signs, and are equally
sources of danger to the community at large.
Cultivations of the Klebe-Loeffler’s bacillus could
always be obtained from these cases, and many of
them subsequently bore out the diagnosis of diph¬
theria by developing post-diphtheritic paralysis, or
cardiac failure, &c.
Being fortunate enough to be in the midst of an
epidemic, I was enabled thus to try the effect of the
antitoxin treatment in forty-five out of fifty-six cases
of pharyngeal and faucial diphtheria.
The majority of cases were seen on the first day of
their illness, and the following generally was the
history of its onset. Namely : that on the previous
evening the patient went to bed in apparently his
usual health, but on the following morning he felt
very languid, weak, and feverish, vomited his break¬
fast, ana complained of his throat being painful for
the first time. The sudden feeling of weakness and
languor appealed to the patient at this early stage
more than any of the other symptoms did, and thus
made him seek medical advice. In all the cases the
extreme pallor of the patient was very noticeable,
and, at the same time, his pulse was rapid (120-140
per minute) and soft, but with this the temperature
in many of the cases was not over 99 degs. F. (In
only one patient did it reach 104 degs. F.)
Another oonstant sign was the enlargement of the
post-cervical glands on both sides of the neck,
whereas the tonsils and submaxillary glands were
often only very slightly enlarged, and then only on
the side corresponding to that on which the patch of
false membrane was situated. On examining the
throat, frequently a single patch of membrane was
all that could be seen, and this in the majority of
cases was situated on the right side. The patch was
leathery in consistence and very adherent, sur¬
rounded by a narrow inflammatory zone, and left a
bleeding surfaoe behind it when torn away. In some
of the cases it could only be seen with great diffi¬
culty, as it was small and nearly hidden behind the
tonsil, this latter being somewhat enlarged, and
presenting at the same time a glazy red appearance.
Even in those cases in which the patch of false
membrane was very small, and the temperature
normal, or almost so, still the diagnosis of diphtheria
oould with reasonable certainty be made. For the
marked constitutional disturbance, the extreme
anaemia, and the rapid and soft pulse, were out of
all proportion to the local signs of the disease, pre¬
sent in the throat; contrasting thus with cases of,
follicular tonsillitis, & c. The post-cervical glands,,
too, were always enlarged from the onset of the
disease, whereas the submax illary glands if they
increased in size, only did so to a slight extent, and
at a later period.
The character of the patch also helped towards the
same diagnosis, it was tough and leathery, not pul-
taoeous like that seen in follicular tonsillitis,
scarlet fever, stomatitis, Ac., and was very tenacious
to the subjacent tissues; and, moreover, it bore no
definite relationship to the mouths of the crypts of
the tonsils (a point of great weight in the diagnosis).
The tonsils also did not enlarge proportionally to
the size and extent of the patch, or patches, present.
A most peculiarly pentrating and typical odour was
noticed in many of the cases; and this was the more
intense in character the larger the amount of mem¬
brane present.
Immediately the diagnosis was made (and also in
many of the doubtful cases), antitoxin was injected
as the first step in the treatment. As regards the
site of injeotion of the serum, the region of the back
at the angle of the scapula was chosen, chiefly
because the insertion of the needle here seemed to
cause less pain than when the abdominal wall was
selected as the site of injection. There was another
reason also why the former position was chosen,
namely, nervous patients (especially children)
not being able to see what was being done to them,
were less liable, therefore, to become restless, and so,
rhaps, in some of the cases the needle was saved from
ing Droken through their fewer efforts to struggle.
Most of the serum was supplied by Burroughs and
Wellcome, and varied from 4 cc. to 5 cc in amount;
but either quantity always contained 1,500 standard
unite. The dried serum, although it keeps better for
a longer period than the liquid preparation, was soon
abandoned because of its slowness to dissolve in dis¬
tilled water; moreover the liquid form, if kept in a
cool, dark place, appeared to lose none of its efficacy,
even four months after it had been sent out by the
manufactu rers.
Of course in the administration of the antitoxin all
the usual antiseptic precautions were most carefully
adopted; the syringe also was taken to pieces before¬
hand and well boiled in distilled water.
The after treatment of the case was as follows A
mixture was prescribed containing 5 minim doses of
tinct. stroph. (B.P. 1885), combined with 3 minim liq.
stiych. hydrochlor. every four hoars for a few days.
After this the patient was put on some form of iron
mixture in order to combat the existing anaemia
and debility. At the same time a 1 per cent,
solution of lysol was used as an antiseptic mouth wash
and throat application, and also a 1 per cent, solution
as a nasal donche; for disinfection of the throat is
important with the object of preventing the develop¬
ment of the streptooocci and staphylococci, which are
generally so abundant in cultures taken from the
diphtheritic patch. No solid food was allowed for
some days, and after a primary purge the bowels
were kept open daily. But what was insisted on
perhaps more than anything else, was the absolute
quietness of the patient, and the necessity of the re¬
cumbent position for about ten days. For it was
observed that those who were allowed to sit up within
a few days after the injection of the antitoxin, were
they who subsequently were the most prone to
develope cardiac weakness, and were also longer in
recovering from the debilitating effects of the disease.
In order to diminish the possibility of the spread of
the disease, the patient was, of course, isolated as far as
Digitized by GoOgle
504 i'm Medical Pbess. ORIGINAL COMMUNICATIONS.
Not. 16, 1899.
it was possible, and only one person allowed to attend
on him. All utensils, Ac., were immediately washed
in a 1 per cent, solution of lysol after the patient had
need them; handkerchiefs were prohibited, old pieces
of linen being used instead for the nasal discharge,
so that they could be burnt immediately after use.
Also for a fortnight after convalescence, the
patient remained as much to himself as it was
possible, and at the same time rigidly adhered to
the use of the antiseptic mouthwash and nasal douche.
With regard to the effects observed on the patient
after the injection of antitoxin, perhaps the most
noticeable one was his changed expression of counten¬
ance; for instead of looking exceedingly ill, and
appearing dull and listless, within twenty-four hours
(in the majority of the cases) he #as much brighter
and stronger ; the distaste for food had passed off,
and he expressed himself as feeling almost quite well
again. In most cases the temperature had fallen to
“ normal ” within twenty-four hours; in a few, especi¬
ally those who were not injected until the second or
third day, it did not reach this level for at least
another twenty-four hours. In not a single case
among those injected did the pyrexia continue for
three days. But with this drop in the temperature
the pulse did not synchronously reach the normal
either in rate or volume; it certainly was not so
frequent, but nevertheless for many days afterwards
it maintained an increase in rate, and was still some¬
what soft.
Both these pulse changes, and also the enlarge¬
ment of the poet-cervical glands, were somewhat per¬
sistent after the other signs of the disease nad
passed off.
As regards the membrane, it had completely dis¬
appeared, or was only loosely hanging by a small
portion to the subjacent tissues, within forty-eight
hours in all of the cases (except one, in which it per¬
sisted for three days). The tonsils at the same time
rapidly diminished to their normal size, and the
nasal discharge also quickly decreased in amount.
Only two cases needed a second iniection—one
patient, a boy, had a recrudescence of the patch (as
proved bacteriologically) fourteen days after the
firet one had disappeared. The other, a male adult,
developed an extensive patch in his right nostril
four days after the pharyngeal membrane cleared off.
Both these patients, however, rapidly improved after
the second injection.
Comparing those injected with the non-injected :
Although in the whole number there was not a single
fatal case, still the subsequent progress of tne
patients in both classes presented many striking
differences. For as already mentioned,' among those
injected the membrane had disappeared in all of
them within three days from the employment of
the antitoxin. But on the other hand, the patch
did not disappear among those who were not injected,
until, on an average, the seventh day after the onset
of the disease (in one case not until the tenth day);
and also among the latter class there was always
present an irregular pyrexia. But perhaps the
most noticeable feature among those who were
not injected was their protracted convalescence;
during this latter they all had attacks of cardiac
dyspncea, and complained of great weakness in the
legs; and the antemia and marked debility, which
were present from the onset of the disease, persisted
for many weeks, and even for some months in three
of the cases. Although none of those who were not in¬
jected developed post-diphtheritic symptoms, while
four of the others did, still, this cannot be urged against
the employment of antitoxin ; for these four cases had
contracted a very severe attack of the disease, and it
is highly probable that if they had not been injected
there might have been some fatal cases among
the number. At all events, it is certain that they
would not have made such rapid recoveries as they
did. In only thirteen cases was albuminuria detected,
and these, too, were among the number of injected
patients; but this complication, like the previous one,
occurred in the severer cases of the disease.
That early injection bears a close relationship to a
proportionally diminished mortality, and incidence
of paralysis, is shown clearly by the statistics con¬
tained in the “ Report of the Committee on the Anti¬
toxin of Diphtheria ” (Longmans, Green, and Co.).
This same “Report ” also shows that the cases in
which the performance of tracheotomy became neces¬
sary, were nearly 50 per cent, less among those
which had been injected, than among those which
had not been so treated.
With regard to the incidence of paralysis occurring
in diphtheritic patients, statistics show what at first
sight appears to be a curious fact, that is, that the
percentage is greater among the injected than the
non-injected; but to read this rightly, it must be
remembered that it has been shown that the duration
of life of the fatal cases treated by antitoxin is
greater than in those not so treated, and also that
the mortality percentage is lower among the injected
than the non-injected ; these two factors in them¬
selves therefore allow of a longer period of time,
and of a larger number of cases, in which the occur¬
rence of post-diphtheritic paralysis may take place.
As regards complications attributable to the use
of antitoxin, the most usual ones observed are some
form of rash. This is generally erythematous,
urticarial, morbilliform, or scarlatiniform; it
usually commences about the seventh day, and as a
rule lasts only two to five days. In 20 per cent, of
these cases the rash appears for the first time at or
near the site of injection; but it may be uniformly
distributed over the body, or may affect only certain
parte, e.g., the extensor surfaces of the limbs. It
must also be borne in mind that some form of
eruption is occasionally liable to precede the onset
of diphtheria ; and the varieties that usually do
so, ace the- morbilliform and the scarlatiniform; but
these and the former types appear to have no influence
on the ultimate result of the case ; and the former
are probably due to the action of the blood serum itself.
Pain in and about the joints (very rarely effusion)
sometimes is a complication due to the injection of
antitoxin, and to this, finally, may be added cellulitis
or absoesses, which have been known to occur at the
site of injection. These latter probably arise from
the contamination of the serum in the process of
bottling it, or from a want of proper antiseptic pre¬
cautions atthetime of its injection.
Lastly, it has been stated, that nephritis has
been caused by antitoxin, but the proof of such a
statement is wanting, for when antitoxin has been
injected into a healthy individual, it has been found
to have no effect upon the kidneys.
In conclusion, I may add from my own experience
that I believe that the early employment of anti¬
toxin diminishes the tendency to a fatal termination,
and at the same time lessens the necessity for
performing tracheotomy, while it also shortens
considerably the stage of convalesence, and robs the
disease of a great portion of its former terrors.
We regret to announce the death of Dr. Reginald
Southey, F.R.C.P.Lond., lately one of her Majesty’s
Commissioners in Lunacy, and for fifteen years
Physician to St. Bartholomew’s Hospital, and
Lecturer on Forensic Medicine, and Hygiene thereat.
He was appointed Gulstonian Lecturer in 1867, and
Lumleian Lecturer in 1881, and was the author of
several contributions to the standard and periodical
literature. He died at the comparatively early age
of 64.
oog
Not. 15. 1899.
TRANSACTIONS OF SOCIETIES. Ths Mbdical Pbbm. 505
(Eltnical JRecorbs,
JESSOP HOSPITAL FOE WOMEN, SHEFFIELD.
Case of Unilocular Cytt of Left Ovary — Operation —
Recovery.
Under the Care of John W. Martin, M.D.,
Hod. Medical Officer to the Hospital.
J-P-, tet. 59, was sent in from 8 win ton by Dr
Fullerton, on Jnly 19th, 1899, for a large abdominal
tumour. The catamenia had practically ceased for 13
years, though there was one recurrence about 5 years
after the first stoppage.
Menstruation commenced when she was 14 years of
age, and was always regular and normal She first
noticed an increase in size last Christmas but thought
she was merely getting stout. Since Christmas she has
felt very poorly in herself, with smarting pains in the
body. Percussion showed that the tumour extended
close up to the ensiform cartilage and well into either
flank—it was very tense. The sound entered the
uterus 31 ins. and to the right. My colleagues agreed
with the diagnosis of ovarian tumour, and the suitability
of the case for a section.
A section was made on August 4th. the cyst (unilo¬
cular) was laid bare and tapped, a very large quantity
of fluid being drawn off ; a small pedicle was secured by
transfixion and a double circle of ligature, and the
peritoneum sewn over the stump. The peritoneal
toilet was carefully attended to, and the abdominal
wound closed by five silkworm gut sutures. The patient
made a good recovery, and was discharged on October
I4th, the delay being due to granulation of one portion
of the wound which was slow in healing.
It ought to have been mentiooed that there were no
adhesions of any importance.
^ransartums of §otictics.
CLINICAL SOCIETY OF LONDON.
Meeting held Fbidat, November 10th, 1899.
Sib R. Douulas Powbll, Bt., President, in the Chair.
Mb. H. Bertram Robinson read the notes of a case of
ACUTE INTESTINAL OBSTRUCTION DUE TO AH INTUS¬
SUSCEPTION of Meckel’s diverticulum,
which occurred in a healthy little boy, tet. 5, who had
been quite well up to forty hours before, enjoying
good health, and never making any complaint,
except of an occasional pain in the belly. After
breakfast, on January 21st, he complained of nausea
and feeling unwell, his bowels were relieved
naturally. During the day he complained of
pain in the belly, but his temperature was normal,
and there was nothing found on examination to point to
any se-ious lesion. Through the night there were
frequent attacks of bilious vomiting with cramping
pains about the umbilicus, hiccough and thirst. Next
morning he seemed a little better, but he vomited after
swallowing anything; there was no distension, and no
lump could be felt in the belly; nothing could be
felt in the rectum. His temperature was 99 degs., and
d se 180. In the afternoon the pain, which hitherto
l been intermittent, was more continuous, and the
belly was a little fuller. An enema was given, but there
was no result; it was noticed, however, that the
returned fluid showed a little blood staining. Mr. R. saw
him in the evening in consultation and found him with
a distressed look and very restless, complaining of the
across the belly at the level of the umbilicus,
temperature was 99 degs. and the pulse 160. He
was vomiting a clear watery bile-stained fluid. No
flatus had been passed during the day. His belly was
distended, coils of small gut being noticed in the upper
part. On palpation there was no rigidity and no special
tenderness; an ill-defined lump could be felt just above
the outer part of Poupart’s ligament on the rignt side.
with comparative dulness over it, but nothing else was
to be made out, and the rest of the belly was
resonant. In the rectum there was no mucous
discharge and no lump, but in the ftecal smear
on the finger was noticed a little blood-stain.
Immediate operation was advised and proceeded
with. Under the anaesthetic the resistance above
Poupart’s ligament disappeared, but per rectum a lump*
was felt in Douglas’s pouch, which could be pushed up
by the finger and then grasped with the other hand
above the inner part of the ligament and to the right of
the bladder. It seemed firm and tubular, and of
about three inches long. Its low situation and free
mobility were rather puzzling. A mid line incision was
made, and on opening the cavity clear fluid escaped but
no lymph coagula. Two fingers were passed down into
Douglas’s pouch, when they seized the lump and drew it
out of the wound. It was seen that it was intusauscepted
small intestine forming a tumour about four inches long.
Without much difficulty the main part of the gut was
reduced, when a hardness presented with a cup-shaped
depression in its oentre; a little further reduction
showed that the normal axis of the intestine was
restored, and that the lump came from its free margin,
proving it to be an inverted diverticulum. The reduc¬
tion of this from its thickened contracted neck proved
impossible, and so there was no alternative but to excise
it. The edges of the gap in the intestine were brought
together by Lemberf s sutures, but owing to the doubt¬
ful state of the bowel at one point, it was thought better
not to entirely close it, but to fix it in the abdominal
wound. An additional reason for doing this was that
the boy’s condition forbade any lengthy resection. After
the operation he revived for about two hours, and then
s jmewhat suddenly collapsed and died.
Mr. Charters Stmons had had no personal experience
of intussusception following Meckel’s diverticulum, but
he had seen two cases of obstruction from that cause.
The first was in a little boy who had repeated attacks of
pain on the right side, like that of appendicitis. The
lad was seen on the fourth day, and was extremely ill.
He therefore operated and found a diverticulum of small
intestine round which bowel was twisted and gan¬
grenous. The second was that of a man, tet. 26,
who came in on the fifth day of an attack of acute
intestinal obstruction. On opening the abdomen he
found a very wide diverticulum round which bowel
was folded. In both cases the intervention was too
late to save life. He urged that the sooner theee
oases were attacked the better for the patient. He had
done eight, only two having been successful. It was,
however, interesting to notice that one of the successful
cases was that of a child of twelve months with an
intussusception reaching from the cacum almost to the
rectum, and his incision extended from the ensiform
cartilage nearly to the pubes. The other was that of a
child only eight months old in which he made an open¬
ing over the caecum. The first case was seen within
twenty-four hours and the second within forty-eight
hours, and both made excellent recoveries.
Mf. Robinson, in reply to the President, said it was
difficult to speak with certainty on the question whether
or not there would be any contraction after the opera¬
tion. That would depend probably upon the area of the
base of the diverticulum. If large, there might be some
oontraotion.
PRIMARY NEPHRECTOMY FOB COMPLETE RUPTURE OF A
KIDNEY.
Mr. Bland Sctton, related the details of a case in
which a man, set. 35, was run over by a cab. On admis¬
sion the patient showed marked signs of internal bleed¬
ing, ana a large ill-defined swelling formed in
the right loin. The overlying skin was not scratched,
contused, or torn. Three hours after admission the
signs of bleeding became marked, and blood appeared
in the urine, so that there could be no doubt that the
kidney had been severely injured. Through an
incision in the right linea semilunaris, it was
ascertained that the remaining abdominal viscera
were uninjured; on detaching the peritoneum over-
lying the swelling in the loin the kidney was found
, y Google
506 The Medical Press. TRANSACTIONS OF SOCIETIES.
Nov. 16, 189*.
completely torn across at the junction of the
lower with the middle third; the laceration had
involved the renal vein, and blood issued from it
with some force. As it was hopeless to attempt to
suture the two parts of the kidney together the
fragments were removed with the surrounding clot.
The peri-renal region was lightly stuffed with gauze and
The wound secured with interrupted sutures of silk¬
worm gut. The patient convalsced quiokly and left the
hospital for the convalescent home in four weeks from the
date of the operation. Mr. Bland 8utton pointed out that
the clinical features were so marked and the line of
treatment so obvious that he thought there oould be no
difference of opinion as to the mode of treatment
adopted. He suggested that the term “primary
nephrectomy ” should be reserved for oases in which the
kianey was removed within twenty-four hours of the
accident, and that where it became neoessary to remove
a kidney some days or weeks-after such an injury, it
should be called secondary nephrectomy. He further
observed that our home literature contained very few
records of primary nephrectomy for rupture of the
kidney, and that a study of the Centralblatt fur
Chirurgie indicated that far too many cases are reoorded
from post-mortem observations, the patients often dying
without surgical intervention. This, he held, was very
regrettable, especially as the signs of this grave accident
are in a large proportion of oases very clear and obvious.
Mr. Q. B. Turner related a very similar case in a
man, set. 57, who also presented a swelling in the right
loin, with rapidly increasing dulness. He diagnosed
rupture of the right kidney, and opened the abdomen in
the same way as the author. The whole of the ascend¬
ing colon and caecum were black with eztravasated blood
which had come from behind. He incised the peritoneum
to the right of the ascending colon, and in the midst of
much blood clot found the kidney torn completely
aero as. It was too mangled to admit of suture, so he
removed it. Patient made a good recovery in spite of
an attack of acute bronchitis, the oough on one occa¬
sion bursting open the wound and allowing a foot of
intestine to escape. He said he was led to operate in that
Case forthwith by having seen, a fortnight before, a man
who had rupture not only of the kidney, but also of the
liver. The patient was intensely oollapaed, and he had
to wait until the third day before opening the abdomen.
He found a slight laceration of thennder surface of the
liver with blood in the general peritoneal cavity, but not
of recent date. There was enormous retroperitoneal
extravasation evidently due to rupture of the right
kidney. The patient vomited persistently and died in a
week. He suggested that the vomiting might have been
due to involvement of some of the sympathetic ganglia
in the clot. He remarked that the amount of urea
secreted in the first oase after the operation was above
the normal.
Dr. Goodk Adams referred to a case in which there was
a considerable but not very extensive rupture of the kid¬
ney, which was not followed by any discoverable hemor¬
rhage, t.e., the urine was not tinged with blood. The
patient was a man, set. 45, seen after a “ buffer ’’ acci¬
dent who had various severe injuries to whioh he suc¬
cumbed, and post-mortem a rupture of the left kidney
was found, measuring half-an-inch, with a small quantity
of blood in the capsule, but none had passed into the
bladder. In contrast to that case he had had in private
practice two oases of injury to young male adults
followed by considerable haemorrhage, in which the
bladder was filled with blood. They both eventually
recovered. Putting these three cases together he was
disposed to question the diagnostic value of bleeding
from the kiadey. In neither of these two cases of
recovery was the accident a severe one, one being a fall
in jumping, and the other the result of a slip.
Mr. Kellock asked why the author removed the
kidney transperitoneally, seeing that it would have been
so much more convenient to have approached the kidney
from the loin.
Mr. Howard Marsh thought the author was right in
opening the abdominal cavity, but asked why, when he
found he had to deal with a ruptured kidney, he did not
close the wound and get at it from behind, externally
to the peritoneum. If he had wished to suture the
kidney it would have opened into the peritoneum. He
urged the value of saline injections when there was
much collapse. With reference to the absence of any
external signs of injury, tie instanoed the esse of a lad
who had been run over and soon died in whom there
was no outward evidence of injury, but in whom, post¬
mortem, the left lung was found torn from its bronchus.
Mr. Bland Button, in reply, admitted that in adopt¬
ing the course he had done he was treading on
deoateable ground. He had been brought up as a “ loin ”
surgeon but had gradually come round to Mr. Knowsley
Thornton’s way of treating these cases. He had dealt
with 25 cases of operation on the kidney through an
abdominal incision, treated transperitoneally, and with
a little care the peritoneum could be brought together so
as to shut off tne general peritoneal cavity, leaving a
more convenient means of draining than that
through the loin. In this respect he dealt with
each case upon its merits. He believed tiie good
results of saline injections oould be obtained by
repeated injections into the rectum, but he preferred
making these injections after the operation because, if
used before, they were apt to give rise to much oozing.
His experience with the injections had been principally
in the treatment of ruptured gravid tubes. He dis¬
cussed the treatment of theee cases by suture of the
ruptured kidney whioh Bradford had shown would
readily unite if the rupture were through kidney sub¬
stance.
Mr. Turner, in reply to the President, said there was
a post-mortem in the second case, but no injury to
intestine was found. He concurred in the view that
the incision through the semilunar line was a good one.
Dr. Norman Dalton on a case of
enlarged spleen, with congenital volvulus of
THE STOMACH AND TRANSVERSE COLON, SIMULAT¬
ING SPLENIC ANXMIA.
A woman, set. 38. The spleen was painless, and had
probably been enlarged since her first pregnancy. It
now reached to the right iliac fossa. There was no
history of malaria, syphilis, or alcohol, and the liver was
not enlarged. All the symptoms of anaemia were present,
and the blood showed 21 per cent, of red discs, 20 per
cent, of haemoglobin, no increase of leucocytes, and
no abnormal corpuscles. No haemorrhages had oc¬
curred. She had noticed the pallor and debility
for one year, and while under observation, remittent
fever was present. Death occurred suddenly. The
stomach was found to be strangulated and extremely
distended by gas; and a perforation due to sloughing
existed at the cardia. The enlargement of the spleen
was such as would have resulted from obstruction of the
splenic vein. Two other abnormalities were found.
1. The transverse colon lay above the stomach (in the
anatomical position) and, before it reached the left;
lumbar region, it was bent In such a way as to encircle
the insertion of the (esophagus into the stomach-
This abnormality was congenital, because the apron of
omentum attached to the transverse colon had not united
with that attached to the stomach, a state of affairs
whioh exists in foetal life. 2. The pylorus lay almost
behind the cardia, so that whenever the stomach became
distended the fundus, by rotating to the right and for¬
wards, would half intertwist the cardia and pylorus, so
as to narrow both orifices. The grip of the colon round
the caidia was apparently not tight enough of itself to
cause obstruction; but, when the spleen became large,
the drag of its weight on the gastro-splenic ligament
E jed the cardia tightly against the encircling ©won.
could be demonstrated on the post-mortem table
by traction on the lower part of the gastro-splenic
ligament. Finally, some extra distension of the stomaoh
produced such a twist of the cardia and pylorus that fat**
strangulation of the involved tubes occurred. The
position of the parts at the cardiac end of the stomaoh
was such that the splenic vein may have been own-
pressed from the first, but, from the history, it probably
became loosened from its attachments at the first
pregnancy and then increased in size from traction and
torsion of its vein. The aneemia and fever can be
Digitiz
Nov. 15, 1890. TRAN8ACTI0N8 OF SOOUSTIESS. The Medical Press 507
explained by the oondition of the stomach. As regards
diagnosis, lymphadenoma, leuoocythoemia, malaria, and
other splenic affections were easily eliminated, and he
came to the conclusion that the large spleen was due to
obstruction of the splenic vein, although he was not able
to discover any cause for such obstruction. It will
be noticed, however, that the blood oondition
(oligocythemia and chloroses without leuoocythemia),
the large spleen, and the fever established a close
resemblance between this case and the disease called
splenic anemia or splenomegaly. There were some
minor differences, snob as the absence of hemorrhages,
and the apparent long duration of the case. He would add
that be was not quite convinced that Banti is correct in
considering that splenomegaly is a “ pathological
entity; ” because, wnile the total number of oases of this
affection, which have been recorded is still small, in
several of those which were most carefully observed
during life, no post-mortem was obtained; and, further,
in a few of those in which a post-mortem was made, it
has been shown that the symptoms could be explained
without calling a new disease into existence.
Dr. Pebct Kidd did not think the condition of the
stomach quite explained the ansmia or the fever. He
observed that in some cases of cirrhosis of the liver the
liver was but slightly enlarged, while there was an
immense spleen with intense anosmia, and he suggested
that possibly some of these cases might have been taken
for a new disease which he thought they should be
cautious in accepting.
Dr. Dalton, in reply, admitted that it was difficult to
explain the anoemia, the connection of which with
stomach disease had not been thoroughly worked out.
He referred to a case in the British Medical Journal a
fortnight ago, of removal of the spleen for “ splenic
anosmia,” in which it was mentioned, however, that post¬
mortem extensive lymphadenoma of the abdominal
glands was met with, yet it was labelled “splenic
anoemia,” and would probably go down as such.
HARVEIAN SOCIETY OF LONDON.
Meeting held Thursday, November 2nd, 1899.
The President, Mr. H. E. Julbr, F.R.C.S., in the Chair.
TREATMENT WITH ANTISTREPTOCOCCIC SERUM.
Db. Wash bourn read a paper on this subject. He
first considered the question as to whether the various
processes associated with the presence of streptococci
were manifestations of a single disease or were distinct
pathological entities. These processes were (1) all cas es
of cutaneous erysipelas; (2) most cases of puerperal
fever; (8) many cases of septic trouble, passing under the
namee of septicaemia, pyremia, Ac. He pointed out that
the clinical symptoms were not trustworthy indications of
the specificity of a disease. A simple poison, such as
lead, might cause cerebral symptoms, paralysis, or oolio,
according to its localisation. The character of the
lesion was also an untrustworthy criterion depending as it
did upon the strength of the virus, and upon its localisa¬
tion. The mode of conveyance of the virus might deter¬
mine its localisation. He concluded that the conditions
above mentioned were manifestations of a single disease.
The absolute proof of the relation between erysipelas and
other allied conditions must depend upon the identity or
non-identity of the associated streptococci. He pointed out
that the determination of the identity of various strepto¬
cocci was a difficult matter. After reviewing the evidenoe,
Dr. Wash bourn believed that there were distinct
varieties of streptooooci only distinguishable by their
behaviour towards serum, and that these varieties of
streptococci might produoe either the same or different
lesions in the human subject. He described the
methods of preparing, standardising, and administration
of serum. He quoted ca ses of pyaemia, septicaemia,
puerperal fever, erysipelas, and infective endocarditis to
show the value of the treatment. He stated that in his
opinion the serum was of extreme value in certain cases,
but that it was valueless in other cases apparently
identical. This he attributed to their causation by
different varieties of streptococci, and he urged the
desirability of using a second sample of serum from a
different source if the first failed.
Dr. Dean had no doubt as to the probable value of
antistreptococcic serum in rabbits, although its action
had nothing like the constancy of the diphtheritic anti¬
toxin, for in one animal many cc. might be required to
produoe the effect produced in another animal by one
oc. The death of a rabbit inoculated with a dose of a
virulent culture causing death in a control animal,
might be much delayed or altogether prevented. He
thought that some ca«es of failure might be due to the
injections being stopped too soon, for he had found
swarms of living streptococci in rabbits as late as the
ninth or even the thirteenth day. The varying virulence
of apparently similar streptococci was insisted upon, and
the remarkable fact had b*en noticed that two strep¬
tococci of the same initial virulence might show great
differences in the ease with which the virulence could
be increased by passage through rabbits. An attempt
was now being made at tbe Jenner Institute to prepare
a poly virulent serum by using streptococci obtained
from different sources. In using anti-streptoooocic serum
it was advisable, as far as practicable, to make the
injections at the site of infection.
Dr. Goodall had tried the serum in a certain number
of ca ses of severe malignant scarlet fever, but without
observing any benefit. He pointed out that such oases
occasionally recovered with ordinary treatment, so that
too much importance must not be attached to the
occasional recovery of a case after the use of the serum.
He mentioned one severe case of phlegmonous inflam¬
mation of the fauces, in whioh he had employed the
serum with apparently groat benefit. There was much
oedematous swelling wi>h high fever and delirium. The tem¬
perature fell to normal, in two or three days the swelling
subsided, and the patient recovered. Such a oondition
following scarlet fever was rare, but it was very fatal.
In this case the diphtheria antitoxin had been used
without benefit. It was thought by some that strepto¬
cocci played an important rdle in some severe cases of
diphtheria, but Dr. Goodall did not think there was
sufficient evidenoe of this to call for the use of the two
serums together in such cases.
Dr. H. A. Calky alluded to cases of infective
endocarditis, in which antistreptococcus serum had
been given with negative results, and to a case of
endocarditis of a subacute type, in which it appeared
to be of service. The variable clinical course of
erysipelas made it difficult to gauge the effect of any
particular therapeutic measures. Occasionally, how¬
ever, the serum appeared to exercise a definite beneficial
action, and he gave particulars of a severe case of facial
erysipelas, in which the administration of each dose of
the serum was followed by marked improvement, the
patient subsequently making a good recovery. It was
noteworthy that some of the recorded instances in
which the serum appeared to have been of conspicuous
value, were cases of recent septic infection associated
with a definite local lesion, so that the administration of
the serum was employed in conjunction with local
measures at the site of the primary lesion.
Dr. Blacker was interested to hear Dr. Wash bo urn’s
opinion opposed as it was to the conclusions arrived at
by Dr Spencer in his report presented to the British
Medical Association this year, and to the report of the
sub-committee of the American Gynaecological Society.
The question was an exceedingly difficult one to decide,
since it was difficult to say at the onset of a case of
septic infection, whether it was going to ran a severe or
a mild course, and the total mortality of cases of
puerperal streptococcic infection was not more than 5 8
per cent., Dr. sucker's own experience had been entirely
disappointing. Most of the cases recorded wt-re worth¬
less from the absence of any bacteriological examination,
and many cases of puerperal infection were due to a
mixed infection which the serum oould not be expected
to influence.
Dr. Ewart briefly referred to his experience with the
serum. In a very severe case of infective fever in which
the streptococcus was found in the blood marked im¬
provement was observed after each injection, and the
oogle
508 The Medical Press. TRANSACTIONS— 1 OF SOCIETIES.. Nov. 15. 1899,
patient recovered. In cases of endocarditis and of ery¬
sipelas the serum bad not proved successful, and in a
case of fcetid bronchitis no improvement had taken place
in the patient’s condition, nor in the expectoration.
In his reply, Dr. Washbouhn stated that he had
noticed the same fact with regard to the pneumococcus,
as Dr. Dean had observed in the streptococcus, viz., that
two organisms might differ widely in the ease with
which their virulence might be increased by passage
through animals. The varying results obtained in the
treatment of ulcerative endocarditis with antistrepto¬
coccic serum might partly be accounted for by the fact
that not all cases were due to a streptococcic
infection; some were caused by the pneumococcus,
and others, again, by the staphylococcus. He had
used a very powerful anti-pneumococcic serum
which could now be obtained with success in a case of
pneumonia following influenza. Dr. Washboum did
not agree with Dr. Blacker as to the mixed infection in
cases of puerperal fever. The discharges might cer¬
tainly contain many organisms, but the lesions were,
he believed, due only to the streptococcus.
LIVERPOOL MEDICAL SOCIETY.
Meeting held Thursday, November 2nd, 1899!
Dr. Armand Bernabd, Vice-President, in the Chair.
Mr.'Newbolt showed a woman, set. 47, upon whom he
had performed “ oholecystotomy" five months ago.
8eventy small calculi were removed, and the patient now
had excellent health.
Mr. R. H. Murray showed a male child, iet. fourteen
months, upon whom he had operated for
• i :IMPERFORATE ANU8.
At the time of the operation the infant was one day old,
and on making an incision in the normal position of the
anus meconium was passed per urethram. The attempt
to find the lower end of the bowel was then aban¬
doned and left inguinal colotomy performed. The
subsequent progress of the case was satisfactory;
at the present time the infant was well grown and in
good health. The question Mr. Murray raised was, can
anything further be done for the child, or must he be
compelled to go through life with an artificial anus.
Considering the great disadvantages the boy would
suffer, especially when he grew older, Mr. Murray
suggested the advisability of opening the abdomen and
endeavouring to bring down the present artificial anus
or some other part of the large intestine to the normal
position at the anus. This he believed to be quite pos¬
sible, considering that in intussusception the ileo-ctecal
valve occasionally projects beyond the anus.
Dr. Hubert Armstrong thought that an operation
involving such grave dangers, and by no means abso¬
lutely necessary in order to prolong life, should not be
performed until the patient was old enough to say for
himself if he would take the risk.
Mr; Paul thought that drainage of the intestine in
iliac colotomy was best effected Dy the use of a glass
tube. In regard to Mr. Murray’s proposal to bring the
bowel down to the region of the anus, he feared the
attempt would fail, as the bowel below the artificial anus
would be atrophied, while to bring the upper part of the
sigmoid flexure down would involve so much division of
its mesentery as to risk the vitality of the cut end. He
would advise either that it be left alone, or that the
proximal end of the bowel be separated and passed
between the muBcles for a couple of inches with the
object of obtaining better control over the faeces.
Mr. Thelwall Thomas regretted that the perineal
operation was abandoned originally, further exploration
with removal of the coccyx if necessary, would in all
probability have led to the bowel. Now, however, it
would be nece*sary to asceitain the condition of the
bowel below the artificial anus, and any subsequent
proceedings, if any, would be based on the knowledge
thus acquired.
Mr. Richard Williams read notes of a ' case of a
foreign body, a small piece of steel, in the right eye ” of a
boy, set. 15. The foreign body bad entered the cornea
at the upper and outer part and penetrated the iriB at
the periphery without injury to the lens. At first it was
plainly visible behind the lens, but on an attempt at
removal under an anaesthetic it disappeared during a
violent attack of vomiting, and had not since been seen.
First attempts with the ROntgen rays failed to discover
the body. Ultimately, however, a good skiagraph by
Dr. Holland showed its presence. The eye recovered
perfectly, and had normal vision, but later on some
turbidity of the vitreous came on with Blight deteriora¬
tion ih vision, and it was a question whether the rays
had had anything to do with this result. At present
the ey£ is quiescent with vision = $.
Drs. Shears, Grossman and Bickerton took part in the
discussion which followed.
.Drs. Grossman and Loewenthal read a paper on
AN ENbfcMIC OF FOLLICULAR CONJUNCTIVITIS IN A
LIVERPOOL SCHOOL.
A case of advanced follicular conjunctivitis without
marked subjective symptoms was accidentally discovered
and led to an examination of all the children of the same
school. It was found that of 700 children 422 had
follicular conjunctivitis (=60 per cent ). The authors
touched upon the appea ances and symptoms of the
disease with percentage of occurrence of the different
stage*; the prognosis of treatment and differential
diagnosis Patients and microscopic specimens were
shown.
BRITISH ORTHOPEDIC SOCIETY.
Meeting held at the Royal Orthop.edic Hospital,
October 28th, 1899.
Mr. Reeves in the Chair.
The Chairman showed an improved instrument for the
ambulatory treatment of congenital misplacement of
the hip. This instrument kept up extension while the
patient walked about It allowed flexion at the knee
and abduction at the hip. He drew the attention of the
Society to the fact that be first employed this method
of treatment a year and a half before Lorenz published
a similar method. The difference lay in the use of
plaster of Paris instead of a steel support. He was
strongly opposed to the open operation for this de¬
formity.
Mr. Jackson Clarke, Mr. Muirhead Little, Mr. Robert
Jones (Liverpool), and Mr. Hy. Baker exhibited cases;
and Mr. E. Luke Freer and Mr. Noble Smith showed
skiagrams
Mr. A. H. Tubby read a paper on the
SURGICAL TREATMENT OF INFANTILE tPA8riC
PARALYSIS.
After briefly summarising what is known of the
pathology of the various forms of the affection, he said
that in micro-cephalic idiotic children surgical opera¬
tions were contraindicated. Craniectomy was disas¬
trous. The occurrence of convulsions which indicated
that sclerosing processes were still going on was another
reason for not operating. Physicians and neurologists
generally treated a contracted arm by advising that the
sound one should be bound up so that the child would
have to use the palsied one, and that the child should
be taught to use its lower limbs and walk. This
treatment was only effectual in slight cases. When
there had been no convulsions for two or three years,
when the mental condition was good and there was no
athetosis the case was favourable for operation. In his
opinion no retentive apparatus was of any use as it could
not fight against the spastic muscles. It oould only
cause sores and increase of spasm. He would, however,
make an exception in oases of talipes equinus where the
foot could be flexed to a right angle with the leg. In
such cases he ansesthetisea the patient and forcibly
dorsi-fiexed the foot and fixed it in gypsum. If the
Nov. 15, 1899.
GERMANY
The Medical Press. 509
tendon were divided talipes calcanea* might result. If
there was distinct equinus to ten or fifteen degrees be- j
yond a right angle, tenotomy should be performed. The
neurologists, however, were opposed to tenotomy. Gowers
had said it was without the least benefit and was not
justified. Tenotomy reacted beneficially on the mental
condition, probably by diminishing the afferent impulses
which were constantly arising from the spastic muscle.
In more severe conditions when the adductors of the
thighs and the hamstrings were contracted he pre¬
ferred to divide the treatment into three stages, dealing
first with the adductors, next the hamstrings, and
lastly the tendo-achilliB. By dividing these tendons in
that order children could be made to walk easily and
well. In the arm division of the pronator
teres and it* conversion into a supinator as
described at the Society’s last meeting gave
good results, combined with open section of the
flexor tendons at the wrist without any attempt
at lengthening and suture. He suggested that at the knee
the gracili*, &o., might be detached from the tibia, and
used to strengthen the quadriceps by suturing them to
its tendon.
Mr. Jackson Clabkk referred to the occurrence of
spastic paralysis in children after influenza, Ac. He
advocated tenotomy of all the affected tendons at one
sitting, but section of the adductors was often followed
by pain in the scar, and he, therefore, preferred to stretch,
instead of dividing, the"i.
Mr. Robebt Jones said that the great force of the
spasm which in the adductors sometimes persisted
under chloroform was most striking. Elongation of
muscles by tenotomy allowed development of their
opponents. He thought that most caseB could be
benefited by operation. A principle that should guide
them was that a wide pedestal for walking was
most necessary. It was no use to operate on the
lower limbs unless the arms were or could be made
useful, as much depended upon them in walking.
After operation slow imitative movements were to be
practised. These were more important than mas¬
sage. He did not think that complete division of
the adductors was practicable subcutaneously. He
divided them by the open method, exercised part of the
tendons and muscles, and kept the thighs abducted
nearly to right angles for at least two months. He used
a walking apparatus which held the limbs abducted.
Mr. Noble Smith remarked on the striking diver¬
gence of opinions between orthopaedic surgeons through¬
out Europe and America and physicians. He emphasised
the importance of treatment after operation.
Mr. Luke Freeb agreed with Mr. Tubby and others
as to the good effects of operations physically and
mentally. He thought all massage and retentive
apparatus useless without tenotomy.
Mr. Muirhead Little referred to the fact that in
many of these cases labour was difficult or prolonged or
premature. He thought that the intelligence was always
sub-normal. He did not think convulsions always indi¬
cated progressive disease. He had operated in children
subject to “fits" with good results. He entirely dis¬
agreed with the views of several previous speakers as to
retentive apparatus. He had often found splints effec¬
tive without tenotomy, and had seen the spasm, instead
of increasing, diminish, or disappear while they were
used.
Mr. Ksetlet thought some cases were of infectious
origin, possibly the infection was the same as that of
infantile atrophic paralysis Some he believed were of
S inai and not cerebral origin. He thought arthrodesis
one leg might prove useful. He believed exercises
alone did sometimes do good, tenotomy was generally
needed,
Mr. Chisholm Williams said that he had operated
on three idiotic cases. The parents preferred their
children straight idiots rather than crooked idiots.
Mr. Tubby briefly replied.
Db. D. J. C. Watkinb has been elected to the post of
Medical Officer of the Lincoln General Dispensary in
plaoe of the late Dr. E. C. Palmer.
6 ermanp.
[FROM OUB OWN CORBB8PONDENT.]
BKRLIX, November 11th. 1890.
At a meeting of the Society for Innere Medizin, Dr.
8. Munter delivered an address on
Hydrotherapeutics in the Treatment of Cardiac
Diseases.
He said that for some time there had been a dread of
cardiac irritation caused by hydrotherapeutical treat¬
ment of diseases of the heart. This had been caused by
Preisnitz, who had applied thermic irritation to its
fullest extent, and had thereby done harm in such cases.
Only in later time* had physicians begun to treat these
diseases systematically by saline and carbonic acid
baths in which, however, heat played the principal
rdle. Only slow progress had, however, been made,
as the knowledge of nutrition and the function of
the heart still presented too many lacuna; whilst
pathological anatomy did not afford sufficient basis for
treatment. Now as functional diagnosis was more com¬
plete, hydrotherapeutics in relation to cardiac diseases
oome to the front.
In passing on to the aim of therapeutics in the
treatment of these affections, he drew attention to
the exceptional position of the heart among muscles
from its enormous activity with only short pauses. It
must be assumed that in order to do such work it must
possess peculiar adaptability for using nutrient material
and for giving off waste products. It is in favour of
this that the heart still makes its contraction when all
other muscles of the body have ceased to act. The
heart also possesses special reserve power to fit it for
emergencies of increased activity. The chief remedy in
cardiac therapeutics is digitalis, which calms exagger¬
ated activity, and by raising the blood pressure brings
about a condition of increased nutrition of the heart.
The great usefulness of slowing of the pulse has been
shown by experiment, according to which, the slower
the heart beats the longer are the pauses between
diastole and systole. So that, independent of the fewer
contractions, the sources for recuperation are distinctly
increased. Thermic stimulation in the form of cold act*
exactly like digitalis, and finds itB place especially
where digitalis has already brought about the needful
rest.
The speaker then turned to the special indications-
He first discussed absolute and relative cardiac insuffi¬
ciency ; whilst in the case of the first treatment was
of no avail, in the latter it was useful in a high degree.
The stimulants were now made use of with special effect.
Hydrotherapeutics are stimulating but not to such an
extent as the centrally acting internal medicaments.
When compensation is brought about by the latter hydro-
therapeutics serve to carry it further and to maintain
it. In acute endocarditis the local application of cold
is useful from the first. The ioe-bag ordinarily used
acts too powerfully and presses too strongly. Leube's
cooling tube apparatus acts better, but the extinction
of heat is not equable as the lower strata of water
become warm. The speaker had invented a cooling
flask, with a permanent flow of cool water through it-
After the application of cold pain ceases, the urine in¬
creases, and the cardiac activity diminishes. Digitalis
always assists in cases of delay of compensation. Also
Digitized by CjOO^Ic
510 Tu Medical Pans.
AUSTRIA. Not. 15, 1800.
after compensation is set up cold serves as a tonic to
the cardiac muscle. They used saline or carbonic acid
baths, cold friction, packs, affusion, douohes, according
to what was required, the particulars of which were
specified by the speaker. Care must be taken to indivi¬
dualise in each case, as hydrotherapeutics was an
energetic means that could increase blood pressure by
contraction of vessels. On the other hand, a depletory
effect oould be produced by action on the peripheral
vessels.
At the meeting of the Society for October 30th, Hr.
Karewaki related two
Casks of Suppuration in the Lungs after
Influenza
with demonstrations. The cases were reported as a
supplement to an address by Herron Korte and Fraenkel
on gangrene of the lungs after influenza, and were
treated by operation on aocount of large cavities that
had formed subsequent to attacks of that disease.
Case I. was that of a man who had extensive exudation
with pleurisy after influenza in 1897. Puncture was
not followed by recovery, but the symptoms continued,
and a second puncture was made with evacuation
of a large qnantity of pus. A subphrenic abscess
was diagnosed, and on April 0th, after resection
of the eighth rib and incising a serous exudation escaped.
On deeper incision a large abscess cavity was reached,
which extended from the longs to below the diaphragm
and the perirenal tissue*. Extensive resection of five
riba was then performed, incision through the diaphragm.
The absoess cavities were made into one, but reoovery
took up several months, and a large lung fistula did not
dose up for 18 months. The speaker believed the
case was one of primary absoess of the lung which had
set up secondary suppuration in the pleura, subphrenic,
and perirenal region.
Case II. was a woman of healthy family who was taken
ill of pleurisy in January, 1899, shortly before her con¬
finement. An empysema formed, which was treated by
resection front and back, but whioh did not lead to
recovery. In July the patient was admitted into the
Jewish Hospital, in the surgical department of which the
speaker was then doing duty for James Israel. The patient
had two fistulas of the thorax, one behind and one in
front, from which thiok muco-pundent material flowed.
The two fistuloe did not appear to communicate with
each other. Above them amphoric breathing was heard,
and from this and from the prolonged duration of the
illness, the speaker came to the conclusion that there
was a cavity in the lung. Operation, July 14th.—An
incision was made downwards that united the two
fistulous openings, then the ninth rib was resected in
order to get at the posterior fistula. It was ascertained
by this that the two fistulee did not communicate with
eaoh other. After further resection of the sixth, seventh
and eighth ribs, an empysema was reached between the
diaphragm and the lungs, through which ran an artery.
This was doubly ligatured and divided. The cavity was
oleared out, and oomplete reoovery had taken place. A
Bdntgen ray illustration showed clearly the defect in
the thorax.
In conclusion. Dr. Karewski showed a patient on
whom, two yean ago, he had performed extensive re¬
section for actinomyoosis of the right lung. Numerous
inquiries had been made of him as to the patient’s
subsequent history. As the man’s appearanoe showed,
he was now perfectly well.
JUtstria.
[from our own corrbbpondmnt.J
Vibes*. November 11th, 18 M».
Bosnian Operation for Calculi.
At the Gesellschaft der Aerate, Preindelsberger gave’
the meeting a racy description of how the Bosnian
surgeon operate* for stone in the bladder. Thediagnoaia
is made by the b imanual method. Having decided to-
operate, two fingers are entered into the rectum above
the stone, which is caught and pressed tightly down on
the perineum ; an incision is then made parallel and near
to the urethra, until the stone is reached, which is next-
caught by foroeps and extracted. The haemorrhage is
checked by pouring hot oil over the bleeding surface, or
the application of boiled egg albumen. The results are
not at all satisfactory. In a series of 160 cases he per¬
formed himself by this method while in the country,
20 per oent. died, and he had no doubt in his own mind
that other practitioners had even muoh higher mortality.
He related two case* that had an urinary fistula in the
perineum after the operation.
His exhibition of the knives, forceps and spoon used in
the operation caused muoh amusement.
Malignant Mediastinal Growth.
Schiff exhibited a man, set, 55, who has suffered for
the last ten years from a great difficulty in breathing.
The laryngoscope revealed a firm compression on the
left side of the trachea. Over the upper part of the
mediastinum, and in the left thorax there was great
bulging, absolute dulness with venectasia of the over-
lying skin. Aneurysm and malignant growth was elimi¬
nated from the diagnosis by exclusion. By making a deep
cough the patient oould make the tumour rise promi¬
nently above the jugulum sterni, as a hard, knotty mass.
The Bdntgen rays were of little service beyond observing
the movement of the enlargement behind the sternum.
It is just possible it might be a movable goitre.
Operating was the most rational course.
Weinlechner remembered several cases of movable
goitre where the swelling produced a rushing Bound ae
if from a ventilator at each respiration. Such a movable
goitre may easily become incarcerated behind the ster¬
num, as in the present case. He thought the operation
practical, and the prognosis favourable.
Albert thought the tumour might turn out to be a-
dermoid cyst, but SchrOtter thought this very improbable,
as dermoid cyst of the mediastinum was a very rare
occurrence. Again, the hardness of the tumour was-
against the hypothesis of a cyst.
Bezoaric Calculus.
Schopf showed a bezoar stone of crinular origin taken
from a young girl, twelve years old. On entering the
stomach and draining off the fluid a longitudinal oon-
cretion was found with a tail extending down the
duodenum 30 oentimetree (11*8 ins.) in length. The
hair of the stone had a bright red colour with projecting^
black hair; the former from the female head, and the
block resembling horse hair. When dried the stone*
weighed 100 grammes or nearly six ounces.
!
Digitized by v^.ooQle
Nov. 16, 1899.
CONTINENTAL NOTES.
The Medical P&us 511
The symptoms before the operation were vomiting,
emaciation, and general malaise.
The diagnosis was a movable tumour easily felt
through the walla of the abdomen, but whether it was
a new growth or floating spleen could not be determined.
Bezoar are very rare in man, although they are fre¬
quently found in horse, cattle, sheep, chamois, and camel
In man they are usually met with in hysterical or
mental imbeciles. They can be borne for a very long
period without danger to life, ranging from six to twenty
years. Inanition is the nsual mode of exit.
The diagnosis of such cases is usually obsoure, although
the history in some cases will easily decide the correct
state, such as the habit of chewing or biting the hair
of the bead or beard. As a rule, however, they are
usually confounded with floating kidney or spleen, cancer
of the stomach, or a faecal impaction in the transverse
colon.
The therapy points to early gastrostomy. An interest'
ing point in these bezoars is the growth of fungi
peculiar to themselves (Schwarzwurzel).
XXKODBBKA PlOKEMTOflA.
Kaposi showed two sisters from Italy who had been
admitted to hospital for xeroderma pigmentosa, a disease
first correctly diagnosed in 1870 as malignant,
hereditary, and rapidly ending in death. The elder of
the two cases showed the disease in a marked degree,
the pigmentary production in some parts being
quite lost, with atrophy and malignant tumours
appearing all over the face, ranging in size from a small
pea to a good-sized nut. The pigmentation was so deep
over the parts affected that she resembled a nigger.
One of the tumours had already destroyed the left eye;
two of tho s e growths wsre situated on the tongue. In
both cases he proposed to scoop out the growths, although
such a senile involutionary prooess gave very little hope
of final success.in-the treatment.
He referred to the article he had already published of
a family of seven who were all affected, and each died
from the disease in rapid succession.
Jratice.
[7BOM OCR OWN CORRESPONDENT.J
Paris, November 12th, 1800.
Exostosis op Both Orbits.
Dr. Chevalleread recently brought before the Paris
Society of Ophthalmology a woman, set. 30, who had come
to him complaining of disturbances of vision and
exophthalmos associated with attacks of violent headache.
The patient was kept under observation for nearly two
years, during which time the condition had not undergone
any marked change. The right eye projected 6 or 7 mill-
metres, and there was complete ophthalmoplegia. On
palpation over the upper and internal angle of the orbit
one could make out a hard, rounded mass, painless and
almost fixed. At the external angle a similar but
smaller mass could be felt, while the whole of the
lower margin of the orbit was felt to be thickened
by bony deposit. Later on, the sight of the left eye
began to fail, and ultimately similar hard tumours were
felt t> be growing. In both eyes there was optic
neuritis, most pronounced in the right eye. No
local pain was at any time complained of, and
tfce nasal mucous membrane was healthy. The patient’s
general health had always been good, and the most
careful questioning failed to reveal the presenoe of any
morbid‘antecedent. Experimental treatment by mercury
gave no result. Inasmuch as surgical treatment would
entail total loss of vision. Dr. Chevallereau refused at
present to advise it, although if the growths should
further increase in size, this may ultimately beoome
necessary.
Viper Poison, Peptone, and Extract op Leeches as
Coagulants.
Mr. Phisalix has been making some further
researchet on the action of viper poison, pep¬
tone, and extract of leeches on the coagulation of
the blood. He found that viper poison, which destroys
the coagulability of the blood in dogs, does not afford
any immunity against the coagulating action of peptone,
and, conversely, injections of peptone do not inhibit the
ooagulating powers of the venom. This remark also
applies to extract of leeohes. He infers from these facts
that the subjects in question do not influenos the
coagulation of the blood in the same mechanism.
Continental ^otcs.
fFROM OUR OWN CORRESPONDENT.J
INNSBRUCK.
As a desirable residence for winter the merits of this
metropolis of the Austrian Tyrol are very insufficiently
known to our British people. Innsbruck has many
advantages which should attract hither a large “ winter
colony ” of English and Americans.
It is a city of over 30,000 population, with all the
incidents of an agreeable city life. An excellent
university, with an effloient staff of professors, second to
none in Austria outside Vienna. Its municipal schools
are equally excellent, and there is an abundance of
private and most competent tutors for those who prefer
such education for their children. Life is economical}
the hotels and pensions are good and very moderate in
terms, and there are so many of them that all varieties
of preferences can be readily suited. Villas and
apartments, too, are abundant. There is an English
church service, other Protestant churches, and many
Catholic edifices with military and other attractive
musical services. Good military and municipal bands
play in the publio gardens and skating rink; the
Tyroless are emphatically a musical people. The officers
of the large garrison give balls during the season. In
fact, the military and music add much life and colour
to the social entertainments of Innsbruck. The theatre,
museum, libraries, Ac., are also good, and the shops
likewise.
In these important items of a pleasant winter sojourn,
Innsbrnck offers many advantages and desiderata, of
which the majority of elevated winter resorts are
deprived. You find at Innsbrnck all the winter amuse¬
ments; skating, sleighing, tobogganing, ski-running,
curling, the chase, and mountaineering; and added to
these special winter pastimes at Innsbruck are the
general advantages of a city life For families, with
children to educate, or with their education to complete,
Innsbruck is unique in its advantages.
The climate is equable and beneficial to the con¬
valescent, nervous, ansemic, delicate, and especially the
over-worked young or old; and our fin de tieclo studies
Digitized by LjOOQle
512 The Medical Press.
THE OPERATING THEATRES.
Nov. 15,1890.
in over-working of the young and not over robust renders
a change of this nature of imperative importance. Winds
are rare, and the clear, cloudless days, even in winter,
are numerous. The rainfall is moderate, and the air dry
and crisp
A range of high mountains not only protect the city
from north and east winds, but they attract and gather
the rays of the southern sunbeam, and throw their heat
back upon the valley, so giving to it a temperature
rarely found at so high an altitude. As one writer well
Bays, “the strength of the north and the tenderness of
the south here unite in pleasing harmony.”. The
beautiful blue transparenoe of the sky throughout winter
is an object of universal comment.
Situated at the junction of the Arlberg and Brenner
railroads, Innsbruck is readily accessible from Switzer¬
land, Germany, Austria, and Italy. It is really too con¬
venient a “thoroughfare,” for many thousands pass
rapidly through it without stopping long enough to even
Bee, much less appreciate, the beauties and advantages
of this
“ Olden town, so true ;
Amongst its green leaves lying
Like drops of pearly dew.”
Its chief hotels are so near the railway station that one
has simply to step across the square to enter their portals.
Commencing this week, new and quicker trains have
been added, facilitating the connections between Inns¬
bruck and Milan, Venice, and the Italian Lakes. Passen¬
gers can now leave Milan daily at 7.30 a m., and arrive at
Innsbruck 8.45 p.m. Thi* train has three classes;
carriages changed at Fink and Ala. Passengers from
Venice leave there 8.45 a.m., and join the Milan train
for Innsbruck at Verona. A first-class express train
also Btarts from Milan every morning at 9.35 and reaches
Innsbruck at 7 p.m. the same day, without any
change of carriages. Trains are now equally con¬
venient from Innsbruck to Milan and Venice. These
improved train-services are due mainly to the
efforts and influence of Mr. Landsee, the proprietor of
the Hotel Tyrol, at Innsbruck ; who for many years has
been steadily persistent in all matters adding to the
prosperity of the place; and especially those which
added to the well-being, comforts, and pleasures of the
visitors to Innsbruck and the Tyrol.
©prcating theatres.
CANCER HOSPITAL, BROMPTON.
Removal of Broad Ligament Cyst.—Extensive
Adhesions.— Mr. Charles Ryall operated on a woman,
eet. 26, who had been admitted for an abdominal tumour.
The symptoms had extended over a year after her
accouchement which was severe, and kept her confined to
bed four weeks, during which time she suffered a great
deal of pain. On getting up she noticed a swelling in
the abdomen, which had been gradually enlarging
up to the date of her admission. She had suffered
a great deal from abdominal pain which was
frequently of a paroxysmal character. She was also
much troubled with constipation. The catamenia
were regular, there was no excessive loss, but a
good deal of dysmenorrheea. On examination a
smooth round tumour could be felt in the right iliac
fossa, extending into the hypo gas trium, and upwards as
far as the anterior superior iliac spine. There was a
fair amount of mobility and no pain on manipulation.
Per vaginam, the uterus was found to be retroverted,
fixed and pushed over to the left side, and the tumour
could be b i m a u all y manipulated through the right
lateral fornix. On opening the abdomen through a
median incision extensive adhesions of the omentum,
small intestine, and sigmoid to the tumour and uterus
had to be dealt with before any view could be obtained
of the pelvic organs, and it was then found that the
tumour was a broad ligament cyst; this was enucleated
by dissection, with a considerable amount of diffi¬
culty owing to the inflammatory changes surrounding it.
The peritoneum investing the cyst was then closed by
suture. The uterus was next libe'ated from the pouch
of Douglas where it was found to be intimately adherent
There was a greai deal of persistent haemorrhage from
the breaking down of these latter adhesions so mnch so
that it was deemed advisable to drain the abdomen by
gauze passed through the posterior fornix into the
vagina. The patient bore the operation well, and before
closing the abdomen which was done in three layers,
a pint of normal saline solution was poured in, and left
in the abdominal cavity. Orders were given that on the
patient’s removal to the ward, the foot of the bed should
be well raised. Mr. Ryall said that there was no doubt
that the extensive adhesions were the result of an
attack of pelvic peritonitis which followed the
patient’s confinement, and none of them pre¬
sented difficulties of an exceptional character*
though a considerable amount of time and patienoe had
to be expended in freeing them. Owing to the oozing>
especially in the pouch of Douglas, it was considered
necessary, he pointed out, to drain, and the vaginal route
was therefore resorted to, as he considered it tfye best.
Drainage through the ordinary laparotomy incision has,
he said, two grave disadvantages. First, it weakens the
abdominal wound at the site of drainage, causing liability
to a subsequent hernia. Secondly, any ligatures in the
abdomen m ay become infected, and thus lead to a per¬
sistent sinus. In breaking down the adhesions
a great deal of raw and lacerated surface was left,
and as those damaged tissues were prone to
infection, and the growth of micro-organisms introduced
at the time of operation rendered the case more liable
to post-operative peritonitis, than in a case in which
little damage was done, saline fluid was left in the
abdomen with the object of absorbing these micro¬
organisms quickly into the lymph stream ; therefore the
foot of the bed was raised on putting the patient to
to bed to encourage the return of the peritoneal lymph
stream. This tilting would be removed in 24 hours. Mr
Ryall oalled attention to the researches of Muscatello
which proved that there was a definite lymph stream
from the abdomen through the diaphragm into the
mediastinal, glands, that fluid was rapidly absorbed
from the abdomen by this route, but the rapidity of
the absorption was considerably increased by more or
less inverting the patient.
It is satisfactory to state that three weeks after
operation the patient was convalescent. Her progress
never gave a moment's cause for anxiety.
ST. PETER’S HOSPITAL FOR STONE.
Nephbo-lithotomy following the Successful
Application of the X-Rays.—Mt.Swinford Edwards
Digitized by Google
Nov. 15, 1899. LEADING
operated on a man, set. about 25, whe had suffered
for some time past with typical symptoms of right renal
eolio. As the patient was a thin subject it was thought
a good case for radiography, more especially as he
himself was anxious to submit to this test before under¬
going operation. Dr. Low, of Sinclair Gardens, was
successful in obtaining a radiograph, which was
seen to throw a distinct shadow on the
right side. The shadow was a peculiar one,
being long, in a vertical direction, thicker below
and gradually tapering upwards. As there could be no
doubt that the patient had a stone in, his kidney, he
willingly submitted to operation under ether. Mr.
Edwards exposed the right kidney by the usual lumbar
incision. After division of its capsule, it was easily
turned out of the abdomen. The stone could be felt in
the lower part of the renal pelvis; accordingly an
incision was made along the outer convex border of the
kidney towards its lower pare, the finger was inserted,
and several calculi felt; these were extracted with
scoop and finger. The organ was carefully palpated ,
for further calculi; at first ineffectually the inoision was I
next closed with three silk sutures, but considering the
shape and length of the shade thrown in the radiograph,
Mr. Edwards thought that there must be other stones in
the kidney, although not to be felt by palpation. He
accordingly incised it in its upper part, and
there came across a whole nest of small calculi,
probably about 20 in number, most of them the size
of a hemp s«ed. After the stones h ad been removed by
a scoop this incision was sutured in the same manner as
the first, and the kidney replaced in the abdomen, a
large drainage tube having been inserted; the abdominal
wound was sutured in layers. Mr. Edwards remarked
that had it not been for the radiograph it was oertain
that the small stones in the upper part of the kidney
would have escaped recognition, and thus the operation,
which was apparently successful, would have been
rendered ineffectual and incomplete. This was. he said,
the second case he had had of successful radiography
in renal calculus. The stones he had just removed he
imagined to be composed of oxalate of lime -, henoe the
good shadow obtained.
THE ARCTIC ZONE AS A HEALTH RE80RT.
The remarkable freedom of the air in the Arctic
regions from all pathogenic micro-organisms, a free¬
dom which, though possibly in a less degree, it
shares with the air of mountains, has led to the
suggestion of the establishment of sanatoiia, in
Spitzbergen, for instance. Scientific observers have
remarked a curious freedom from diarrhoea, catarrh,
intermittent fever, and other microbial diseases
in places situated within the boreal regions.
Incidentally, this fact appears to justify the
suggestion' that mere change of temperature is
not per se sufficient to cause fever, apart from the
introduction of pyrexia-producing organisms. Re¬
peated exposure under very unfavourable conditions,
it was noticed, never gave rise to the usual morbid
reactions, but, on the other hand, it was remarked
that even trifling wounds were unduly long
in healing. Even the ordinary bacteria of
water appear to be unable to exist under the trying
conditions of Arctic life, so that imported germs would
probably stand a poor chance of making fresh
victims.
ARTICLES. _ The Mxdical Panes. 513
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8ALU8 POPULI 80PREMA LEX.”
WEDNESDAY, NOVEMBER 15, 1899.
THE DECLINE OF SYPHILIS.
If further proof were wanting to show that syphilis
as a disease is distinctly declining in this country, it
8 supplied by the definite, unqualified opinion on the
subject expressed by Mr. Johnathan Hutchinson at
the recent Congress in Brussels. Probably no one
has had such ample opportunities for comparing and
judging the effect of syphilis during the past thirty
years as this well-known authority, and, therefore,
great weight must of necessity be assigned to bis
observations. An American contemporary the Inter-
State Medical Journal for October publishes a verba¬
tim report of Mr. Hutchinson’s speech at the Congiess,
and the report is of value, inasmuch as the opinions
therein expressed appear to be new so far, indeed, as
we are acquainted with Mr. Hutchinson's published
works. Upon the subject of inherited syphilis, he states
that daring the last ten or fourteen years in England
the deaths from this disease have been greatly
reduced, in the proportion of from seventeen to
twelve, and he scouts the idea that the inheri¬
tance of syphilis, as held, among others, by
Fonrnier, is a means of reducing the stamina of
the race. He holds to the belief that the
third generation is not in the least hurt by
the transmission of syphilis. Furthermore, the
explicit statement is made that among the more
educated classes in England syphilis is almost
infinitely rare, “ we scarcely ever see it at all,” Mr.
Hutchinson adds. Presumably, however, in this
estimate, account is taken of the members of the
‘educated classes,’ “ who, having found themselves to
be the subjects of acquired syphilis, promptly betake
Digitized by v^ooQle
514 Th* Midical Press.
LEADING ARTICLES.
themselves to a continental health resort for
systematic treatment. There is no doubt that for a
good many years the advantages of adopting such a
procedure ” as this have been fully believed in by the
“educated classes.” The next point upon which
Mr. Hutchinson has something to say is that of
treatment, and we are glad to see that he expresses
himself to the effect that there “ is an improvement
in the treatment which is likely to be productive of a
great diminution in the prevalence of syphilis.” He
states that mercury is being UBed before secondary
symptoms develop, “and in English practice we
scarcely see,” he adds, “ a secondary stage at all—we
suppress it altogetherby this means much is done
to prevent the manifestation of tertiary symptoms.
So far as statistics are oonoerned the mortality ratio
for syphilis in this country has fallen from 78 per
million to 61 per million during the last fourteen
years. Taken then, altogether, it is evident
that the views of such an authority as
Mr. Hutchinson entitles us to regard with some
optimism the waning prevalence of syphilitic disease
in this country. Although the statistics to which
attention has been drawn may not be regarded as
trustworthy, it is nevertheless significant that they
should coincide with Mr. Hutchinson’s experience.
Again, it is quite possible that the experience of many
surgeons during past years has tended to show a
decline, both in the number of cases and in the
severity of syphilis. It would he interesting, however,
to learn whether this is really the fact, and whether
any general agreement prevails in this regard; to judge
merely from private patients would not>be sufficient.
Perhaps, indeed, the most valuable observations
would be those based entirely upon hospital practice,
since it is mainly among the lower orders that the
dissemination of syphilis occurs. If it could be
actually shown by inquiry that hospital patients
suffering from syphilis are now much less numerous
than used to be the case, a great point would be
gained in the matter. At present, however, although
no direct evidence is forthcoming, everything tends
to indicate that syphilis as a disease has been latterly
robbed of a good deal of its terrors, and is progres¬
sively on the decline.
DRUNK OR DYING ?
The reproach to the medical profession conveyed
in the above stereotyped newspaper heading is never
absent from the public gaze for any long period
of time. This recurrence of an error in medical
diagnosis that is not only avoidable hut also fraught
with serious consequences suggests an analysis of the
facts of the case with a view of lessening the scandal.
Last week a tale of far too familiar type was unfolded
before a South London coroner. A police constable
found a man in a sitting posture in the front garden
of a house in Bermondsey. Finding that this person
could not speak or walk, and that he smelt of rum, the
constable took him away on an ambulance to the
police station. At the latter place the Assistant
Divisional Surgeon, saw the patient and pronounced
Nov. 16, 1899.
him drunk, on the ground that he smelt strongly of
drink and looked like a drunken man, and that he
seemed to understand what was said to him, although
he could not speak Although not mentioned defi¬
nitely in the newspaper report from which our
information is derived it may be inferred that the
unfortunate man did not recover consciousness and
was removed to the neighbouring workhouse infir¬
mary, where he died four days after his being found
insensible in the garden. When admitted to the
infirmary the deceased was unconscious and paralysed
on one side. After death a post-mortem examination
revealed “ a large blood clot ” on the brain.
It was pointed out to the jury by the Workhouse
Medical Offioer that the symptoms arising from
apoplexy might readily be mistaken for those resulting
from an excess of alcohol. That contention, it may
be conoeded, may hold true of a hurried or careless
medical examination, but we venture to assert the
great improbability, and in the vast majority of
instances the impossibility, of any error of diagnosis if
the latter be conducted carefully and systematically.
Unconsciousness may be a sign of alcoholism, head
injuries or cerebral disease, lunacy, and narcotic
poisoning. There are, however, points of difference
that would enable any. competent investigator
to make a differential diagnosis in ninety-nine
cases out of a hundred. There are the many valua-
able signs and symptoms to be investigated, such as
facial appearances the nature of the breathing, the
depth of the unconsciousness, the state of the pupils,
the signs of injury, the pulse, the temperature, and
the occurrence of local paralyses and other nervous
symptoms. The fallacy of the smell of drink is so
ancient that one would imagine any medical man
would in practice at once relegate it to the region of
entirely subordinate and little trustworthy pheno¬
mena. Nowadays the standard of general intelli¬
gence demands from the police constable an ac¬
quaintance with the elementary distinctions between
drunkenness and apoplexy. It is quite to be ex¬
pected, however, that a mere layman will often be
hopelessly at fault when called upon to reduce his
theory to practice. But what is to be said of the
error of medical men who hold official posts as
police-surgeons, where they are from the nature of
their position constantly called upon to decide as to
the actual cause of unconsciousness in persons
brought to police stations. It seems to us that the
mistake must arise from a want of systematic in¬
quiry into each individual case. Alcohol is the cause
in perhaps ninety-nine cases out of a hundred, and it
is assumed to be so in the hundredth, where a
ruptured cerebral artery may be overlooked. But
apart from actual errors of diagnosis, to which
human nature must be always more or lees
liable, there are other important aspects of the case.
It is surely a canon of scientific medicine that a
drunken man is in a state of danger. The
depressed circulation and the fall of temperature,
not to mention other hardly less important factors^
constitute elements of risk that may lead to immediate
or to remote fatal results. Yet in spite of these well
Google
Digitized by
LEADING ARTICLES. Tke 3&.*diculL Fun. 515
Not. 15, 1899.
recognised facts, it usually happens that when a man
brought to a polioe-station has been pronounced
drunk, either with or without medical authority, he is
lodged in a cell and left, either with infrequent super¬
vision or he is not visited at all. The simple rule of
never leaving an unoonscious person alone is para¬
mount in all well-regulated nursing organisations’
and there is no apparent reason why police
<fells should be excepted from the operation
of so reasonable and elementary a precaution.
A skilled attendant left by the side of a
man suffering from unreoognised apoplexy would
soon become aware of the fact, and some provision of
this kind, at any rate in the larger polioe-stations,
would prevent the recurrence of the discreditable
scandal of a confusion between drunk and dying
persons. After the lapse of a few hours the effects
of alcohol pass away, but during the time of alcoholic
unconsciousness the sufferer requires attention as to
warmth, position, and other circumstances of his
unhappy state. By the observance of a few
simple rules in all doubtful cases the police
would do mush towards lessening their own
reponsibility, and at the same time would increase
the respect and confidence of the public.
The need of more careful and systematic investigation
by police surgeons has been already hinted at, and we
are sure the suggestion will be received in the spirit of
kindly sympathy with a most difficult task that has
inspired the present article. By a combination
of these two official branches of polioe administra¬
tion, it may be hoped that the occurrence of “ Drunk
or Dying ” cases will be reduced to the extremest
tenuity possible within the unavoidable margin of
human error. From an academic point of view a
thorough grounding of the medical student in the
subject of unconsciousness would be of infinitely more
practical use to him in his professional life than
much of the high standard examination lumber
with which he is now overweighted in the interests of
aspiring examiners and competing colleges.
LUNACY IN IRELAND.
We print in our Supplement of this day an abstract
of the latest report of the Inspectors of Lunatic
Asylums for Ireland, and as we have already devoted
so much spaoe to discussion of the subject, it is im¬
possible for us to attempt to epitomise it at length.
The controversy starts from the admitted fact that
the number of persons charged against the taxpayer
has, of late years, enormously increased in Ireland,
as in every other part of the United Kingdom, and
pari passu the outlay for their accommodation and
maintenance has come very near to breaking strain.
As to the cause of this there are two opinions: (a) That
held by the official party, who say that, in consequence
of the increased pressure of life conditions, insanity
has actually largely increased, and of course must
be provided for at any cost. (6) That held by the
soeptics, who assert that the increase is in great
measure apparent, and that it arises from mistaken
legislation and misconceived administration, and
might be met by other expedients than the monstrous
expansion of public asylums and of the administra¬
tive staffs. In both of these views there is, we think
an element of truth. In other places which are
outside the influences which dominate the question in
Ireland, a steady and material increase in lunacy has
been recognised of late years, and it may be
reasonably be supposed that the causes have
been made more potent by the impulsive character of
the people and the incidence of the acrimonious
political agitations of the past twenty years. But,
even so, the rapidity and amount of the increase in
Ireland cannot be accounted for, and we are driven
to the conclusion that those who hold the second
opinion above enunciated are right. Apart from the
ordinary fluctuations in the prevalence of lunacy
there are special ruling influences. First there is
the supposition that the people who were wont to
keep their insane relatives at home, where they were
never heard of, have of late years learned that,
by a very simple process they can get rid of
them at the expense of the taxpayer. Second,
that the Boards of Guardians have not been slow to
learn the same lesson, and have been glad to pass over
their workhouse lunatics from their own establish¬
ments, where they have been supported by the rates,
to the asylums, supported by the grand juries and
the Government. We believe that the Dangerous
Lunatics Acts of 1867 and 1875 are at the bottom of
it all; for the committal of lunatics they are as
speedy and convenient as the ordinary Lunacy
Acte are complicated and troublesome. It is
only necessary for a farmer who wishes to
relieve himself of the maintenance of an idiot boy to
send for the nearest policeman and asseverate that
the boy is obstreperous and dangerous, whereupon
the policeman charges the patient at the next petty
sessions, before two magistrates, for being in a condi¬
tion to commit a felony. The nearest dispensary doctor
is called in, and upon his certificate, that the report
of the policeman is true, the boy is sent off to the
asylum. In this way a considerable section of the
humbler population is being transferred from their
own homes, where they cost nothing, and from the
workhouses, where they cost very little, to the
asylums where they cost a great deal. Upon
this and other grounds the advocates of
the “apparent lunacy” theory maintain that
Irish asylums have been filled up with
individuals who, twenty years ago, would have been
working in the fields, and that their incarceration at
the public expense is being made the excuse for a
perfectly amazing waste of money upon architects
and builders for the enlargement of old asylums and
the building of new ones. Without being prepared
to pin our faith to this, we are certainly ready to say
that the outlay for these purposes has been, for
years, monstrous and intolerable, and that a stay
ought to be put upon the erection of palatial build¬
ings and luxurious appanages until the subject is
investigated by those capable of forming a just
opinion.
Digitized by Google
616 Thi Midicax Paxss.
NOTES ON CURRENT TOPICS.
Nov. 15, 1899.
<4to&s mt Current ^lopicB.
The Joint-Stock Consultation Club.
The proposal to establish in Birmingham a sort of
medical consultation club in which every member
will be entitled to the services of a Consultant (save
the mark) for the humble fee of half a guinea, does
not appear to make progress considering that it is
many months since it was promulgated, and the
scheme has lain dormant. The Hospital Saturday
Fund has now taken up the idea, and hopes to attain
popularity thereby. We shall not expend space on
urging upon the practitioners who may be
disposed to act as consultants on these terms,
that, in doing so they lower their professional
position. They would, probably, be quite con¬
tent to do so if it pays. But we may suggest to
the public that the consultant whom they obtain for
10s. 6d. is in no respect a better adviser than the
general practitioner whom he is called to supplment.
No specialist who has much pressure on his time will
give the portion of it necessary for a competent
consultation diagnosis for any such sum, and
the only alternative the joint stock consul¬
tant could adopt would be to run the patients
off as in a fourpenny dispenary at five minutes a
piece. We should suppose that any really sick
person who has undergone such a consultation will
conclude that he does not desire any more of the
article. There is, in fact, no such thing as a second
or third class consultant. Any aspiring practitioner
may assume the name but, unless he is a recognised
expert in his own specialty the general practitioner
will not want his help, and the patient will not be
content to pay for it.
Tame Deer Hunting.
Since the famous speech with which early in this
year the Duke of Portland favoured the counsels of
the anti-vivisectioniste in St. James’s Hall the scientific
world has waited, in vain for further information as
to certain of liis Grace’s views upon sport. No such
authentic statement has been forthcoming but the
hunting of tame deer is still being carried on merrily
by the Queen’s Buckhounds. As master of the so-
called sport provided by the royal pack the Duke has
a somewhat formidable list of casualties to justify in
support of his proposition that this kind of him ting
is good for the deer. Last week the season was
opened by uncarting a quarry at Salt Hill. The
incidents of the chase that followed, at least, if they be
as reported in the newspaper, are calculated to wring
tears from any individual who is not blinded by the
fetish of sport towards the claims of kind-hearted
humanity and conscience. The deer’s first exploit
was to join a flock of sheep, and afterwards to lie
down by the side of a haystack. Later in the run
the unfortunate animal took refuge with a herd of
cows, and followed one of the latter into a cowshed,
whence it was driven back to the hounds by a cowman.
The quarry then swam the Thames, and was reported
to have been at length captured in the forest. The
usual record of wounds by barbed wire is wanting,
possibly because the reporter thinks that side of the
subject has lost its novelty. Why cannot the anti-
vivisectionists try and put a stop to this degraded
cruelty perpetrated in the sacred name of sport. The
Queen’s Buckhounds are carried on for the behoof of
as motley a concourse of sportsmen as ever disgraced
a hunting field.
Bad Meat for British Troops.
The history of the part played by the army con¬
tractor in the fate of nations, would furnish preg¬
nant reading to the student of human nature. If
current rumours have any foundation in fact the
service contracts are more or less honeycombed with
secret commission and other abuses. At the same
time it is only right to say that many schemes have
been devised and put into practice by Government
with a view of putting an end to the shifty cunning
of a dishonest tribe. A disgraceful attempt to palm
off a cargo of bad meat was last week happily foiled.
The troopship Arawa was about to sail for the
Cape, when it was discovered that the supply of meat
on board was in a bad condition. The embarkation
officer inspected the stuff with the result that
be ordered the whole consignment to be turned
out on the quay. A fresh supply was speedily forth¬
coming, and the ship was despatched after a delay of
some twenty-four hours. Now, this meat was taken
aboard at Plymouth before the ship sailed to the
embarkation point at Southampton. It consisted of
about 15,000 lbs. of beef and mutton, both foreign
and colonial. When turned out at Southampton it
was unfit for human food. In the official inquiry
that must follow the public' will demand that the
responsibility of passing the condemned meat be
fixed upon the proper persons. A scandal of this
kind demonstrates the rottenness of Government
service supervision of contracts. If the Arawa
had been allowed to sail it is likely that the troops
on board would have been exposed to danger not less
fatal than those contingent upon the campaign to
which they are now speeding. The question now is,
who is to be hanged for that bad meat P
Measles in General Hospitals.
The management of Guy’s Hospital can hardly be
congratulated on some of the incidents connected
with their institution that attain publicity from
time to time through the medium of the Coroner’s
court. Last week, an inquest was held on the body of
a child who had been discharged from the hospital
mentioned because of the development of measles.
The mother took the child home where it afterwards
died, and a medical man refused a death certificate.
The mother, however, obtained the requisite
document from the House Physician under whose care-
deceased had been while in the wards. His right to
Bign was called in question by the Coroner, who com¬
mented severely on the incident. To those who have
studied the facts of death certification in this country,
this occurrence will cause little surprise, as the whole
system is so riddled with inconsistencies and fallacies
as to be in not a few instances worthless. That the
Digitized by Google
NOTES ON CURRENT TOPICS. The Medical Press. 517
Nov. 15,
residents in hospital know little and care less about
the interests of outside practitioners is notorious.
T be barm they do in that way is incalculable, they
are careless of what has been said or done by other
medical men to patients before coming to hospital,
and they never trouble to inquire as to the suitability
of applicants for relief. In these particulars they
simply follow the lead of the hospital authorities, by
whom the existence of a medical profession outside is
simply ignored. It is sad to think how one day
many of these careless and jovial house-surgeons and
house-physicians will find themselves heavily handi¬
capped in the struggle for existence by the medical
charities. By the way why has not this tolerably
wealthy charity of Guy’s Hospital an isolation ward
whither a child developing measles could be con¬
veyed P
Further Definitions of Professional Secrecy.
For some inscrutable reason the doctrine of
professional secrecy <1 Voutrance has always received
support and legal endorsement in France, and while
we fully concur in the general principle of the
inviolability of knowledge acquired in the exercise of
professional functions, it is obvious that there must
be limits to the obligation. It is no part of the duty
of the medical man to denounce crime, but he must
be careful, on the other hand, not to throw his pro¬
fessional mantle over the crime and the criminal.
Some recent decisions of the French Courts extend
and define the doctrine. One of them formally
declares that a medical man may not reveal to a life
insurance company any details concerning the
life-history of a person, whom he has been
requested to examine, which have become
known to him in his capacity as medical
adviser to the examinee. Another decision declares
it to be a violation of professional secrecy when a
medical man delivers a certificate to a third person i
stating the exact injury received by a workman who :
is bringing an action for damages. At first sight
these decisions may appear somewhat extraordinary,
but on scrutinising them more closely it will be seen
that they only embody principles which must receive
the approbation of every conscientious practitioner.
They simply amount to the statement that informa¬
tion acquired by the doctor in the course. of his pro¬
fessional ministrations cannot be utilised for any
other purpose than the treatment of his patient,
indeed to do otherwise would, even in this country,
expose the careless or unscrupulous practitioner to
the risk of an action for damages for breach of con¬
fidence provided the plaintiff could allege specific
injury on which to base his claim.
Municipal Crematoria.
The progress of cremation is shown, if further
proof were wanted, by the growing feeling in favour
of the establishment of municipal crematoria. The
city of Hull has just led the way in this regard. Last
week, with much ceremony, the foundation-stone of
a municipal crematorium was laid by a member of
the corporation. We also understand that the
Sanitary Committee of the Court of Common Council
of the City of London have carried a recommenda¬
tion by which the corporation have agreed to pro¬
mote a Bill next session to provide powers
for the erection of a crematorium at Ilford
cemetery. At present the nearest crematorium for
Londoners is that at Woking, but for all save
those whose means are fairly ample, the cost of the
process is prohibitive. In order to encourage the
masses to adopt cremation clearly the first step to be
taken in the matter is to arrange a scale of charges
which shall be “ popular that is to say, within the
means of all persons who have any means at all. The
opportunity of so doing is now about to be afforded
by the erection of municipal crematoria. It would
be quite within the power of the municipal
authorities to provide facilities for cremation at a
figure which would be very moderate, and yet, at the
same time, cover all expenses. Moreover, so far
as large towns are conoemed crematoria may be made
the means of saving much expense now attaching to
the disposal of the unclaimed dead. But these are
matters of the future, and do not concern the question
of cremation just yet. Nevertheless, we believe that
the time will come when the necessity will be shown
to exist for municipal crematoria throughout all the
^arge towns in the kingdom.
Dentistry for Women.
We should not have thought that dentistry would
have commended itself much to women as a profes¬
sional occupation. But a woman’s paper suggests
that it would prove to be a lucrative profession for
women, and this opinion appears to be based upon the
fact that there is at the present time a woman who
is successfully practising as a dentist in London. Of
course, the old argument will not fail to operate here,
that “ one swallow does not make a summer,” and
whether women would or would not prove to be good
dentists could only be determined by actual
experience. Meanwhile, there would probably be few
who would care to make the experiment.
Praiseworthy Generosity.
We understand that a crisis in the financial affairs
has occurred in connection with the Norfolk and
Norwich Hospital. This gloomy condition of things
has been mainly brought about by the serious
decline in annual subscriptions, the vertebral
column of every charitable institution. The result
of this lack of support has compelled the governors to
consider the necessity of closing a portion of the
hospital, a step which, if carried out, as the Eastern
Daily Press very rightly observes, would be a reflec¬
tion upon the whole district. Under the circum¬
stances, therefore, some special local county effort is
clearly required to avert so undesirable a contin¬
gency, and we are glad to see that the philanthropic
ball has been set rolling in this regard by some well-
known Norwich residents. For example, Messrs.
J. and J. Column have doubled their annual sub¬
scription of fifty guineas; Mr. S. G. Buxton increases
his annual subscription to £100; Mr. J. N. Gurney
Digitized by Google
518 The Medical Frbbs.
NOTES ON CURRENT TOPICS.
Nov. 16, 1899.
increases his to £50; Mr. H. G. Barclay to £20. and
Messrs. Boulton and Paul to ten guineas. These are
praiseworthy examples of practical philanthropy
which can scarcely fail to have an indirect influence for
good. All that is wanted now for the Norfolk and
Norwich Hospital is for the other annual subscribers
to follow suit and thus help to place the institution
upon a sound financial basis. We should hope that
this consummation will be attained, for the charity
in question has a long and honourable record, and
for this reason should be one of the first of those to
secure the cordial support of town and country
Norfolk men and women.
Bicycle Knee.
Considering what an important part is played by
the knee joint and adjacent structures in propelling
the bicycle it is rather a matter for surprise that
attention has not been called to the troubles of which
it may be the seat as the result of too protracted
or too severe a strain in riding. Numerous cases
have been brought to our notice of incapacity for this
form of exercise occasioned by the pain to which it
gives rise. This pain presents several characteristic
features. It occurs in only one knee, and,' as
a rule, is not felt in walking. Moreover, it often
does not supervene at the beginning of a ride, but
oomes on gradually, ultimately attaining an intensity
which may absolutely prevent the rider from con¬
tinuing his excursion and oblige him to adopt some
other method of locomotion for the purpose of re¬
gaining his domicile. One feature appears to be
common to all these cases, namely, that the pain is
exterior to the joint, and the swelling, if present, is
limited to the sheaths of the tendons which run past
the joint or to the insertions of muscles in that
neighbourhood. It is not associated with mani¬
festations in other parts of the body which
would justify the diagnosis <rf rheumatism, and it
occurs in persons who are not, as far as one can judge,
the subjects of the rheumatic diathesis. In most
instances abstention from the use of the cycle suffices
to bring about a cure, but in some, the minority, it
displays a tendency to recur under stress, and in this
event it constitutes a formal contra-indication for
more than very moderate indulgence in this pastime.
It is due, no doubt, to immoderate strain of the ex¬
tensor muscles, which are mainly concerned in driv¬
ing the machine, and is strictly akin to the pain, &c.,
felt when the muscles of the forearm are subjected
to unwonted strain. In most of the cases that have
pome under our notice the primary cause would seem
to be too high a gear, which throws an exaggerated
strain on the muscles, or a saddle placed too low ;
down so that the flexion of the knee is unnecessarily
increased. In the absence of either of these causes
hill-climbing has been known to bring on an attack,
but in reality this amounts to the same thing as too
high a gear. When we speak of a gear as too high
we mean, of course, too high for all-round work, for
it is evident that a gear which may be suitable enough
for the home counties would be quite unsuitable for
eronshire or the Lake District. It is necessary to
put cyclists on their guard against a complication
which may debar them from their favourite pastime,
and they should learn to be wanted by the earlier
admonitions without waiting for absolute incapacity
to supervene.
The Power of the Imagination.
The influence of the imagination is a factor with
which physicians have to reckon very largely and in
the minor ailments of life, at any rate, the most
successful practitioner is be who possesses the faculty
of inspiring confidence in himself to begin with, and
then in the treatment he advises. A recent number
of the Pyechological Review relates an interesting
experiment made by Mr. Sloe son with the view of
demonstrating how easily this faculty can be called
into play. In the course of a popular lecture he pre¬
sented to his audience a bottle containing dis¬
tilled water, which he uncorked with elaborate pre¬
cautions and then, watch in hand, he asked those
present to indicate the exact moment at which the
peculiar odour was perceived by them. Within fifteen
seconds those immediately in front of him held up
their bands, and within forty seconds those at the
other end of the room declared that they distinctly
perceived the odour. There was an obstinate
minority, largely composed of men, who stoutly de¬
clared their inability to detect any odour, but Mr.
Slosson believes that many more would have given in
had he not been compelled to bring the experiment
to a close within a minute of opening the bottle,
several persons in the front rank finding the odour
so powerful that they hastily quitted the lecture
room. It would have been interesting to know the
attitude of the audience on learning the liberty that
had been taken with their imaginations, but on this
point unfortunately the report is silent.
A Curious Case.
The last number of the Therapeutic Gazette con¬
tains the account of a very curious case, so curious
indeed that we should like further evidence before
accepting it as duly authenticated. Dr. Eckman, of
Philadelphia, was called to a woman, set. 25, who was
very ill, and in whom, on examination, a distinct
mass was felt below, and to the right of the umbili¬
cus. This appeared to be continuous with the uterus
which was much displaced upwards, and was barely
accessible. As she improved somewhat, nothing was
done until a month later when he was again called to
the patient who then complained of an inflamed and
tender umbilicus. This was poulticed, and after a
time a solid something projected from the navel
which proved to be a No. 9 linen catheter. On
questioning the patient he elicited from her that
three months previously, (three weeks before
his first seeing her), her physician had attempted
to bring about a miscarriage by introducing a
catheter into the uteres, directing her to return on
the following day to have it removed. This she was
prevented from doing for some days, and when she
did so the physician was unable to find the catheter
She subsequently developed alarming symptoms, and
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NOTES ON CURRENT TOPICS.
Thk Mbdioal Pubs. 519
Not. 15, 1899.
became bo ill that her life was despaired of when Dr.
Hickman was first sumoned to her. We share with
Dr. Eckman a difficulty in explaining the route taken
by the instrument, which could hardly have per¬
forated the uterus in the first instance.
Physical Competitive Examinations.
In an exhaustive letter to a medical contemporary,
Mr. Henry Cayley discusses the physical tests for ad¬
mission to the Public Services, and in the course of
his remarks he says that, “ so far as the interests or
welfare of the candidates are concerned, it is prob¬
ably, quite immaterial whether they are sub¬
mitted to physical examination immediately before
or after the competitive,” and he proceeds to
argue against physical examination in advance, on
the ground that the condition of health of candidates
must be established at the exact time of their
admission, and, if preliminary physical examination
were the rule, that condition might have materially
altered during the period of study. While fully
agreeing to this contention, we are unable to see
why it should be impossible to submit a candidate to
preliminary physical examination at any reasonable
period before his examination, and also to a final corro¬
borative test after he has passed the competitive
examination, especially if he is willing to pay for the
additional privilege. Mr. Cayley says that “no
official Medical Board could give any more decisive or
binding opinion than that given by a private medical
man,’’ but it is manifest that no private opinion, by
whomsoever it may be delivered, can have more than
a moral influence on the Army authorities or can, in
any way, protect the candidate against subsequent
ostracism by the Medical Board. Again he asks :—
“ If one were rejected on the second occasion who had
been previously pronounced fit, what a flood' of
grievances this would give rise to.” At the first
physical examination all obvious physical disqualifi¬
cations would be revealed, such as narrowness of
chest girth or high astigmatism, and an official record
thereof would be preserved until, if ever, the candi¬
dates came up for final physical examination, when
nothing would remain to be tested save the conform¬
ity of the second examination with that of the first.
Moreover, in this matter, we strongly suspect that
preliminary physical examination is resisted by the
authorities because they object to the trouble of such
an examination for each candidate, and we, also,
apprehend that physical fault is made an ex¬
cuse for disqualifying candidates who do not appear
to the Medical Boards to be up to standard in respect
of social or regimental requirements.
Ventilation of Railway Carriages.
Thk plan of ventilating railway carriages via the
open window obviously suggests many objections.
Not only is the air laden with grimy dust, but the air
surrounding a train on the road is stated to contain
T8 to 2 28 per cent, of carbonic acid gas. A German
railway engineer makes a valuable suggestion in this
connection, he proposes, in fact, that the air should
be conveyed to the carriages by conduits starting
from the front of the locomotive, so that it would be
free from dust and deleterious impurities. This plan
does not present any technical difficulties of moment,
and it would be easy to warm the incoming air on its
passage through, or along, the engine, thus obviating
the necessity for other means of keeping up the
temperature during the cold season. We submit this
suggestion to the managers of our railway companies,
ooupled with the expression of a hope that they may
see fit to give it a trial.
The First Epileptic Home in England.
The founder, the late Mr. Henry Cox, did not live
to see the full fruit of his munificence; but an account
of ten years pioneer work has just been published
which contributes a tribute to his memory of the
most gratifying kind, The nucleus of the work was
begun in Manor House, Maghull, an old country
house outside Liverpool. The evolution of the
scheme is most interesting reading; the famous
colony at Bielefield, in Germany, was first visited;
but though much pleased with it, “the committee
felt that they could not hope in England, even if it
were desirable, to imitate the plan pursued at Bielefield,
whereby a large Btaff of nurses and assistants gave
their services voluntarily, with no hope of gain.”
They recognised the noble ideals of such men and
women, but felt that “our nurses and attendants
would require a ‘ living ’ wage instead of mere sus¬
tenance here, and the hope of a reward hereafter.”
They count also on no small measure of devotion
from paid labour, and they are right. Some with
good hearts and minds must have pay, for affluence
or even a modest competence is not their lot. It
was neoessary that each patient should pay, and
they were graded in three classes—paying two
guineas, one guinea, and seven-and-six a week
respectively, the profits from the first and second
class to meet the deficiencies of the third. The institu¬
tion had prospered as it deserved to do, and another
buildinghas been erected. The number of patients has
increased from 20 the first year to 120 last year. We
would specially recommend a careful perusal of this
report to all interested in the welfare of the epileptic.
It gives interesting information regarding the various
occupations of the patients, with illustrative views of
lawn-mowing, milking, harvesting, Ac., the medical
results, hints to parents and guardians of epilep¬
tics, Ac.
Practice on Single Qualifications.
In the correspondence columns of a medical con¬
temporary we notice the statement that the lioenoe
of the London College of Physicians “ is a qualifica¬
tion under the Medical Acts, and is recognised by the
(English) Local Government Board, and its possessor
would thus, if registered, be entitled to hold a Poor-
law appointment.” This statement is, no doubt un¬
intentionally, entirely misleading, and, if allowed to
pass, might plaoe other colleges in a false position.
Under the third section of the Medical Act of
1886 no single qualification entitles a person
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520 The Mxdical PbKS8.
NOTES ON CURRENT TOPICS.
Nov. 15, 1899
to go on the Register. It most be com¬
bined with a qualification in the correlative subjects
derived from another body, or, in the case of a
university, from itself. In fact, the registered
diplomas must represent separate qualifications in
medicine, surgery, and midwifery, and no single
qualification fulfils this requirement, nor can any ,
one go on the Register in respect of such single
qualification. But any one possessing a single quali¬
fication can have it entered on the Register if he has
already presented a diploma in the correlative sub¬
ject, and, pro tanto, the Local Government Board
will recognise such entry when complete, but not
otherwise. It is, therefore, not the whole truth to
say that any single diploma qualifies for a public
position.
Voluntary Notification.
We note that, at Norwich, the municipality has
agreed that a fee shall be paid for the voluntary
notification of phthisis, and that Manchester is being I
urged to adopt the same arrangement, but as to who ,
is to notify and to receive the fee we are not informed-
From a professional aspect this is a very important
point. Every one will be delighted if the public will
take upon themselves the duty of notifying this and
all other diseases, but the proposal that a medical
practitioner shall surreptitiously communicate to the
public authorities the information which he may obtain
in private practice, and shall aooept a fee for doing so,
is a different matter. When the Compulsory Notifi¬
cation Acts were in progress, we were told that no
breach of professional confidence was involved inas¬
much as the law would compel all practitioners alike
to be guilty of that breach. This is not the case
under voluntary notification, and we do not hesitate to
say that it is open to the gravest question that a
practitioner, being under no legal compulsion wha t-
ever, shall be encouraged to sell the information
which he obtains as a private medical adviser to the
public authorities without the complete assent of the
patients who are interested. If such a principle be
admitted in the case of phthisis, why not in the case
of syphilis, or any other disease ?
The Certificate Question at the Cardiff
Infirmary.
We referred a few weeks since to the question which
had been raised at the Cardiff Infirmary as to the
destination of the fees charged for certificates given
by the medical officers of the infirmary to patients of
that institution. A committee was appointed to
inquire into the practice which had come to the
front on a motion to the effect that all such fees
should be placed to the credit of the hospital funds.
The decision just arrived at is that in future no fees
whatever shall be charged for such certificates, and
this, we believe, is in accordance with the general
practice at similar institutions elsewhere. It is
obvious, however, that there must be a limit to the
giving of such certificates, for while they may pro¬
perly be delivered without fee when they are to be
used for the purpose of obtaining sick pay, no such
indulgence is called for when the certificate is
intended for the purpose of bringing legal pro¬
ceedings, civil or criminal. In such cases the
medical officer is entitled to refuse to provide
evidence unless summoned in the usual way and paid
the usual fees.
Chrysarobin a Specific for Warts.
Db. G. M. Fitz calls attention to the excellent
results which are obtained in the treatment of warts
by solutions of chrysarobin. He first pares down
the wart until there is rather profuse bleeding, and
then applies a ten-per-cent, solution of the drug, the
vehicle being either ether or the ordinary gutta¬
percha solution. As a matter of fact, chrysarobin is
by no means the only effectual means of dealing with
these often refractory conditions of epithelial hyper¬
trophy. The essential part of the treatment is
unquestionably the removal of the thickened epithe¬
lium. When this has been done the application of
chromic acid or a collodion solution of salicylic acid
will, in most cases, cause the disappearance of the
growths within a few days.
The Prevalence of Typhoid Fever in the
County of Durham.
The County Medical Officer of Health for Durham,
in his recent quarterly report, pointed out that the
County of Durham has had for some years past a
higher death-rate from typhoid fever than any other
county in England and Wales. Dr. Eustace Hill
states that some of the most serious epidemics of
the disease which have occurred were probably due
to pollution of the water supply. But these outbreaks
were not sufficient to account for its marked preva¬
lence and high mortality in this county year after
year. The matter has claimed the attention of the
Durham County Council, and a decision has been
arrived at to invite the Local Government Board to
institute an inquiry.
The Belfast Royal Victoria Hospital and
Professor Cuming.
At a meeting of the Committee of this hospital, on
the 9th inst., the President of the Queen's College
proposed a resolution of ’."egret on the death of the
late Professor Cuming, and delivered an eloquent
eulogy upon his personal and professional character,
and the resolution, needless to say, was adopted by
acclamation, A letter was then read from the Right
Hon. W. J. Pirrie, presenting to the hospital the
sum of £7,000 on condition that one of the wards
shall be named after the deceased Professor, a pro¬
viso which, of course, was at once accepted. The
Committee of the hospital has now in hand nearly
£76,000 towards its completion and endowment, and
it is anticipated that numerous endowments have yet
to come in.
A Skin Hospital for Dublin.
In a previous issue we referred to the effort made
to organise in Dublin a special hospital for diseases
of the skin, we have reason to believe that the scheme
has now sufficiently progressed to allow of the Out-
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Not. 15, 1899 MEDICAL SOCIETY OF LONDON. Thr Medical Press. 521
■patients’ department being already available for nee.
Tbe hospital is to be non-sectarian. Dr. C. M.
O’Brien, who is an old Middlesex Hospital man, and
at present an examiner in the Apothecaries’ Hall.
Ireland, and formerly senior member of the resident
staff of one of the Dublin hospitals, has been
appointed physician. Mr. G. B. White, who is also
an examiner, and known ns a contributor to our
pages, has been appointed surgeon.
. Strabismus a Sign of Neuropathic
Inheritance.
TpERK is a popular idea that a squint is associated
with a more or less marked mental peculiarity, and
this view is supported by Dr. de Micas, who has
found that the immediate and collateral ancestors
of persons who squint comprise many with neuro¬
pathic antecedents. Of course, any ametropic child
may squint, but if, with the error of refraction, is
associated this neuropathic predisposition, a squint is
the rule-. Even in the absence of any error of re¬
fraction, the children of neuropathic parents appear
to be peculiarly liable to this deformity, which, in¬
deed, may be the outward and visible sign of the
morbid inheritance.
Dr. Nestor Tirard, Professor of Materia Medica
and Therapeutics in King’s College, London, will
deliver a course of three lectures on Pharmacy and
the New Pharmacopoeia " at the Society of Apothe¬
caries on Tuesday next and the two Tuesdays follow¬
ing at four o’clock. Members of the medical profee.
eion will be admitted free on presentation of their
■cards.
gartUmft.
[FROM OUR OWN CORRESPONDENT.]
A Fighting Doctor Finxd. —One of the most
respected physicians in Perth, one day last week,
happened to be out on his bicycle, and to have occasion
to pass a blacksmith standing on the road. He rang his
bell to no purpose, and as he passed close to the fellow
was knocked off his cycle by what he averred later in
Court to be an intentional protrusion of an elbow. On
picking himself up and remonstrating, the blacksmith
showed an intention of fighting, and the doctor, wishing
as he explained, to get the first exchange, got in the first
blow, drawing blood. The doctor may have been hasty,
but the other surely was most to blame. However, it
was the blacksmith who got off scot-free in Court and tne
doctor who was fined one pound.
Edinburgh Medical Students Start for the
Transvaal — On Saturday night a party of medical
students left Edinburgh for London, purposing to go
out to South Africa under the leadership of Dr. Neeth-
ling of Bradford, to act as an ambulance party in aid of
the Boers. The scheme is said to have originated in the
South African Union in Edinburgh, and is suggested to
be financed by Sir James Sivewright. The men are all
Cape Colony lx>rn and bred, and British subjects, though
almost all of Dutch extraction.
Faculty of Physicians and Surgeons. —At a
meeting of the Fellows of the Faculty of Physicians and
6urgeons, held on the 6th inst., the following office
bearers were duly appointed for the ensuing year:—
President: Dr. H. C. Cameron. Visitor: Dr. James
FinlayBon. Councillors : The President ex-officio.
*lso as representative to the General Medical Council—
the Visitor ex-officio ; the Treasurer ex-officio;
I Dr. John Glaisler, Dr. Bruce Goff, Dr. Robert
Perry, Dr. D. N. Knox, Dr. John Barlow, Dr.
J. Lindsay Steven, Dr. W. L. Reid. Treasurer: Dr.
James D. Maclaren. Hon. Librarian: Dr. James Finlay-
son. Secretary and Librarian: Dr. Alexander Duncan.
The usual examiners, both for the Fellowship and for the
License were appointed.
Sequel to Glasgow Univebsitt Rectorial
Election. —On the day of the election, the Students’
Representative Council lodged a protest with
the senators regarding the action on the part
of Professor George Gilbert Ramsay during the election.
The names of three students were tendered as having
being forcibly interfered with, in fact assaulted by the
professor, while keeping the door on behalf of the
Liberal party. The students were requested to meet
Professor Ramsay-Stewart and the Principal on a
certain day. They accordingly presented themselves,
when they discovered that no official member of the
Representative Council, by whom tbe protest was lodged,
had been invited to attend. Under the circumstanoes, the
students summoned to appear declined to discuss the
matter until such an official member was requested to
attend and was present. The secretary of the Students’
1 Representative Council was then sent for, with the
result that Professor G. G. Ramsay agreed to apologise
individually to the three students conoerned, and also to
the students generally through the secretary of the
S.R.C.
Professor Sir William T. Gairdner, K.C.B.—The
worthy and gifted Professor of Practice of Physic, as he
likes to call it, has’ just entered upon his seventy-sixth
year of age and his thirty-eighth session as Professor
of Practice of Medicine in the University of Glasgow.
He was a graduate of Edinburgh University as long ago
as 1845, and was in 1863 appointed Medical Officer
' of Health for the City of Glasgow, being the first officer
i of the kind, which post he held for eleven years, when he
resigned and his assistant, Dr. J. B. Russell, was appointed
i to succeed him. Sir William holds many honorary titles,
and is Physician-in-Ordinary to the Queen for Scotland.
On December 25th, 1856, he was one of four medical men
who were present at the poBt-mortem examination on
J the body of Hugh Miller, and he is and always has been
a great favourite of the students, by whom he is known
as W. T. G.
MEDICAL SOCIETY OF LONDON.
Last Monday’s meeting was devoted to clinical cases.
| Dr. Cautley showed two cases, one a curious one of
aphasia and agraphia in a man, at. 71, in process of cure,
which he attributed to a small haemorrhage in the
second and third frontal convolutions pressing on the
centres for speech and writing. (2) A lad with a well-
marked systolic thrill and bruit perceptible over the
base of the heart as well as in the neck and back,
which he thought must be due to a congenital defect of
the aortic valves, especially as there was hypertrophy
of the left ventricle.
In the remarks that followed, however, arguments
were advanced in favour of the lesion being of the nature
of a persistent ductus arteriosus, though the absence of
cyanosiB was against it. The lad’s health was good,
and though the bruit was very loud it did not appear to
involve much obstruction.
Dr. Ewart showed an Italian, who came with sym¬
ptoms which at first sight suggested that he was suffer¬
ing from Addison’s disease. There was great loss of
flesh, weakness, vomiting and pigmentation of the skin
and nails; but on further consideration the pigmentation
was found to be of old standing, andprobably due to his
occupation as an asphalte-layer. His liver and. spleen
were much enlarged, and there was an .increase in the
white corpuscles and eosinophiles, with a decrease in the
red corpuscles. There was no history of malaria, so that,
although the idea of its being a case of Addison’s disease
must be dismiss* d, the diagnosis remains obscure.
Dr. Ewart also showed an interesting patient, in whom
an attack of persistent lockjaw was relieved by a deep
incision into an inflamed portion of gum, of which Dr.
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522 The Medical Press.
LITERATURE.
Nov. 15, 1899.
Kingscote gave two other examples under his own ob¬
servation.
Mr. H. L. Barnard showed a man, set. 20, with an
enormoas hernia cerebri, which had followed removal of
a large piece of skull done to relieve serious pressure
symptoms of four years’ standing. Great relief of the
symptoms followed, though the tumour could not be
reached, and its nature is still obscure.
Mr. Wallis showed three cases, two of Pott’s fracture,
and one of fractured tibia, in which he had secured co¬
aptation -of the fragments by wiring, with excellent
results.
Lastly, Mr. Morgan showed a young mam who, after
treatment of a huge axillary abscess, suffered occa¬
sionally from solid cedema of the arm and forearm, the
hand being exempt, due presumably to blockage of the
lymphatics.
(ftorrtsponiicncc.
We do not hold ourielvee responsible for the opinions of oor
correspondents. - ■ - -
MEDICAL ATTENDANCE GBATI8 AT THE R.A.M.
To the Editor oj The Medical Press and Circular.
Sib, —A former patient of mine, a student at the Royal
Academy of Music, tells me that she will no longer have
occasion to consult me because a certain medical man
has volunteered to attend the pupils of the Academy
gratis.
Now, the pupils of the Royal Academy of Music are
presumably persons in fairly good circumstances; in
any event, they are scaroely persons who can have any
claim to gratuitous medical treatment, and it would be
interesting to know what motives could have prompted
this medical pseudo-philanthropist to p’ace his services
gratuitously at their disposal. Possibly some of your
readers may be able to tnrow some light on conduct
which has excited mixed feelings in my bosom.
I am. Sir, yours truly,
A General Practitioner.
literature.
McKEOWN ON « UNRIPE CATARACT." (a)
Db. McKeown is well known in connection with the
treatment of so-called “ unripe ” cataract. In the
prefaoe he informs us that he brought the matter before
the profession in 1884, and from that time up to the
present his injeotion and irrigation method of treatment
of immature cataract has been constantly followed in his
practice. He has now resorted to it in about 700 cases
of various kinds. The present volume is the outcome
of the experience which he has gained in this special
subjeot. To those who are desirous of learning the
latest details of the author’s method the work will prove
mightily useful. But the treatise is really a monograph
upon the subjeot of cataract, and as such it may be use¬
fully perused by all ophthalmic surgeons. After dis¬
cussing the classification of the disease the author
f rooeeds to describe in detail the methods of operation,
t would rather seem that this chapter had been
placed in the wrong position; presumably, it should
have followed that on “Operations for Cataract." The
author points to six methods of dealing with the cornea.
Three of these are preliminary. —(1) The needle opera¬
tion; (2) Foster’s artificial maturation; (3) the intro¬
duction of a liquid inside the capsule of the lens imme¬
diately before the stage of capsnlotomy, and three which
are applicable after expulsion of the body of the lens;
(4) By pressure and friction on the outer surface of the
eye whether by spoon or finger, and directly on the eye, or
on the eye through the medium of the lids; (5) scoop¬
ing out by a scoop introduced into the eye; (6) the
(a) “ A Treatise on Unripe Cataract.” By William A. McKeown.
M.D., M.Ch., B.U.I., 8urgeon to the Ulster Eye, Ear and Throat
Hospital, Belfast; Lecturer on Ophthalmology and Otology, Queen's
College, Belfast. Illustrated by 9 plates, containing 00 original
drawings. London: H. K. Lewis.
force and disintegrating action of liquid introduced into
the eye. Dr. McKeown has not muoh to say in favour
of Foster’s method, and in ' any case he believee
it'to be of limited application. In regard to the intro¬
duction of liquid- into'the capsule at the time of operation
he claims that it renders transparent substance opaque,
breaks up striated, flaky, mother-of-pearl cornea, and
separatee cortical snbstanoe from the capsule. These, of
course, are great advantages in comparison with other
methods. So far as the irrigation method is concerned,
after the lens has been expelled, the ahthor lays down
that the liquid presses the posterior capsule of the lens
backwards, usually causes the cut and torn capsule to
come forwards, and to flap about according to the
direction and force of the stream, and reaches every
part of the interior of the capsule, searches every corner
for cortical remains, whether large or small, con¬
cealed or exposed, opaque or transparent. The author
further points out that he has had experience of
three combinations of methods, viz:—(1) Combina¬
tion of injection by fine hollow needle and massage;
(2) combination of scooping with irrigation; (8)
combination of irrigation with massage. A list is-
also subjoined of cortical cataracts, and details given of
the methods of treating them which in the author’s
hands have proved to be most beneficial. A useful
chapter follows upon the subject of preparation for
operation. Here we notice that Dr. McKeown pledgee
his faith in chinosol as an antiseptic agent, so much so,
that he new-uses no other. He significantly remarks
that if a solution of perchloride of mercury be used for
washing out the anterior chamber, the cornea is apt to
beoome opaque, with disastrous effects to the vision,,
whereas he adds that he has several times irrigated the-
anterior chamber in cases of severe suppurative
keratitis, with a solution of chinosol, without any
opacity of the cornea being caused. The other
chapters in the volume are “ Detailed Descrip¬
tion of Apparatus for Injection and Irrigation
and Method of Use," “ Operations for Catar¬
act,’’ “ Post-Operative Incidents and Treatment,”
and a" Statement of Cases." Two appendices also are-
added, in one of which is discussed the ever verdant-
question of iridectomy in cataract operations. Whether
or not Dr. McKeown’s methods of the treatment of
cortical cataract are destined to come into favour among
ophthalmic surgeons, cannot be determined at present;
If it were always possible to extract a cataract in its-
capsule, there would be no need for surgeons to oonoerm
themselves about the cornea, but since it is impossible to
deny that the operation of cataract extraction is often
seriously complicated when there is soft lens matter to
deal with, it is well to know that the method of treat¬
ment in such cases elaborated by Dr. McKeown holds out-
prospects of the attainment of good results.
KINGSCOTE’S ASTHMA, (a)
The author of this work is kind enough to inform us*
in his preface that it is not to be considered an exhaus¬
tive treatise on asthma. The caution is not necessary,,
for there is no possibility of such a mistake being made.
The book is divided into sixteen chapters, and practi¬
cally only three of them are devoted to asthma. It is
not until the twelfth chapter is reached that chere-
seems to be even the most remote reference to that
subject. This, we think, is pretty clearly shown by the
fact that the initial headings to this chapter are :—
“ Introduction—History—known to be described by
Hippocrates." Even in an exhaustive treatise on the-
subject we should expect to get beyond the time of
Hippocrates at so advanced a stage of the work. In this
short chapter quotations are frequent, but the next
article on “ Etiology” is made up almost entirely of
extracts, the late Dr. Hyde Salter, whose book was pub¬
lished as far back as 1868, being laid heavily under con¬
tribution. The chapter on “ Treatment ” is ambiguous,
and although the author profesaes to “ define his prac¬
tice," we are left very much in doubt as to the methods
(a) “ Asthma: Recent Developments in its Treatment.” By
Eraeat Kinjrscote, M.B., C.M., L.B.C.S.Edin.,Fellow of the Medical'
Society of London. London: Henry J. Qlaieher. 1899.
ed by Google
Nov. 15. 1890. MEDICAL NEWS. Th* Medical Prers. 523
he adopts. A perusal of his “ Illustrative Cases ” throws
very little light on the subject, although in a case of
aortic dinmim (p. 130) the author Btates that he “ read
the Eiot Act.” Whether this document was read aloud
to the patient, or perused by the author for his own
edification in the privacy of his own chamber, we are
not told, but we fail to understand how the reading of
a legal document, or of any number of them, could
cause the disappearance of a cardiac murmur. There
is a mystery about the whole procedure which we are
unable to fathom. The author gets very neatly over
any difficulty that might be experienced in connection
with the bibliography of the subject by referring the
reader to the Index-Catalogue of the Surgeon-General of
the U.S. Army. He evidently lays considerable stress
on a series of “ Don’t* ” which he copies from a Trans-
Atlantic paper. The following are examples:—“ Don’t
conclude that every murmur means disease of the heart;
don’t neglect to note the character of the pulse when
you examine it; don’t examine the heart through heavy
clothing.” For whose benefit these sage maxims are
reproduced we " don’t ” know. If books were classified
on the same principle as stage plays this particular
work would undoubtedly be placed in the category of
farcical comedy.
LIFE OF MAN ON THE HIGH ALPS, (o)
Professor Mosso has long been known as a past
master of the subject of muscular work and of the influ¬
ences brought to bear on it by various concomitant cir¬
cumstances. He is also an expert Alpine climber. No
one, therefore, could be better fitted for a study of the
variations induced in the phenomena connected with
muscular action or of the circulatory, respiratory and
other changes produced by residence in high altitudes.
The present volume is worthy of its author’s reputa¬
tion. Wishing to study some of the problems pres en ted
by life in the High Alps, Professor Mosso determined to
take up his abode on the summit of Monte Rosa,
4,560 metres above the sea, in the hut named
after the present Queen of Italy. Here he could
uonduct at his leisure a number of aocurate researches
into the various effects produced by high altitudes upon
the bodily processes. The subjects of his experiments
were provided in the persons of ten soldiers belonging
to the Italian Alpine regiment. It would be impossible
here to detail the facts observed by Professor Mosso
during his stay on Monte Rosa, or even a tithe of the
experiments recorded in this book. In the first place we
may say that it is exquisitely illustrated, and that the
translator has done his work with great ability.
The chief subjects investigated comprise the pheno¬
mena shown by muscular force, respiratory aotion,
circulation of the blood, and condition of the heart,
mountain sickness, diet, body temperature, training and
oerebral conditions as produced at great heights.
Perhaps the most interesting part of the book for
those who are not specialists in physiology, is that whioh
deals with accidents caused by excessive fatigue and
nervous exhaustion. Mosso has before now shown that
every act of the will, even by the simple forcible olinch-
ing of the hand, causes some degree of cerebral fatigue;
that this contraction of the muscles brings about a
consumption of foroe in the brain, which requires
renewal.
In mountain olimbing he notes that the member of a
party who oocupies the foremost position, and so is at
the tore end or the rope, suffers sooner from fatigue
than the others. This is not only due to the greater
amount of wor k entailed in cutting steps. Ac., but arises
also from the greater responsibility. On the other hand,
however, the front man of an Alpine party having to cut
steps and pick the way, is always stronger and more full
of oourage than those who have to wait upon him.
Illustrative examples are also given of the profound
mental effect which the severe labour and excitement
caused by Alpine ascents produce. The numerous other
(a) " Life of Man on ths High Al[w." By Angelo Mosso. Trans¬
late 1 from the Italian by E. Lough Kiesow. London : T. Fisher
Unwin, 1809.
points of interest must be consulted in the original. The
whole book is an example of the truism that truth is
stranger than fiction.
4ttebieal fittos.
Another case of death from anthrax was the subject
of an inquest at the London Hospital on Satuiday last,
the victim being a man, set. 54, a horse-hair curler. It
was stated that another man was at present under
treatment at St. Bartholomew’s Hospital for the Bame
disease.
Royal College of Physicians, Edinburgh : Royal College of
Burgeons, Edinburgh; and Faculty of Physicians and
Burgeons of Glasgow.
The quarterly Examinations of the above Board in
Edinburgh, took place in October, with the following
results:—
First Examination, 4 Years’ Cours*. Of 11 candidates
entered, the following 5 passed the examination
Randal Herley, William Anderson, Norman Pigott Fairfax, John
Wilton, and Patrick James Kerwin : and 1 passed in Histology and
1 in Chemistry.
First Examination, 5 Years’ Coarse. Of 35 candi¬
dates entered, the following 13 passed the examina¬
tion :—
Lionel Walpole Thomson, Thomas McMnster Glen, Peter Oswsld
Jollie, John Joeeph Lawton, John Archibald Turnbull, Johu
Bryden, Cecil James Todd, David Haig, John Walker, Gerald
William Smith wick, Michael John McCarthy, Robert Septimus
Walker, and Edward Rainsford Mum ford ; and 8 passed in Physics,
and 2 in Biology.
Seoond Examination, 4 years’ oourse. Of 20 candi¬
dates entered the following 7 passed the examination: —
William Christopher Brown, Sidney Gerald Gomes, Claude St.
Aubyn Farrer, William Henry Burnhul, Felix MaoSwiney, Walter
Percy Warburton, Morgan Howard Howard Jones, and 2 passed in
anatomy, 1 in physiology, and 3 in materia medica.
Second Examination, 5 years’ Course. Of 22 candi¬
dates entered the following 10 passed the examination:—
Ryder Percival Nash, Clara Hind, Joseph William Robert
Sutton, Percy Jeremiah Bateman, John Browne Grogan Mulligan,
Daniel Joeeph Cagney, Robert Thompson, John Arthur Doyle,
W illia m Robert Addison Coatee, and Thomas Fryer Okell.
Third Examination, 6 years’ Course. Of 29 candidates
entered the following 17 passed the e x a min ation .—
Cbarlotta Rudd, John Blair Conner, Henry Ayrton Chaplin,
George Herbert Leon Hammerton, David Crombie, William'
Brown Heagerty, Alexander Wilson, Frew, Henry Christian,
Ernest Quin, Prudence Elizabeth Gankin, John Philip Cameron,
Alioe Miles, Charles Stephenson Oliver, Robert Peel Parker, John-
Bui man Mason, John Bell Walker, George Weldon Hibbert, and
Basanta Kumar Chatterjee, and 1 passed in Pathology and 2 in
Materia Medica.
Final Examination. Of 107 candidates entered the-
following 52 passed the examination and were admitted
L.R.C.P.E., L.R.C.S E., and L.F P. and S G.
William Hewley Wharton, Sydney Edgar Price Philip
Heywood Hadfleld, John Archibald Wolverson, William-
John Morgan, John Allen Bootland, Martin Francis Ellis, Nellie
Jardine, Elizabeth Beatty, Alioe de Boer, Daniel William Jones,
Eyre William Powell, Charles George S tree ton, Leeds, Bartholo¬
mew, Francis Murphy, Alice Le&rnmonth McKenzie, William
Morris Williams, Allan Douglas Cameron, William Frederick
Oliver, James Curtis Fianklin, Douglas Massey Burnside, Nathaniel
Hodgetta, James Duncan Wilson, John James Scanlon, Jean Sinclair,
Dobson Robertson, William Welsh, John McClintock, Arthur Gibson,.
Roderick McKenzie Skinner, Joseph Fulton, Prabala Rama Chan-
drayya, Arcot Kodanda Parri Mudali, James Clement Purcell
Reardon, Charles Braginton Solway, John Smith Outhridge,
Ch-rles Richardson White, James Michael O’Sullivan. George
Powell Hay (with honours), Henry Grattan Johnston, Ewen
Mackenzie, Sidney Jacob. Robert James Love, John Kirkpatrick,
William Ebenezer Way mark. Hugh John Drennan Mackay, Bar¬
tholomew Connolly, Lionel Robert Popham, James Valentine
Roche, James Michael Aloyaius Manning, John Joeeph Fuller,
Harry Parker Dall y, Charles Louis Francis, and Robert Jackson
Mackay; and 12 passed m the division of Medicine and Therapeu¬
tics, 2 in Surgery and Surgical Anatomy, 13 in Midwifery, and 10 in
Medical Jurisprudence.
The following gentlemen, having passed the requisite-
Examinations/received the Conjoint Diploma in Public
Health :—
Maurice Paterson, John William Myers, William McLean, Joseph
Chambers, John Geddes McColl. and Alexandre di Fonceca Diae.
Digitized by Google
524 Th« Mbpical Perm NOTICES TO CORRESPONDENTS._Nov. 15 , 1896 -
4totice* to
CorrcBpottbctttB, Short 'jtettaro,
Correspondents requiring a reply In this oolnmn are par¬
ticularly requested to make use of a dintinctive signature or
initials, and avoid the practice of signing themselves " Reader,"
"Subscriber,” "Old Subscriber,” 4c. Much confusion will be
spared by attention to this rule.
Local Reports and News.—C orrespondents desirous of drawing
attention to these are requested kindly to mark the newspapers
when sending them to the Editor.
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 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.
THE WAB FUND.
The sum now being raised for the widows and children of soldiers
killed in the Transvaal War is assuming magnificent proportions,
contributions from Her Majesty the Queen to working men in
various factories flowing in from all sides and from all parts of the
United Kingdom. Theatrical managers and manufacturers alike
are vying with each other in special efforts, the latest being that of
“ Vinolia,” which promises to contribute one halfpenny for each
cake of soap sold within a month; and so enormous is the consump¬
tion of this popular article, that the proprietors anticipate the War
Fund will benefit by nearly £7,000 from this source alone.
Typewritten letters may be reproduced to the extent of sev eral
hnndreds from one original, all equal in appearance to an ordinary
typed letter, and for this work the " Automatic Cyclostyle ” has no
rival, the best possible results being obtained on account of the
evenness of rolling.
A PHILANTHBOPIC ADVERTISEMENT.
To the Editor of The Medical Press and Circular.
“ A little nonsense now and then,
Is relished by the best of men.”
Sir,— The offer made under above heading in your " Notices to
Correspondents” last week, reminds me of a similar offer made by
an American, who advertised he would remove all of a person’s
teeth for two dollars and insert a complete new set for ten dollars,
besides giving six months' credit. " People are fond of bargains, so
there was a rush for the dentist’s office. He was busy for two weeks
pulling teeth, and at the end of the time numbers of people had
empty gums, and a bone dust factory in the neighbourhood doubled
it* workmen to grind the teeth into bone dust. While people were
waiting for the new sets the abandoned scoundrel eloped with the
hotel keeper's wife, and now 2,000 or 3,000 people cannot eat any¬
thing tougher than gruel or soup. All the butchers have shut
shops, and not a biscuit has bean sold for months. One man, it is
said, whittled out a wooden set for himself, but the first glass of
whiskey he took set the teeth on fire. The dentist will hear of
something to his advantage if he comes back.”—From “ Awful
Crammers,” by Josh Billings.
I am, Sir, yours truly,
A. D.
General Practitioner.— The treatment of alopecia areata is
varied, and fully laid down in the text books on dermatology. As
opposed, however, to drug treatment, n French authority claims
that much can be done by means of mechanical irritation. He re¬
commends a stiff brush to be applied to the affected area, and to be
used from four to six times a aay so as to cause hy perse mil of the
part.
PBOFESSOB CHIENE ON MISTAKES IN DIAGNOSIS.
The most common cause of mistakes, remarked the speaker in a
recent address, is the imperfect, careless examination of a patient. 1
Ignorance is thought to be the most common cause of mistakes.
My experience does not lend itself to that view. To imperfect |
examination, I think, is due the maiority of my mistakes. Learn {
from your mistakes. Be methodical as well os thorough. When |
you touch in surgery, make your diagnosis, if possible, painlessly, j
THE WEIB-MITCHELL TREATMENT.
A correspondent writesWeir-Mitcliell published his original
plan in a work entitled “ Fat in Blood, an Essay on the Treatment
of Certain Forms of Neurasthenia and Hysteria. ' Playfair also de¬
scribes the method in his work on * The Systematic Treatment of
Nervous Prostration and Hysteria.” The subject is also dealt with
at some length in Allbutt'B “System of Gymecology.” The last
.edition of the first-named work is dated 1899.
Jtteetittgs of the Societies aitb Xectures.
Wednesday, November 15th.
Royal Microscopical Society (20, Hanover Square, W.).—
7.30 p.m. Mr. A. Eurland : Exhibition of Foraminifera.
Society of Arts.— 8 p.m. Sir J. W. Barry: Opening Address of
the 146th Session.
St. Jon's Hospital por Diseases of the Skin (Leicester
Square, W.C.)—4.30 p.m. Dr. Eddowes: Keratoses. (Poet-graduate
Course.)
Thursday, November 16th.
Harveiax Society of London (Stafford Booms, Titchborne Street,
Edgware Road).—8.30 p.m. Dr. A. H N. Lewers: On some
Interesting Cases of Fibroid Tumours of the Uterus.
Central London Throat, Nose, and Ear Hospital.— 5 p.m. Dr.
D. Grant: Diagnosis of Nasal Diseases characterised by Pain, Dis¬
turbances of Smell, 4c.
Friday, November 17th.
Anatomical Society of Great Britain and Ireland (Physio¬
logical Theatre of the London School of Medicine for Women,
Hunter Street, W.C.).—4 p.m. General Meeting. Election of Officers
for the ensuing year. Communications: -Mr. S. Boyd: A Persistent
Left Inferior Vena Cava. - Miss Stoney (introduced by Mr. 8. Boyd):
Specimen of Sacculated (Esophagus.- Prof. A. M. Patterson:
Child’s 8kull showing Parietal Perforations.- Prof. B. C. Windle
and Mr. F. G. Parsons: Note on the Morphology of the Biceps
Flexor Cruris.—Mr. C. B. Lockwood: Lantern Demonstration of
Certain Points in the Lymphatic System of the Appendix. Meeting
of Council to Elect Members of Committee of Management.
lacaitritt.
Bracebridge Asylum, Lincoln.—Junior Assistant Medical Officer,
unmarried. Salary £125 per annum, with furnished apartments,
board, attendance, Ac.
British Hospital, Buenos Aires.—House Surgeon. Salary £200 first
year, £250 second, £!00 third, with board, lodging, and wine
allowance. Apply to Dr. Louis Colbourne. Berkhamsted, Herts.
Carmarthenshire Infirmary.—Resident Medical Officer for 12 months,
unmarried. Salary, £100 per annum, with furnished apartments,
hoard, attendance, fire, gas, and washing.
Derby Borough Asylum.—Assistant Medical Officer. Salary £120
per annum, with board and washing.
Liverpool Dispensaries, 34, Moorfields, Liverpool.—Senior Surgeon
of the East Dispensary, unmarried. Salary £200 per annum,
with board and apartments.
Suffolk General Hospital.—House Surgeon. Salary, £100 a year,
with board, lodging, and washing. Apply to the Secretary, Bury
St. Edmunds.
Three Counties Asylum.—Second Assistant Medical Officer, un¬
married. Salary commencing at £125 par annum, with board,
anartments, washing, and attendance. Apply to the Clerk to
the Visiting Committee. St. Neots, Hunts.
appointments.
Baker, John, M.B., C.M.Aberd., Deputy Superintendent of the
State Asvlum at Broadmoor.
Bendle, L. H., L.B.C.P., M.B.C.S., Medical Officer to the York
County Hospital.
Clome, Napier, L.R.C.8.Irel„ L.B.C.P.Edin., Medical Officer for
the Chard >o. 2 Sanitary District.
McElliuott, Maurice G., D.P.H., L.B.C.P., L.B.C.S.,Irel.,
Medical Superintendent of Belper Isolation Hospital.
Scott, W. J , L.R.C.P., L.B.C.8.Irel., Medical Officer for the No. I
Sanitary District of the Windsor Union.
Smith, W. Brownlow, B.A., M.D., B.Cli., B.A.O. (T.C.D.), Deputy
Medical Superintendent of the Belper Isolation Hospital.
Squire, M.F., M.B., B.S.Durh., LR.C.P.Lond., M.R.C.8., Medical
Superintendent and Medical Officer of the Workhouse for the
Parish of Paddington
Willis, Harrt Legse, M.R.C.S., L.R.C.P.Lond., Junior Assistant
Medical Officer to the Govan District Asylum.
#irths.
Noble.— On November 7th, at The Moorings, Walthamstow, the
wife of W. G. Noble, L.S.A., of a daughter. •
Wohlmann.— On October 29th, at Gay Street, Bath, the wife of
Arthur Stanley Wohlmann, M.D., B.S., of a daughter.
4ttarriagc0.
Hamilton—DearMan. — On November 8th, at St. Giles’s Church.
Bramhope, Roger Kerr Hamilton, M.R.C.S.E.. L.R.C.P.I,, of
Woodbine Cottage, Whittle-le-Woods, Chorley, to Edith,
eldest daughter of William Dearman, of Sydney, N.S. W.
deaths.
Adams.— On November lOrh. nt 241, Mosley Rond, Birmingham,
. Gerald W. Adams, M.R.C.S., L.R.C.P., aged 35, son of Dr.
Ernest Adams, of Clifton, Derby.
Burt.— On November 8th, at Eastbourne, John Walter Bury, M.D.,
aged 63 years.
Dixon.— On November 7th, at Chepstow, Thomas Dixon, M.D.,
formerly of Chesbunt. and Norfolk Crescent, London, aged 74.
Morlet. — On November 11th, at 45, High Street, Portsmouth,
Frederic Morley, M.R.C.S., L.S.A., aged 57.
Wioan. —November 9th, at Portishead, Somerset, of pneumonia,
Margaret, the beloved wife of George Wigan, M.D., aged 73.
Digitized by GoOglC
Ik* Redial §?**ss »tul Circular.
" SALU8 POPULI SUPREMA LEX"
Vol. CXIX. WEDNESDAY, NOVEMBER 22, 1899. No. 21.
(Original Communications.
THE TREATMENT OF ACUTE
PSYCHOSES BY REST IN BED.
By Dr. P. SERIEUX,
Physician to the Asylum for the Insane for the Department of
the Seine.
[Specially Translated for The Medical Press and
Circular.]
(Continued from page 502.)
The data which we have given are far from com¬
plete, and are useful in so far as they define the
general indications for applying the treatment. They
justify, however, the use of this treatment in certain
cases from a physiological point of view; in cases of
•excitement for example, it has the advantage of
moderating cardiac ana respiratory movements, which
are always somewhat tumultuous, and of lowering the
temperature which is sometimes above normal. In
eonaitions of depression rest in bed regulates the
functions of nutrition, overcomes irregularities of the
circulation, and prevents the patient from taking
cold, while it also checks disassimilation.
From a clinical point of view, most authorities are
agreed on the indications for the bed treatment.
They can be very briefly formulated:—The treat¬
ment is indicated whenever rest of the brain or of
-the entire organism is necessary. Moreover, with
persons suffering from the acute psychoses, the
special symptom to be looked for is the exhausted
state of the brain and of the organism in general.
Cerebral exhaustion brought on by irritation of the
moto-sensory and sensory centres in the cortex,
exhaustion following agitation, insomnia, and
inanition plainly call for rest, physical as well as
mental.
It is unnecessary to emphasise the indications for
physical rest, the importance whereof was insisted
upon by the earlier observers. Weir-Mitchell looks
upon his method as particularly suitable in cases of
prostration, anaemia, and emaciation. According to
Lradwig Meyer, who has for thirty-five years practised
this treatment, it is especially to the physical mani¬
festations that we must look for indications of the
necessity for this treatment, and the length of time
it will require to be applied. This author admits
that mental symptoms are markedly benefited
thereby. In short, physical conditions requiring rest
in bed are loss of appetite, emaciation, general
debility, advanced age, the puerperal state, chlorosis,
anaemia, circulatory disturbances, and febrile or
subfebrile conditions. These various symptoms fre¬
quently present themselves in melancholics and in
maniacal patients, as well as in post-infectious, toxic,
and puerperal psychoses. With regard to indications
for psychical and cerebral rest, they are always
present in acute cases.
"It does not matter whether they are states of ex¬
citement,^depression or Iconfnsion, or even of acute
delirium with hallucinations—all these psychoses
originate from more or less serious impairment of
nutrition of the cerebral cortex, and sometimes even
of the whole cerebro-spinal axis (polyneuritic
psychoses). If the brain be overwrought by undue
activity of the motor zones (maniacal conditions), of
the sensory zones (melancholia), of the sensorium
(hallucinations), or if its activity be paralysed for
the time being by a toxic influence (confusion), in all
these cases it is a matter of primary importance to
give the intoxicated or overwrought organism rest,
so as to permit the processes of nutrition to return
to normal. Rest in bed alone can secure complete
repose of the brain. Apart from the fact that the
horizontal decubitus facilitates the oerebral circula¬
tion, and the brain is therefore better supplied with
blood, the treatment further renders complete re¬
laxation of the muscles possible, with, conse¬
quently, rest of the motor oentres. It also reduces
to a minimum peripheral stimulation (thermal,
visual, auditory, cutaneous, Ac.), and therefore all
motor reflexes. It is favourable to sleep, and it
diminishes the intensity of hallucinations by re¬
ducing the sources of excitement.
Rest in bed, moreover, advantageously modifies the
environment. In a ward where all the patients are in
bed order and silence are seldom disturbed because of
the absence of every kind of excitement and disorder
associated with promiscuity. Conversation with, or
the mere sight of, other patients, their goings and
comings, the meals in common, intensify the suffer¬
ings of melancholic people, just as they excite
maniacal patients, and reinforce the sensory dis¬
turbances of patients suffering from hallucinations.
All these troublesome influences are avoided in our
wards, where patients are ensured physical as well as
mental repose.
In short, rest in bed is advised in all the acute
psychoses, on account of the necessity for complete
rest of body and mind. This gives one some idea of
the.number of sufferers amenable to the treatment,
the proportion varying from a third to over a half of
the total inmates.
In a good many foreign asylums an excellent
method has been adopted in virtue of which
every patient on admission, after having taken a bath
and put on clean clothes, is kept in bed for several
days. This method is justified by the fact that there
are very few patients who, on admission, are not
emaciated and prostrated by restleBsless, insomnia,
and inanition, or whose general state of health does
not leave much to be desired.
We agree with Paetz, who asserts that patients
who at first appear to be free from nutritional distur¬
bance nevertheless display symptoms of excitement,
and exhaustion, circulatory, digestive, and nutritive
disturbance. The majority, we find, are quite incapable
of calling one’s attention to these various symptoms,
and this shows the necessity of a general method
of investigation applied in a systematic manner.
Under treatment by rest in bed a fairly rapid im-
led by
Google
526 The Medical Pbesb* ORIGINAL COMMUNICATIONS.
Nov. 22, 1899.
provement both in the physical and mental condition
of the patient is brought about. Excitement and
irritability are calmed, fits of depression are rendered
less frequent, and hallucinations become less vivid,
digestion is less hampered, and the general condition
improved. Lastly, the patients have every oppor¬
tunity of obtaining refreshing sleep on the occurrence
of an interval of comparative quiescence.
In short, the amelioration of the symptoms of acute
psychoses following rest in bed is unquestionable.
We may be asked whether the same can be said of
influence of rest in bed on the subsequent course of
the disease; in other words, does the treatment bring
about recovery sooner or better than other methods
of treatment P It is impossible to answer such a
question categorically, but one fact appears to us
incontestable, viz., here we have a method of treat¬
ment which invariably attenuates the intensity of the
more acute symptoms of mental disease, which gives
the exhausted brain, and the organism as a whole the
beet chanoe of remedying grave disturbances of
nutrition. Such a method must rationally conduce
to recovery. It certainly averts the disastrous
physical and psychical complications to which the
fatal termination in acute cases is invariably due,
and it helps to avert dementia and passage into a
chronic condition. It may not be amiss to give the
opinions of various authors on the benefits of rest in
bed. Professor Ludwig Meyer, with his wide
experience, states that, with few exceptions he had to
congratulate himself on the results of the treatment.
One of the most marked features of this treatment,
he observes, is the rapidity with which the
first signs of improvement make their appearance.
Timofeier and Govseier agree that attacks of deli¬
rium treated by rest in bea display less intensity and
pass off sooner. According to Bernstein, patients
treated in this way do not recover more quickly, but
their symptoms are markedly attenuated, and Roh-
rick states that without shortening the period of the
attack the treatment obviates denutrition (collapsus),
and reduces the symptoms of agitation. There are other
advantages, in addition to those already mentioned, to
be placed to the credit of this treatment. The use of
hypnotics and sedatives can more easily be dispensed
with, and isolation of patients in special wards, which
has been so much abused, is rarely called for. The
nureing of the patient is facilitated, the patient does
not contract uncleanly habits (gatism, coprophagy)
as many isolated patients are apt to do. Organic
affections no longer run the risk of being overlooked
and consequently not treated, though these might
easily escape recognition were it not for the facility of
examination ensured by the patients being undressed
and in bed. Visceral complications which might lie
caused by sudden changes of temperature or pro¬
longed exposure to cold in melancholic patients, for
example, who dislike movement of any kind are avoided
by the equable temperature which is maintained.
In addition to this the treatment by rest in bed
leads the patient to be treated not as a pariah,but as
an ordinary patient as well by his nurses as by the
members of his own family. This treatment, more¬
over, in certain cases may impress the imagination
of the patient, and assist in convincing him of the
morbid character of his symptoms, and so accustom
him to the idea that be requires care. Lastly, this
treatment has one result which, in our minds, is all
important, viz , the complete transformation which it
brings about in the environment of our lunatic
asylums. The mere fact that half the patients are in
bed, and the suppression of isolation in padded rooms,
the “ prison," where it has long been the custom to
huddle together the curable and the incurable cases,
f o far to convert the lunatic asylum into an ordinary
ospital for the treatment of mental disease. Dis¬
ciplinary measures are replaced by appropriate thera¬
peutical treatment, and the attendants become nurses.
We have done with the aggregations of restless andl
agitated patients, who mutually excite each other,.
rendering any serious examination of the symptom*
impossible. Instead of these “ lunatic dens ” we have
wards where those suffering from acute diseases,,
requiring as muoh care as patients suffering from
typhoid, are treated in bed, are carefully looked after
and daily examined.
(7o be continued.)
REMOVAL OF MYOMA UTERI BY
ABDOMINAL HYSTERECTOMY 00.
By CHARLES RYALL, F.R.C.S.,
Surgeon to the Cancer Hospital, Brompton, and to the Gordon-.
Hospital for Diseases of the Bectum ; Surgeon to Out-Patients,.
London Lock Hospital.
S. E., ®t. 48, an unmarried woman, was admitted
into the Cancer Hospital on July 18th, 1899, and
gave the following history :—For the last ten years
she has suffered from pain in the abdomen, over the
sacrum, and down the thighs, and this has been,
getting worse of late. Palliative treatment had been
tried for some considerable time, but without
alleviating her symptoms to any great extent, and
she was therefore anxious to have any operation per¬
formed that would give her the necessary relief.
She was a well-nourished woman, and never had.
any previous severe illness.
The catamenia were regular, duration about five-
days, amount lost not great, and always accompanied
with pain.
On examination, a hard and irregular shaped,
tumour could be felt rising out of the pelvis and
reaching upwards to a point about midway between
the umbilicus and the pubis. Per vaginam a hard
rounded swelling was found in Douglas's pouch,
and appeared to be part of the tumour that was felt
in the abdomen. The whole mass was incorporated
with the uterus and almost completely fixed in the
pelvis.
Abdominal hysterectomy was recommended as the
only means of curing the pain, and moreover there
was every evidence that the tumour was increasing
in size, and frequency of micturition, combined with
troublesome constipation, showed that the functions
of the bladder and rectum, were being interfered
with.
Operation, July 28th, 1899.—The abdomen was
opened by the ordinary median incision, extensive
adhesions of the omentum, small intestine, and sigmoid
had to be freed before the tumour could be brought
into view. After ligating and severing the upper
parts of the broad ligaments, turning down a flap from
the anterior surface of the uterus, and partly enucleat¬
ing the tumour in the pouch of Douglas, one was enabled
to lift the whole mass out of the pelvis. There was no
difficulty then in securing the uterine vessels and
cutting through the cervix. The only other things
of note in the operation were the enucleation of a
small myoma from the cervical stump, and the
method adopted in dissecting the posterior flap.
Instead of dissecting it from above downwards, a
procedure which is not always easily accomplished,
it was dissected from below upwards after the cervix
had been divided. The operation was finished off in
the ordinary way, which lias been described so many
times, and the patient did not appear to suffer from
any great amount of shock.
I saw her daily for a week after operation, and
during that time she made rapid progress in recovery.
(a) Bead before the British Gyntecological Society, November
9th, 1899.
Nov. 22, 1890.
ORIGINAL COMMUNICATIONS. Ths Midicil Pbub. 527
■ttnd on the last day of the week she was taking solid
food and appeared to be perfectly well. I saw her
a?ain on the twenty-fifth day after operation, and
then learned that she had gone on very well up to
the twenty-first day and had not given the least cause
for anxiety. On the twenty-first day she was seized
with sudden and acute pain in the calf of the right
leg, and on examination no pulsation could be felt in
the posterior tibial artery though it persisted in the
dorsalis pedis artery. The following day the pulsa¬
tion disappeared from the dorsalis pedis ana dry
gangrene set in. On the third day after the onset of
these symptoms she developed aphasia which rapidly
became complete. When 1 saw her on the twenty-
fifth day after operation she was unconscious and
had lost control of both sphincters. There was
marked rigidity of the muscles of the right side of
~the body, both pupils were equal and dilated, and the
left proved to be less active to light than the right.
'The right leg was undergoing dry gangTene to witnin
two inches of the knee joint. The patient became
gradually worse, and died on the twenty-eighth day
after operation.
No post-mortem examination was made owing to
•the objection of her relations.
Clinically, one was unable to detect any signs of
arterial or cardiac disease, and I am at a loss to
-explain why she should have developed this trouble.
An embolus apparently first lodged in the posterior
-tibial artery, and then thrombosis extended back¬
wards to the bifurcation of the popliteal and thus
implicated the anterior tibial. The cerebral trouble
•was quite independent of this.
NOTES ON AN UNSUCCESSFUL CASE OF
ABDOMINAL hysterectomy
roa
MYOMA, (a)
By HERBERT SNOW, M.D. (Lond.), Ac.,
Surgeon to the Cancer Hospital since 1876.
Considering that more may often be learnt from
a failure than from even a brilliantly successful case,
1 venture to bring the following under the notice of
the Society. Although incomplete, the facts seem to
me of sufficient importance to be narrated very
briefly; and of considerable significance in relation
-to a prevailing fashion in technique.
8arah L., single, set. 38, was admitted into the
Cancer Hospital on August 14th last, with multiple
•myomata uteri, noticed five to six years. There had
been recently a rapid increase, with a feeling of dis¬
tension and weight in the lower part of the abdomen.
Latterly there had been amenorrhcea for periods of
two to three months. The mass filled Douglas'
pouch. In front, the large “ lump ” was prominent
slightly to the right of the umbilicus. A consulta¬
tion was duly held, and the patient pronounoed
suitable for abdominal hysterectomy.
The patient was a rather florid young Jewess,
highly neurotic, and with obvious indications of free
resort to alcohol. She had no albuminuria, or other
sign of organic disease. There was plainly “ alcohol
in the family; ” as before the operation, a brother
came to see the patient in the hospital ward, in
an advanced stage of intoxication, and had to be
turned out.
Abdominal hysterectomy was performed on August
25th. The method adopted was that modification of
Dr. Heywood Smith’s, which I have previously
described before the Society, which involves dissect¬
ing off thin muscular flaps, and not merely the
•a) Read before the British Gynaecological Bociet/, November
9th, 1899.
peritoneal coating of the uterine tumours. The
Trendelenburg posture was necesssary. The abdominal
wall was sutured on the line I have invariably
used for cceliotomies during the past two years, and
which has always answered perfectly, viz., a catgut
continuous suture for the peritoneum, and interrupted
silk or silkworm gut for the remainder of the abdo¬
minal wall. The only untoward point in the opera¬
tion was that the dissection of the projecting bosses
took over two hours, and so involved prolonged
etherisation, always more or less hazardous in an
alcoholic patient. [Specimen and temperature-chart
exhibited.]
The next day all was well. There was no vomit¬
ing, a good pulse, and a very favourable tempera¬
ture-reaction. The next morning my favourite
enema of glycerine and peppermint water was ad¬
ministered early, and the bowels acted well. All
through the night, however, the patient was very
restless and excitable. Tho season, it will be remem¬
bered, was then excessively hot. On paying an
early visit at ten o’clock. I was informed she had tried
to get out of bed. had called out that they were
giving her ether instead of soda-water, had been
pushing away the nurses with all her strength, and
had, in short, been so violent that the friends had
been sent for merely to restrain her. The tongue
was moist and clear; and the attack was hysterical
rather than maniacal, the patient subsequently ex¬
pressing to the nurses her contrition for having been
so troublesome. When I saw her she was exhausted
by these struggles, and the pulse was rather slow ;
but she was calm, answered rationally, and showed
no bad symptom. At twelve, however, she began to
collapse. The house surgeons transfused, but with¬
out even transient improvement. She died at half¬
past two. Being a Jewess no autopsy could be
obtained.
In explaining the mode of death, I am loth to fall
back upon the vague term “ shock.” There may
have been internal nsemorrhage; but I consider that
possibility negatived by the absence of any improve¬
ment after the transfusion. I would ask the Society
to remember the highly interesting case reported last
session by my colleague, Mr. Charles Ryall; and to
bracket mine therewith. In that instance, vomiting
1 persisted after cceliotomy, and death took place in
about six days. Then it was found that tne peri¬
toneum had railed to unite; that the internal catgut
layer of sutures had ruptured, and that the intestines
lay in direct contact with the muscular parietes.
Although unable to verify the view, I therefore
infer that death was due in this unfortunate case
also to rupture of the flimsy catgut layer holding the
peritoneal edges. I submit to the Society that the
resent fashion of suturing in layers is highly
angerous, without provision to secure the whole
thickness of the panetes. We are completely at the
mercy of our patient. So long as she lies still, all
oes well; but otherwise, the slightest tendency to
ysteria or to mania proves unavoidably fatal. The
old mode of a single layer of silkworm gut sutures
traversing every coat was really far safer than that
recent plan of numerous layers, amounting in Howard
Kelly’s hands actually to four.
Provided primary union is secured, there is little
chance of tne common bugbear, parietal hernia.
But, certainly, so far as I have seen, we can much
more confidently rely upon obtaining that union
by an independent layer of peritoneal suture than by
the former plan. Hence I suggest, as the ideal
method, three or four silkworm gut sutures traversing
the whole parietes, in addition to the two layers of
catgut for peritoneum, and silk for muscle and skin.
This would render impossible the accident I presume
with confidence to have here taken place.
C
528 .The Medical Press. ORIGINAL COMMUNICATIONS.
Not. 22, 1899.
THE STRAWBERRY:
ITS PLACE IN THE HISTORY OF
THERAPEUTICS.
By JOHN KNOTT, M.A, M.D.,
Ch.B. and Dip. Stat. Med. (Univ. Dub.);
M.R.C.P J. ; M.R.I.A., Etc.
The recent recommendation of the use of the
strawberry as a special dietetic treatment of the in¬
numerable ills of gout, may make the therapeutic
history of this Tory palatable fruit interesting to the
majority of the reading members of the profession. I
have accordingly culled the most important evidence
on the subject from the pages of the prominent
herbal authorities of the past centuries, and submit
them for the perusal of the readers of the Medical
Press and Circular.
The (juaint and always entertaining John Gerard
gives his readers the following information on the
subject of the therapeutics of the strawberry
“ TheKindeg. —There be diuers sorts of Strawberries,
one red, another white, a third sort greene, and like¬
wise a wilde Straw-berrie, which is altogether barren
of fruit.
“ The Description. —The Straw-berry hath leaues
spred vpon the ground, somewhat snipt about the
edges, tnree set together vpon one slender foot-stalke
like the Trefoile, greene on the vpper side, and on the
nether side more white : among which rise vp slender
stems, whereon do grow small floures, consisting of
fiue', little white leaves, the middle part somewhat
yellow, after which oommeth the fruit, not unlike to
the Mulberrie, or rather the Raspis, red of colour, hau-
ing the taste of wine, the inner pulpe or substance
whereof is moist and white, in which is contained
little seeds: the root is threddy, of long oontinuance,
sending forth many strings, whioh diagnose them¬
selves far abroad, whereby it greatly increaseth.
“ The Temperature. —The leaves and roots do coole
and dry, with an astriction or binding quality : but
the berries be cold and moist,
“ The Vertues. —A. The leaues boyled and applied
in manner of a pultis taketh away the burning neate
in wounds: the decoction thereof strengthneth the
gummes, fastneth the teeth, and is good to be held
in the mouth, both against the inflammation or
bumiDg heate thereof, and also of the almonds of the
throat: they stay the ouermuch flowing of the bloody
flix, and other issues of bloud.
B. The berries quench thirst, and do allay the in¬
flammation or heats of the stomack: the nourish¬
ment which they yeeld is little, thin and waterish,
and if they happen to putrifie in the stomacko, their
nourishment is naught.
C. The distilled water drunke with white Wine is
good against the passion of the heart, reuiuing the
spirits, and making the heart merry.
D. The distilled water is reported to scoure the
face, to take away spots, and to make the face faire
and smooth; and is likewise drunke with good
successe against the stone in the kidnies.
E. The leaues are good to be put into Lotions
or washing waters, for the mouth and the prinie parts.
The ripe Straw-berries quench thirst, coole neate
of the stomack, and inflammation of the liuer, take
away (if they be often vsed) the rednesse and heate of
the face.
In the voluminous “Theatrura Botanicum,” Par¬
kinson gives the following description and history
The Names.
The whole plant is called in Latine Fragaria, and
the berries Fraga a fructus fragrantia odoris &
gustus, for it haoh no eertaine Greek name that I
know, unless as Tragus thinketh it may be referred
to the TflfvXksv of Dioscorides, or as others thinke to
the Kifiapm Comaron of Apuleius, but neither of them
is likely; others suppose that Dioscorides did
understand this plant under his rtrrmfaiK A. Some
have called it Rubus Idaaus non spinosus, but there is
a shrubbe like unto the Raspis that beareth no
thornes. as I have showed. Pliny maketh mention of
Fraga, lib. 25, c. 9. Servius calleth them Mora
terrestria, and therefore some would referre it to the
Chamsebatus : the Italians call the plant Fragheria,
and the berries Fraghe and Fragole; the French
Fraisier and Fraises; the Germans call the fruit
Erdheer; and the Dutch, Erdbesien; and we in
English, Strawberries.
The Vertues.
These Strawberries .... the leaves of them all
being oooling in the first degree, and yet some say
hot and drying in the second, the roote is more
drying and binding, the berries while they are greene
are cold and drie, but when they are npe they are
cold and moist: the berries are excellent good to coole
the liver, the bloud and spleene, or an hot chollericke
stomacke to refresh and comfort the fainting spirits,
and to quench thirst; they are good also for other
inflammations, yet it behoveth one to be oautetous, or
rather to refraine them in a feuer least by their putrify-
ing in the stomacke, they encrease the fits and cause
them to be the more fierce: the leaves and rootee
boiled in wine and water and drunke doe likewise
coole the liver and blood, and asswage all inflamma¬
tion in the raines and bladder, provoketh urine, and
allaieth the heate and sharpenesse thereof: the same
also being drunke staieth the bloudy flixe and womens
courses, and helpeth the swellings of the spleene;
the water of the berries carefully distilled, is a sove-
raigne remedy and cordiall in the palpitations of the
heart, that is, the panting and beating of the heart,
and is good for the overflowing of the gall, the yellow
jaundise; the juyce dropped into foule ulcers, or
they washed therewith or with the deooction of the
heroe and roote, doth wonderfully dense them and
helpe to cure them. All lotions and gargles that are
made for sore mouthes or ulcers therein, or in the
privie parts, or else where are made with the leaves
and rootes hereof, which is good also to fasten loose
teeth, and to heale spungie foule gummes: the same
also helpeth to stay catarxhes ordefluxions of rheume
into the mouth, throate, teeth, or eyes: the juyce or
water is singuler good for hot and red inflamed eyes,
if some thereof be dropped into them, or they bathed
therewith, the said juyce or water is also of excellent
propertie for all pushes, wheales, and other eruptions
of hot and sharpe humours into the face or
hands, or other parts of the body to bath them
therewith, and helpeth to take away any rednesse
in the face, and spots or other deformities of the
skinne, and to make the skin cleare and smooth;
some use thereof to make a water for hot inflam¬
mations in the eyes, and to take away any filme or
skin that beginneth to grow over tnem, or other
defects in them that any outward medicine can helpe
in this manner: Take what quantity of Strawberries
you please, and put them into a brasse vessel!, with a
little salt cast upon them, which being covered, set
into a wine cellar for eight dayes, in which time the
berries will be dissolved into a greene water, which,
being cleared from the rest, keepe in a glasse close
stopped to use when you neede; a droppe or two put
into the eyes serveth for the purpose aforesaid;
some in misliking both salt and brasse for the eyes,
make a water both for the eyes and for the deformities
in the skinne, be it morphew, leprey, or the like in
this manner: Into a large destillatory or body of
glasse, they put so many Strawberries as they thinke
meete for their use; if a few, the lesser glasse body
will serve, which, being well closed, let it be set in a
Digitized by Vj
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Nor. 22, 1899-
ORIGINAL COMMUNICATIONS. Thb Mbdicai Paxes. 529
bed of hot horse dung for twelve or fourteene dayee,
and after distilled carefully and the water kept for
your use.
But good old William Salmon gives, as usual, the
most comprehensive account of aU ( Herbal, London.
1711).
Of STRAWBERRY.
I. The Names. —It has no Greek Name that we
know of; but it is called in Latine, Fragaria: and in
English. Strawberry. The Fruit is called Fraga; (a
fructis fragrantia odoris & gustus:) Strawberries.
Pliny, lit. 25, cap. 9, makes mention of Fraga; and
Servius calls them Mora terrestria: Yet it is no
species of the Moras, whether you understand by it
tne Mulberry or Bramble.
II. The Kinds. —Authors make many Kinds
hereof, but those which are most common with us,
are 1. Fragaria Sylveetris vel Nemorensis,
Wood-Strawberry, 2. Fragaria vel Hortensis,
Garden Strawberry. 3. Fragaria vel Fraga Magna
Alba, Fraga Maxima Bohemica, the great white
Strawberry. 4. Fragaria Viridis, the Green Straw¬
berry. 5. Fragaria Minime Veeca, sive Sterilis, the
Wild, or Barren Strawberry.
III. The First, or Wood Strawberry.—The Descrip¬
tion of this Plant is the General Description of all
the Kinds, the material or chief difference being in
the Form of the Fruit: Its Root then is reddish and
long, with several small Fibres or Threads at it:
which sends forth from the head thereof long reddish
Strings, running upon the Ground, which shoot
forth Leaves in many places, by which it is much
increased. Its leaves are closed together at irst
springing forth, which afterwards spread themselves
into three divided Parts or Leaves, every one standing
upon a small long Footstalk, green on the upper side,
grayish underneath, and snipped or dented arx>ut the
edges: From among which, rise up small Stalks,
bearing four or five Flowers at the tops, consisting of
five white round pointed Leaves; something yellow¬
ish in the bottom, with some yellow threads therein :
After which come the Fruit, made of several small
Grains set together, in a Fleshy Substance (not much
unlike in substance to a Mulberry, Raspberry or
Brambleberry;) which are very red when they are
ripe, and of a pleasant Winy taste, (as are all the
kinds) in which are enclosed many small blackish
Seed. The Berries of the Wood Kind are very red,
and the smallest of all the sorts.
IV. The Seoond, or Garden Strawberry (which is
our most Common kind. This according to the
Opinion of Parkinson, is only the Wood-Plant
Transplanted into our Gardens, where by the richness
of the Soil it is Jidvanced in Goodness, being full as
red, if not redder; almost as large again, and also
meliorated in its Winy Taste.
V. The third, or great white‘Strawberry. This is
a very large Strawberry, extremely Fleshy, and of an
admirable Taste, and for Beauty surpasses all others :
Parkinson says that he had seen some of the Berries
measured, which had been near five inches about: I
have seen them of an extraordinary bigness, admir¬
able to behold. I am apt to believe, that this is the
so much admired Virginia kind, which I have seen
grow to an admirable perfection in the Gardens in
Carolina, exceeding any that ever I saw in England.
It has been no long Inhabitant with us, being first
brought hither from Bohemia. At first for want of
Skill in managing it, it very rarely bore any fruit;
but now, if Planted in good Ground, it bears in a vast
f ilenty. Formerly a Gardiner (one Vincent Sion),
iving by the Bank-Side, near the old Paris Garden
Stairs, said that from seven Roots, in one year and a
half, from their increase, he had Planted an acre and
a half of Ground, besides those which he gave away
to his Friends, which bore strawberries of that Magni¬
tude or Greatness never before mentioned. If you
would have them bear kindly, you must not suffer
them to grow with many Strings, but still cut them
away. The Fruit of this differs, not from the Garden
red, but in its Magnitude, this being so very much
bigger, and not so globular, but of a more Oval
form ; and in its Color, it being much whiter, viz., of
a yellowish white on one side, and enclining to red¬
ness on the other, when it is full ripe.
VI. The fourth or Green Strawberry. It differs
not from the second kind or Garden Strawberry, but
in its Fruit only, which is green on all sides wnen it
is ripe, except on the Sunny side, where it is a little
red or reddish; and in magnitude is much equal to
the seoond or Garden kind.
VII. The fifth, or Wild, or Barren strawberry. Its
Root is like the former, and in its Leaf much like to
the first Wood kind, but differs in its flower (if it has
any) which is Green, bearing rather a small head of
n n Leaves, many set thick together like unto a
>le Ruff, in the midst of which stands the Fruit,
which, when ripe, shews itself to be soft, and some¬
thing reddish, like unto a Strawberry, but with many
small harmless prickles on them, which may be eaten
and chewed in the Mouth, without any manner of
hurt, and is pleasant like a Strawberry; but it is
truly without any great Sap or Juice, and a little
Styptick or harsh upon the Taste. It is no great
Bearer, but those it does bear, are set at the top of
the Stalks close together, pleasant to behold, and
which a Gentlewoman may wear in her Bosom as a
rarity instead of a Flower.
VIII. Gerard says, Its Roots and Leaves are like
the others, but somewhat lees, its Leaves softer,
slightly indented about the edges, and of a light
green color : Among which rise up slender Stems,
bearing such Flowers as the Common Strawberry
does, but lesser; which whither away, leaving behind
a barran or chaffy head, in shape like a Strawberry,
but of no worth or value.
IX. The Places. —The first grows in Woods both in
England and America; upon Hills, Vallies, Woody
and Shadowy places : But the four first kinds are
inhabitants in our Gardens, all which I have seen
grow admirably in Carolina, exceeding in Beauty,
Largeness, and Pleasantness, any I ever saw grow in
England. The Barren kind is a Wild sort, and has
been found growing (as Gerard says), on Black-heath,
Greenwich Park, &c., but for its rarity has been
brought into Gardens.
X. The Times. —The Leaves are said to continue
Green all the year : In the Spring they spread
further with their Strings, and Flower in May, the
Berries being ripe in June and July. The Barren
one Flowers in April and May, but never bears any
Edible Fruit.
XI. The Qualities. —The Roots, Leaves and
Berries whilst green, are cold and dry in the first
Degree, but the Roots more than the Leaves. Ab¬
stersive, Astringent, Arthritick, and Vulneraly. The
ripe Berries are temperate in respect to heat or cold,
and moist in the first Degree : Cool the Blood, Liver
and Spleen, Comfortative and Cordial.
XIL The Specification. —The Leaves and unripe
Berries stop Fluxes and Catarrhs, cool the heat of
Fevers, heal Ulcers in the Mouth, Throat, and
Tonsils; and stop the Courses in Women.
XIII. The Preparations—Ot the Roots, Leaves,
and Green Berries are made, 1. A Liquid Juice. 2.
A Decoction in Wine or Water. 3. A Lotion or
Gargarism. 4. A Distilled Water. 5. An Ophthal-
mick. 6. The Ripe Berries. 7. A Syrup of the
Same. 8. A Distilled Water from the same.
The Virtues.
XIV. The Liquid Juice.— Taken to the quantity
Digitize
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530 The Medical Press. _CLINICAL RECORDS._Nor. 22, 1899.
of^three or four spoonfuls or more, either mixed with
the Syrup of the ripe Berries, or with a little Mutton
Broth, Morning and Night, it cools the Blood and
Liver, allays Inflamations of the Reins and Bladder,
provokes Urine, takes away the heat, sharpness, and
scalding thereof; stops Women’s Courses and the
Bloody Flux, and decreases the Tumour or Swelling
of the Spleen. Applyed to the Gums it fastens
loose Teeth, stops Catarrhs, or Defluxions of Rheum
to the Mouth, Throat, Teeth, and other Parte, and is
singular good for hot, red, and inflamed Eyes, being
dropt into them: As also to repell hot, red, ana
sharp Tumours or Eruptions in the Skin, whether
Face, Hands, or other parts; and to take away red-
nees of the Face, Spots or other Deformities of the
Skin.
XV. 1 he Decoction of Root It, Leaves, or unripe
Fruit in Water and Wine. —It has all the former
Virtues, being used in the Bame manner, and may be
taken to half a Pint at a time Morning and Night.
XVI. The Lotion or Gargarism.—T&ke of the
Liquid Juice or Decoction a Pint, Honey three or
four Ounces, Spirit of Wine two Ounces, mix and
dissolve. It cleanses and heals foul Ulcers in the
Mouth, Throat, Privities, or other parts, heals
Ulcerated and Spungy Gums, and fastens loose
Tocth
XVII. The Distilled Water of the same Roots,
Leaves and Berries. —It is good for hot and inflamed
Eyes, redness of the Face and Skin, and other De¬
formities of the sume; hot Eruptions of the Same,
Anthonies Fire, &c.
XVIII. The Ophthalmick. —Take of the former
Distilled Water a Pint, Honey three Ounces, Spirit
of Wine two Ounces, mix and dissolve. Dropt into
the Eyes 3 or 4 times a day it is good against an
Ophthalmy, redness, inflamation, and hot Rheums in
the Eyes.
XIX. The Ripe Berries. —They cool a hot and
cholerick Stomach; as also the Blood, Liver, and
Spleen : quench Thirst, and refresh weak and fainting
Spirits.
XX. The Syrup of the same Berries. —It has all
the same Virtues, and may be given two or three
Ounces at a time upon Occasion
XXI. The Distilled Water of the Ripe Berries .—
It is a Cosmetick for the Skin, good against Fever,
and Inflamations of the Eyes; Anthonies Fire, and
other like hot Eruptions; Melancholy, Faintings
and Passions of the Heart.
All readers of the above record must admit that the
latest of the “ new ” remedies for gout has in former
ages occupied a rather prominent position in the
therapeutic armamentarium. And that the judicious
internal administration of strawberries—with or
without cream or other correspondingly pleasant
adjuvant—will always prove “ comfortive and
cordial” as well as “ arthritick,” to the gouty as to
those not so afflicted, the present compiler, for one,
entertains no doubt whatever.
Clinical ^ccoris.
ST. GEORGE’S HOSPITAL.
Persistent Lockjaw in an Edentulous Subject, Relieved by
Incising a Tender Portion of the Gum. (a)
By William Ewabt, M.D., Cantab.
The patient, a decorator, ret. 47, moderately addicted
to alcohol, was suffering from an extensive chronic ulcer
of the right leg. His illness began with a severe cold,
three weekB before his admission into St George's Hos-
(a) Shown at the meetingof the Medical Society of London, Not. I
13th, 1899.
pital, on September 20th, 1899 (Med. Reg. No. 1606).
The lockjaw set in suddenly in the night, a week later,
when he woke in a fit of suffocation, due to the closure
of his lips, unsupported by teeth, whilst the nasopharynx
was probably closed by a spasm of the muscles of the
palate. The same nocturnal attacks continued to occur
in the Hospital until the trismus was relieved. The
rigidity of the jaws, of the floor of the mouth, of the
platysma of the neck, and of the abdominal muscles
was intensified by excitement, but there was neither
opisthotonos, nor any spasm of the limbs. Speech,
respiration, and alimentation were much impeded,
leading to loss of flesh and weakness.
The case was diagnosed from the first as one of reflex
spasm from periosteal irritation and tenderness at the
left posterior extremity of the upper jaw, and local
treatment was recommended. This was finally resorted
to, after various remedies had proved ineffectual,
and the symptoms rapidly disappeared after the tender
gum had been freely incised.
The case is a good illustration of the reflex tetanoid
symptoms occasionally induced by irritation of the
dental nerves, These cases do not present the complete
symptoms of traumatic tetanus, they do not end fatally,
and they are invariably cured by a removal of the
offending cause. The few cases of fatal tetanus which
have been observed after operations on the teeth were
probably cases of accidental infection with the bacillus.
The case exhibited is a perfect instance of a purely
reflex causation due to nerve irritation, since, owing to
the absolutely edentulous and dean condition of the
gums the mouth contained no source of septic infection.
A Case of Pigmentation of the Skin and of Partial
Pigmentation of the Nails, simulating Addison’s
Disease, in an Asphalt Worker, and of Anaemia asso¬
ciated with Hepatic and Splenic Enlargement.
The patient, ret. 43, an Italian born in England, has
been out of health since May, when he was laid up in
bed for seven weeks with a severe attack of influenza,
followed by great loss of weight and of strength. On
admission he presented marked brownish discolouration
of the skin, without any staining of the buccal mucous
membrane, slight pyrexia, some dulness, and a few
riles at the right apex, and considerable depression. The
liver was moderately enlarged, and the spleen much
increased in size. One of the left cervical glands was
much enlarged, but is now much smaller. The diagnosis
of Addison’s disease was made on the strength of
the pigmentation, of the feebleness of the pulse,
the muscular weakness and of the olinical history of
progressive emaciation sinoe the influenza, and the
brownish discoloration of the distal portions of the nails
was regarded as an unusual feature of the affection.
On further inquiry, however, it was ascertained that
the discolouring of the skin had existed for upwards of
twenty years, and that the patient had been constantly
exposed to the smoke of heated asphalt. These circum¬
stances, and the total absence of pigment from the
proximal ends of the nails, both in the hands and in
the feet, led to the abandonment of the original
diagnosis, although the patient had greatly improved
under treatment by suprarenal extract. The association
of a glandular swelling with a marked splenic enlarge¬
ment had suggested the unlikely view that the case
might be one of Hodgkin’s disease. Tfie patient had
had an attack of jaundice at the age of fifteen years,
but no recent symptoms of hepatic disease. The blood
presented decided decrease in the number of red cells
with moderate leuoocytosis, and the eosinophilic cells
were increased in number.
CANCER HOSPITAL.
Case of Myomatous Uterus Removed by Subperitoneal
Hysterectomy (a).
Under the Care of Dr. F. A. Purcell,
Surgeon to the Hospital
C. P., of Clapham, ret. 36, married, a housewife,
a dmitted to the Cancer Hospital, September 18 th.
(a) Bead before the British Gynaecological Society, November
9th, 1899.
Digitized by GoOglC
Nov. 22, 1899.
TRANSACTIONS OP SOCIETIES.
The Medical Press 531
1899, one child 18 yean old, one miscarriage six weeks
after. Menstruates regularly, amount normal. Looks
a fairly healthy woman, but anaemic, tongue clean,
bowels regular, defseoation not painful. A year or so ago
she noticed herself getting stout, and suffers pain m
abdomen at varying intervals. Has a yellow vaginal
dircharge, which, on examination proved to be non*
specific. This was treated for four weeks, operation in
consequence was postponed. Urine, sp. gr. 1020 acid,
with a trace of albumen.
Abdomen distended by tumour in hypogastric region, it
encroaches into right and left inguinal regions, it is dull,
firm on palpation, movable, abdominal wall moves freely
over its smooth surface, oervix low down in vagina.
The mass fills Douglas’s pouch.
October 11th —Operation : Under gas and ether the
abdomen was opened in the middle line from umbilicus
to pubes, a large myoma uteri turned out about the
size of a foetal head at full term, peritoneal flaps were
dissected down in front and behind, right appendages
and ovary being left attached to the uterus. The left
ovary was allowed to remain. The neck was severed above
the os and within the flaps, the uterine arteries then caught
and tied. A further wedge-shaped piece was cut from
the neck, to admit the surface above beingsewn together
by means of three sutures of catgut. The peritoneal
flaps were carefully stitched together with catgut, no
blood was lost, the pelvis was dry cleaned, the omentum
carefully placed, and the abdominal wound united by
single rows of silkworm gut sutures. On the ninth day,
October 20th, stitches were removed, patient had no
marked rise of temperature, and her convalescence was
uninterrupted. The ovary removed was cystic, the left
ovary which remained was normal.
‘tEransartioitB of §ocictU0.
BRITISH GYNECOLOGICAL SOCIETY.
Mutiko hxld Thubsdat, November 9th, 1899.
The President, Dr. Macnauohton-Jones, in the Chair.
Specimens.
Dr. Herbert Snow showed the specimen from an
unsuccessful case of Hysterectomy for Myoma, the notes
whereof will be found under the head of “Original
Communications.”
Dr. F. A. Purcell showed a Myomatous Uterus re¬
moved by Subperitoneal Hysterectomy. The notes of
the case are published under the head of "Clinical
Records.”
Mr. Charles Rtall showed a specimen of Uterine
Myoma removed by Abdominal Hysterectomy, the de¬
tails whereof will be found under "Original Com¬
munications.”
In the discussion on these specimens, Dr. Purcell said
that there was no doubt that Jewesses were not good
subjects on which to operate. The late Sir Andrew
Clark laid stress on this fact, and used to advise that a
Jewess should never be operated on if it could be helped.
Dr. Snow had not given any account of the amount of
urine passed after the operation; with all the trouble
that he had experienced in dealing with the uterine
artery, it was quite possible that the ureter might have
been kinked, and the cause of death might have been
uraemic poisoning. In Mr. Ryall's case the method of
dissecting the posterior flap was of great interest; but
in his own experience there was usually no special
difficulty in this step of the operation. He would suggest
that perhaps in Mr Ryall’s case also, the cause of death
might have been renal.
Dr. Mansell Moullin agreed with Dr. Snow that
suture <n masse was the beet method of securing the
abdominal wound; but it was still capable of being i
improved on. There was no object in securing the
peritoneum separately, this as well as the skin was
ite well secured by the through and through suture;
was advisable, however, to suture the layer of fascia
parately, and he thought that this was best done by
terrupted catgut sutures. It was a mistake to sup¬
pose that buried sutures strengthened the wound; on
the oontrary, they were a source of weakness. Catgut
was therefore eminently suitable, sinoe it became ab¬
sorbed as a rule in four days. It was, as a matter of
fact, during the first forty-eight hours that the sutures
were most necessary.
Dr. Hetwood Smith did not agree with Dr. Mansell
Moullin’s views as to the best method of suturing.
With one layer of sutures, hernia was formerly a not
infrequent complication; but since the introduction of
three layers this accident had been of much rarer
occurrence. It was not advisable to sew the peritoneum
with catgut, because peritoneum was best secured with
a fine suture, whilst catgut, to be efficient, must be
thick. The best material for the peritoneum was fine
silk. For the middle layer, catgut answered very well;
and for this purpose it gave much less trouble than silk¬
worm gut. He regarded the three-layer method- as the
typical one for abdominal wounds. With regard to Mr.
Ryall’s case, he pointed out that in all cases of operation
for fibroids there was risk of embolism. But as to the
cause of embolism, he thought there were no facts
known.
Dr. Bedford Fenwick said that they were all agreed
that wounded peritoneum united very readily; so that
the old idea that failure of healing in the peritoneum
might give an opportunity for suppuration in the wound
to extend into the abdominal cavity was a fiction. If
they put complete sutures through the peritoneum and
abdom inal wall, the peritoneal surfaces were sure to
unite. It seemed to him a fallacy to provide against a
theoretical danger by putting interrupted BUtures
through the peritoneum and leaving them there, and so
introducing an actual danger; it was much better to
employ sutures which they could remove in seven days.
Cases in his practice in which there had been peritonitis
seemed to have been due to the buried sutures. True,
the peritoneum had a protective action, and might
prevent this result; but in other cases it might not. He
thought it probable that the danger of ventral hernia
might be diminished by the use of a separate suture
for the fasoia; but it ought to be some absorbable
material, and should not remain in the peritoneum as
an irritant; consequently, the best material was catgut.
He had seen such good results from through and through
sutures, that he was loth to believe that there was any
advantage in the three or four layer method.
Mr. Bowreuan Jessett said that until three or four
years ago he always used the single layer of sutures ;
then he yielded to the fascination of the triple layer
method and met witl: disaster and disappointment; as
a rule he had to fish out the sutures afterwards with
a cror.het hook, even when he had taken the precaution
of boiling them immediately before use, because they
suppurated. He then went back to the old system.
The reason of failure in the old plan was the practice
of passing the sutures straight through the abdo¬
minal walls; the fascia retracts beyond the muscle,
and so often escaped inclusion. The best results
were obtained by picking up each layer carefully in
one Buture. Mr. Ryall’s case was very interesting; it
was curious how those cases of embolus came about. He
had some time ago a case of a lady with a large ovarian
cyst -, she did well for three weeks and then got an
attack of hemiplegia, from which she was still confined
in the hospital, though it was twelve months ago. This
might also have been due to embolism. Phlegmasia
dolens also was common after hysterectomy, but he had
not seen a case of embolism of the tibial artery. He did
not think it was necessary to form a definite posterior
flap, as Mr. Ryall suggested; at any rate when doing a
panhysterectomy.
Dr. Inolis Par6ons said that eight months ago a
patient came to him who had had her ovaries removed
at a provincial hospital; hernia had followed after a few
weeks. She was again operated on, but with a like
result. Each time the abdominal wall had been closed
with a single layer of sutures. He did not think that
this was enough in the case of a patient with thin
abdominal walls. He cut out the circular cicatrix, then
cut down above the original incision, dissected out the
Digitized by vj
oogle
532 The Medical Press. TRANSACTIONS OF SOCIETIES.
layers separately, and sewed up the peritoneum with fine
silk, the muscles and fascia with silkworm gut, and the
skin with silver wire. There had been no return of the
hernia since. Dr. Bedford Fenwick and Dr. Mansell
Moullin had said that they objected to buried sutures;
if thick silk was used, the objection was valid, since it
was apt to set up irritation ; and for the middle layer he
thought that both silk and catgut were unsuitable. With
regard to the question of securing the peritoneum, one
of his colleagues had a suture abscess some years ago in
one of his cases, resulting in infection of the peritoneal
cavity and a fatal issue; and he thought this would not
have happened if the peritoneum had been sewn up.
Mr. Charles Btall suggested that in Dr. Snow's
case the cause of the fatal result might have been trau¬
matic delirium. In his own case, to which Dr. Snow
had referred, the first symptom of trouble was shock,
from which, however, she rallied, and there was then
nothing to show that the wound was at fault. Then
shock again supervened, and the wound was found
gaping. With regard to the method of suturing it was
to be remembered that the suturing of the peritoneum
did not add to the strength of the abdominal wall; the
object of it was to protect the peritoneal cavity from
raw surfaces. To suture the abdominal wall in three
layers was anatomically correct; and what was ana¬
tomically correct could not be surgically wrong.
The President observed that Dr. Snow had broached
a subject of great importance to every operator, viz.,
the hysterical temperament. His case was typical of
this condition, and it was one of the most serious that
a surgeon could tackle. In such cases a short operation
was specially to be aimed at. He thought that the fatal
result must be regarded as an instance of sudden death
from vascular disturbance. On the question of sutures
many battles had been waged, and at present the war
was still going on over material ana methods. In
America and on the Continent operators with the widest
experience had all adopted the plan of sewing up in
three layers; and this seemed to him the most
workman-like method. For some years past he had
given up the single-layer plan; and on only two or
three occasions had he had to remove a buried Buture
on account of suppuration. The peritoneum should
be closed for the purpose of protecting the bowel.
With regard to operations on Jewesses, it was well known
that these patients were very liable to glycosuria; and
he believed that under these conditions operations were
very dangerous. He had no fear of using silk or catgut
for buried sutures, as long as it was aseptic; and he
could not agree with Drs. Bedford Fenwick, and
Mansell Moullin that a rapidly-absorbable suture was
a desideratum; on the contrary, he thought that with
such sutures they were more likely to get hernia. While
agreeing with Mr. Ryall in the use of the triple layer
method, he could not quite endorse his generalisation that
what was anatomically correct could not be surgically
wrong, for he thought that not uncommonly what was
anatomically correct might be furgically inadvisable.
Dr. Snow, in reply, thought that one great objection
to the layer-to-layer method was the time it occupied;
and this was often an important element in recovery.
He agreed with Dr. Bedford Fenwick’s remarks on the
rapidity of peritoneal union; in a long operation he
had seen the peritoneum show signs of uniting before
the operation was finished. Mr, Ryall’s case illustrated
the same point. In reply to Dr. Purcell, he said that
uremia could be excluded in his case, for the bowels
and kidneys acted on the day after the operation.
Dr. Purcell and Mr. Btall briefly replied.
Mr. Bowreman Jessett showed, for Dr. A. Duke,
(]) a new curette ; (2) a prehensile forceps.
Dr. R. H. Hodgson read a short communication on
“ A Case of Tuberculous Peritonitis Simulating Abdo¬
minal Tamour, with Operation, followed by Recovery,”
which we hope to publish next week with the discussion
thereon.
Mr. Robert Bent Ball, Regius Professor of Surgery
in the University of Dublin, has been seriously ill of
typhoid fever, but is now able to be out of bed and is ;
steadily recovering.
Nov. 22, 189b.
SHEFFIELD MEDICO-CHIRURGICAL SOCIETY.
Meeting Held November 9th.
The President, Dr. Burgess, in the Chair.
Mr. Simeon Snell introduced the following cases:—
(1) A young woman who had been the subject of
tuberculosis of the ocular conjunctiva, illustrating the
value of treatment by application of lactic acid. (2) A
similar case in a young woman in which the left upper
eyelid (inner surface) had been chiefly affected; treated
also by lactic acid. (8) A young girl with double
papillitis associated with incomplete palsy of both
external recti.- vision was hardly affected. (4) A man
with bilateral palsy of external recti (no optic neuritis),
with symptoms of ataxic paraplegia coming on after
influenza. (5) A man with a fragment of steel
embedded in the lrft lens.
Mr. Simeon Snell exhibited a number of lantern
slides from photographs taken at several large workB
bearing on the causation and prevention of eye acci¬
dents in trades.
Dr. Arthur Hall read notes of a case of
A8THENIC BULBAR PARALYSIS.
The patient, a married lady, set. 42, began with
symptoms of general weakness, was easily tired on slight
exertion, could hardly hold a tea-cup to drink out of.
This was in November, 1896. One day she fell down in
the house, from her legs giving way altogether. About
two months after this began, slight ptosis, especially
in the left eye, was noticed ; there was also some ocular
paresis, variable in amount and difficult to estimate.
8he was apparently free from this in the morning,
but as the day went on her symptoms got worse. Except
for this muscular weakness, there was no evidence of
organic nervous disease. Weir-Mitohell treatment was
tried, and the patient improved greatly during a few
weeks; but after a somewhat profuse menstrual period
she relapsed, and new symptoms were added, notably, a
nasal twang in the voice, occasional attacks of dys¬
pepsia, some difficulty in swallowing. One day, some six
months from the commencement of her illness, she
suddenly turned queer whilst drinking some soup,
gradually lost consciousness and died from failure of the
respiratory centre a few hours later. At the autopsy
nothing abnormal could be found in the brain pons or
medulla oblongata. Portions of these were carefully
preserved and examined with great care, but no evidence
of disease in the nerve cells, fibres, or interstitial tissue
was discovered.
Dr. W. N. Barker read the notes of 22 cases of
POISONING FROM TINNED BEEF
which occurred in Sheffield on October 11th. All who
had partaken of the meat suffered, but especially the
children, of whom there were twelve. The amounts
eaten varied from a piece the size of a hazel nut to lib.
The symptoms came on usually about 2£ hours after
eating the meat, the onset being marked by drowsiness
and giddiness, followed by headache, abdominal pain,
profuse vomiting, and diarrheea. Collapse was a marked
feature in the majority of the cases. The treatment
was washing out of the stomach, repeated if necessary
with stimulants and purgatives. One case died, convul¬
sions occurring before death. Post-mortem, hsemorrhagio
erosions in stomach wall and a general hyperemia of
gastro-intestinal tract. All the other cases convalesced
rapidly Dr. Robertson described the meat as looking
well, and it had a faint sweetish odour. The bacillus
enteritis of Gartner was found in all the cultures.
This bacillus was the active cause in most of the similar
reported outbreaks. In this case Dr. Robertson thought
the active toxin had been introduced in the meat.
The Golden Square Hospital for Diseases of the
Throat, Nose, and Ear, after undergoing reconstruc¬
tion and enlargement at a cost of upwards of £10,000,
was re-opened last week by Lady Rothschild, whose
husband is the President of the institution.
Digitized by VjOOgl
Nov. 22, 1899.
GERMANY.
The Medical Press. 533
Sermanp.
[from OUR OWN CORRESPONDENT.]
BERLIN, November 18th, 1600.
Th* Diagnosis of Typhoid.
At the meeting of the Society for Innere Medizin, Hr.
PierkowBki explained his simple process for the rapid
determination of typhoid. He usee a preparation of
alkaline urine gelatine with an addition of t per oent. of
peptone, and 2 per cent, of gelatine and cultures, at a
temperature of 22 degs. C. After fifteen hours, typhoid
bacilli are seen to have developed with long spiral-
shaped offshoots; whilst coli bacilli show at the moat
small pointed offshoots. The proof is available from the
third day of the fever to the end. It is important that
the urine used should be only slightly alkaline, and the
alkalescence is most easily attained by adding a small
quantity of urine already become alkaline by standing,
to fresh urine.
Hr. Burchardt said that in repeating the test in
fourteen cases he had found the colonies in twelve; in
two the attempts failed, as the nutrient soil had been too
strongly alkaline. In his experience, however, not only
the form described by Pierkowski had been developed,
but also some with small offshoots. The latter also he
saw always with B. coli. In the case of other oooci
there were scarcely ever any off-shoots; he saw them
once in the case of a boy suffering from angina. The
urine gelatine was very suitable for the early diagnosis
of typhoid. The reaction, however, gave the earliest
certainty. He had seen symbioses of typhoid and coli
baoilli.
Hr. Schutze had made use of the test six times in v.
Leyden’s Klinik, and in five had found Pierkowski’s
forms. The sixth case showed itself at the post-mortem
to be a perimetritic exudate. In one case Pierkowski’s
process gave a positive result, whilst Widal’s did not.
It was the case of a woman of 40, with high fever,
great prostration, without roseola, and with slight
splenic enlargement. Positive diazo reaction and the
remittent fever gave rise to a suspicion of typhoid, which
Pierkowski’s process confirmed, so that its use was to be
recommended.
Injxction of Gelatine before Operation for the
Prevention oe Hemorrhage during It.
Dr. Karchesy has an article on the subject in the
Kin. Therapeut. Wochentch., 37/99. It had already been
ascertained that by the injection of gelatine into the
peritoneal cavity the coagulability ef the blood was
much increased. The knowledge was applied practically
by the injection of a 1 per cent, to 3 per cent, solution of
gelatine in an average quantity of 200 mm. subcuta¬
neously for the purpose of producing coagulation in the
dilated walls of an aortic aneurysm. This method of
procedure introduced by Lancereaux was followed by
the writer, in his case for the prevention of haemorrhage
in large operations. An hour before the operation 200 |
gms. of a 2 per cent, solution of gelatine in 0 8 per
omit, saline fluid were injected subcutaneously into the
thigh. The gelatine solution was certainly sterile, and
it had been kept in an ice chamber. Previous to using,
the gelatine was melted in warm water, and injected by
means of a syringe holding 60 grms. The punc¬
tures were made some distance from one another
in order to spread out the gelatine over a larger
area. After the injection the limb was bandaged
to further absorption by pressure. On making the
incision the muscular tissues were found to be drier than
usual, and they glistened abnormally like wax. The
larger arteries and veins bled as before on being
severed, the smaller, however, and the capillaries
distinctly less, and soft clot was readily formed on the
surface of the wound. Examination of the urine at the
close of the operation, showed that the gelatine had
already entered the circulation. In all cases a heightened
temperature was observed.
The practical value of the injection surgically speaking
could not be very high.
At the Medical Society Dr. Schuster showed a case of
Recovery from Tetanus.
The case was of interest, as it had afforded opportunities
of trying the different therapeutic measures recom¬
mended. The patient, a boy of six, was admitted into
Professor Mendel’s Klinik in July. The mother, a not
very intelligent woman, stated that on the 3rd the boy fell
on to a bench on the left side of the head, and from there
to the floor. Some days after the face was drawn to the
left, and three days later there was trismus. On admis¬
sion there was no sign of a wound, nor any abrasion.
Beyond the spasms there was nothing apparently
in the nerves. In addition to the continuous tension,
there were spasmodic attacks, which came on about
every fifteen minutes, and which could be excited by
the least disturbance, such as walking across the floor-
The diagnosis of severe tetanus was confirmed ; temp. 88
degs. C. On the following day an injection of tetanus
antitoxin (Tizoni) was given direct into the dural sac.
The operation was not easy owing to the continued
movement of the patient. The first visible result of the
injection was a rise of temperature to 39 degs. C., and
the attacks increased from 50 to 70. The following day
the condition was unchanged. The next day the sym¬
ptoms were much worse, complete asphyxia, dilated
pupils not reacting to light. A second injection was
made, but no improvement, and a fatal ending was con¬
sidered certain.
On J uly 20th, as it seemed as if nothing could do any
harm, 10 grms. of pig’s brain, emulsified with 30 ccm.
of water, were injected into the abdominal wall
(Kochiewicz Wasserman and Takaki had shown that
brain and spinal marrow substance of most animals had
the property of binding the tetanus poison). The
operation was well borne; the temperature rose again,
however, to 39 degs. C., but the next day improvement
set in. On July 28th there were only four attacks, and
in the beginning of August the boy was discharged
cured. The case was not an absolute proof of the
effectiveness of the method, but in view of the desperate
nature of the case it encouraged the employment of this
form of treatment, especially as the tetanus antitoxin
treatment bad not come up to expectation. According
to Holsti's statistics, of 174 cases, 73 died. In con-
sequenco of the want of success the French had pro¬
posed other methods, injection of the antitoxin direct
into the brain, whilst Jacob injected it into the dural sac,
and other authors had proposed to treat the tetanus
with other substances that in experiments fixed the
tetanus virus.
Digitized by
Google
534 The Midical Press.
SPECIAL ARTICLE.
Austria.
[FROM OUR OWN COBRB8PONDENT. J
Vienna, Kovember 18th, 1890.
Injury bt the Rontgen Rats.
At the Geselschaft der Aerzte, Kaposi showed an
elderly gentleman suffering from a severe form of
dermatitis which had extended over the body after treat¬
ment with the Rflntgen rays for epilation on the back of
the hands. Kaposi said this was not an isolated case,
as he had now met with severe forms of erythema,
eczema, necrosis, and gangrene after treatment by the
rays. Many of these diseases are aggravated and com¬
plicated by this treatment within four weeks after the
application, when transplantation has often to be
resorted to before the patient can be cured. The histo¬
logical examination demonstrated severe injury to the
tissues, particularly the vascular constituents.
Notwithstanding the success of Schiff and Freund in
the treatment of sycosis and favus, Kaposi thinks that
these dangers should be borne in mind when treating
these conditions by the Riintgen rays. Schiff tells us that
out of eighty cases he has only had one which has gone
wrong. This admission in an enthusiast is in itself suffi¬
cient to prove that there is danger in the treatment.
Benedikt thought the Rftntgen rays were safe enough
as a diagnostic agent, but dangerous as a therapeutic
factor, and should not be used unless under special
circumstances.
Kaposi said that he hoped none of the members would
believe that he condemned the rays in diagnostic in¬
vestigation.
An Unusual Form of Syphilis.
At the Medical “ Club ” Seines exhibited a patient
who had acquired syphilis four years ago, and a year and
a half later had severe tertiary symptoms although
carefully treated with specifics. Later on gum¬
matous infiltrations appeared on the left eyebrow
which proved refractory to treatment, although he had
gone to Lindewieee, where such cases usually improve,
with the result that other gummata appeared in the lach¬
rymal sacs. On his return he presented himself at Lany’s .
clinic with a large fluctuating swelling over the left
temple which appears to have been the original centre 1
of disturbance, and where a lamella of the bone was
found necrosed. Since that time the conditions had
very little changed, and all specifics had proved quite
useless. He is of opinion that a cure might be effected
if nutrition were improved.
Atrophy of the Right Arm after Injury to the
Left.
KienbOck brought forward a country labourer, te t. 32,
who had always enjoyed perfect health till he fell from
a cart about the end of August last, the whole distanoe
fallen being only H metre or five feet, but immediately
on falling the wheel passed over his left arm, fracturing
the humerus at the distal end. with a nasty wound.
For some time after the fall, he lay unconscious on
the ground, but after recovering walked home with the
assistance of a friend. It should be noted here that
nothing was observed to be wrong with the right arm,
as no visible injury was sustained nor any trace of weak¬
ness present. 8trange to say the right arm is now
greatly atrophied, more particularly the muscles of
Nov. 22,1899.
the fingers, so that the movements of the fingers and)
wrist are greatly diminished.
On the other hand, sensibility is normal, the deeper-
reflexes exalted, while no injury can be detected
in the nervous system. The left, or injured arm
is free and mobile about the wrist and fingers
without any appearance of atrophy. The patient's own
observations are that the right arm began to gradually
wither away some time after the injury without any
apparent cause, but within the last two weeks had more
rapidly gone down.
The first diagnosis of the case would probably be in
favour of an ascending nerve injury having produced
in the cord a descending neuritis leaving, the left
arm unaffected, but it is more probable that the
case is a chronic form of anterior poliomyelitis with a
congenital weakness in the anterior ganglia of the-
cord. The imperfect development of the muscles of
the lower extremities lend confirmation to the latter
hypothesis, the injury no doubt having excited the pro¬
gress of the disease in the right side, but, properly
speaking, without other primary lesion to the cord.
Such cases are of considerable interest from a forensic
point of view, as the injury could not be held to be the-
real cause of the disease.
Eulenburg and Jolly record similar cases which they
attribute to a preceding neuritis or central injury,,
which was not present in the preceding case.
Special Article.
THE WELLCOME PHYSIOLOGICAL RESEARCH*
LABORATORIES.
Mesbr8. Burroughs & Wellcome have just com¬
pleted some excellent Physiological Research Labora¬
tories at Herne Hill, and last week we had the privilege
of inspecting them, an excursion which could not fail to
be interesting to a medical visitor, especially as Dr.
Dowson, the medical director of the establishment,,
personally conducted the party over the buildings and
grounds, pointing out the particular points of interest.
All the apparatus is of the most modern description,,
and all the arrangements have been most carefully
planned and carried out. Of course cleanliness—surgical
cleanliness—is a marked feature of the institution, as it
must be if success is to attend any branch or depart¬
ment of bacteriological work. Even tho sinks are
detached from the benches and walls, so that they are
readily accessible for thorough cleansing.
The taps by Baird and Tatlock and Tyler, of Newgate
Street are so constructed that even with a large stream
of water there is no splashing. An excellent incubator
of Hearson’s was particularly noticed. It is fitted with
a new and ingenious automatic registering valve, so that
the temperature is maintained constantly at 37
degs. C., and requires no supervision. An incubator
on a very much larger scale has been built in a sort of
cellar, which is heated by warm air. Arranged round the
room are shelves in tiers for the various cultures ; each
tier having a different temperature owing to the rarefied
warm air being constantly highest, and so providing
suitable temperatures for the different cultures.
The researches on animals: chiefly mice, guinea pigs
and horses, are of course of the greatest practical
interest. One small stable is kept exclusively for horses.
Digitized by
Nov. 22, 1W.
THE OPERATING THEATRES.
Thx Medical Press 535
*hen they just arrive, here they are isolated and kept
under observation for a time to make sure they are
healthy: this point having been satisfactorily settled,
they are then housed in the large stable with stalls for
about twenty horses.
Diphtheria toxin was injected into a horse for our
benefit, a process which it had already undergone
some sixteen times, and this gave us an oppor¬
tunity of observing the ornate precautions which are
observed in operations of this kind. These admirably
fitted laboratories with their simple yet thoroughly
satisfactory arrangements are calculated to inspire
every confidence in the trustworthiness of the products
therein prepared. Not indeed that the preparation of
serums is the only, or the chief, object of this costly
installation. It is pleasing to note that with a public
spirit which is rare in connection with commercial
undertakings every facility and inducement are offered
for studying points—and they are many—which still
call urgently for full investigation.
sEhc (Operating theatres.
MIDDLESEX HOSPITAL.
Operation for Perforated Gastric Ulckb. —Mr.
John Murray operated on a woman, iet. 18, who had
been admitted with symptoms of perforated gastric ulcer.
She had suffered for some months from antemia, and for
a fortnight previous to admission had complained of
epigastric pain after food On the evening previous
to admission she was suddenly seized with violent
pain in the epigastrium. She vomited once; she became
profoundly collapsed, with a subnormal temperature.
When admitted twelve hours after perforation had
occurred, the patient was pale and collap*ed; the tem¬
perature a few points above normal, pulse 120, respira¬
tion entirely thoracic, no apparent movement of the
abdominal wall; the woman complained of extreme
tenderness of the abdomen most marked in the epigas¬
tric, left hypochondriac and left iliac regions ; the abdo¬
minal wall was rigid *, there was no marked distension
of the abdomen, the liver dulness was almost entirely
obliterated, and there was dulness over the lower part
of the abdomen up to a point midway between the
umbilicus and the pubes. At the operation an hour after
admission an incision five inches long wa3 made in the
middle line between the ensiform cartilage and the
umbi icus; on opening the abdomen the anterior sur¬
face of the stomach was first examined, but was
fonnd to be normal; the omentum between the stomach
and colon presented an cedematous appearance, and on
tearing through it a quantity of fluid escaped from the
lesser peritoneal sac; the opening in the omentum was
enlarged, and the stomach drawn out of the wound, and
its posterior surface carefully examined ; there was a
good deal of lymph adherent to its surface, and near
the lesser curvature towards the cardiac end a Bmall
perforation was found partly concealed by lymph, the
wall of the stomach at this spot being thickened and
indurated. The opening was closed by a double row of
Lemberf s sutures invaginating the walls of tie stomach,
and the viscus replaced in the abdomen. No
solid particles of food apparently had been
extravasated, but a quantity of slightly turbid
yellowish fluid was found in the peritoneal cavity.
! and there was a considerable amount of influnma-
tion of the peritoneal coat of the intestine. The perito¬
neal cavity was carefully sponged out; and as a quantity
of the fluid was found in the pelvis, a small opening was
made between the umbilicus and the pubes to facilitate
the thorough cleansing of that part of the abdominal
cavity. A glass tube was passed through this opening
into the pelvis and the ends of the wound united with a
few points of suture. A rubber drainage tube was
passed from the upper wound into the lesser
peritoneal sac, the wound being then sutured
with silkworm gut, the sutures going through the
whole thickness of the abdominal wall. The patient
was very much collapsed, and a brandy enema was
administered before Bhe left the table. Mr. Murray
said that the diagnosis in the case seemed perfectly
clear; the history of pain after food for a fortnight; the
sudden onset of pain in the epigastrium accompanied'
by the marked collapse, and the loss of liver dulness
which he knew was not present until shortly before
admission, together with the signs of aoute peritonitis,
all pointed to perforation of a gastric ulcer. He pointed
out that the only difficulty in the operation con-isted-
in finding the perforation; this was due to two
causes: first, the position of the perforation; secondly, to
the fact that the posterior surface of the stomach was
partially covered by lymph. With regard to the closure
of the perforation, he thought the method of invaginating
the stomach wall by means of Lembert’s sutures was infi¬
nitely preferable to excision of the ulcer, first of all because
of the longer time the latter procedure occupied, together
with the additional hGemorrhage which excision entails, and
secondly .because the results of the former showed that heal¬
ing readily occurred after simple suture. Moreover, in the
present case excision of the ulcer would have been almost
impossible, owing to the situation of the lesion. He did
not wash out the peritoneal cavity : first, because the
condition of the patient was so bad that it was advisable
to complete the operation as quickly as possible;
secondly, as no solid portions of food had apparently
escaped from the stomach, and the contents of the
peritoneal cavity consisted only of slightly turbid serum,
thorough cleansing of the peritoneum could be effected
by sponging. He thought that in these cases it was
always advisable to drain the pelvis by means of a tube
introduced above the pubes, and that the additional
precaution of draining the lesser peritoneal sac was ad¬
visable, because in that situation the peritonitis was most
marked. In closing the upper wound he employed silk¬
worm gut sutures passed through the whole thickness of
the abdominal wall in cases where buried sutures were
liable to become infected ; he preferred this method, he
remarked to that of closing the incision layer by layer,
but he considered that closure in three layers was to be
recommended in aseptic cases, owing to the less likeli¬
hood of the subsequent development of a ventral hernia;
hernia was, however, not so likely to occur after
wounds above the umbilicus.
We understand that the Army authorities am
taking up a large number of civilian chemists to do
the work of the Army Compounders at home, the latter
having been sent off to the war. These new hands
will receive 5s. 6d. per day.
Digitized by Google
536 The Medical Press.
LEADING ARTICLES,
Nov. 22 . 1899.
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Published every Wednesday morning, Price 5d. Pest free, 5id.
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Small announcements of Practices, Assistanciee, Vacancies, Books
ftc.—Seven lines or under, 4s. per insertion; 6d. per line
beyond.
Letters in this Department should be addressed to the Pub lishers.
^ebical frees anb Circular.
“ 8ALU8 POPULI 8CPREMA LEX.”
WEDNESDAY, NOVEMBER 22, 1899.
IDEAL ASYLUMS FOR THE INSANE.
A very interesting and appreciative description is
given in the Newcastle Chronicle of the new asylum
extension at Coxlodge. It is satisfactory to see so much
public attention given to the latest developments of
asylum construction, and the new views which find
practical application in the adminstration of modern
asylums. In the article referred to the following
statement appears. *• A tour through the eight
wards is a pleasant experience. It leaves, above
everything, the impression of cheerfulness and
perfect wholesomeness, and one cannot help
feeling that, under such circumstances as these,
the lot of the unfortunate inmates is alleviated and
lightened so far as all human skill, and care, and
consideration, can work to such an end. In such a
place, surely, the thought of imprisonment can never
enter. It is a refuge not a gaol.” This is all very
interesting and satisfactory so far as it goes, but
there can be no question that it is only those who
specially inquire into our asylums for the insane who
really know anything of the subject. As a matter of
fact the greatest ignorance prevails regarding asylums,
their internal arrangements, treatment of the patients,
and character of the staff. It is much to be regretted
that, even in our own profession, there is a great deal
of stupid talk, simply because medical men do not
take so much interest in the subject as to prompt
inquiry on the spot. Ninety-five per cent, of our
medical men have never been through the wards of an
asylum, and now that insanity has become a compul¬
sory subject of medical instruction, it would appear
that some who have had such instruction, have only
studied mental disease on the threshold of the
asylum, and not in view of its medical environment.
Medical superintendents should give post-graduate
-courses in the wards, and in this way the old prejudice
would be wiped out to a large extent, and it would be
seen that asylum medical men are doing as good
work in their own department, as in any other de¬
partment of medicine. From the statement which
has already been quoted there is a line not quite
correct, viz., “ In such a place, surely, the thought
of imprisonment can never enter.” This statement
is too optimistic. It does not take into account that
asylums have still locked doors, and that the more
intelligent and sensitive patients must realise this
and feel the jar of lock and key. Above all things
freedom is dear to the insane as well as to the sane,
and when we can do without locked doors in
asylums (and in some asylums, we must admit,
this to some extent has been done) the last lingering
association of the olden times will be wiped off the
slate of memory. He is a very demented patient,
indeed who does not appreciate the sense of freedom,
the conditions of home life, and the feeling of liberty.
Into the details of the article referred to, we need not
enter, for they are details which find repetition in our
new asylums. Suffice it to say, that such articles
cannot be too widely broadcast, and the public and
our profession cannot too soon make themselves more
correctly aufait with the management of our modern
asylums. They have sprung into being without due
recognition, and they are veritable hospitals for the
insane in the best sense of the term. Newcastle has
done well in this matter, and her citizens ought to
know it.
THE HOSPITAL QUESTION IN THE
ANTIPODES.
That the burning question of hospital abase is
growing apace in our Australian colonies has been made
more and more apparent of recent years. Its dimen¬
sions, however, have reached a size that will come as
a surprise to members of the medical profession in
Great Britain, who have long had their own troubles
of a similar kind. The whole subject has been care¬
fully investigated by Mr. L. Brack, of Sydney, who
has embodied the results of his labour in a pamphlet
entitled, “ The Uses and Abuses of the Public
Hospitals in Australia, Tasmania and New
Zealand.” While many of the points raised,
resemble those with which British readers are
only too familiar there is a peculiar feature
in the Antipodean position arising from the fact
that in nearly all cases half the annual oost o*
hospitals is contributed by Government. Under such
circumstances the statement can hardly be wondered
at that these institutions are frequently established
merely as a blind to induce a medical man to settle
in a sparsely-populated district. Five years ago the
then Chief Medical Adviser to the New South Wales
Government advised that no government assistance
should be granted to any hospital unless the Prin¬
cipal Government Medical Officer certified the actual
need of such an institution. That simple and obvious
precaution has not been taken, so that the in¬
ordinate increase of needless hospitals goes
on with the aid of public money. This
Digitized by
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Nov. 22, i«99. LEADING
state of matters is incapable of any serious
defence, and it seems to show that in Australia as in
Great Britain special medical legislation of the kind is
enacted regardless of the interests of views of the
profession. It appears that throughout Australasia
there is one hospital to every 12,299 persons, an
allowance which certainly would seem to be far above
the needs of the case, unless, indeed, we are to con¬
clude that the average prosperity of the community
has fallen to so low an ebb as to forbid them paying
for medical attention. At any rate the case as
represented by Mr. Brock demands the careful con¬
sideration of every medical practitioner througboutthe
whole of the vast area —about seven-eighths of the size
of Europe—which is dealt with in his pamphlet. He
estimates the value of medical attendance on in and
out-patients, including operations, at the great total
of £625,741, which sum represents services rendered
gratuitously to the community by the profession.
Yet medical men appear to be just as anxious to
encourage the multiplication of hospitals, and to
secure honorary posts in those institutions in
Australasia as they are elsewhere. In other words
the individual fights for his own hands and ignores
the benefits to be derived from combination.
The pay system at hospitals flourishes in these
colonies, a parasitic plant of 6vil growth that
has done much to sap the honesty of
the medical charities in our own country. Most
members of the profession here at home will agree
with Mr. Brack’s contention that all public hospitals
should be absolutely free to all comers, and not one
penuy ought to be received from the patients. Natu¬
rally our professional brethren across the sea will
point to the example set by such classical institu¬
tions as Guy’s, St. Thomas and the London Hos¬
pitals, to say nothing of smaller fry in shoals. Per¬
haps one of the best means of control that could j
be devised over the hospitals would be to
make a medical man's recommendation com¬
pulsory to every admission. Pay wards can
never be tolerated by general practitioners unless they
are permitted to attend patients thereto. The out¬
patient departments in Australasia appear to be no
better than our own, and the writer of the article
does not hesitate to say that they are “ mere mediums
for pauperising the people,” and further, that “ de¬
ducting the very poor who are fit subjects for
gratuitous treatment, there must be considerably
more than half of all the patients who could afford
to pay for medical advice and medicine.” One
hospital at Bulong offers medical attendance and
medicine for the modest sum of one shilling a week
to all residents in the district within a radius of
a mile and a quarter. This scheme, be it remem¬
bered, is carried on by means of the Government
subsidy previously mentioned, which enables an
institution to be conducted on these disreputable
lines at the expense of the taxpayers of the Colony.
Mr. Brack is not content with destructive criticism
alone, for he concludes with thirty-two practical
suggestions. Among the chief suggestions are that
the words “ for the sick poor ” be placed upon every-
ART1CLES. _ Tkb Xvdi cal Pr ess. 537
thing connected with the hospitals, and “for the
destitute poor” in connection with out-patient de¬
partments ; that a medical man’s recommendation
be a compulsory condition of admission; that
patients’ payments be abolished; that any patient
found imposing upon a medical charity be pro¬
secuted for obtaining money under false pretences;
that accident and emergency patients who can pay
for treatment be detained only so long as absolutely
necessary; that all public hospitals be carried on
by Government; that if boards of management be
retained one half of their members shall be chosen from
the honorary medical staff of the institution; that no
honorary medical officer hold any one post longer
than four years." There are other stringent and
cogent recommendations made by Mr. Brack, whose
directness are nowhere more strikingly shown than
in the concluding advice, which is printed in large
type, and runs: “ Finally, I most emphatically
suggest that subscribers withhold their subscriptions
from all those charitable institutions which do not
adopt the more important of these suggestions.’’
That passage reveals a thorough-going conviction
and belief as to the practical power of the purse that
should appeal to our Anglo-Saxon relatives in the
Antipodes.
THE TEMPERANCE QUESTION.
It would be interesting and certainly of great value
if we could ascertain the views of the medical pro¬
fession throughout the country on the temperance
Question. Some medical men are inclined to con¬
sider it from a social, others from a religious, and
some from a political, point of view. Taking the
clergy as a body we should find some difference of
opinion if dealing with it as a religious question; for
when the Right Rev. Dr. McGee declared that he
would rather see England “ free than sober,” it is not
likely that the Right Rev. the Archbishop of Canter¬
bury would be supported in his views by all the minis¬
ters of the Church of England. It does not certainly
appear easy to find support, in the Holy Scriptures
for teetotalism; and we think that such a question
as that of temperance had better be dealt with by the
medical profession than by the Church. If we limit
the discussion to evidence for and against alcohol,
from a medical point of view, we must begin by
defining accurately what we mean by the word
alcohol. If we intend it to mean strictly the chemical
compound (C 4 H s OHO) obtained by the distillation of
fermented saccharine fluids we must be careful not
to allow liquids such as wine and beer to be treated
in the same way as pure alcohol. It is true that they
are obtained by the fermentation of compounds con¬
taining sugar, yet there is only a small percentage
of alcohol, and a great deal more that is not alcohol in
them. The teetotalist is one who avoids carefully
every fermented liquid on account of its containing
alcohol. We might ask him if his views of fermen¬
tation would extend to the making of bread, and
generally to all forms of fermentation, whatever they
may be. If we ask such a man why he objects to
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538 The Medical Passe. _NOTES ON CURRENT TOPICS._ Nov. 22, 1899.
alcohol he would say that it is on account of the evils
of drunkenness. That it is a reasonable objection if
it is impossible to use fermented liquids in any way
without such an effect. Total abstinence according
to him is the only way to deal with the evil of drunken¬
ness. It was the plan preached by Mahomet and
instilled into the very life of his followers. It is,
probably, from seeing the condition of the
Mahommedans of to-day, that Dr. McGee preferred
freedom to sobriety in this country. But if we
admit in this argument that drunkenness is a great
evil, it does not follow that we believe that alcohol is
nothing but a poison. Opium is a poison, and
arsenic, and many others of the gifts presented by
Nature for the good of man, and if we turn from them
because some poor weak creatures will indulge in excess,
are we acting for the best P To what extent are we
justified in allowing the lunatic to be at large P
Some antivaccinationists, and teetotallers, and anti-
opinionists, and other kinds of fanatics are ready to
sacrifice themselves to what they think is a noble
cause. We see the same spirit in the wild delirium
of religious excitement, particularly in some parts of
the world; but it is doubtful whether the character
of the English people is likely to lapse into any such
a pitiable condition. Drunkenness is an evil, but it
is well to consider whether the indulgence in any
kind of poison is not akin to a concentrated essence
ending in suicide. The tendency shown by many to
indulge in excess in the use of any such agents as
opium or alcohol is, in the opinion of the profession,
an evidence of disease, and if the teetotalist hopes
to cure the disease by doing nothing but withholding
the agent, it must be clearly shown that this plan
succeeds. Some of the strict teetotallers belong to
the class of people who regard all disease as a divine
infliction, which man has no right to contend against,
and the medical profession would not be appealed to
by them for help to cure any such malady as
drunkenness. To leave those free who are suffering
from this malady, and are a danger to society, is a
question that the medical profession ought to take a
great interest in. To put a poison in the way of the
feeble and the ignorant is certainly unwise, but to say
that we ought never to use the process of fermenta.
tion, though of great value to many, is absurd
It is well for us to study somewhat closely the pro¬
cess of fermentation, There is no doubt but that it
is impossible to obtain more than a certain percentage
of alcohol in any fermented liquid; and that the
separation of alcohol by distillation is not a part of
that process. The simple fact that alcohol will arrest
fermentation, suggests the doubt whether it is wise
to use it without great caution. It seems as if it is
necessary to deal with alcohol obtained as it is, in a
very different way from those liquids which have
simply undergone the process of fermentation. “ Beer
therefore,” says one of the best writers on the
ohemistry of common life, “ is food as well as drink.
A little beef eaten with it makes up the deficiency in
gluten, as compared with milk; so that beef, beer and
bread—our characteristic English diet—are most
philosophically put together, at once to strengthen, to
sustain, and to stimulate the bodily powers.” Surely
all sensible men will agree upon the best way of
treating those evils against which the temperance
reformers are struggling, if they will look at the
subject in the way in which we believe most of the
members of the medical profession do, though the
views of the profession have not yet been expressed-
So far as legislation is concerned, the chief point to
consider is the sale of liquids containing alcohol,
certain restrictions being imposed on those which
contain a high percentage, or in which the alcohol is
not the simple result of fermentation. All distilled
spirits require control, and if this were entrusted to
the medical profession, it might simplify matters.
4totee cm Current topics.
A Serious Blunder.
An extraordinary blunder on the part of a medical
man came to light last week at the Cardiff Assizes
where a woman was to be tried on a charge of having
wilfully murdered her husband. It seems that in
the early part of last month her husband was found
dead in bed under somewhat unusual circumstances.
At the inquest the accused stated that the deceased
had been ailing for several days with laboured
breathing which mustard plasters failed to relieve.
The medical man who had made the post-mortem
examination gave evidence to the effect that death
was the result of a broken neck caused by a violent
blow, of which the re'were marks behind the ear, and
he formally asserted that there were no signs of
pneumonia in the lungs, whereupon the woman was
arrested on the charge of murder. At the magisterial
inquiry which followed, the medical witness repeated
bis statements, and located the exact spot where the
neck had been broken. Subsequently an order was
obtained for a re-examination of the body by an
expert appointed by the Home Office, who found that
there was no trace of a broken neck, while on the
other hand there was abundant evidence of death
having been due to acute pneumonia. The accused
was at once admitted to bail, and the prosecution
has since been abandoned. Mr. Justice Bucknill»
in ordering her release, expressed himself in very
strong terms on the terrible blunder that had been
committed by the medical witness who, he urged
ought to make every compensation in his power to
the unfortunate victim of his carelessness, she having
had a narrow escape of her life in consequence thereof.
In his lordship’s strictures we must all concur but
with the feeling of shame and regret which all prae-
titionere of medicine must feel at such an unpre¬
cedented occurrence is mingled a certain dose of
curiosity as to the possibility of so grotesque an error.
A broken neck is not an occult lesion as to the
existence whereof there can be any room for un¬
certainty, and the pneumonic lung is tolerably
characteristic. In any event this unhappy and
regrettable occurrence cannot fail to emphasise our
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Nov. 22, 1806. NOTES ON CURRENT TOPICS. The Medical Paxss. 539
oft-reiterated contention that the conduct of post¬
mortem examinations is quite a special department
of medical work for which the training and experience
of the average practitioner equip him very im¬
perfectly.
Epidemics and Circulating Libraries.
The danger which circulating libraries entail to
the public at large in times of epidemic is now pretty
generally recognised, and sundry plans have been
suggested having for object the disinfection of books
which have been exposed to infection. Now the dis¬
infection of books by any means short of destruction
is practically impossible, and it is high time the
sanitary authorities took steps to circumscribe the
mischief which books may be the means of causing when
infectious disease is prevalent. The Medical Officer of
Health is empowered to close schools when this step
appears to be indicated in the interest of the public
health, and he ought to have the power to prohibit, or
at any rate to regulate, the circulation of books. The
least that could be done would be to oblige librarians
to exact from every applicant for the loan of books to
sign a declaration of th6 freedom of the house from
infectious disease, false statements being punishable
by fine or imprisonment. We doubt, however, if this
plan would work satisfactorily, and it would be far
better to prohibit the loan of bookB altogether for a
time. This step would not condemn the inhabitants
of the stricken town to intellectual idleness, but it
would oblige them to purchase their literature instead
of borrowing it, a result which would not excite much
opposition, at any rate on the part of publishers. It
is hardly necessary to add that the destruction of all
books known to have been in an infected house would
be an indispensable corollary of these measures of
precaution.
The Annual Meeting at the Royal College
of Surgeons, England.
The annual meeting of the Fellows and Members
of the Royal College of Surgeons, England, took
place at the College on Thursday (16th) last, and
about fifty of the “ body corporate ” were present.
Owing to the absence of the President, Sir William
MacCormac, the chair was taken by the senior Vice-
president, Mr. H. G. Howse. The proceedings were
of the usual character, that is to say, after the chair¬
man had drawn attention to the report of the Council
for the past year, the ever redoubtable champion of the
members' cause, Mr. Joseph Smith, again assumed
his accustomed warlike attitude, aad “went for” the
■Council for not agreeing to the oft-repeated claim of
the members for direct representation on the govern¬
ing body of the College. The usual arguments, now
hoary from their antiquity, were advanced in favour
of this reform, and the usual resolution embodying
the wishes of the members in this regard was also, as
usual, carried by an overwhelming majority. Sir
Thomas Smith rather transferred the responsibility
of the Council's refusal of the reform to the Fellows,
inasmuch as he stated that upon two occasions
the Fellows had been directly appealed to for their
decision in the matter, and in each instance that
decision had been in the negative. Personally, it
would seem that some members of the Council are
favourable to the desire of the members being grati¬
fied, but, however this may be, it is quite certain that
the time has not yet come when the Council will give
way on this muoh debated point. In one respect, at
least, the Council should be chary of granting the
reform, for if this contentious matter were removed
from the arena of debate, it is quite impossible to say
what else the “ body corporate ” would find to discuss
at these annual meetings. A resolution was then
passed calling upon the Council to prohibit the
Fellows or Members from accepting duty in con¬
nection with the medical aid associations. But the
Vice-President pointed out that, however unpro¬
fessional the holding of such appointments might be,
they were not illegal, and serious difficulties would be
encountered were the Council to attempt to enforce
the suggestions contained in the resolution. The only
course, therefore, open to the members of the College
was to try and bring the pressure of public opinion
to bear on the Legislature with a view to an alteration
in the law.
The Side-Saddle.
The Health Protection Society of Cleveland,
U.S A., have undertaken a campaign against the side*
saddle for women which they hold to be injurious,
and they advocate the ordinary masculine position on
horseback for females. While they are on the war¬
path they also tilt against the fashionable tall hat
corsets, and trailing skirts. If this Society should
attain any measure of success in their campaign we
shall be greatly surprised, for they are proceeding on
the utterly fallacious assumption that the care of the
health is the primary object of every intelligent
citizen and the lady members of his family, whereas
it, in reality, comes low down on the list of objects to
be aimed at.
Intercostal Neuralgia.
The etiology of this common, troublesome, but not
very dangerous complaint is ill-understood, but its
occasional occurrence in epidemic form has suggested
the possibility of its being an acute infectious disease.
Although it is not usually attended by any marked
depreciation of the general health, the suffering
which it entails is often of exceeding severity, and
excites suspicions of pleurisy or pneumonia, from
which, indeed, it can be distinguished only by very
careful clinical investigation. Dr. T. F. Reilly, of
New York, recently described an epidemic of the kind
which he had observed. His cases were characterised by
chilliness and malaise, lasting a few hours, followed by
pain along one or more of the intercostal nerves, rapidly
increasing in intensity and often associated with a
mild febrile movement. In a certain proportion of
the cases a herpetic eruption developed along the
track of the inflamed nerves or in some other
situation. Obstinate oonstipation was a marked
feature in all, and in none was there the tender spot
which is invariably complained of in ordinary inter_
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NOTES ON CURRENT TOPICS.
Nov. 22, 1899.
costal neuralgia. He referred to a similar epidemic
reported from Germany, where upwards of a hundred
cases occurred within a few weeks. Quinine and
other drugs failed to afford relief, and strapping of
the thorax was the only measure that appeared to
reduce the pain. There does not seem to have been
any close relationship between the prevalence of this
affection and any particular type of weather, and the
• precise nature of the affection must for the present
remain matter for conjecture.
Morphine and Alcohol in the Profession.
In a paper read not long since before the New
York State Medical Associatisn by Dr. T. D.
Crothers, some startling conclusions were brought
forward bearing on the alleged proclivity of medical
men to indulgence in morphine and alcohol. The
author's averages are arrived at in a rather obscure
way, and we do not feel justified in accepting his
statement that 10 per oent. of medical men in general
are addicted to the morphine habit. In this country,
for instance, it is obviously at variance with fact,
though, on the other hand, it is possible that the per¬
centage of medical men addicted to the use of alcohol
in excess would compensate for the error in respect
of morphine. He refers to the fact that of ninety-
two victims of the morphia habit treated in a certain
German institution, nearly a third belonged to the
medical profession, and there really seems to be some
ground for the assertion that medical men are, as a
class, more addicted to the abusive use of morphine
and alcohol, than the members of other professions,
and although it is not difficult to explain this prone-
nees it is none the less a very disquieting tendency.
Lactation in a Virgin.
La Medecine Modems gives publicity to a curious
letter addressed to a physician by a young lady
under the following circumstances:—The distressed
applicant had had charge of an infant six months
of age whom it was necessary to wean, a process to
which the infant objected in the way that is the
wont of infants under similar circumstances. To
console her irritable charge she put it to her own
breast, which, she adds, were not very voluminous,
but in the course of a few days the breasts under¬
went an increase in size, and to her surprise and un¬
easiness a fairly copious secretion of milk became
manifest, sufficient, with a little assistance, to satisfy
the infant, whose health and development left
nothing to be desired. Her object in applying to
the physician was to ask advice how to put a stop
to a condition of things which, she felt, was, to say
the least of it, unusual in a virgin. It is not to be
supposed that any difficulty was experienced in
arresting the secretion, but the substance of the
letter appears genuine enough to give it a physiolo¬
gical interest. We remember to have heard of similar
occurrences, more or less well authenticated, in non-
pregnant females, even of advanced years ; indeed, an
abundant lacteal secretion has actually been noted in
the newlv-born, even of the mele sex.
Bird’s Bye Statistics.
Dr. Stmons, the Medical Officer of Health for
Bath, has adopted a method of formulating his death-
rates that is worthy of a passing note by those who
are concerned in either drawing up or in reading such
documents. His plan is to issue a short comparative
list by which the relations of Bath mortality to that of
other parte of the United Kingdom may be seen at a
glance. Thus, for example, the death rates per
thousand annually of all ages for all causes alone and
for zymotic causes is recorded for the two week®
ending October 28th and November 4th. This is first
given for the 33 great towns at 21T and 18 5 general,
and 2*2 and 2 zymotic. The lowest in the first
week was at Cardiff, with the remarkable figure
of 10T and zymotic 0*3; for the second week,
lowest at Derby, with 11*3, and no zymotic. London
showed 211 general and 2 0 zymotic during the first
week, and 18*6 general, 1*6 zymotic during the second
week, and, as one might expect, this nearly
approached the total average. The highest rate for
the first week at Bristol, which reached 297 with 1*9
zymotic, and for the second week at Bolton, which
registered 25*7 and 3'5. After this it is an easy task
to estimate the significance of the Bath crude death
rate, which has no zymotic and gives, 18*8 and 20*8
for the respective weeks, or when corrected 15*8 and
16 7. A similar comparative method is adopted by
Dr. Symons in hie quarterly returns of zymotic and
infantile mortality. Statistics, although doubtless
full of interest and value, are usually presented in
undigested form and any attempt to furnish results
in a readily understandable summary is worthy of all
commendation. Bath appears to occupy a most
enviable position as regards general healthiness, and
has acted wisely in securing the “ whole time ”
services of an energetic Medical Officer of Health.
The Infantile Death-Rate in Cheshire.
The Cheshire Council has been much exercised over
the infantile death-rate and high general mortality
in the boroughs of Hyde, Stalybridge and Dukin-
field. The Public Health Committee sent in a
resolution, afterwards withdrawn, to call the attention
of the Local Government Board to that point, as well
as to oertain insanitary conditions prevailing in the
three districts mentioned and the absence therein of
isolation hospital accommodation. The chief point
to be noted with regard to the insanitary conditions
is that they had been under report for the past five
years. So far as the infantile mortality is concerned
the lot of Cheshire much resembles that of the rest
of the United Kingdom, the inhabitants whereof have
grown accustomed to the ever present massacre of
the innooents going on in our midst. The causes of
this lamentable waste of human life are manifold.
Artificial feeding aocounts for a great deal of the
damage, and insanitary environments, especially by
its indirect contamination of milk, may be credited
with more. Summer diarrhoea, which is a filth
disease of mixed microbial origin, should materially
lessen before a rigidly enforced hygiene of milk.
Google
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NOTES ON CURRENT TOPICS. The Medical Press. 541
Nov. 22,
Then there is overcrowding, which flings ite bane
over almost every domestic condition, including
ventilation, the storage of food, close contact of sick
and healthy, spread of infection and other equally
important contributory causes of infantile mortality.
It may be broadly asserted that the greater amount
of that destruction is preventable. Science is
gradually bringing within her grasp the exact causes
of the evil, and it is to be hoped that some day in a
not very distant future the raising of the general
standard of intelligence will put an end to this great
reproach of modern civilisation.
A Nefarious Trade.
The magistrate at the Thames Polioe Court last
week was called upon to deal with a case which threw
a lurid light upon “ tricks of the trade.” The pro¬
secution was undertaken by the Poplar Board of
Works, and the defendant was a man whose occupa¬
tion was that of selling bad condensed milk for human
consumption to a pastry cook. In all he disposed
of 385 tins to the latter, and futher investigation
revealed the disturbing fact that millions of tins of
bad oondensed milk were stored in a warehouse in
Barking. In the course of the proceedings the
pastry cook admitted that it was usual in his
trade to pay a very low price for condensed milk. The
price in this instance was a halfpenny a tin, or three
shillings and sixpence for a case of seventy-two,
while the proper price of such would be from eleven
shillings and ninepence to fifteen shillings. Thus a
considerable profit can be made out of tins contain¬
ing unsound condensed milk, and apparently there
is a ready market for them. This being the case, the
local authorities throughout the metropolis should
keep an eye upon the pastrycooks in their respective
districts. Apart from the gross fraud practised upon
the public by the use of such an unwholesome
addition to our food supplies, it cannot fail to
be deleterious to the health, and provocative in
all probability of dyspepsia or other intestinal
irritation. It is satisfactory to record that the
substantial fine of £50 and ten guineas costs was
imposed upon the defendant, or in default, three
months’ imprisonment. To deal leniently with a
case of this kind would be simply to place a premium
upon the fradulent practice, whereas to exact a heavy
penalty is likely to act as a deterrent in the preven¬
tion of its repetition.
The Operative Treatment of High Myopia.
Professor Silex, of Berlin, stated at the Utrecht
Congress of Ophthalmology that the method of treat¬
ing high myopia by removal of the transparent lens
should in his opinion only be resorted to with caution,
as much mischief might be caused by it. During a
period of nine months in Berlin he had observed
twenty-three cases of detached retime after extracting
the transparent lens, while during the same period
he had only met with three detached retinae in non-
operated cases. On the other hand, Yon Heppel, at
the same meeting, expressed his belief that comparing
the number of myopes who have been operated upon
with those not operated upon, the detachments of the
retinae were about equal.
The Members’ Gown at the Royal College of
Surgeons, England.
By persistently “ pegging away,” the members of
the Royal College of Surgeons have at last been able
to persuade the Council to grant them a special
gown. It is a little difficult to understand when the
gown could be worn by the members. Even the
Fellows have found it a very difficult matter to make
any use of their gown, so much so, we believe, that
probably about 90 per cent, of the Fellows have not
the remotest idea what their gown is like. The
only occasion upon which the academic apparel
can be appropropriately worn is, it would seem, at the
annual ceremony of the Guild of St. Luke held, in St.
Paul’s Cathedral. But we question very much
whether any Fellow or member would consider it
worth his while to incur the expense of obtaining a
gown merely for the purpose of enabling him to give
it an annual airing in the cathedral of the Metropolis.
Therefore, we think, that although the members are
now entitled to wear a gown in connection with their
diploma, there is reason for doubting whether they
will find the privilege of any use to them.
The Toxic Effects of Aniline Dyes.
It is, of course, well known that aniline dyes are
virulently toxic. But it is set down that many cases
occur in which their virulent effects am not shown.
An instance, however, was recently reported in the
public press of an American girl who was poisoned by
the ink used on typewriter ribbons. She stained
her fingers with the ink, and thus oonveyed some of
the latter to a sore on her upper lip. Acute toxic
symptoms subsequently quickly developed, asso¬
ciated with great oedema and pain locally, and a fatal
result shortly afterwards ensued. This unfortunate
incident should be accepted as a warning by all
typists to avoid letting any of the ink in the ribbons
come in contact with a sore that may be present upon
their skin. Although the rapidity and fatality of
the symptoms in the above case rather point to a
septic cause, nevertheless it is wise to be careful,
especially when, under such circumstances, preven¬
tion against accidents is a matter of no difficulty.
Veils and Red Noses.
A German physician formulates an indictment of
the veil as a cause of acne rosacea affecting the nose,
and he relates a number of instances in which young
women, otherwise in excellent health, developed this
distressing condition consequent upon the habit of
riding, cycling, &c., in veils. His view is that the
lesion is caused by the friction of the skin against the
veil, impregnated with moisture from the breath, the
effect being exaggerated by the tightness with which
it is necessary to attach the veil when indulging
in athletic pursuits. The remedy is obviously to
abandon the use of the veil or to wear it loose,
anointing the nose with lanoline or other suitable
lubricant.
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342 Thb Mkdioal Pbisb.
NOTES ON CURRENT TOPICS.
International Congress of Malaria.
The Liverpool School of Tropical Diseases have
just embarked upon another new enterprise. The
authorities thereof are now making arrangements
for the organisation of an International Congress
upon the subject of malaria, to be held under the
auspices of the school in that town. It is stated
that the researches of Major Ronald Ross in
connection with malaria have attracted considerable
attention in Germany, France, and other countries
having possessions in the Tropics, and it is felt that
the time has arrived when an international exchange
of opinion upon the subject would be generally ad¬
vantageous. The conference will probably be held
early next summer, and from the favourable recep¬
tion which the proposal has already received, it is
anticipated that the attendance will be fully re¬
presentative of those who have given special attention
to investigating malarial and other tropical diseases.
The Presidency of the Royal College of
Surgeons, Ireland.
We noted recently that a movement had been set
on foot in Limerick to present to Dr. Thomas Myles,
Surgeon to the Richmond Hospital, and Vice-Pre¬
sident of the Irish College of Surgeons, a testimonial
on the occasion of his election as President, and we
-now observe that the Limerick Urban Council has
resolved to present him with the freedom of the city
on that occasion. While congratulating Dr. Myle6
upon his anticipated honours, we desire to remove a
misapprehension which seems to exist. Unless the
. existing President, Mr. Swan, retires—which we have
no reason to think he contemplates doing—Mr.Myles’s
promotion to the Chair in the College cannot take
place until the first Monday in June, 1900, when,
without reasonable doubt, be will be elected Pre¬
sident, and will be in a position to accept the
demonstrations of appreciation offered to him by his
■ native town.
The Dublin Preliminary Examinations.
We publish elsewhere a note of the results of the
examinations of the present month and of October,
1898. For this examination thirty-seven candidates
entered, eighteen passed and nineteen were rejected,
For the October examination sixty-four candidates
entered, thirty-two passed and thirty-two were re¬
jected. Owing to the severity of these examinations
the numerical strength of the Medical Student Classes
at the Dublin medical schools and hospitals will be
considerably reduced for the next few years. Are
the General Medical Council aware that many of the
rejected candidates at these examinations have no
difficulty in finding an '* open door ” elsewhere, and
pass an examination and have their names registered
as medical students? These are the preliminary
examinations which the University interest in the
General Medical Council have been, in vain, trying to
crush out of existenoe, just as the College of
Physicians interest tried, in vain, to crush out their
rivals, the Apothecaries’ Hall. It is difficult to
respect a public body which allows itself to be used in
Nov. 22, 1899.
this way for the benefit of particular educational
cliques.
The Operative Treatment of Tuberculous
Peritonitis.
The operative treatment of tuberculous peritonitis
has generally been regarded as satisfactory, and yet
some figures recently published by Wunderlich refer
to a rather high percentage of failures. Out of ten
patients operated upon four died within three months,
three grew worse, and only three at a subsequent
examination were found to be in good health. The
recorded cases of tuberculous peritonitis now amount
to 500; among those 688 per cent, had ascites;
27"2 per cent, adhesions; and in 4 per cent,
suopuration occurred. After three years of observa¬
tion, it was found that recovery had taken place in
23'3 per cent, of the first cases, and in 9’8 per cent,
of the second. Of the suppuration cases 9 died out
of 20.
The Evil Example of the Leicester
Guardians.
The evil example of the Leicester Board of
Guardians in refusing to comply with the Vaccina¬
tion Act is now being followed by the Luton Board of
Guardians. The anti-vaccination section, beingstrong
on the Board, have determined to set the Local Govern¬
ment Board at defiance. By a vote of two to one, they
have resolved to terminate the contract with the pub¬
lic vaccinator of Luton, and have also refused to
pay the fees of this official. Of course, the central
authority will call upon the Guardians to conform
with the law, and if the demand be not complied with
the same procedure will be adopted to compel com¬
pliance, as was put in force at Leicester. It is
lamentable that public officials should thus childishly
determine to resist authority.
The Opening Meeting of the Dublin
University Biological Association.
On Tuesday, the 28th inst.. at 8 p m., Dr. William
R. Dawson will inaugurate, as President, the session
of this Association in the front hall at Trinity
College, with an address on “ The role of the Blood
Supply in Mental Pleasure and Pain.” The speakers
at the meeting will include :—William Aldren Tur¬
ner, M.D., Physician to the Hospital for Epilepsy and
Paralysis, Regent’s Park, London; Professor D. J.
Cunningham, D.Sc., M.D., F.R.S., Professor J. M
Purser, D.Sc., M.D., and Conolly Norman, F.R.C.P.I.,
Medical Superintendent, Richmond District Asylum.
Drug Trade Contract Trade.
The tenders presented by drug contractors to Irish
Boards of Guardians since the new regulations of the
Irish Local Government Board came into force throw
much light upon the drug contract system. Under
the old system the contractors tendered whatever
prices they pleased* and if they had friends on the
Board of Guardians no questions were asked. Under
the new system the Local Government Board quoted a
reasonable maximum price for each article, and invited
the contractors to state what discount they would allow
Digitized by
Nov. 22, 1899
SCOTLAND.
The Medical Press. 548
^cotlanb.
off the official prioee. We note that one firm in
Dublin haa last week obtained a contract by quoting
50 per cent, off list prices, from which we may con¬
ceive what a profit may be made on drugs and to
how vast an extent the ratepayers were robbed under
the old system.
M. Balland, the Principal Pharmacist at the
Invalides in Paris, has just presented to the Academy
of Sciences a communication on the nutritive value
of fruits. He finds that of ripe fruits, such as straw¬
berries, raspberries, &c., 72 to 92 per cent, are com¬
posed of water. The nitrogenous matter which they
contain does not, in some instances, amount to more
than 0.25 per cent, of their weight. The most sus¬
taining fruits are nuts, but it is questionable whether
they are digested.
PERSONAL.
Sib Hugh Bkbvob, Bart., M.D.,has been appointed a
full Physician at King’s College Hospital, London.
Mb. Edwabd William Scott Carmichael, M.B., C.M.,
was last week elected to the poet of Surgical Registrar
to the Royal Infirmary, Edinburgh, vacant by the
death of Dr. W. M. Hutton.
We regret to learn that Lady Stokes, wife of Sir
William Stokes, Professor of Surgery in the Royal Col¬
lege of Surgeons in Ireland, has been dangerously ill
with typhoid fever, but, we are glad to say, is now con¬
valescent.
Dr. Josiah Blomfield has been presented with a
cheque for 100 guineas by the Board of Management of
the Licensed Victuallers’ Asylum, in recognition of his
completion of fifty years’ service as Medical Officer to
the Institution.
We learn that Mr. William I. Wheeler, Surgeon to the
City of Dublin Hospital, has been and is still seriously
ill of typhoid fever at his residence in Merrion Square,
Dublin. It is hoped that his illness will shortly take a
turn for the better.
Senior Assistant-Surgeons M. S. A Caldeira and A. X.
Dias, of the Bombay Medical Department, have been
promoted to the honorary rank of Captain; and
First-class Surgeons H. D. Walker and D. B. Fonseca
have been raised to the position of Senior Assistant with
the honorary rank of Lieutenant.
It is understood that Mr. Edmund Owen does not
intend to seek re-election on the Court of Examiners of
the Royal College of Surgeons, England, when his term
of office expires in December. Mr. Anderson and Mr.
Page go out of office at the same time, but will offer
themselves for re-election. Written applications for the
office must be sent in before December 0th.
Royal College of Burgeons In Ireland—Dental Examinations
The following candidates have passed the primary part
of the examination for the Licence in Dental Surgery of
this College Mr. E. T. Pasley, Waterford, and Mr. H.
Schlegel, Dublin.
[from OUB own correspondent.]
Women Doctors in Edinburgh. —The female doctors
and their supporters in Edinburgh are difficult to
please. The infirmary has stretched several points
within the last few years in their behalf, but still they
hanker after more. They have a medical and a surgi¬
cal ward allotted to students of their sex exclusively,
they have the entry to all the special departments, but
they ask for more. They wish to see female clinical
tutors appointed to the wards they attend, bo that they
may have tutorial instruction from those of their own
sex. They have just established a nursing home in a
square close to the university and infirmary, supplied
with three beds for paying patients, and pro¬
spectively with a few for women only able to
pay nominal fees; while the staff will be entirely con¬
fined to women. A guinea a week will be charged in
the case of paying patients, only half-a-crown to the
others. If the paying beds be constantly in service £150
a year would come m. The lady doctors of Edinburgh
had guaranteed .£100 per annum, and £180 was looked
for from the public.
The scheme is commendable so far as it goes, but when
the promoters of it proclaim that .the reason
underlying their action is due to the lack of
opportunity given by the infirmary authorities to
medical women they are hardly charitable. Do they
aspire to the appointment of female resident*, female
chiefs, female lecturers ? If they do their penalties will
assuredly surpass any theoretical, sisterly gain, and their
opportunities of sitting at the feet of Gamaliels, whose
rank accords with the wide range of choice permitted by
large numbers of male students in accordance with the
monetary return accruing from them, will be exchanged
for that of teachers of their own sex, who, if realiy com¬
petent, will not be content with the remuneration afforded.
The Fellows of the Royal College of Surgeons of
Edinburgh held their annual dinner on Friday of last
week. Dr. Dunsmure, their President, in the chair. A
feature of the dinner consisted in the entire absence of
all but the loyal items from the toast list, the question¬
able delights of after-dinner oratory being replaced by
contributions from the harmonists, a very clever
quartette of part-song singers of local upbringing, and
musical interludes supplied by a small orchestra of first-
class executants. The result was much appreciated.
Bumbledom and Biology. —The Medical Officer of
Health for Glasgow recently suggested to the Town
Council of that city that it might be useful were
provision made for the biological testing of the milk
supplied to the citizens from different sources, with the
view of ascertaining how far it was contaminated with
the bacillus of tuberculosis. An ex-Baillie, when the
matter came up before the Council, at once wished to
know if the biological testing of milk was not vivisection.
After a confused and muddled argument arising from
this, a member of the Council became so affected by the
thought of the tortures experienced by poor tubercle
bacilli, undergoing vivisection that he moved the rejec¬
tion of the Medical Officer’s report. Ultimately, how¬
ever, one was found to assure the Council Members that
no cruelty was intended by the Medical Officer, that it
was better that an animal should suffer than man, and so
influenced the corporate mind that the suggestion was
unanimously agreed to. Even if the tests made use of
included the inoculation of a few guinea-pigs and mice,
is it not immensely more important that the milk supply
of hundreds of thousands of human beings should be
proved to be innocuous or dangerous to them, as the case
may. be, than that a few guinea-pigs inoculated with the
milk Bliould be killed whenever they show indisputable
signs of tubercu’ous infection from the milk—the milk, in
fact, which the objectors to the trials of the guinea-pig
give to their own children, and take themselves, at much
the same risk.
An anti-vivisector who objects to the practical testing
of milk because it may possibly harm an animal, and
subjectively cause it to become diseased, cheerfully, we •
Google
Digitized by
544 The Medical Press.
CORRESPONDENCE.
Nov. 22, 1899.
■suppose consents to the similar though not so imme¬
diate vivisecting of his child, because that does not
involve the infliction of a prick of a needle, a prick no
more painful than his women-folk experience every time
they sew a seam.
Cotrespanbcntc.
We do not hold ourselves responsible for the opinions of our
correspondents.
“ THE DECLINE OF SYPHILIS.”
To the Editor of The Mbdical Press and Circular.
Sir, —My attention has been drawn to your Leader of
November 15th, in which I am reported as having said
at Brussels that “ in England among the more educated
classes syphilis is almost infinitely rare.” Of course I
never said anything so absurdly untrue. What I did
say was, “ inherited syphilis, Ac.” I was arguing in
support of the two years before marriage rule, and
alleging that it was now generally observed by the class
mentioned.
I am, Sir, yours truly,
Jonathan Hutchinson.
15, CavendiBh Square, W.,
November 16th, 1899.
To the Editor of The Medical Press and Circular.
Sir, —The cheery optimism which pervades your
leading article under the above heading in your issue of
November 15th is surely very misplaced, and your
last phrase “— syphilis as a disease has been latterly
robbed of a good deal of its terrors, aad is progressively
on the decline,” contains a] very dangerous assertion,
especially when made in the columns of a medical paper
of sixty years’ reputation. I have not had the oppor¬
tunity of reading Mr. Hutchinson’s speech at Brussels,
but I hope you will allow me to discuss the various
points contained in it which are brought forward in your
article. I suppose that the mention of deaths from
“ inherited syphilis ” means the infant mortality in chil¬
dren of syphilitic parents, the statistics upon which are
very misleading by the fact of their being so difficult to
obtain, yet even accepting the statement that this
mortality has been reduced in fourteen years in a
proportion of from seventeen to twelve, how can Mr.
Hutchinson scout the idea that the inheritance of
syphilis is a means of reducing the stamina of the race
when he acknowledges in the same breath there t* a
mortality from inherited syphilis, thus showing that a
constitutional disease is transmitted to the offspring
of the affected parents which may prove fatal,
and, if not fatal, may lead to serious compli-
tions; is it not much more logical to believe that
the stamina of the race is not reduced in late
years owing to the fact that the syphilis is not
transmitted at all in a large number of cases owing to
the parent, the original recipient of the disease, having
been cured by our improved methods of treatment, and
how much more would this apply to the third genera¬
tion even if the taint had appeared, and then been eradi¬
cated by treatment in the second. On this account
inherited syphilis, I am quite willing to admit, is
declining, but the same cannot be said of acquired
syphilis, and after more than twenty-five years experi¬
ence I cannot endorse the explicit statement that
“ among the more educated classes in England syphilis
is almost infinitely rare,” and “ we scarcely ever see it
at all,” if so, why the account that follows of the pil¬
grimage of members of the educated classes to Con¬
tinental health resorts for systematic treatment, which
treatment, by the way, is almost always undertaken in
the tertiary stage of the disease. The dictum “ there
is an improvement in the treatment which is
likely to be productive of a great diminution in
the prevalence of syphilis ” would be very true
did it say, “ prevalence of inherited syphilis
and prevalence of tertiary syphilis. I was much asto¬
nished at the statement, “in English practice we
-scarcely see a secondary stage at all, we suppress it
altogether, and this because mercury is administered
before secondary symptoms develop." In my opinion
no treatment will prevent the appearance of secondary
symptoms; in hundreds of cases I have begun the mer¬
cury from the very first apparition of the initial lesion,
and I have in every case seen the secondary symptoms
appear ; it seems to me that one might as well hope to
suppress by treatment the eruption of small-pox or the
rash of Bcarlet fever. When we consider the difficulty
that even the most experienced surgeon, has in the
diagnosis of venereal sores we must allow that in all
probability simple (so inaptly called soft) sores, or even
a spot of herpes, in these oases of so-called non-appear¬
ance of secondary symptoms may have been mistaken
for the initial syphilitic lesion, and treated most un¬
necessarily with mercury. Now, Sir, comes a phrase
in your article with which everyone who has studied
syphilis will most heartily agree : “ By this means ”
(t.e., by treatment) “ much is done to prevent the mani¬
festations of tertiary symptoms.” This, to my mind,
and as I have endeavoured to point out over and over
again, is the key of the whole position, for the object of
the surgeon in the administration of mercury for
eighteen months, two years, or even more is to safe¬
guard his patient as far as possible against tertiary
symptoms which constitute really the dangerous part of
syphilis.
As you very correctly say, the most valuable observa¬
tions would be based entirely upon hospital practice,
and the reason of this is not, as you assort, that it is
mainly among the lower orders that the dissemina¬
tion of syphilis occurs, but because of the greater
field of observation, for in my own experience of
venereal diseases in hospital patients, and in private
cases, there is, pro ratio, a higher proportion of syphilis
to simple (or soft) sores and gonorrhoea in the latter
than in the former. In neither class of my patients,
however, have I noticed any decrease of acquired
syphilis.
I am Sir, yours truly,
H. de Meric.
Duke Street, Portland Place, W.
EXCESSIVE OPERATIVE INTERFERENCE IN
APPENDICITIS.
To the Editor of The Medical Press and Circular.
Sir,— In your issue of October 25th, you refer to a
protest of mine against the doctrine that every case of
appendicitis should be operated on the moment the
diagnosis is made, and that the appendix should be re¬
moved in every case. You ask, “ whoever in the land of
Nicholas Senn advocates operation unless, first, the con¬
dition is of itself serious, or second, has recurred on
several occasions ? ” Had you read the debate in the
American Medical Association at Denver, in June, 1898,
you would have seen that my protest was called out by
the stand taken by Dr. Murphy (of button fame)
advocating instant operation in every case, the moment
the diagnosis of appendicitis was made, and the removal
of the appendix in every case. This opinion is shared
by Dr. John B. Deaver, Dr. Robert T. Morris, and others.
It was against this doctrine that I somewhat vehemently
protested. Moreover, as has been amply Bhown, even
the men who advocate it in theory do not practice it in
fact.
I am, Sir, yours truly,
1729, Chestnut Street, Philadelphia, W. W. Keen.
November 7th, 1899.
INCONSISTENCIES.
To the Editor of The Medical Press and Cibcular.
Sib, —You rightly consider that an anti-vivisectionist
who condones the hunting of tame deer is a little incon¬
sistent, and you ask “Why cannot the anti-vivisec-
tionists try and put a stop to this degraded cruelty,
perpetrated in the sacred name of sport ? ” I am per¬
sonally acquainted with a great number of anti-vivi-
sectioniBts, every one of whom views with horror and
disgust the adventures of the Queen’s Buckhounds,
and is using what interest he can exert to put' a
Nor. 22. 1890.
LITERATURE.
THK Muni r at. Pirn 545 .. _
stop to them. The Ber. J. Stratton, of Woking¬
ham, Beading, is a prominent worker on onr
side, and he has for yean past devoted mnch
of hie time to protesting, by voice and pen,
against this scandalous “ sport.” Tell ns what more we
can do in the matter and we will do it. But all this has
nothing to do with the crusade against what we consider
scientific cruelty, and we cannot refuse the support and
infiuenoe of persons who, while oondoning the cruelties
of some kinds of sport, are able and willing to help us
in what we cannot but feel is a great ethical question.
But, 8ir, we are all more or less inconsistent on some
K int or other. Emerson said that " Inconsistency is the
gbear of little minds ”; and certainly we should do
nothing in the way of progress if we waited till we were
all properly consistent in all we do.
I notice that on the same page in which you sug¬
gest the rectification of antivivisectionist inconsistency
you say that “ the whole system [of death certification] |
is so riddled with inconsistencies and fallacies as to be
in not a few instances worthless.” I will so far add that
the hospital residents “ know little and care less about
the interests of outside practitioners.” This is brave of '
you and perfectly true. I know something of the ways
of the ignorant and supercilious young fellows. They
are very inconsistent but they have their uses, and if
our hospitals were to be closed till we had reformed
their uncultivated ways it would seriously imperil
medical education. Verbum mpienti.
I am, Sir, yours truly.
Edwahd Bsbdos, L.R C.P.E., M.R.C.S.
London, Notember 17th, 1899.
-»
(Dbituarp.
DB. REGINALD SOUTHEY, F.R.C.P.
Wx regret to have to announce the death of a widely-
known and popular member of the profession in the
person of Dr. Reginald Southey, F.R.C.P., who died at
his residence, Belringham, Sutton Valence, Kenc. on the
8th inst. Dr. Southey was the youngest son of the late
Dr. Henry Herbert 8outhey and nephew of Robert
Southey, the poet. Born in 1835, he was educated at
Westminster School, w'nenoe he proceeded to Christ
Church, Oxford, where he graduated B.A. in 1855, M.A.
in 1857, M.B. in 1858, and M.D. in 1866. At Oxford he
obtained a first-class in the honour school of Natural
Science, and was appointed a Radcliffe Travelling
Scholar. He became a member of the Royal College of
Physicians of London in 1860, and was elected to the
Fellowship in 1866. He delivered the Goulstonian
lectures before the College in 1867 and the Lumleian
lectures in 1881. Dr. Southey was formerly physician
and lecturer on forensic medicine and hygiene to St.
Bartholomew’s Hospital. In 1883 he was appointed, on
-the retirement of Dr. Nairne, a Commissioner in Lunacy,
an office which he retained until about a year ago. He
was the author of “The Nature and Affinities of
Tubercle ” and “ The History of Bright's Disease,” and
contributed various papers to the 8t. Bartholomew’s
Hospital reports, the transactions of the Royal, Medico-
Chirurgical. Clinical, and Pathological Societies, and
translated Vol. XIV. of Ziemssen’s “ Cyclopaedia of
■Practical Medicine.
$aboratorg
BRAND’S NUTRIENT POWDERS.
(Prepared by Messrs. Brand and Co., Mayfair.)
This powder is claimed to be prepared from
“ muscle fibre only, from which the moisture has been
removed at a temperature below the coagulation point
of the muscle proteids. It is sterilised and tasteless,
and is rapidly and easily digestible. It oontains all the
constituents of lean meat in an unaltered condition.”
The statement as to its rapidity and ease of digestion
is one that must be left to medical men to ascertain by
actual use, though we entertain no doubt on this point,
as the other statements of the manufacturers are com¬
pletely borne out by the figures that we have obtained
on analysis, which are as follows:—
Moisture . 11-0 parte.
Dried solids. . 89 0 „
in 100 parts.
The composition of the dried bo lids shows them to con¬
sist practically entirely of flesh and bone-forming con¬
stituents, that is to say,
Albumenoids .82*5 per cent.
Mineral matter. 4'6 „
The mineral matter consists almost entirely of phos¬
phates of calcium and potassium, and is free from added
salt, which is a far too frequent addition to many of the
ordinary meat preparations. On treating some of the
powder with water, filtering and then heating the
aqueous solution, we obtained a considerable precipitate
of albuminous matter.
It will at once be admitted by those who are familiar
with the examination of meat preparations, that this is
an ideal way of presenting the entire and unaltered
constituents of lean meat, and we have the fullest
confidence in commending this preparation to medical
men.
♦
JCiterature.
NORRIS AND OLIVER ON DISEASES OF THE
EYE. (a)
| This monumental work, of which the present volume
forms the third, is a credit to editors and publishers
alike. Nothing of the kind on this special subject
has ever been attempted before, and the enterprise
which has been shown in its production is deserving of
the commendation of the ophthalmological world. The
i following is the list of local diseases dealt with:—
“ Diseases of the orbit,” “ diseases of the eyelids,” “ ope¬
rations performed upon the eyelids.” “diseases of the
lacrymal apparatus,” “ diseases of the conjunctiva and
solera,” “ diseases of the iris and ciliary body,” “ diseases
of the choroid and vitreous,” “ diseases of the retina,"
“ the anatomy of staphyloma posticum and the relation¬
ship of the condition to myopia,” “ diseases of the optio
nerve,” “ glaucoma,” “wounds and injuries of the eye¬
ball and its appendages,” “sympathetic ophthalmia.”
In addition a chapter is added upon “ Operations usually
performed in eye surgery.” Thus it will be gathered
that in this list there are two important omissions,
namely, injuries and diseases of the oornea and cataract.
Presumably for some editorial reason, the articles upon
these subjects have been reserved until the concluding
volume of the work. We have not space to enter upon
a detailed criticism of this volume, suffice it, however, to
say that all the articles are up-to-date, and worthy of
their contributors, and that the reputation of the
“system” already attained by the previous volumes is
in this well maintained.
ELLISON’S MASSAGE, (b)
Wx have read over this volume of 124 pages
with much pleasure, and it would appear that the author
had in view the intention of providing a short summary
of the elementary knowledge necessary for those
beginning the study of massage. The subject is divided
into twelve chapters of carefully-written matter. A
medical preface has been written by Dr. H. H. Hulbert,
Medical Officer of the School of Physical Health Culture,
London, in which he states he has carefully read through
the chapters on the anatomy and physiology of the body,
and have found these an embodiment of simplicity,
clearness, and accuracy. The whole work is evidently
(«) “System of Diseases of the Eye.” Bv American. British,
Dutch, French, German, and Spanish authors. Edited by William F.
Norris, A.M., M.D., and Charles A. Oliver, A.M., M.D.. Phila¬
delphia, V.8.A. Volume III. Local Diseases, Glaueom-, Wounds,
and Injuries, Operations. With 50 full-patre plates, and 186 text
illustrations. London and Philadelphia : J. B. Lippincott. Company
(no date'.
(h) “A Manual for Students of Maseatre” By M. A. Ellison,
L.O.S , Member of the Society of Trained Masseuses. London:
Bailliere, Tindall, and Cox. 1809. Price 3s. fid.
oogle
Digitized by
546 Thu MxDICAL Pb*88.
MEDICAL NEWS.
Nov. 22, 1899.
the outcome of diligence and perseverance in overcom¬
ing the many difficulties which necessarily attend the
study of both the theoretical and practical sides of mas¬
sage. We have read and reviewed many works on this
important subject, and we have an idea that the enthu¬
siastic authors of such books very often imagine that
massage is a “ cure all ” in every disease under the sun.
This we feel justified in saying by way of warning is
not the case. However, anyone wishing to get a
good practical knowledge of the subject will do well to
peruse the pages of this little work before us.
CLARKE'S ORTHOPEDIC SURGERY, (a)
It is to be regretted that so many practitioners are
unaware of the simplest rules in connection with this
important branch of surgery. When a case of either
congenital or acquired deformity turns up in their
5 >ractice they invariably give the patient or friends a
etter to the nearest instrument-maker with directions
to construct an appliance which he thinks suitable for
the case. The instrument-maker, as a rule, is quite
ignorant of the anatomical or physiological cause of its
progress, and of the termination which is likely to occur,
and makes a costly instrument or appliance which may
appear to be suitable, but in the end goes a short way
to effect a cure of the deformity present. Many surgeons
of repute may be very skilful in the use of a scalpel, but
when their services are required in connection with the
suggestion of a mechanical appliance for the cure of a
deformity they display a hopeless ignorance of
how huch an appliance should be constructed or
applied. If practitioners would only devote some
special attention to this branch of surgery they
would not have the profession divided up into so
many “ specialisms,” which may be good or bad, as the
case may be, for the public, but it is certainly not to the
advantage of the practitioner, who frequently has to
confess his ignorance with this branch of his work.
The careful perusal of such a work as that before us
might remedy many a defect in our practical knowledge of
the subject. At page 4 the author states the reason why
he directed his attention to the study of orthoptedic
surgery.
He says: " When I began my work as surgeon to
out-patients I felt the lack of training in orthopaedic
surgery. For help with simple rachitic deformities I
sent for an instrument maker whom I knew to be em¬
ployed at a large general hospital. I found that he
usually made the instruments to fit the deformity, and so
to exclude the possibility of any improvement being
obtained. For cases of club-foot I sought the assistance
of another instrument maker, who had been recom¬
mended to me as being employed at a general hospital
and a large special hospital for children. This man was
always ready to air bis views on the anatomy and
pathology of the various kinds of club-foot.
“ His pathology was grotesque, and the instruments
he made were usually wrong in principle.”
We have carefully read through this work of nearly
450 pages, and consider the subject lias been very fully
treated. The illustrations are numerous, and, on the
whole, very good. We strongly tecommend the work to
those interested in this special branch of surgery.
WALTERS' SANATORIA FOR CONSUMPTIVES. ( b )
This book appears at a psychological moment, when
all the world is keen upon the cure of consumption. Its
author lias dealt with the whole question of special
sanatoria in a systematic and thorough manner, and has
then given detailed sketches of individual institutions
in different parts of the world. The questions of sites,
construction, furniture, general and special hygiene, diet,
(а) “ Orthopedic Siu^ery: A Text-Book of the Pathology and
Treatment of Deformities.” By J. Jackson Clarke M.BLond.,
F.R.C.S., Surgeon to the Out-Patients at the North-West London
Hospital; Surgeon to the Orthopaedic Hospital. With 300 illustra¬
tions. London: Cassell and Company, Limited. 1S99.
(б) “Sanatoria for Consumptives.” By F. B. Walters, M.D.,
Physician to the North London Hospital for Consumption.
London : Swan, Sonnenschein and Co. IwH*. l*rioe 10s. fid. net.
exercise, rest, medical supervision, the rdle of fresh air,
ooet of building and maintenance, are all duly con¬
sidered. Indeed the book is a mine of information for
all who are interested in the subject. The question of
the duration of treatment is an important one, and w«
learn that the practice with regard to that point differs
widely in various countries. Thus at Basel a minimum
of thirteen weeks is fixed. Three months is a-
common period abroad, although most medical
officers of these sanatoria regard that as scaroely
sufficient to train the patient in necessary hygienic-
methods and to put him on the road to recovery. “ At
Canigou patients who begin to be home siok are sent
home for a time, to return again for farther courses of
treatment. Dr. Gireese regards this interruption as a
oonceasion to human frailty rather than as medically
desirable. In some sanatoria quite a different system
prevails, the patient staying until he is apparently
cured, irrespective of how long he may require. Thus,
at Nordrach patients stay until for about twenty
examinations no, tubercle bacilli have been found in
their sputa, and until the injeotion of their sputa into-
a guinea-pig (which is next done) does not cause
tuberculosis. At Davos and other Alpine sanatoria
at least two winters and one summer are advised;
in Colorado, too, at least two years’ residence is con¬
sidered neoessary. At the Adirondack Cottage Sana¬
torium patients stay until they are apparently cured v
the average Btay being six months, and one year nomi¬
nally the limit.” The author thinks that in most cases
if a patient has made progress hs may be sent back
after a few months, with directions for a prompt return
in case of relapse. The descriptions of the Sanatoria are
helped by numerous illustrations and ground plans,
which add much to the practical value of the work,
which will doubtless remain for some time the standard
book upon this important subject.
Jttettcal ^etos.
British Gynecological Society.
The annual dinner of this Society took place on
Thursday evening last at the Cafe Monico, the pre¬
sident, Dr. MacNaughton-Jones in the chair, supported
by a large gathering of Fellows and many distinguished
guests. The toast of the guests was responded to by
Sir James Dick, Director-General R.A.M.C., who
defended the medical department of the Army,
and by Surgeon-General Jamieson, who, in a humor¬
ous speech, said he had had some experience of
gynecology himself when in Canada, where he was in
medical charge of a regiment of 500 men, with 500
wives and 1,200 children. He referred to modern improve¬
ments in the equipment of the army medical department,
of which Mr. Makins, before leaving, had remarked that
he could find no addition to suggest except a few nail-
brushes. He remarked that the suggestion for the
employment of oivil surgeons in the field had emanated
from himself, so it could hardly be construed as a
reflection on the department. He referred to the inci¬
dence of enteric fever, and mentioned incidentally that
they had made a series of observations at Net-ley on the
value of the various filters in the market, and only two
had been found worthy of confidence, viz., the J’asteur-
Cliamberland, and the Berkefeld filters. He called
attention to the experiments that were being carried on
with anti-typhoid inoculations adding that while the
mortality among the vaccinated was only 7 per cent.,
that among the unprotected was about double, the con¬
ditions being the same in the two series. Dr. F.
Roberts, the president of the Medical Society of London,,
humorously remarked that if there had been a gynte-
cological society in Canada, there would probably not
have been 1,200 children. He asked why if the Govern-
n ent thought it necessary to send out civil surgeons to the
war they did not also send civil physicians, seeing that
the bulk of the mortality in warfare was generally from
disease rather than injury. The toast of the Society
was responded to by Sir James Crichton Browne in a
Digitiz
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PA8S LISTS.
Not. 22, 1800.
The Medical Press. 547
characteristically amusing speech, in which he fully
admitted the excellent work that had been done, and
was being done, by it. An excellent selection of vocal
music and recitations agreeably filled the intervals
between the toasts, and the proceedings were continued
until a late hour.
Boyal Medical and Chlrurglcal Society.
The Fellows’ dinner of this society was given at the
Whitehall Booms, Hotel Metrop<tte, on Saturday last,
the President, Mr. Thomas Bryant, in the chair, sup¬
ported by the Bishop of London and a number of guests
representing the sister societies, the Royal Colleges, &c.
The toast of the guests was proposed in a singularly
felicitous speech by Dr. Pye-8mith, and was responded
to by the Bishop of London who, in a happy vein,
referred to the manypoints of contact between medical
and clerical work. The President of the Royal College
of Physicians of London also replied. The toast-list
closed with that of the Chairman, proposed by Mr.
Timothy Holmes, which was enthusiastically drunk.
Dr. Beev or and Dr. Habershon contributed some vocal
music, snd Dr. Q. Ogilvie some racy Scotch and other
etories, w hich were listened to with great interest.
Bsvsnth International Otological Congress.
We are asked by the Honorary Secretary to announce
that owing to the date for holding the International
Medical Congress falling in 1903, it has been decided
that the next International Otological Congress will be
held in 1902. The meeting will be held at Bor¬
deaux under the presidency of Dr. Moure.
The Mortality of Foreign Cities.
The following are the latest official returns, and re¬
present the last weekly death-rate per 1,000 of several
of the populationsCalcutta —, Bombay 49, Madras
38, Paris 18, Brussels 16, Amsterdam 18, Rotterdam 18,
The Hague 17, Copenhagen 16, Stockholm 17, Christiania
17, St. Petersburg 19, Moscow —, Hamburg 15, Dresden
16, Breslau 21, Munich 24, Vienna 16, Prague 21, Buda-
Pesth 19, Trieste 27, Rome 16. Turin (10 days) 13,
Venioe 17, Cairo 31, Alexandria 27, New York (including
Brooklyn) —, Philadelphia 16.
The Talisman Frss Institute Trust.
Under the above title a new medical charity was
-formally brought into existence last week at the
Langham Hotel, Portland Place, London. Its ends and
aims are simplicity itself, and more than justify the
launching of a scheme that bids fair to bring valuable
relief within the reach of the poor throughout the length
and breadth of the United Kingdom. Ab most of our
readers probably know, the special treatment introduced
hy Mr. Tallerm&n consists in the local application of air
superheated to a temperature varying from 260 deg. F.
-to 300 deg. F. Although the heat is applied to a limited
part of the body the beneficial effects are shown upon the
whole system. The results in chonic.rheumatio and gouty
conditions il remarkable, and still more so in the mixed
or rheumatoid or osteo-arthritic types. For some years
past a few charitably-disposed persons have applied an
apparatus given them by the inventor to poor inhabitants
ofadensely-populated South London district. A mission
room was borrowed for the purpose, and the cost of the
undertaking has been merely nominal. It has occurred
to Mr. Tallerman that the poor of the United Kingdom
might be benefited by the extension of a similar system
of free institutes. He has accordingly called together
an infln oTitial , general and executive committee
to assist in carrying out that intention, and has
generously offered to provide free of all cost the
necessary apparatus. It is clear that the proposal is
fraught with blessing for the crippled and suffering poor
of Great Britain, for upon them falls the brunt of
diseases of the osteo-arthritio type. The suggestion is
that local committees be formed in the chief provincial
'towns by prominent clergymen and citizens, and that
■each one appoint an honorary medical officer, who
will determine the eligibility or otherwise of candidates
for relief. The charity is meant solely for
the necessitous poor. Responsible applications - from
medical men ana clergymen wishing to undertake the
formation of local oentres may be sent, accompanied
with full particulars, addressed, The Tallerman Free
Institute Trust, under oover of the Editor, Medical
Press and Circular. It is only fair to state that Mr.
Tallerman has not advertised his treatment in lay
papers, and always worked loyally with the medical pro¬
fession, whose support he certainly appears to merit in
his new philanthropic departure.
Vital Statistics.
The deaths registered last week in thirty-six great
townB of England and- Wales corresponded to an
annual rate of 18 0 per 1,000 of their aggregate population,
which is estimated at 11,404,406 persons in the middle
of this year:—
Birkenhead 19, Birmingham 19, Blackburn 24, Bolton
16, Bradford 16, Brighton 14, Bristol 24, Burnley 16,
Cardiff 16, Croydon 10, Derby 10, Dublin 37, Edin¬
burgh 17, Glasgow 17, Gateshead 15, Halifax 10,
Huddersfield 13, Hull 16, Leeds 20. Leicester 20, Liver¬
pool 26, London 17, Manchester 19, Newcastle-on-Tyne 16,
Norwich 17, Nottingham 18, Oldham 19, Plymouth 17,
Portsmouth 17, Preston 18, Salford 19, Sheffield 16,
Sunderland 18, Swansea 11, West Ham 14, Wolver¬
hampton 20. The highest annual death-rates per
1,000 living, as measured by last week’s mortality,
were:—From measles 11 in Bradford, and 2 7 in
Birkenhead ; from scarlet fever, l'l in Oldham ; from
whooping cough, l’O in Salford; from fever, 12 in
Wolverhampton and in Sheffield, and 2 0 in Nottingham.
In none of the large towns did the death-rate from
diarrhoea reach l'O per 1,000. The 142 deaths from
diphtheria included 68 in London, 10 in Sheffield, 7 in
Leeds, 7 in Leicester, 6 in West Ham, 6 in Liverpool,
5 each in Portsmouth, Birmingham, Manchester and
Blackburn, and 3 (each in Dublin, Glasgow, and
Brighton. Two deaths from small-pox were registered
in Hull, but not one in any other of the other large
towns.
PASS LISTS.
Public Health Examinations of the Colleges of Physicians
and Burgeons in Ireland.
The following gentlemen have passed the examina¬
tion for the Conjoint Diploma in Public Health of these
Colleges:—
Honour*: Dr. E. J. McWeeney. Pass: Dr. B. H. Draper, Dr.
J. J Earls, Dr. T. W. Heywood, Dr. Q. O. Lawson. Passed Part I.:
Dr. J. C. McWalter.
Society of Apothecaries of London, November, 1899.
The following candidates passed in:—
Surgery: F. G. Aldrich (Section L), Charing Cross Hospital ;
B. Brookes (Section n.), Westminster Hospital; J. M. Edwards
(Section I.), Charing Cross Hospital j D. Hamilton, Boyal Free
Hospital; F. Marriott, Edinburgh : G. G. Membery (Section I.),
Toronto; T, C. Mitchell (Sections I. and II.), Leeds; H. J. Picker¬
ing (Sections I. and II.), St. Bartholomew’s Hospital; and E. D.
Wortley (Sections I. and II.), St. Ba rtholomew’s Hospital
Medicine: C. B. S. Amos (Section I.), Boyal Free Hospital;
G, H. Bedford (Section I-J^Guy's Hospital ; B F. Ellery (Section
II.), 8t. Bartholomew’s Hospital; B T. Forster (Section I.),
Leeds ; J. B. Hall (Section II.), Leeds ; W. K. S. Hay-Coghlan, St
Mary’s Hospital; G. G. Membery (Section I.), Toronto ; and T. C.
Mitchell (Sections I. and II.). Leeds.
Forensic Medicine: C. B. S. Amos, Boyal Free Hospital; G. H.
Bedford, Guys Hospital: T. Burdekiu, University College
Hospital; E. E. Evans, Boyal Free Hospital; B. T. Forster
Leeds: M. P. Gabe, Middlesex Hospital; w. K. S. Hay-Coghlan,
8t. Mary's Hospital; G. G. Membery, Toronto; and T. C. Mitchell,
Leeds.
Midwifery : J. B. Clemens, St. Thomas's and London Hospitals;
F. B. Featherstone,Guy’s Hospital; B. T. Forster, Leeds ; w. K.
S. Hay-Coghlan, 8t. Mary’s Hospital; H. Jessop, Birmingham; G.
L. Parsons, Westminster Hospital; J. B. Pooler, Birmingham; and
C. H. Williams, St. Bartholomew’s Hospital.
The Diploma of the Society waa granted to the follow¬
ing Candida toe, entitling them to practise medicine,
surgery, and midwifery:—Messrs. M. P. Gabe, D.
Hamilton, F. Marriott, T. C. Mitchell, H. J. Pickering,
and E. D. Wortley.
The Dublin Colleges—November Preliminary Examination
Honours in Order of Merit.—J. W. Harvey, M. Campbell, M.
J. C. Kennedy.
Pass—Alphabeticallt.— J. L. Allen, E. A. Bernard, F. L.
Bradish. H. L.Cohen, W. J. Connolly, J. F. Crean, M. B. Fisher, P,
E. Harrison, B. Jackson, T, B. N. Miles, J. Murray, J. O'Kelly, E.
H. Patman, W. D. Sammon, 8. W. Talbot.
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A QUESTION FOB WELSH PATHOLOGISTS.
Dr. Boswell Pabe, of Buffalo New York, writes to a correspon¬
dent as follows:—“I ask you to institute an inquiry for me based
were sp eak ing of appendicitis, and he made the statement that
long before this disease was known the Welsh hod a common term
for the appendix, which was known in their vernacular as the death¬
trap or death-drop. If this be really so, it would be exceedingly
interesting to know just whence the idea came which was thus
embodied in so significant an expression.”
Perhaps one of our Welsh correspondents may be in a position to
help us in the elucidation of this matter.
Ex CEqcali.—P rofessor Oster said the other day that instead of
proceeding on the Anglo-Saxon principle of considering every fever
Innocent of typhoid until it was proved guilty, it would be well to
try the Gallic plan of considering every fever guilty until it proved
proceeding on the Anglo-Saxon principle of considering every fever
Innocent of typhoid until it was proved guilty, it would be well to
try the Gallic plan of considering every fever guilty until it proved
that it was innocent of the charge of being typhoid.
Senectus.— Our correspondent will find on reference to the report
of the trial that the charge was withdrawn.
'A Fortiori.— The power is vested in the hands of the Privy
Council.
F.B.C.S.—The system that requires the canvassing of Governors
is decidedly objectionable. Unfortunately it is your only vehicle
towards the appointment.
M.R.C.P.—Our correspondent will find an action at law decidedly
expensive, even if it wrings an apology from the other side. We
suggest that an agreement to appoint an arbiter would be a wiser
and more satisfactory way of adjusting the difficulty. Above all,
we oounsel the avoidance of lawyers except as a very last; resource.
Agobieved.— Under the Copyright Act of 5 and 6 Will. IV., c. #5,
lecturers are protected if, at least two days before the delivery of
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It is highly probable, however, that the law, or the construction of
the law, in respect of the copyright in reports of lectures and
speeches will be modified. _ „ _ , .
Nemo.— The rule laid down by Dr. Fordyoe Barker was to give
iron when the menses are scanty and lack colours, and arsenic when
the flow is too frequent, too profuse, or too prolonged.
of the §ocietie0 aitb $ecture0.
Wednesday, November 22b d.
St. Johb'8 Hospital fob Diseases or the Skib (Leicester
Square).—4.30 p.m. Dr. Morgan Dockrell: Benign New Growths.
(Post-graduate Course.) _ ,
Dermatological Societt or Great Bbitaih ahd Ireland (20,
Hanover Square, W.). 5 p.m. Ordinary meeting, 4.30 p.m. Informal
Exhibition of Cases.
Thursday, November 23rd.
Central Lohdon Throat, Nose, and Ear Hospital (Gray’s Inn
Boad).—5 p.m. Dr. D. Grant: Treatment of Inflammatory and
Specific Affections of the Nose.
Fridat, November 24th.
Clinical Society or London (20, Hanover Square, W.).—8.30
p.m. PapersMr. Howard Marsh; A Case of Senile Tuberculosis
—Mr. Arthur E. Barker: A Case of Excision of the Caecum for Car¬
cinoma of the Ileo-Csecal Valve and Obstruction—Dr. Chas. W.
Chapman: A Case of Obstruction of the Inferior Vena Cava, probably
Syphilitic (with Patient). .
Medical Graduates College and Polyclinic (22, Chemes
Street, W.C.). - 4. p.m. Consultation (Ear and Throat), Dr. Dundas
Grant.
Rot al Academy or Medicine in Ireland. —Obstetrical Section.
Exhibits:—1. Dr. Purefoy, Five Cases of Myomatous Uterus, three
Removed by Supra-Vaginal Amputation and two by Pan-Hysterec¬
tomy ; Four Cases of Ovarian Cyst; Two Mutilocular Ovarian Cysts;
Two Cases of Cystic Ovary; Two Cases of Pyo-salpinx; Three
Ectopio Gestation Sacs: One Case of Carcinoma Uteri ; Two Coses
of Removal of the Clitoris tor Malignant Disease; One Cystic Ovary
Removed by Colpotomy; One Calculus Removed from Bladder (size
of a walnut)—2. Dr. Alfred Smith. Seven Fibro-Myomatoua Uteri
Removed by Retro-Peritoneal Hysterectomy: Six Ovarian Cvsto-
mata; One Dermoid Cyst; One Pyo-salpinx—3. Dr. Kidd, Myo¬
matous Uteri Removed by Abdominal Hysterectomy- 4. Dr. Glenn,
Coccyx excised for Persistent Coccygodynia due to Dislocation;
Case of Tuberculous Tubes: Tube Removed for Salpingitis in a Case
of Ventro-Fixation for Fixed Retro-Version; Case of Myomatous
Uterus Removed by Retro-Peritoneal Hysterectomy: Sac of Umbili¬
cal Hernia following labour. Papers:—1. President s Address (Dr.
A. V. Macan); 2. Demonstration by Dr. Macan of Laplace s Instru¬
ment for Gastro-Enteroetomy and Intestinal Anastomosis—3. Dr.
Cole-Baker, Observations on a Successful Case of Ctesarian Section
—4. Dr. Purefoy, Case Illustrative of a Bare Form of Ulceration in
the Female Urethra-5. Dr. Kidd, Short Notes on a Case of Wound
Celled Sarcoma of Ovaries.
Tuesday, November 28th.
Society or Apothecaries (London, at 4 p.m.)—Lecture by Dr.
Nestor Tirard on the Pharmacopoeia in its Relation to Medical Men.
Clinical Demonstration. —1 p.m. Dr. Fletcher Beach Caselof
Epilepsy and other Convulsive Disorders.
Uacattcies.
Birmingham City Asylum.—Junior Assistant Medical Officer, un¬
married. Salary commencing at £100 per annum, with board,
apartments, washing, and attendance, Ac.
British Hospital, Buenos Aires.—House Surgeon. Salary £200 first
year, £250 second, £300 third, with board, lodging, and wine
allowance. Apply to Dr. Louis Colbourne, Berkhamsted, Herts.
Ballyshannon Union. Kinlough Dispensary District. — Medical
Officer. Salary £100 a year as Medical Officer, and £20 as Medical
Officer of Health, together with Voocination Fees. Applications
to J. B. Chism, Clerk of Union. (See Advt.)
Carmarthenshire Infirmary .—Resident Medical Officer. Salary, £ 100
City Asylum, Nottingham.—Second Assistant Medical Officer,
married. Salary £125, with board, apartments, and washing.
County Council of Salop.—County Medical Officer of Health. Salary
£750 per annum, to include all travelling and other expos
£750 per annum, to include all travelling and other expense*,
except office and stationery. Applications to Mr. E. C. Peele,
Shire hall, Sbrewesbury.
Devonshire Hospital. Buxton, Derbyshire.—Assistant House Sur¬
geon. Salary £50 per annum, with furnished apartment, board,
and washing.
Manchester Royal Infirmary.—Resident Medical Officer for one year,
unmarried. Salary £150, with board and residence.
Royal College of Surgeons of England, London.—Three Examiners.
(See Advt.)
West Biding Asylum, Wakefield.—Assistant Medical Officer os
Locum Tenens. Salary £3 3s. per week, with apartments and
board.
Weston-Super-Mare Hospital and Dispensary.—Medical Officer to
the Provident Dispensary attached to the Hospital. Salary £90
per annum, with board, lodging, and washing.
Appoint rtuitt0.
Brockbank, Edward Mansfield, M.D.Vict., M.R.C.P.Lond.,
Honorary Physician to the Ancoate Hospital, Manchester.
Forward, E. L. M.B.C.S., L.R.C.P.Lond., Assistant Medical Officer
to the Coppice Asylum, Nottingham.
Fox, W. J., L.R.C.P.IreL, L.F.P.S.Glasg. L.A.H., and L.M.Dub.,
Medical Officer, Medical Officer of Health, Police Surgeon,
Public Vaccinator, and Registrar to the Ballinalee Dispensary
District of the Granard Union.
Hobson, H. Overton, M.B., C.M.Edin., Junior House Physician to
the North-West London Hospital.
Mason. Gerald Bovell, M.R.C.S., L.R.C.P., Resident Medical
Oflieer to the Ticehurst Asylum, 8ussex.
Montgomery, W. P., M.A.Oxon., B.S. & M.B.Lond., F.R.C.S.,
Honorary Surgeon to the Ancoats Hospital, Manchester.
Moore, H. C., M.B.C.S., Medical Offioer of Health, pro tem., for
the Hereford Combined Rural Sanitary District.
Orton, John, L.B.C.P.Lond., M.B.C.S., D.H.P.Edin., appointed
Medical Officer for Foleehill and Stoke, Coventry.
Richardson, I. B., M.R.C.S., L.B.C.P.Lond.. Assistant House
Physician to the General Hospital, Birmingham.
Savage, Smallwood, M.A., M.B., B.Ch.Oxon., F.R.C.S.Eng.,
Honorary Surgeon to the Birmingham Lying-in Charity.
Watkins, D. J. G., M.A.Camb., M.B., B.C., L.B.C.P.Lond.,
M.R.C.S., Medical Offioer of the Lincoln Dispensary.
Westmacott, F. H., IF.R.C.S.Eng., Honorary Aural Surgeon to the
Manchester Children's Hospital, Pendlebury.
Carriage©.
Lankester—. Archibald.— On November I4th, at Karachi, Ceci
Pryor Lankester, Esq., M.B.C.8., L.B.C.P., of the C.M.S. Hos
S ital, Peshawar, India, youngest son of Henry Lankester, Esq.
,P.. of Leicester, to Cecile Florence, second daughter of
W. F. A. Archibald, Esq., Master of the Supreme Court,
London.
Olsen—Sibley.— On November 16th, at the Old Church, Calcutta,
the Rev. C. L. Olsen, M.A., C.M.S., to Edith Mabel Fanny,
eldest daughter of the late 8. D. Sibley F.B.C.S., of Harley
Street.
Thornely—Smart. —On November 14th, at St- Mary's Church, Bye,
William Thornely, M.B., B.C. Cantab., of 00. Herne HUl, S.E.,
youngest son of the late James Thornely, of Baycliffe, Woolton,
Liverpool, to Mary Elizabeth, elder daughter of the late Robert
Smart, B.N., of Cranborne, Dorset.
$**th 0 .
Buckell.—O n November 9th, at his residence. North Pallant, Chi'
Chester, Leonard Buckell, M.D., in the 80tn year of his age.
Cubitt.—O n November 8th, at Somersby, Castle Hill, Maidenhead,
George Robert Cubitt, M.B.C.S., aged 73.
Graves.— November 15th, after a long illness, Christine Jessie, the
wife of Charles Graves, M.R.C.S., L.R.C.P., of Commercial Rood,
Portsmouth, aged 28.
Johnson.— On November 15th, at his residence, Cliff Bank House,
Stoke-upon-Trent, Samuel Johnson, M.D.Ch.M., Medical
Officer of Health for the Borough, aged 53 years.
Newnham.— On November 13th, at Margate, Ernest Edmund
Newnham, M.B.C.S. and L.S.A., aged 42.
Goog
"SALUS P0PI7LI SUPREMA LEX.*
Vol. CXIX. WEDNESDAY, N
(Original Communications.
ON THE
PHYSICO-CHEMICAL CHANGES
CONCERNED IN THE PRODUCTION
OF
VERSION OF THE UTERUS, (a)
By JAMES OLIVER, M.D., FR.S.Edin., F.L.S.
Physician to tlie Hospital for Women, London.
In treating of the normal position of the uterus,
Quain says : “ Its upper end is directed upwards
and forwards, the lower downwards and backwards ;
so that its axis corresponds with that of the inlet of
the pelvis and forms an angle or sudden curve with
the axis of the vagina which corresponds more
nearly with that of the outlet of the cavity.'’ To
estimate precisely, and define more accurately, the
natural inclination of this organ, is imposssihle: con¬
sequently, it must suffice us to know that the fundus
or upper pole which ascends toward the abdominal
cavity, should also be directed forwards, and that the
cervix or lower pole which projects into the vagina
should, to a correlative extent, be directed back¬
wards. Now so long as the integrity, not only of the
uterus, but of those tissues on the harmonious
relationship of which the maintenance of its rigidity
depends, is preserved, the normal position of thi6
organ is not appreciably disturbed by any of the
ordinary alterations in the position of the body of the
female.
When the bladder or rectum, or both viscera are
unduly distended the resulting increased tension and
pressure cause the natural inclination of the uterus
to become altered, but it is not intended that this
organ should, under ordinary circumstances, impose
the burthen of its weight upon a neighbour. So too.
with regard to the intestines, although portions of
the bowel come frequently in contact with the free
surface of the uterus, still -the latter is not required
in the ordinary course of events toaid in supportingthe
former. Throughout the universe we witness evidence
of a cohesive affinity, and it is this agent which no doubt
serves to maintain the various organB of the body in
position. As the natural direction of the fundus
uteri is towards the anterior abdominal wall it is
commonly a debatable question whether in any given
case the true limit of inclination forward has been
exceeded, and the condition should or should not be
considered one of anteversion. When, however, the
fundus is directed more or less backward it is
generally easy to recognise that the inclination of
the axis is the reverse of normal, and we are justified
in assuming that the change is due to some abnormal
state.
The peritoneum which invests the body of the
uterus is extended laterally on both sides from the
anterior and posterior surfaces of the organ to the
(a) Paper read before the British Gyntecoloical Society, Novem¬
ber 9th, 1899.
0 Y E M B E R 29, 18 9 9. No. 22.
pelvic wall. Included by these folds we find muscular
fibres, which are continuous with the superficial
muscular layer of the uterus itself; consequently, it
is impossible to doubt that the maintenance of the
normal inclination of this viscus is in some measure
dependent upon the state of integrity of these serous
expansions. Some authorities attach much im-
poi’tance to other structures located in the broad
ligaments, such as the round ligaments and the
ligaments of the ovary, and although these dense
fibro-areolar cords do occasionally become sclerosed,
yet it is altogether improbable that the position of
the uterus is ever materially disturbed by change
occurring in these structures alone.
The neck of the uterus is embraced by, and is
structurally continuous with, the vagina, which
reaches higher up on the cervix uteri behind than in
front, a condition of affaire which, together with the
inclination of the axis of the outlet of the pelvis,
accounts for the uterus assuming so commonly a
retroverted position when it is dragged down by
volsellum forceps applied either to the anterior or
posterior lip of the cervix. Now the vagina is a
distensible and highly elastic tube, and by virtue of
this elastic property the force of gravitation is so
counterpoised that the uterus is not only maintained
at a fairly uniform height in the pelvis, but is enabled
to descend and ascend in unison with the respiratory
movements. This same elastic property of the
vagina is a powerful factor in maintaining the
natural inclination of the uterus since it opposes
those physico-vital qualities which characterise th e
uterine tissue proper, and are displayed by that por¬
tion of the peritoneum which lines the pelvis.
When we remember that rather more than one-
half of the weight of our bodies consists of water, it
is impossible for us to ignore the fact that this com¬
pound plays a most important part in the role of the
organic economy. It is absolutely necessary for the
carrying on of all vital phenomena. The consistence
of all the soft structures of our bodies, and the
maintenance of their well-being depends to a greater
or less extent upon the amount of water which phy¬
siologically they are capable of retaining. This, as
we know, is not however a fixed quantity. Through
the medium of the kidneys, skin, lungs, and bowel,
loss of water is perpetually taking place, and this loss
must be replaced by fresh aqueous solution. Without
this interchange the processes of nutrition would
rapidly fail. By the agency of water, nutrient
materials in a state of solution are earned to every
cell of the body, and waste products are in turn
eliminated from the system.
During pregnancy and after parturition, the uterus
undergoes a great and somewhat rapid variation in
its molecular state, and the changes which take place
under such circumstances are effected through the
agency of water in consequence of the extraordinary
diosmotic power possessed by this viscus. When a
retroverted uterus harbours a fecundated and
developing ovum it tends spontaneously to assume
an erect position about the tenth or twelfth week ; it
may occasionally even do so as early as the sixth
550 m Medical Pbkss. ORIGINAL COMMUNICATIONS.
■week. Now the pregnant uterus is virtually a
growing organ, and we know that growth can only
take place when cell tension is well maintained, con¬
sequently we are justified in assuming that the
alteration in its position is in part attributable to an
increased turgescence. I may here remark that the
uterus which before conception was retroverted is
extremely prone to return to this position after
delivery.
_ It is, of course, very evident that the firmness and
rigidity of many organic structures depend to some
extend upon turgescence. The stalk of a cut flower,
for example, soon loses its rigidity and droops in
consequence of a diminution in the cell tension
brought about by the loss of water by evaporation ;
the cell tension may, however, be restored and the
structure may thereby regain its rigidity and display
once more its erect propensity if we place the cut
end of the stalk in water before the cells have unduly
lost the power of absorption. When death ensues
water is lost by evaporation, and as no renewal
takes place organs which in the living state were
firm and elastic become more or less limp and flaccid.
In the dead body the uterus is very commonly found
overlying Douglas’s pouch, with its fundus in contact
with the rectum, and so generally in fact is this
osition displayed when sections are made of frozen
odies that some pathologists have gone so far as to
affirm that this retroverted position is the natural
one. Clinicists have no hesitation in repudiating
this assertion, and will no doubt allow that this
pathological phenomenon may be attributed to the
loss of water by evaporation and other physico¬
chemical changes consequent upon death, and is
determined by the position of the body, which is
invariably dorsal.
Elasticity and compressibility are, however, un¬
doubted properties of the uterus, and the main¬
tenance of the natural inclination of this organ is to
a greater or less extent dependent upon the preserva¬
tion and due exercise of these. The aqueous solution
we know, which the uterine tissue contains, cannot
be compressed by those forces to which it is sub¬
jected, consequently the perpetually compressed
state—to which we shall refer later—in which the
healthy organ exists is not in any way’related to the
presence of water, although the compressing agent
is more or less decidedly influenced by it.
If over the fundus we incise the peritoneal covering
of the uterus between the Fallopian tubes, the wound
will soon begin to gape on account of the resiliency
of the uterine tissue, and the elasticity of the serous
membrane. In its natural state, therefore, the
uterine tissue is perpetually more or less compressed,
and if it were possible to remove entirely the serous
capsule without otherwise disturbing the vital state
of the organ, the latter would forthwith become
more bulky, being freed of its compressing agent.
The peritoneum, as every gynaecologist knows full
well, is an extensible and highly elastic structure,
but we overlook the fact that that portion of it
which envelops the uterus, and enters into the forma¬
tion of the broad ligaments, exists under ordinary
circumstances, and at all times, in a state of passive
extension. The elasticity of this portion of the
peritoneum is constantly being opposed by the
resiliency of the structures which it circumscribes.
If, in fact, it were possible to remove intact the serous
covering from the uterus without disturbing its
physico-vital qualities, it would become so contracted
that it probably could never again be made to cover
the organ; in other words, the peritoneal covering is
virtually too small for the uterus, whilst the uterine
tissue proper is, at the same time, too bulky for its
capsule. Between these two tissues in their natural
connection there exists a mutual tension, and the
maintenance of the normal inclination of the uterus
N ov. 29, 1899.
is in a very high degree dependent upon their har¬
monious action and reaction.
Mutual tissue-tension is a phenomenon displayed
by many organic structures, by the tubular flower-
stalk of the dandelion, and, notably, by the leaf-stalk
of the rhubarb plant. To demonstrate this pheno¬
menon, take a piece of a fresh leaf-stalk from a
rhubarb plant and make both ends rectangular to
each other. Remove from this a strip of the epidermal
tissue, together with the collenchyma layers, which,
strengthen it. and it will be observed that the strip
becomes forthwith so elastically contracted that it
is no longer capable of filling up the gap produced by
its removal. This shows that in the natural condition
the epidermal and collenchyma layers are passively
extended. If we now remove the whole of the epi¬
dermis from the piece of stalk it is remarked that the
remaining structure which consists chiefly of paren¬
chyma, and very extensible vascular bundles has
become elongated and altogether more bulky.
This shows that the elastic pressure of the epidermis
compressed and restrained the natural resiliency of
the parenchyma. In the case of the uterus it is
highly probable that the shape of the organ favours
the action of this mutual tissue-tension.
In the organic world it is difficult to find a structure
which is circumstanced like the uterus. The hump,
however, on the camel’s back bears some analogy. It
projects stiffly, is composed chiefly of fat (which, by
the way, is but feebly elastic), and is invested by an
elastic epidermal membrane. As a rule, it is solid
and firm, but it becomes limp and soft when the food
is insufficient.
Having summarily dealt with those conditions
which determine the natural inclination of the uterus,
let us attempt to discuss now those changes in state
which may cause this organ to lie more or less pas¬
sively in the pelvis and assume a position which we
are accustomed to speak of as one of version.
The uterus is said to be verted when the body
assumes a more or less recumbent posture, the cervix
at the same being correlatively displaced in the
opposite direction, or. in other words, when the axis
ot the organ as a whole assumes an inclination which
is materially different to that which we recognise
as normal. The displacement is specifically desig¬
nated according to the direction towards which the
fundus is deviated, hence we have anteversion, retro¬
version, right lateral version, and left lateral vereion.
Retroversion is very commonly noted in associa¬
tion with more or less descent or prolapse of the
uterus. Now we are able in some measure, but
necessarily very imperfectly, to simulate this patho¬
logical state by dragging the cervix down by vol-
sellum forceps, and it is noteworthy that under such
circumstances retroversion is very frequently induced,
and will persist so long as the traction is maintained,
When therefore the elasticity, or in other words the
staying and resisting powers of the vaginal canal are
more or less markedly impaired, in consequence of
defective assimilation and metabolism, or are anta¬
gonised and practically annulled by dragging the
cervix down it is observed that version, and especially
retroversion, of the uterus is apt to result. The re¬
duction to a greater or less extent of that tissue-ten¬
sion which exists between the cervix and vagina
where they are incorporated, and which is a con¬
comitant of prolapse, aids undoubtedlv in bringing
about an alteration in the natural inclination of the
uterus, but the mere descent of the latter organ it
would seem, is sufficient to induce this. Virtually
the uterus is suspended in the pelvis between two
elastic structures, and in their normal state these two
in their action oppose and supplement each other.
The peritoneum which envelops the uterus, and enters
into the formation of the broad ligaments, is elastic,
and existing as it does in a state of passive extension,
Nov. 29, 1899.
ORIGINAL COMMUNICATIONS. Th« Medical Prxss. 551
it exerts constantly a certain amount of pressure
upon, and oompresses the underlying structures, In
this action it is aided by the staying and resisting
powers of the vaginal canal; if, however, these
become enfeebled, the peritoneum is then so dis-
advantageously circumstanced that it is rendered
practically inert, and it no longer contributes towards
maintaining the natural, but favours rather the pro¬
duction of a backward inclination of the uterus.
Turgescence of the uterine tissue proper plays, as
has been already remarked, a part in maintaining the
natural inclination of the uterus, and it is efficiently
preserved so long as the elasticity of the oell walls
continues unimpaired, and so long as the aqueouB
solution in the cells is not unduly diminished, is not
reduced beyond what one would term the minimum
amount.
Constantly there is a movement of fluid to and
from the interior of all living cells, and this dios-
motic phenomenon, which depends upon some
peculiar property of the cell membrane, is influenoed
not only by the chemical composition of the cell
itself and its contents, but by the character of the
liquid which bathes the cells. Normally, the state of
turgescenee of the uterine and of all other tissues of
the body must and does vary from time to time,
seeing that the recurring chemical processes neces¬
sary for nutrition, and the affinities concerned in
depuration are dependent upon the presence, and are
effected by the agency of water. So long, however,
as the elasticity of the cell wall and the hydrostatic
pressure in the cell itself act and react upon each
other harmoniously, so long will turgescence aid in
maintaining the natural inclination of the uterus.
Under ordinary circumstances, the walls of the
cellular elements of the uterus which are kept per¬
petually on the stretch, more or less, by internal
hydrostatic pressure offer some resistance to filtra¬
tion, and it is evident that the firmness and rigidity
of the organ as a whole are in some measure
dependent upon this. If, however, this resisting
power should be inhibited, a too rapid filtration
from the cells will take place and the organ
rendered thus more limp and flaccid will tend
to assume that position which the resultant of
the forces acting upon it may determine. The
suddenness with which apparently version of the
uterus occurs in consequence of physical or mental
shock may be accounted for in this way. In the
vegetable world we find instances in which water is
rapidly displaced from the cells of a turgescent
tissue as a result of a touch or a shake. In this way
we can bring about a relaxation of the cells of the
motile organs of Mimosa pudica, and cause the leaves
to move. The leaves of Dioncei muscipnla (Venus’
fly trap) are in like many responsive to contact or
shocks. On the inner face of each half of the leaf
of this plant are three long fine bristles, and if one
of these be touched roughly the two halves of the
leaf will approach each other with great rapidity.
The shock induces some change in the molecular
state of the organic membrane whereby a too rapid
filtration takes place, but at present it is impossible
to say what may be the nature of this change.
Diosmosis is necessarily an obscure aod complicated
phenomenon, since it depends nob only upon the
molecular state of the filtering membrane but upon
the attractive powers of the materials located
within and circulating outside the cells. The
excretion of nectar is an osmotic phenomenon,
and Dr. H. P. Wilson (Cambr., Mass., U.S.A.) has
shown that this excretion may be arrested and
held in abeyance for an indefinite length of time by
merely washing the external surface of the nectary
with plain water, and that when thus suspended it
may be re-established by placing a very small particle
of sugar on the washed surface. In this case the
exosmotic current is staid by brushing the external
surface of the gland with water, but it is forthwith
set in motion again by the attraction of the sugar.
On reflection it is very evident that osmosis is a
phenomenon which may be readily and seriously dis¬
ordered. Now the nutritive and depurative processes
in our bodies are effected by osmosis, consequently
any serious derangement of this phenomenon may
cause not only an undue diminution in the amoun 1
of water in the cells, but may impair more or lesfc
markedly [.the tone of the cellular elements them¬
selves. In the case of a muscular structure like the
uterus atony of its cellular elements means impair¬
ment of the compressibility and resiliency ot the
organ as a whole, impairment, i.e., of two properties
which aid materially in pieserving that mutual
tissue-tension which playB such an important part in
maintaining the natural inclination of the uterus. If
therefore diosmosis should be badly effected then the
physico-vital state of the uterine tissue may be so
deranged that the organ is no longer enabled to
withstand the influence of adverse forces, but tends
to assume that inclination which the resultant of
these forces may determine.
The mutual tissue-tension to which we have just
referred depends, on the one hand, upon the physico-
vital properties which characterise healthy uterine
tissue, and on the other upon the manner in which
the living perimetrium opposes and responds in turn
to the influence of these. The perimetrium is an
elastic structure which in its natural connection is
passively extended. In enucleating solid and cystic
tumours from the broad ligaments in emptying a
uterus distended with menstrual blood in consequence
of an imperforate hymen, and in operating upon the
female pelvic organs generally we are constantly
and forcibly reminded that the peritoneum which
covers the uterus and enters into the formation
of the broad ligaments is highly elastic. I desire
now to draw your attention to the fact that this
quality is often diminished and occasionally it
is even entirely lost. In the case of certain cysts
of the ovary spontaneous rupture occurs when the
elasticity of the peritoneal covering and of the fibrous
tissue entering into the formation of such morbid
growths is completely destroyed. So, too, rupture of
the uterus during pregnancy is due to those chemical
changes which induce a loss of this same quality.
Ruptures taking place from this cause in the organic
world resemble somewhat those which take place in
the artificial and growing cells formed by the precipi¬
tation membrane of Traube. If, for instance, we drop
a small quantity of a concentrated solution of chloride
of copper into a vessel containing a solution of yellow
prussiate of potash a closed precipitation membrane,
an artificial cell, i.e., is instantaneously produced on
the contact of the two fluids. The wall of this cell is
permeable to water, and this is attracted towards the
interior by the chloride of copper which has a great
affinity for water. The endosmotic current thus
induced causes gradually an increase in the size of
the cell, and in the internal hydrostatic pressure. As,
however, the cell wall is inelastic it becomes more
and more attenuated and eventually it ruptures.
Forthwith this breach in the wall is repaired by the
coming together of the chemical agents, and so long
as unused chloride of copper remains the endosmotic
current will continue, consequently these cells may,
by the repair of successive ruptures, grow to a con¬
siderable size. These artificial cells remain intact
until the gradually thinned wall can no longer resist
the internal pressure; so, too, in the case of certain
cysts of the ovary spontaneous rupture occurs in the
same way.
If the elasticity of the perimetrium is greatly im¬
paired or completely destroyed, then that mutual
tissue-tension which depends in part upon the
GoogI
e
552 The Medical Pbkss. ORIGINAL COMMUNICATIONS. Not. 29, 1899.
preservation of this quality is annihilated. Such an
alteration in the physical state of the uterus causes
the organ to become limp and flabby, and renders it
less able to withstand the influence of gravitation
and other antagonistic forces; consequently, it is
extremely liable to assume under such circumstances
a more or less recumbent position, a position, i.e., of
version. The elastic pressure exerted by the uterine t issue
keeps the peritoneum of the meso metrium passively
extended, and the tension resulting therefrom aug¬
ments in turn the staying and resisting powers of the
vaginal canal, In this way the normal firmness and
natural inclination of the uteras are secured. If,
however, the harmony of these tensions and pressures
is damaged by any alteration in the physico-chemical
state of the structures concerned in their production,
then the uterus is less able to withstand the action
of adverse forces, and will tend in consequence to
assume that inclination which the resultant of these
may determine.
A CASE OF TUBERCULOUS
PERITONITIS, (a)
By ROBERT HUGH HODGSON, M.D.,
Peckham.
R. F., zet. 9, a female twin child, whose twin sister
died in a fit, is one of a family of ten. About two
years ago her health commenced to fail, she wasted,
lost strength and colour, suffered from constipation,
and experienced occasional attacks of abdominal
pain. When I saw her in March last she was
very emaciated, had a hectic, fluctuating tem¬
perature ranging between 99 and 102, and a quick
feeble pulse. Her appetite was bad and she had
a slight cough. Her abdomen was extremely dis¬
tended, tympanitic and tender to touch, and
she suffered from constant abdominal pains.
Her bowels were obstinately constipated. Tuber¬
culous peritonitis was diagnosed. By repeated doses
of castor oil the bowels were opened, and by opium
and hot poultices the pain was much relieved. The
improvement in her symptoms was, however, only
temporary. After again relieving the bowels and
pain I was enabled to feel the outline of a large
tumour, globular in shape, and occupying the left
lumbar region. I explained to the parents that
although the child was apparently dying from
“ tuberculous peritonitis ” it was just within the
bounds of possibility that she had a tumour in her
abdomen which was undergoing degenerative change.
Wishing to give the childevery chance the parents con¬
sented to the abdomen being explored. Accordingly
ether was administered on May 4tli, and the abdomen
opened in the middle line, with the result that there
was an immediate rush out of about a pint and a half of
darkish yellow fluid. The parietal peritoneum was
thickly covered with yellow tubercles, and the whole of
the intestines were matted together into one round
mass, which was situated on the left side and covered
with tubercles. The liver was much enlarged. The
abdomen was first washed out with hot water, and
afterwards with water and carbolic acid in the propor¬
tion of 1 in 80, leaving as much in the abdomen
as it would hold The abdominal walls, which
were scarcely thicker than brown paper, were
united with silkworm gut. The wound healed with
exception of the lower end, through which after a
fortnight a thin dirty brown fluid commenced to run
in small quantities, and which no attempt was made
to stop. This discharge continued for four months
and then ceased, the lower angle of the wound closing.
On the day of operation, and for five days subse-
(a) Paper read before the British Gynecological Society, Novem¬
ber 9th, 1899.
quently, the temperature remained subnormal, after
which it rose for two days to 101, and then fell to
normal, and has remained so to the present time.
From the date of the operation the pain in the
abdomen ceased until about two months ago, since
when, with the return of constipation, periodical
attacks of pain occur. They are relieved by
purging. The abdominal tumour cannot now be
felt, and the liver has resumed its natural size, the
abdomen is fairly flat, the temperature is normal,
there is no cough and no hectic flush. The child has
gained a little flesh and is bright and cheerful.
During the last month there has been Lienteric
diarrhoea, which has now ceased under treatment.
Although the improvement is good all round, I have
but little hope of a permanent cure, since the emacia¬
tion and disease were so far advanced. I have brought
this case forward with the double object of showing
how the whole of the intestines may be gathered
together into one mass simulating a new growth and
also in the hope that although the result is far from
what one would wish to see, still it may be some in¬
ducement to look with more favour upon carbolic
acid in large doses, as the drug to at least hold in
check active tubercle. The moot points in this case
appeal 1 to me to be :—
1. What caused the arrest of the tuberculous activity,
was it the carbolic, the ether, or the admission of
air ?
2. Was the amount of carbolic acid left in the
abdomen sufficient to cause poisoning ?
3. Did the ether counteract the danger of carbolic
acid poisoning, and did it intensify the therapeutic
action of the carbolic ?
4. What caused the increased size of the liver ?
1. I think from one’s general knowledge of the us©
of carbolic acid I am justified in attributing the
arrest of tuberculous activity to the action of carbolic
intensified by the diffusibilitv the ether imparted to
it. Against the statement that the mere admission
of air has produced similar results one must set ofE
the possibility of the anesthetic used being the
germicidal agent and its sufficiency in slight cases.
One would not open a tuberculous pleura, admit air,
and then seal it up without expecting an empyema.
2. Roughly estimated, the amount of carbolic acid
left in the abdomen was one drachm, which in the
circumstances that the child was very emaciated and
in extremis, was, in my opinion, sufficient to cause
oisoning. Bearing in mind that the cooling of the .
ody by ether passes off within two days, I think the
continued subnormal temperature was probably due
to the carbolic, and not to shock, since little was done
to cause shock, and that if shock did exist, it was
removed by the warm abdominal washing, and the
warm fluid left behind.
3. The ether by its stimulating power nullified to a
certain extent the paralysis which would otherwise
have followed the carbolic acid acting upon the nerve
centres.
4. The increased size of the liver I take it was
caused directly by the growth of tubercle which could
hardly have been reached by a few minutes inter¬
change of air in the abdominal cavity.
I may add that I saw the child again this morning,
and my opinion is now more favourable than it was
when I wrote these notes; the temperature is
perfectly normal, all abdominal pains have ceased,
and the bowels act twice daily, and she is decidedly
gaining flesh.
Mr. Chable8 Lekdham Green has been selected by
the Director of the Army Medical Department as civil
surgeon to the 4th Divisional Hospital in South Africa,
Mr. Green is one of the casualty surgeons at the Queen’s
Hospital, Birmingham. He expects to leave England
early next month.
j by Google
Diqitizec
Not. 29, 1899.
ORIGINAL COMMUNICATIONS. The Medical Press. 553
THE TREATMENT OF ACUTE
PSYCHOSES BY REST IN BED.
By Dr P. SERIEUX,
Physician to the Aaylum for the Insane for the Department of
the Seine.
[Specially Translated for The Medical Press and
Circular.]
(Concluded from page 526.)
There do not seem to be any absolute contra¬
indications to this method of treatment; at most it is
possible to point to certain drawbacks associated with
its employment. These drawbacks, for the most
part quite unimportant, should nevertheless be care¬
fully studied, in order that we may be enabled to
obviate them by special measures. To Weir-
Mitchell belongs the credit not only of having shown
the satisfactory results, both physical and psychical,
of the treatment, but also of having pointed out its
drawbacks and the way to obviate tnem. The method
employed by the American neurologist has indeed
for object, to solve the problem how best to secure
for our patients the benefits of rest in bed without
any undesirable consequences. Weir-Mitcbell insists
on the fact that rest in bed diminishes the heart¬
beats by at, least twenty a minute, that is to say, we
reduce them approximately by one-third; that the
blood circulates languidly through the capillaries;
that prolonged rest in bed constipates and tends to
abolish appetite, and lastly, that the muscles under
too prolonged disuse degenerate and become atrophied.
These undesirable consequences of prolonged
rest are overcome by Weir-Mitohell by means of mas¬
sage and electropathy. These therapeutical measures,
far too much neglected m asylums for the insane
are capable of rendering very great service in respect
of patients undergoing the treatment by rest in bed.
Massage, indeed, obviates most of the evils which
are apt to follow prolonged rest, and acts efficaciously
on* the nutrition of the skin and muscles, on the
peripheral circulation, on the temperature, and on
the sensitiveness af the skin, exciting a reflex trophic
action, like other peripheral stimulants. According
to Weir-Mitchell massage is a “ delicious sedative.”
Electrotherapy, employed in the form of the
induced current, acta on both the muscles and the
skin.
We will now deal briefly with the complications
which may be ascribed to prolonged rest. Anorexia
is sometimes observed, and in these cases only
readily assimilable food should be given, such as milk,
beef-tea, soups, egg and milk, mashed vegetables,
and minced meat. The food should be given at
frequent intervals, but no refusal is to be accepted.
Dyspeptic troubles and gastro-intestinal atony are
treated by an appropriate r/gime by general massage,
especially directed to the abdominal region.
Constipation, a symptom that is constantly pre¬
sent at the very beginning of the treatment, usually
disappears spontaneously after a few days. Should
it persist a change of position from the dorsal decu¬
bitus to the sitting posture in an arm chair will per¬
haps have the desired effect, otherwise enemata or
mild laxatives must be resorted to.
With respect to hebetude and dirty habits, close
looking after of the patient will ofteD suffice. The
patient should be taken to the lavatory at a fixed
hour, and he should be incited to use the bedpan.
The tendency to masturbation requires constant
watching. As a rule it does not constitute a contra¬
indication. Nei88er, however, discountenances the
treatment for young women suffering but slightly
from motor excitement, but who are the subjects of
marked sexual erethism.
When the treatment causes ansemia the best
remedy is to wheel the patient on to the veranda,
and in certain cases he may be allowed to recline
on a sofa in the garden. We have already insisted
on the necessity for ample ventilation in wards set
apart for this treatment, and the windows should be
opened at frequent intervals.
In presence of amyotrophy and stiffness of the
joints, electricity, massage, passive movements,
Swedish gymnastics, and short walks in the garden
are indicated.
It is hardly necessary to insist on the prevention
of bedsores and hypostatical pneumonia. These com¬
plications, which, moreover, are very rare, can be
arrested by proper care of the integument, by daily
baths, frequent changes of position, and occasional
permission to adopt the sitting posture.
Having completed the description of the technical
details of the treatment by rest in bed, its physiolo¬
gical effects, its results and its inconveniences, we
shall now proceed to discuss those mental conditions,
which we believe to be amenable to this treatment,
laying stress on the special points presented by each.
All acute psychoses should be treated by rest in bed,
and under the heading of “ acute states ” we under¬
stand recent and suddenly developed delirium (toxic
and hallucinatory delirium, maniacal and melan¬
cholic conditions) and acute outbursts occurring in
the course of chronic conditions (general paralysis,
circumscribed cerebral lesions, systematic delirium,
Ac.).
Febrile delirium .—We shall only say a few words
in reference to these forms whicn all develop with
great rapidity. Their supervention in the course of
an acute, usually infective disease, constitutes an
indication for this treatment.
Alcoholic delirium .—We may consider alcoholio
delirium as the type of the toxic deliriums. Accord¬
ing to Magnan, it is in this mental condition that
the treatment yields its best results. The patient
with febrile delirium tremens ought to be subjected
to this treatment just like any other pyrexial case.
This applies equally to simple alcoholic delirium,
that is to say, delirium tremens without fever or
complications. Constant surveillance, day and night,
is indispensable. Rest in bed should not be made a
pretext for securing the patient by means of a
straight-jacket or other means of ensuring immo¬
bility. Bad as this practice is in ordinary cases of
excitement, it may prove disastrous in the subjects
of alcoholic delirium.
Magnan, who was the first in France to apply this
treatment to acute and subacute cases of alcoholism,
gives his results as follows :—Alcoholic delirium,
which consists almost entirely of illusions, hallucina¬
tions, and general sensory troubles, becomes inten¬
sified as soon as the patient, isolated in the dark, no
longer receives any external sensations. The illusions
produced by alcohol are modified by the transmission
to the centres of perception of well-defined
external impressions. These, being more consonant
with actuality, are more vivid and take the place of
illusions, which are always more ephemeral, and so
they soon change the course of the delirious ideas.
Rest in bed is one of the most powerful therapeu¬
tical agents, in that it brings the patient face to face
with the reality whenever he recovers himself, and it
enables us to dispense, for the most part, with the use
of hypnotics. We may add that the rapid evolution
of the disturbances due to alcoholic intoxication, both
acute and subacute, facilitates recourse to this
method.
The Morphine habit .—The chief symptoms in this
class of patients which justify the treatment are the
deterioration of their physical condition, and the
prostration of the organism and the imminent danger
of cardiac manifestations. If the patient be subjected
to immediate deprivation of the drug, a plan which
D
Digitized by VjOOglC
554 The Medical Pssm
ORIGINAL COMMUNICATIONS.
Not. 29, 1899.
daily becomes more popular, he should be kept in bed
until the phenomena of morphia intoxication have
entirely disappeared.
Mental confusion.— This malady is almost entirely
due to exhaustion of the cerebral cortex, a fact which
renders this treatment peculiarly appropriate.
Chaslin, who has made a special study of the
question, recommends this method of treatment very
strongly, inasmuch as the somatic condition of the
body is that of a person really ill. The treatment
has the advantage of checking further exhaustion, of
removing all causes of fatigue; it prevents a chill,
and has a sedative action, whicn action is not
without its importance in cases of excitement.
Another advantage, this time of a moral character,
and therefore included in the psychical treatment, is
that the patient, who may have a vague idea of his
pathological state, or may have lucid intervals, on
finding himself in bed, understands that he is really
ill and requires nursing, and this assists in restoring
his mental equilibrium and in dissipating the mental
confusion.
This treatment, although it plays a very important
part in dealing with mental confusion,is not, however,
the only therapeutical means at our disposal. The
exhaustion of the brain imperatively calls for hyper¬
alimentation, and in certain cases injections of saline
solution will prove beneficial; lastly, the excitement
is overcome by a tepid bath or the wet-pack, and
depression by alcohol or strychnine.
Acute hallucination. —What has just been said in
regal'd to mental confusion applies equally to acute
hallucination, which is a very similar morbid condi¬
tion. Rest in bed is verv effectual when there are
hallucinations and it constitutes, indeed, the veritable
etiological treatment. In these last two maladies the
morbid symptoms are apt to persist for several
weeks, sometimes even for several months, so that it
becomes difficult to apply the treatment throughout
the whole course of the disease. If by the end of
six or seven weeks signs of recovery have not shown
themselves, the patient should be got out of bed for
several hours every afternoon, the continuous treat¬
ment being reserved for attacks of intermittent
excitement which invariably manifest themselves in
the prolonged forms of the disease.
Hysteria. —It was in cases of grave hysteria that
Weir-Mitchell applied the method of treatment which
bears his name. It is now too well known for it to
be necessary for us to discuss its special advantages.
Hysteria, during the paroxysms, should be treated by
rest in bed, and the attack itself, which may be
looked upon as a fit of hyperacute hallucination,
constitutes an indication for this treatment. Every
precaution must be taken to prevent the patient
from injuring hei'Belf, but these do not include the
use of ligatures, straight jackets. &c , so much in use
at Salpetriere since the time of Georget. The treat¬
ment becomes more than ever necessary if the patient
becomes confirmedly delirious, for the patient then
falls into the category of acute hallucinations, which
may culminate in attacks of excitement, hilarious or
melancholic, according to circumstances. In special
cases, a period of isolation in a room with padded
walls may become necessary, the patient being
always kept under close observation.
Epilepsy. —Neisser, since the year 1893, has laid
stress on the results to be obtained by treat¬
ing epilepsy by rest in bed. In seven cases of
epilepsy under his observation, he states that,
under the influence of the treatment, the con¬
vulsions diminished in frequency and intensity
for about six weeks, the increase in weight being very
marked. Schmidt, who has treated excitable
epileptics by this method, scutes that they can be
kept in bed without any difficulty, and that they
become calmer and more manageable.
The treatment by rest in bed is indicated in
delirious outbreaks of an epileptic nature, as in all
the acute psychoses, but occasionally serious
difficulties preseut themselves. The most marked
cases of excitement are met with in delirious
epileptics, consequently a great many authorities
abandon the treatment m these cases. If
need be padded box-beds on the floor, short periods
of isolation with constant watching in padded rooms
with the floor covered by mattresses, must be resorted
to. Dr. Pochon, in his thesis, describes Magnan’s
method of treatment. He says : “ The possibility of
the treatment will depend on the intensity of the
excitement. If the patient be violent it is quite use¬
less to insist on this treatment, and an attempt at all
hazard to keep the patient in bed would be courting
disaster, in such cases isolation must be unhesitatingly
had recourse to. In cases of less intense agitation,
where the movements of the patient are not so
violent,the treatment by rest in bed should be
employed, The exhausted condition of the patient
following these attacks will thus to some extent be
attenuated.’’
Neurasthenia. —Weir-Mitchell's method of treat¬
ing neurasthenic patients is described in all treatises
on therapeutics, so we need not go into the details.
Maniacal Conditions. —The application of the
treatment to cases of maniacal excitement and to
violent lunatics, who are always the prey of an unsur-
mountablepronenessto disordered movements appears
at first sight impossible. The experience of the last
few years, however, has demonstrated the possibility
of treating excited patients in this way. It greatly
diminishes the intensity and even the duration of the
attack, and also obviates complications.
J. P. Falret was the first to recommend this treat¬
ment for patients suffering from “ certain acute
maniacal and semi-febrile conditions.’’ At present
the indication for the treatment is not to be sought
exclusively in the state of the patient’s general
health. Excitement per se is sufficient to justify
resort thereto.
According to Magnan the no restraint method
and the treatment by rest in bed are the two general
methods to employ in cases of mania. We quote his
description of the application of the treatment in
cases of this kind. ‘'The maniacal patient, when in
bed, continues, of course, to be restless, to gesticulate,
to talk at random, to shout and to sing; he throws
away his pillow, his bolster, and discards the blankets
and sheets, and is always trying to get up; but in
the course of two or three days, though still agitated,
he ceases his attempt to leave the oed, and, at any
rate, returns promptly on simply being told to do so,
in deference to the influence of imitation and ex¬
ample. When in bed, as soon as he can be got to
sleep, he is completely at rest, and these hours of
sleep go a long way towards expediting recovery.
When he wakes, he again starts talking and
gesticulating, and he gratifies his instinctive
desire for movement by disordered gestures.
When the patient is very boisterous and noisy he is
not allowed to sleep in the dormitory, but is put into
a room with a perforated door so that the attendant
can see all over the room. It goes without saying
that the patient must be retained in bed without
having recourse to any means of physical restraint.
The very presence of a nurse at his bedside will
usually suffice to keep him from getting up. In
certain cases, hypnotics may be employed, especially
at the outset when the patient has not as yet become
accustomed to being in bed. Gem rally, however,
the avoidance of forcible measures of restraint and
recourse to the bed treatment, render it quite excep¬
tional for isolation in a cell to be required. This is
not one of its least important advantages : “ Bed,”
says Neisser, “ replaces the padded loom.”
Nov. 29, 1899.
ORIGINAL COMMUNICATIONS. Th« Mxdioal Puu. 555
Dr. Toulouse has been the advocate in Franoe of
the mixed treatment of prolonged bed treatment
varied every day by two nours’ walk. The walk
relieves the excitement of the maniacal patient as
has been recognised in Sootland, where it forms one
of the methods of treating the insane. This plan
obviates denutrition, and combats the tendency to syn¬
cope to which prolonged rest in bed is apt to give rise.
In our hospital, where we practice the ted treat¬
ment, we have almost completely abandoned the
isolation of patients in special rooms as a means of
calming maniacal excitement. Our observations
tally with those of Magnau, who asserts that the
hyper-acute manifestations of insanity disappear
under rest in bed. just as what Esquirol called
“ maniacal anger ” disappeared with the abolition of
the straight-jacket.
Bernstein, who has tried the bed-treatment
in his hospital service nt Moscow, notes the
promptness with which most maniacal patients
become accustomed to bed, their excitement subsides
in a marked degree, and the padded rooms remain un¬
occupied. We witness no more of the scenes with which
we were familiar when the system of isolation was
prevalent. “ The patients retain their human qualities
which degenerated rapidly in former times when the
patient was imprisoned in a cell. Imbecility which
was inseparable from sojourn in the cells no longer
exists.” According to this author the treatment
does not notably expedite recovery, but on the
other hand, Timofeier and Govseier state that it does
hasten recovery, in addition to increasing the propor¬
tion of cures.
Pochon considers the treatment by rest in bed as
both possible and necessary for maniacal patients.
The febrile state associated with the onset of the
attack, the furred condition of the digestive tract,
menstrual troubles and emaciation are sufficient in
themselves to require rest in bed for these patients.
This method of treatment diminishes the excitement,
one no longer meets with the congestive conditions
which often culminated in acute delirium and death.
Sleep, when it oomes, is vastly more recuperatory in
bed than on the floor of a cell; the patient is better
looked after, he becomes better acquainted with his
attendant, and vice versa.
Melancholia. —Melancholia in its various forms was
one of the earliest mental states to derive advantage
from the treatment by rest in bed. It is to these
forms that the treatment is now most readily applied.
We may add, that in so doing one is often consulting
the patient’s wishes, for many of them would gladly
stay in bed if allowed. In melancholia we find a
whole series of symptoms which call for rest in bed,
such, for instance, as unsatisfactory general condi¬
tion, emaciation, due to want of nourishment and to
insomnia, cyanosis and oedema of the extremities,
and anemia. Rest in bed is readily agreed to by the
majority of these patients. It sometimes happens,
however, that a difficulty is experienced in keeping
excited melancholics permanently in bed (Paetz and
Kraepelin). What has been said of the other psy¬
choses applies equally to melancholic states. Rest in
bed dispenses to a great extent with the use of
hypnotics, does away with cellular isolation, averts
visceral complications, ameliorates the general con¬
dition, and at the same time lessens the chances of
the attack terminating in dementia, chronic melan¬
cholia or death. It also averts many psychical com¬
plications such as hallucinations, delirium, which are
conduced to by exhaustion and want of sleep.
In certain patients (melancholic, but not delirious,
or on the way to recovery), the method need not be
* too vigorously, but in every case the patient
should only be allowed to get up after lunch, and
should spend the forenoon (which is the worst part of
the day for him) in bed.
What we have said concerning rest as a therapeu¬
tical agent in the acute psychoses will explain the
good results obtained by the treatment in melancholic
patients. It is especially rest that the melancholic
subject requires. From the physical point of view
rest is favourable to the amelioration of the general
health, to the loss inflicted on the organism by
insomnia, refusal of food and anxiety. The heart
beats more regularly and with greater force, the pulse
at first small and quick improves (Guislar Muller);
cerebral circulation is facilitated by the horizontal
position, and consequently the brain is better supplied
with blood; the vaso-motor disturbance subsides ;
loss of heat is avoided, an important point in subjects
whose muscular activity is practically nil , in whom
respiration is comparatively inactive, and in whom
temperature is often below normal. The cutaneous
functions, which leave so much to be desired, are
stimulated by rest in bed, and assist in securing a
more general supply of blood to the skin : “ under its
influence the integument, usually so dry, becomes
moist.” (Guislain.)
Rest in bed is not less beneficial from the mental
point of view. The improvement in the general
health is of itself sufficient to explain the attenuation
of melancholic symptoms, if we adopt the views of
Lange, G. Dumas, and Maurice ae Fleury, that
depressed states are merely the consciousness of the
condition of the body, due to the hypotonus of the non-
striated and striated muscles, to the result of want
of muscular and cerebral nutrition. Remedying
the nutritive disturbances of the brain and oi the
organism as a whole, we modify the debility which had
awakened a distressing echo in the conscient organ.
Rest in bed also exerts a direct influence oi the
mind not less beneficent in its way. It is well known
how vivid is the psychical bypersesthesia of melan¬
cholics, how intolerable the moral agony, and how
well marked their inertia. Feeling, thinking, wishing,
moving are to such patients all painful forms of
cerebral activity.
Rest in bed, as we have seen, diminishes to a great
degree visual, auditory, tactile and thermic sensa¬
tions, suppressing, as it does, all muscular activity
in respect of environment; it spares the patient
all voluntary acts, all exercises of the will. The
patient is thus ensured complete repose. In short,
rest in bed ought to be considered as the primary
indication in the treatment of melancholic states.
Periodical Psychoses. —We need not dwell on
the periodical psychoses. They are similar in
all respects to typical melancholia and mania.
It frequently happens, in these morbid states,
that the patient, recognising the good results
he derived from rest in bed during a pre¬
vious attack, is the first to ask for the treatment
when he feels that an attack is imminent. This is
one of the best testimonials we can have of the
beneficial effects of this method of treatment.
Before concluding, there only remain a few words
to be said on the acute periods of chronic psychoses.
They are similar to hallucinatory delirium, and,
therefore, what we have said concerning mental
confusion and acute hallucinations is applicable here.
Chronic Systematic Delirium. —It will be but rarely
that the treatment by rest in bed requires to be
applied to this class of patients, the more so, as these
patients are perfectly conscious, but owing to their
mental state interpret every act on the part of their
immediate surroundings as an insult; they even
refuse to submit to the directions of the physician.
Neisser, however, keeps such patients in bed for the
first week after admission.
In certain outbursts of hallucination some benefit
may be derived from a short period of rest in bed.
General Paralysis. —The treatment by rest in bed
has been tried on general paralytics by Dr. Joffroy
Goog
356 Tkb MbDiCAL- Pr*88.
CLINICAL RECORDS.
‘Noy. 29, 1899.
(1897). In Germany it ha9 been suggested to keep
tbe patient in bed for at least ten weeks at tbe com¬
mencement of the disease, in order to attenuate the
initial symptoms. This treatment, it is urged, also
exerts a favourable influence on the frequency of
apoplectic attacks or convulsions (Rochricn). Rest
in bed is especially indicated in cases of general
paralysis, when, after a congestive attack, tbe patient
shows signs of mental confusion. We have then to
do with attacks of hallucinations, with automatic
excitement, often very intense, analogous to poet-
convulsive epileptic delirium.
The treatment is therefore justified not only by
psychical troubles, but also by the somatic pheno¬
mena.
Idiocy, Dementia. —Lastly, idiocy, cretinism, and
dementia of every description, and even the morally
insane, may conceivably derive benefit from tbe treat¬
ment in the event of a passing fit of excitement, to
which they are so prone. Further research alone
can establish the actual value of the method as a
treatment in these cases, which, so far as we are aware,
have not been methodically dealt with in this way.
We have now concluded the list of special indica¬
tions for the treatment in the principal forms of
psychoses. We trust we have justified our inaugural
statement, that all acute conditions, whether of
classical type or merely incidents in the course of
chronic diseases, impose treatment by rest in bed.
Rest in bed alone can ensure to these patients that
rest which the brain and tbe organism as a whole
require ; it is easy of application, its results in respect
of the most troublesome symptoms of mental disease
are indisputable, it obviates tbe physical and psy¬
chical complications which often impede recovery,
and it enables us to dispense witb prolonged isolation
in a cell.
So thoroughly convinced are we of the advantages
of this therapeutical method, that we do not hesitate
to assert that it will rank with the suppression of
restraint (no restraint), the open-door and the
colonisation methods, as one ot the most valuable
acquisitions of modem psychiatry, and this method
involves as a corollary a radical rearrangement of
our superannuated system of dealing with the insane,
a system which will henceforth stand condemned. The
general application of the method will, of necessity, do
away with our prison asylums, where therapeutical
requirements count for so little, and will replace
them by hospitals for the treatment of acute cases, by
agricultural colonies for convalescents, intermittent
and chronic cases. The treatment raises the lunatic
to the dignity of a patient, a measure called for close
upon a century ago by Pinel. The bed treatment
alone will effectually complete the change, we shall
no longer be satisfied with shutting up the insane,
they will be treated, and we shall be enabled to return
to tbeir families and friends, a good number of
unfortunate beings, who have hitherto been con¬
demned by tbe imperfect method of treatment at our
-disposal to remain uncured.
SULPHUROUS ACID
AS A
BEMEDY IN £KIN DISEASES.
By TOM ROBINSON, M.D.,
Physician to the Western Skin Hospital.
Modern microscopical and bacteriological investi¬
gations have so strongly confirmed the fact that
many of the skin eruptions are attributable to the
invasion of the Bkin by micro-organisms that it has
become tbe practice to attack such cutaneous mani¬
festations by extreme remedies, remedies strong
enough to kill the bacteria. The Germans hare
been in advance of us for many years in their
successful treatment of skin diseases. But Unna
must be awarded the apple because he has
possessed the art of combining remedies with
a firm grip of physiology and pathology. It weuld
be idle to allude to the many remedies which are
advocated and used by us all, and it may be thought
pedantic to say much about another one. The only
excuse is that in sulphurous acid we possess a
remedy which will not stain the skin, which will
enetrate the epidermis, and which will certainly
estroy most, if not all, of the flora which
attack the skin, nails, or hair. Tbe first group of
cases which yield rapidly to its action are those
which are connected with a faulty secretion of the
sebaceous glands. The two varieties met with on the
scalp, Seborrhcea sicca, and Seborrhcea oleosa, are the
forerunners of alopecia, and have called for more
commercial attention than any other skin affection.
These will recover completely if the patient is directed
to scrub the entire scalp once every twenty-four
hours with recent sulphurous acid, and to wash the
same once a week with common yellow soap. Tbe
varied varieties of seborrhcea met with on the face or
trunk, will also yield to the same treatment. Incases
of acne in which suppuration lias taken place,
the acid may be swabbed on the skin twice a
day without dilution. In the ringworm group
sulphurous acid, if persistently applied, will give as
good results as any of the other germicides which
are in common use. Its action in alopecia areata is
excellent. In the ringworm of the scalp met with in
children tbe affected areas should be washed with
soft soap every day, afterwards swabbed at frequent
intervals with the undiluted acid. The eruptions
which occur between the scrotum and the thigh or
wherever two folds of skin rub each other as in fat
women under the breasts, armpits, and lower parts
of the abdomen. These will yield to sulphurous
acid if used diluted with spirit and water,
equal parte of each and after its daily use
a dusting powder, such as recommended by Dr.
Walsh, and composed of two ounces of powdered
starch and two drachms of boric acid and calamine
powder. The object in writing these few remarks
has been to call attention to a remedy which has
not. I think, been sufficiently used in practice. There
is only one word of v/aming necessary, it is that in
ordering sulphurous acid let it be distinctly stated
that the acid must be recent, otherwise it may act as
an escharotic in consequence of the change of the
acid from H 2 S0 3 to H 2 SO., or in other words from
sulphurous to sulphuric acid.
(EUntcal JKecorbs.
JESSOP HOSPITAL FOB WOMEN, SHEFFIELD.
Sub-peritoneal Fibroid in Douglas’s Pouch — Operation.
Under the Care of John W. Martin, M.D,
Honorary Medical Officer to the Hospital.
L-O-, let. 36, married, no children ; admitted
into the hospital September 16th, 1899. Quite regular
as to her menstrual periods, the last commencing
just after admission. About twelve months before
admission she commenced to notice a sense of
distension, especially towards the end of the day when
tired from work. Inspection and palpation of the
abdomen detected nothing. Per vaginam, the cervix was
felt small and conical, and the sound wan not easily
introduced. When it did pa as, it entered 21 inches
and to tbe right. Douglas's pouch was occupied by
what seemed to be a large hard tumour which
oonld be well mapped out by the bimanual
examination. The body of the uterus felt dis¬
tinct from it, lying up along the right side of the
Digitized by \J
oogle
Nov. 29, 1899.
TRANSACTIONS OF SOCIETIES.
Thk Medical Press. 557
tumour. Movement of the tumour imparted a certain
amount of movement to the sound in the uterus. A
section was decided upon; the operation was done on
October 18th. The tumour was found to be
a sub-peritoneal fibroid, springing low down from
the back of the uterus in Douglas’s pouch. Its
size was tliat of a good sized closed fist; its pedicle
was about one-and-a-half to two inches in breadth. The
operation was carried out in the usual way. The tumour
was brought well out into the abdominal wound;
fortunately there were no adhesions of importance to deal
with ; the peritoneal covering was incised before and
behind, and reflected, the mass peeling off pretty easily.
Haemorrhage was arrested by ligature, some little
difficulty being experienced in securing the largest
vessel owing to retraction among the uterine tissues.
Douglas’s pouch was carefully washed out. The edges
of the peritoneum were brought together by interrupted
sutures. The abdominal wound was closed by five
sutures. The patient did well, and was discharged on
Saturday, November 18th, 1899.
transactions ot Societies.
CLINICAL SOCIETY OF LONDON.
Meeting held Fbidat, November 24th, 1899.
Sir R. Douglas Powbll, Bt., President, in the Chair.
A CASE OF SENILE TUBERCULOSIS.
Mr. Howard Marsh read notes of a case of tuber¬
culosis in an old lady, an example of the “ senile
scrofula” of Sir James Paget. In June, 1894, a
lady, set. 71, complained of swelling and pain in
left ankle with dusky-red cedematous skin over it.
In the following Octolier it suppurated, when the
joint was opened and drained. The pus, however,
burrowed up the leg in the sheaths of the flexor
tendons, with muscular wasting and general loss of
strength. Amputation through th6 lower third of the
leg was performed in March, 1895, The wound slowly
healed, and the patient recovered her general health.
Twelve months later the patient developed periostitis
of the left ulna, which ultimately suppurated, and was
opened and cleared, a small sinus remaining for three
months. Nine months later, the patient being then 73,
similar changes occurred in the right ankle, and a further
amputation became necessary in March, 1897, which
healed in five weeks. In June, 1897, an abscess formed
over the ulna in the site of the 1896 periostitis, which was
opened and slowly healed. She remained well for
eighteen months, when, at 75 years of age, her right knee
began to give trouble. The disease progressed rapidly
and she lost flesh. Amputation through the lower third
of the thigh was done four months’ later, and healed
without suppuration in six weeks. The patient had had
no further trouble since. The condition of all three
joints was the same, the disease having evidently begun
in the synovial membrane, leading to cc mplete destruc¬
tion of the ligaments and articular cartilages, the bones
being ulcerated in some spots. The cavity was occupied
by tawny-coloured and friable granular tissue
and cheesy pus, while the neighbouring soft
structures were infiltrated with pus. He observed
that the older the patient the greater was the tendency
towards progressive, and usually rapid, destruction of
the joint, the resistance of the tissues to the tuberculous
process being greatly diminished by age. Diagnosis was
often difficult at first, the symptoms closely resembling
those of osteo-arthritis. Within two or three months, if
not earlier, however, the infiltration of the soft struc¬
tures, &c., would assist the diagnosis. Suppuration
was a marked feature of senile tuberculosis leading to
extensive and rapid destruction of the joint structures.
The President asked if there was any early history
of tuberculosis in this case, and whether the structures
had been examined for bacilli ? In his experience tuber¬
culosis in the aged chiefly affected the lungs, and he
thought the tendency of the disease in these patients
was to remain local so that the prognosis was more
favourable than in younger subjects.
Dr. Percy Kidd concurred iu the President's remarks
as to the less virulence in elderly Bnbjects, and referred
to a case of his own in a patient over 70 who died of
peritonitis in which he found a tuberculous ulcer of the
Ileum. He thought tuberculosis of the joints in old
people must be rarer than tuberculosis of the lungs.
Mr. Raymond Johnson asked what results the author
had obtained in tuberculous disease of the joints by other
operations, such as excision, in the aged. He thought
the virulence of the process in the aged was greater than
with the same lesions in the young. He asked what
explanation could be offered of the remarkable differ¬
ence in the virulence in carcinoma and tubercle,
pointing out that in the former growth was slow in the
aged, whereas ’tubercle spread with great rapidity. He
asked how it was, if surgical tuberculosis was so serious
in the old, owing to defect of resistance, that they were
not more often affected by the disease.
Dr. J. S. Richards said that as Medical Superinten¬
der t of a Poor-law Infirmary he had seen a good many
of these cases. He had abstracted 500 post-mortem
examinations made in the institution during the last
twoyeais; there were 17 of patients over 70 who had
died of acute tuberculosis, 4 of them having miliary
tuberculosis; while between 60 and 70 there were 16,
3 of them havirg miliary tuberculosis. About 6 6 of the
whole number <f deaths examined post-mortem (about
half the whole number) were thus tuberculous. He did
not take such a despairing view of tuberculous dir ease of
the joints and bones as the auth< r, for they often got
good results, the effect of reBt and improved diet being
immense.
Mr. Marsh, in reply, said there was no early history
of tuberculosis in patient or family. No bacilli had been
isolated, but the anatomical evidence was quite clear.
The President had once remarked to him that joint
tuberculosis was rare in phthisical patients, and his own
experience at the Hip Hospital was that children with
tuberculous joint disease seldom had the lungs diseased.
He remarked that the incidence of the disease appeared
to be different at different periods of life. In illustra¬
tion of the very destructive effects of the disease he
referred to the case of a lady, a>t. 56, with hip disease,
which, in four or five months, ran on to complete
destruction and the patient developed phthisis and died.
He pointed out that such an operation as excision was
hardly applicable to patients over seventy. He thought
that the disease affected old people much more fre¬
quently than was generally believed.
Mr. Barker on a case of
excision of the c.«cum.
The case described is that of a disease rare in the
pathological condition found on operating, and also in
the operative treatment to which it was submitted.
Carcinoma of the ileo-ca'cal valve is shown to be a rare
disease by reference to the Transactions of the Patho¬
logical Society, and of the Clinical Society. That
it Bhould have given rise to intestinal obstruction is shown
to be also rare. The case was that of a man, a?t. 29,
who was admitted into University College Hospital
under the care of Dr. Risien Russell, by whom it was
placed in the hands of Mr. Darker for operation, all
other measures for relief having failed. The man had
had attacks of chronic obstruction for a considerable
period, culminating in an acute attack. The usual
symptoms were well marked, but the patient’s condition
was generally good. On opening the abdomen in the
middle line the small intestine was found much
distended and hypertrophied. This was opened
and five pints of liquid faeces of an intensely foetid
character were evacuated. It was then possible to
introduce the hand, when a hard mass was discovered
in the ileo-caecal valve plainly obstructing the bowel. As
it appeared dangerous to remove it at once owing to the
presence of much liquid faeces,the ileum was anastomosed
to the hepatic flexure of the colon by suture, and
wound was closed. The patient made a steady
recovery, only checked by some stitch abscesses.
At the end of six weeks and three days after the first
operation a long oblique incision was made over the
caecum, and the latter was excised with some of the
Digitized
oogle
558 The Medical Press. TRANSACTIONS OF SOCIETIES. L. I Nov. 29 , 1899 .
ascending colon and about six inches of the ileum above
the valve. Both visoera were divided a few inches below
the ileo-csecal union. The wound was packed with
antiseptic gauze and left partially open. Convalescence
was good, but a small fecal fistula remained open for
some weeks, and then closed. The growth was found to
be a carcinoma of the ileo-ctecal valve with many poly¬
poid excreeoences projecting into the caecum. The
specimen was shown as well as microscopic sections.
The patient was also present for examination. He is in
excellent health, and has returned to work as a
plumber. His botvels act well, and he has no signs of
recurrence so far.
Dr. Voelcker agreed that it was probably adeno¬
carcinoma. He could recall at least three examples of
ileo-ctecal cancer met with post-mortem, all being cases
of adeno-carcinom a.
Mr. Howard Marsh did not think that this affection
of the caecum was particularly rare, and referred to a
specimen in their hospital museum. He approved of the
method of operation, vit., in two stages, some cases not
being strong enough to undergo the graver operation,
and he mentioned two cases in which removal of the
ctecum had been practised with good results. He him¬
self preferred suture of the intestine, but admitted that
there were many eases which couid best be dealt with
by Murphy's button.
Dr. Norman Dalton referred to a case of his own of
what looked like undoubted cancer of the ctecum
in which, as the lump appeared to be slightly movable,
he advised operation, and Mr. Burghard successfully
removed the ctecum two years ago, since which time the
patient had remained quite well. He agreed that
this position for cancer was not so very rare.
Mr. Charters Symons showed a drawing of a case of
malignant disease which had begun in the ileo-ctecal
valve in a woman, tet. 50, in which he removed the
caecum with success. He mentioned two other cases in
which he had operated, the patient being still living,
and he had just lost a patient in whom he had attempted
the whole operation for obstruction. He thought that when
there was an obstruction the operation should be under¬
taken in two stages, though in other cases it might well
be done at one sitting. He had united the colon to the
small intestine by lateral anastomosis, removing the
excluded parts at a second operation. He agreed that
direct suture was better, as it gave a freer passage than
the button. He remarked that in the early stage the
growth in all three cases had first occurred as a small
hard movable nodule almost under the skin, followed by
symptoms of slight appendicitis with ulceration, which
healed and formed again, making the cases very pro¬
tracted.
Mr. J. Hutchinson, jun., said that he had looked out
the statistics of resection of intestine for gangrenous
hernia, which showed that whereas the proportion of
recoveries with the button was 7 per cent., careful direct
suture showed 40 per cent. He alluded to the extreme
difficulty of diagnosis of malignant disease in this situa¬
tion, and gave two illustrative cases. One was that of
an elderly man with carcinoma of the ccecum and
symptoms of obstruction. Having relieved this, he was
about to remove what looked like a cancer of the ctecum,
but was deterred by the matting of the surrounding
tissues, yet that patient had since steadily improved.
In the other case the lesion was in the
sigmoid flexure, in a middle-aged woman with
obstruction. After exploration, median and lumbar,
he found what had the appearance of a malig¬
nant growth with much inflammatory thickening
around, rendering removal impossible. That patient,
however, forthwith improved, and had remained well
two years since. Treves and others had pointed out the
impossibility in some cases of distinguishing between
inflammatory infiltration and cancer.
Mr. Barker in reply, thought that as the large intes¬
tine was often the seat of malignant disease, it was
curiouB that the valve should be bo rarely involved, at
any rate so far as recorded cases went, He referred to
two cases of gangrenor s hernia treated by suture which
recovered, while two others treated with the button had
died.
Dr. C. W. Chapman read a paper on a case of
OBSTRUCTION OF THE INFERIOR VENA CAVA—PROBABLY
SYPHILITIC.
The patient, who was present, had been shown at a
Clinical Meeting of the Society last Session. The
patient was a hair dresser, set. 48, who was admitted
into the National Hospital for Diseases of the Heart on
October 4th, 1897. He then complained of palpitation,
shortness of breath on exertion, a shooting pain
in the head, and a sense of suffocation when he
leant forward. There was a history of syphiliB twenty
years previously, for which he had had only a two
months’ treatment. There were no secondary symptoms.
His next illness was influenza in 1892, which was fol¬
lowed by palpitation. About nine months’ later he had
a sudden but transient severe pain in the head followed
by swelling of the face, which, however, soon dis¬
appeared ; he also was subject to syncopal attacks. The
superficial abdominal veins gradually became enlarged
and varicose, and subsequently the veins of the right
leg were similarly affected. The action of the heart
was feeble, and the pulse was 54. A systolic murmur of
a harsh character was heard at the sternal margin of the
4th left space, also a soft systolic murmur at the
apex which was heard in the left axillary line. The
second pulmonic sound was a little accentuated. Liver,
but little enlarged. Urine normal. No tumour could
be discovered in the abdomen. There was a hard
swelling at the back of the neck the size of half
a walnut. The case was diagnosed as obstruction of the
inferior vena cava for syphilitic disease either from
pressure of a gumma or from thrombosis. Under
specific treatment the swelling diminished, the symptoms
relieved, and the health improved, though the condition
of the external veins was unaltered. After referring to
the more usual causes of obstruction of the inferior vena
cava. Dr. Chapman quoted from Mr. Hutchinson’s con¬
tribution on “ Visceral Syphilis,” where the author ex¬
presses his belief in the existence of a syphilitic phlebitis.
He also drew attention to the article on syphilitic phle¬
bitis in the Archives G6n6ralea de Mtdecine for 1894,
where the author refers to two cases of phlebitis asso¬
ciated with gummatous tumours. Mr. Battle’s paper,
18th volume of St. Thomas’s Hospital Reports, was also
quoted as bearing on the subject.
Mr. J. Hutchinson, jun., asked how it was that there
was no marked enlargement of the veins of the lower
limbs and no varicocele inasmuch as the vena cava was
undoubtably obstructed. He mentioned the case of a
lad of 16 with varicocele in both sides, the veins of the
legs being extremely dilated and tortuous, in whom
there was obvious obstruction of the lower vena cava.
There was no ascites, but the liver and spleen were
decidedly enlarged, with other evidences of congenital
syphilis. This pativnt improved under KI. and Hg.,
though the veins did not regain their normal size.
The obstruction was undoubtedly due to a gumma
at the posterior surfaoe of the liver, but he pointed out
that with syphilitic disease of the liver and spleen ther
might be tertiary disease of the lymphatic glands lying
behind the inferior vena cava. It was well known that
gummatous disease of the lymphatic glands had a
greater tendency to infiltrate neighbouring vessels than
tuberculous disease. He referred to a case of gumma in
the cervical lymphatic glands pressing upon the carotid
and infiltrating the hypoglossal nerve, also a case of ob¬
struction of the superior vena cava which was obliterated
by a large gummatous mass which had apparently started
in the mediastinal glands. There was a specimen in
the College of Surgeons’ Museum of obstruction of the
superior vena cava. In this case, as the subject had
angular curvature of the spine, it was of course open to
the suspicion of tubercle, but Mr. Targett, who had care¬
fully examined the specimen, decided that it was
syphilitic. Dr. Barlow had given him notes of a case in
which the veins of the right arm and chest were
enormously distended in which reoovery had followed
vigorous antisyphilitic treatment.
Dr. Chapman, in reply, remarked that the veins of the
legs were also greatly enlarged in his patient.
Die
Nov. 29, 1899.
TRANSACTIONS OF SOCIETIES. The Mhdicai Pbbss. 559
HARVEIAN SOCIETY OF LONDON.
Mxxting held Thursday, November 16th, 1899.
Dr. W. J. Gow, Vice-President, in the Chair.
SOUK INTERESTING CASKS OP FIBROID TCMOCBS OP THE
UTERUS.
Db. A. H. N. LxwiRs'read a paper on nine cases of
fibroid tumours of the uterus. The cases illustrated
some of the principal varieties of uterine fibroids, and
showed some of the chief methods of treating them in
use at the present time. In Case 1 the chief point of
interest was the remarkable diminution in the Bize of the
fibroid tumour following removal of the uterine appen¬
dages. On one side the ovary formed a suppurating
ovarian cyst the size of a cocoa nut. Cases 2. 3, and 9
were typical examples of large uterine fibroids,
suoeessfully removed by abdominal hysterectomy,
with intra-peritoneal treatment of the stump.
In Case 8 a point of interest was, that in
one place the fibroid had undergone cystic change,
and the cavity so formed contained pus. Case 4
was an example of pregnancy complicated with a large
subperitoneal fibroid, in which expectant treatment was
adopted with a satisfactory result, the patient being
delivered naturally at term, without any complication,
either during the labour or afterwards. The patient
was seen some two or three months afterwards, when
the subperitoneal fibroid could still be easily felt on
abdominal palpation alone. Cases 5 and 6 were examples
of removal of fibroids, partly submucous and partly inter¬
stitial, from the cavity of the body of the uterus after
dilatation of the cervix by enucleation and “morcel-
lement.” Case 8 was one of large sub-peritoneal fibroid
removed by myomectomy with inti a-peritoneal treatment
of the pedicle, and in this case the body of the uterus
was not removed. Case 7 was, on account of its rarity,
perhaps the most interesting of the whole series. It was
a case where an interstitial fibroid of the posterior wall
of the uterus sloughed en masse and was discharged
through an opening formed in the posterior lip of the
oervix. When first seen (May 30th, 1899) the case
appeared an ordinary one of uterine fibroids, the tumour
reaching nearly to the umbilicus. The vaginal cervix at
that time was not encroached upon by the fibroids at all,
but on July 20th, 1899, the upper part of the vagina was
found occupied by a large fcetid friable mass. Careful
examination under anesthesia showed that the
os uteri lay in front of it, and that this
mim« was coming through an opening formed in the
posterior lip of the cervix. The patient was feverish
and extremely ill. All that was done was to remove the
fcetid mass with the fingers as completely as possible,
much as a decomposing retained placenta would be
removed, except that in the present case the decom¬
posing mass (the fragments of which weighed 2 lbs. 8ozs.)
was situated in the substance of the posterior uterine
wall, and not in the cavity of the uterus. The patient
continued to suffer from septic fever even after the
sloughing fibroid had been removed as completely as
possible, and finally died from it some three months
later. The specimens corresponding to several of the
cases were shown.
The Chairman refeired to the importance of the sub¬
ject under discussion because, since the mortality of
hysterectomy had so greatly diminished, the indications
for operative treatment had considerably altered. He
criticised the employment of drainage after abdominal
hysterectomy, and considered that it was seldom
necessary.
Mr. Alban Doran dwelt on different surgical methods
for the treatment of uterine fibroids which he had seen
introduced, practised, supported by plausible arguments,
and yet often discarded. There was still great room
for improvement; the removal of small fibroids which
caused no symptoms was bad surgery, though it might
be brilliant operating. Altogether retro-peritoneal hys¬
terectomy was preferable to the more conservative
myomectomy and to the more radical panhysterectomy.
Too great stress was now laid upon the supposed advan¬
tages of leaving the ovaries, just as too much im¬
portance was attached twenty yean ago to their
oomplete removal. The surgeon must remember that
leaving the ovary might mean shutting up in the abdo¬
men a portion of a diseased tube with its mucous mem¬
brane exposed. Abel and Zweifel had shown on clinical
evidence that when the ovaries were left behind they
nearly always atrophied so that the menopause oocurred
within three yean of the hysterectomy. Zweifel
believed that when this atrophy aid not occur it signified
that a portion of the body of the uterus was left in the
stump; hence he now made large flaps consisting of
more than the tissue of the cervix. We had yet much
to learn, but in the meantime we could remember that
an artificial menopause was seldom very formidable.
Dr. W. H. Tatx agreed with the remarks of the Chair¬
man with regard to drainage in cases of abdominal
hysterectomy for fibroids. He considered that drainage
was rarely necessary where the broad ligaments and
uterine arteries had been securely ligatured, and the
stump carefully sutured. Referring to Case 7 in the
paper, he wished to ask Dr. Lowers whether he did not
think removal of the whole uterus might not have
given the patient a chance of life, seeing that partial
removal of the sloughing tumour per vaginam had
failed to relieve her. Dr. Tate had assisted Dr.
Cullingworth in a case in which a large sloughing
fibroid tumour occupied the vagina, and an attempt had
been made to remove it. It was found impossible to
remove the whole tumour—the portion left behind
sloughed, and the patient’s condition became
extremely grave. Three days after the first
operation Dr. Cullingworth decided to perform
abdominal hysterectomy, and the patient made an
excellent recovery. Mr. Doran had referred to the
greater mortality in the cases of operation on large
fibroid tumours compared with small. He (Dr. Tate)
did not agree that this was the case, as it frequently
happened that a large fibroid tumour was much more
easily and safely removed than a small one. Bearing on
the operation of o&phrectomy for fibroids, he thought it
was important to consider the symptoms before deciding
on this means of treatment. Even when the size of the
tumour did not contraindicate the operation, the sym¬
ptom of severe pain over the tumour suggested some
degenerative or necrotic change in it, and it
was doubtful whether, under these circumstances, re¬
moval of the ovaries would be followed by the desired
result.
Dr. Boxall drew attention to the difference in fibroids,
to variation in their position and mode of growth, and
of the symptoms to which they gave rise ; differences
which affected materially the question of operative inter¬
ference and the choice of the most suitable operation in
individual cases. He instanced several cases which pre¬
sented unusual features and, in particular, directed
attention to the necessity of taking measures to prevent
large abdominal fibroids from sinking into and becoming
impacted in the pelvis during the shrinkage whioh
usually takes place after the menopause.
Dr. Lewers replied.
BRITISH GYNAECOLOGICAL SOCIETY.
Meeting held Thursday, November 9th, 1899.
(.Report continued from our last issue.)
The President, Dr. Macnaughton-Jones, in the Chair.
Dr. R. H. Hodgson brought forward a case of
TUBERCULOUS PERITONITIS.
Full notes of this interesting case will be found on page
662. In the discussion that followed,
Mr. Charles Ryall remarked that the reason
of the disappearance of the tuberculous condi¬
tions in these cases was not known; it might
be brought about by means of the portal conges¬
tion whioh followed abdominal section. This view had
been carried out in practice in the treatment of
tuberculosis of the knee-joint, by compression of the
Digitized by CjOOglC
Nov. 29, 1899.
5«0 The Medical Press. TRANSACTIONS OF SOCIETIES.
veasels of the thigh. He did not think that any anti¬
septic was of much good in the peritoneum, since to kill
the bacilli it must alto kill the peritoneal cells. The beBt
peritoneal antiseptic was normal salt solution; the next
best was plain water.
Dr. C. H.F. Bouth eaid that the opening of the abdomen
was enough in many cases of tuberculosis to cure the
disease. He would not say that they should be satisfied
with opening the abdomen; but when nothing more
could be done, they might still hope for good results.
In the same way some cases of cancer were benefited.
It was on this principle that tuberculosis was cured by
the open-air treatment and by oxygen. It seemed to
him a very straDge thing to leave a drachm of carbolic
acid in the abdomen.
Dr. Inglis Parsons thought that they could accept
Dr. Hodgson’s diagnosis in this case. The use of car¬
bolic acid was interesting, and it did not appear to him
likely to be followed by toxic effects; for in all cases in
which there had been peritonitis they found that after
abdominal section there was very little reaction on the
part of the peritoneum. With regard to the effect on a
tuberculous peritoneum of opening the abdomen, it was
interesting to note that Howard Kelly mentioned
several cases in which a patient was operated on for
tuberculous peritonitis and died some time afterwards
from some other cause; the tubercles were still to be
found in the peritoneum, but isolated and encysted; the
tubercle bacilli also were there, but unable to do any
harm.
Mr. Bowreman Jessett believed that Dr. Inglis
Parsons’ explanation of peritoneal immunity was the
correot one, otherwise the patient would probably have
died, with a drachm of carbolic in her peritoneum. For
himself, he hardly dared to use carbolic for his instru¬
ments in abdominal operations.
The President said that he could look back to many
cases in which he had got quite unexpected credit for
cures after opening the abdomen for tuberculosis. The
reason for the improvement or the cure was not yet
quite satisfactorily explained. Dr. Hodgson’s treatment
with carbolic was rather heroic; but they should re¬
member that the peritoneum, of children especially, in
cases where there had been tuberculous peritonitis, did
really become case-hardened as Dr. Inglis Parsons had
said; and under those circumstances a drachm or two
of carbolic acid did not perhaps much matter. A similar
induration of the peritoneum was found in the case of
diseased appendages.
Dr. Hodgson briefly replied.
Dr. James Oliver read a paper on the
physico-chemical changes concerned in the pro¬
duction OF VERSION OF THE UTERUS.
This paper will be found in another column. The dis¬
cussion thereon was adjourned to the next meeting.
BOYAL ACADEMY OF MEDICINE IN 1BELAND.
Section of Pathology.
Meeting held Friday, November 3rd, 1899.
Dr. E. H. Bennett, President of the Academy, in
the Chair.
Dr. Arthur H. Benson and Dr. H. C. Earl exhibited
a series of Pathological EyeB, half globes, mounted in
formalin, and Microscopic Sections, (a) They showed
a specimen of glioma from a child, a?t. four months.
It was now seven months since the operation,
and so far do recurrence had taken place. (6) The
second specimen, sarcoma of choroid, was from a boy,
set. 3. On admissiou a fungating mass, the size of a
duck's egg, was protruding from the right orbit. The
contents of the orbit were removed, but it was found
that the orbit back to the posterior foramen was com¬
pletely filled with the growth, and the optic nerve was
so disintegrated that no trace of it was visible to the
naked eye. As the growth could not be entirely re¬
moved the prognosis was bad, and recurrence did actually
take place a month after the child's return home.
(c) The third specimen, epithelioma of cornea and
conjunctiva, was taken from a man, set. 69. The
whole cornea and part of the ocular conjunctiva
were covered by the growth, which was so extensive,
and seemed to penetrate so deeply into the sub¬
jacent tissue that it could not with safety be
excised, enucleation giving the man his only chance.
The tumour was unpigmented, flat, and sessile, with a
very broad base, and had ulcerated, (d) Bony degene¬
ration of choroid in a woman, set. 60, who had had a
diabotic cataract removed from one eye in 1898. It was
irritable and painful to the touch, and, as it was believed
to be the source of irritation in consequence of possess¬
ing a bony choroid, it was removed. The choroid was
found converted in its whole extent into a layer of true
bone. The lens was calcified but not ossified, (e) Intra¬
ocular haemorrhage. Patient, tet. 45, gave history of
cataract of right eye of four years’ duration. During
the last three months the pain in the eye had been very
severe, and one month ago a large haemorrhage occurred,
which filled the anterior chamber, and the pain became
constant and intolerable. The tension was about — 1,
and the globe had the appearance of a shrinking one.
Enucleation was performed. No cause for the haemor¬
rhage. which probably came from the iris, was found. (/)
Collapsed globe, after cataract removal, in a woman on
whose left eye a combined extraction of an opaque lens
was performed. An asthenic suppurative cyclitis
resul ed, the globe shrank, and the vision was lost in
the eye. Seven and a half months after the globe was
collapsed, and the right eye had a condition very sug¬
gestive of sympathetic ophthalmitis — serous iritis
keratitis punctata, pupil fixed, tension normal, and
slight circumcorneal vascularity. • The lens was opaque,
and no illumination of the fundus could be obtained.
There was no pain. As the shrunken left globe was
believed to be the cause of the trouble in the right eye
enucleation was performed. Four days later the patient
became delirious. She continued in a low state, and
thirteen days after operation refused food altogether, and
the bowels acted involuntarily. No organic lesion could
be found, and she died sixteen days after operation.
Mr. Henry Gray Croly exhibited specimens of (1)
fracture of the base of the skull; (2) sarcoma of testis.
The fracture of the base of the skull was the most
perfect he had ever seen. It extended through the
petrous bone, body of sphenoid, and ethmoid. The man
was found on the road in a pool of blood, and was
carried to hospital in a collapsed state. There was
great haemorrhage from both ears. He recovered con-
t sciousness sufficiently to say that he felt himself better.
; He lived for three days. There was no lesion of the
brain, and no haemorrhage into the brain. There was no
fracture of the vault of the skull.
The President recalled a case of fracture of the skull
in which the occipital and frontal regions could be
moved on each other. The maa recovered completely.
Mr. Croly, in reply, thought the case mentioned by
the President was one of fracture of the vault of the
skull. Men recover occasionally from fracture of the
base of the skull. In this case the remarkable fact was
that the man lived so long.
Dr. Knott showed some specimens of fractured
humeri. In connection with one showing fracture of the
lower end of the bone, he drew attention to the fact that
the epiphyseal line of the lower articular surface of the
humerus does not involve the condyles.
The President concurred in the diagnosis of one of
the specimens as a fracture passing obliquely through
the elbow-joint, as it had none of the features of an
epiphysary displacement.
Mr. Croly, referring to one of the specimens, pointed
out a fact which he thought a great many did not
know, and which Bobert Smith had drawn particular
attention to—namely, that epiphysary fracture of the
upper end of the humerus included the tuberosities. He
himself, in teaching fractures of the upper end of the
humerus impresses on his pupils that there were two
fractures of the surgical neck, one being epiphysary below
the tuberosities, one lower down in the surgical neck.
The line of fracture through the anatomical neck i
above the tuberosities. Speaking of the specimen D
Bennett had drawn attention to, he would certainly sa
Digitized by G00gle
Nov. 29, 1899.
GERMANY.
The Medical Puss 561
it was not an epiphysary fracture, since the oondyles
here were carried forwards instead of backwards, which
they knew was distinctive of epiphysary disjunction.
Dr. Knott, in reply, said that the epiphysary line at
the upper end of the humerus was always exactly
horizontal. In addition to the observation Mr. Croly
hid made that from the action of the triceps it would be
almost necessary that there should be a backward dis¬
placement in epiphysary disjunction of the lower end of
the humerus, there was also the point that his specimen
involved the external condyle, which it would not do if
it were an epiphysary disjunction, as the external
condyle did not belong to the epiphyses, but to the shaft.
The Section then adjourned.
cJrranct.
[from our own corresponding]
Paris, November 26th, 1899.
Wound of the Bladder.
At the last meeting of the Societe de Chirurgie, a
member related the case of a man who was wounded in
the bladder through a stab of the knife in the gluteal
region. The blade, after having traversed the sciatic
notch passed into the bladder, which was filled with
blood. Vomiting, accompanied with considerable dis¬
tension of the abdomen, decided the speaker to perform
laparotomy ; the peritoneum was untouched, but beneath
it existed a vast effusion of blood. A probe introduced
through the external wound showed that the wound in
the bladder was behind ; not being able to suture it, the
operator closed the abdomen and turned his attention to
the gluteal wound where he found the artery of the same
name cut. He passed a ligature on it without difficulty,
and the man recovered.
InTERCRANIAL A B8CE88.
M. Schwartz spoke on a case of intercranial abscess in
a girl of eleven years and cured by operation. The
patient suffered after an attack of scarlatina from sup¬
puration of the middle ear, and one day was suddenly
seized with cerebral symptoms of extreme gravity, and
the mastoid process became painful to pressure. The
apophysis was accordingly incised, and the cells found
to be filled with pus, but the operator was convinced that
there was a collection of pus inside the skull, tre¬
phined the floor between the antrum and the middle
fossa from the base of the brain through which a con¬
siderable amount of pus was extracted. The patient
recovered rapidly.
Chronic Eczema.
A confrere asserts that he obtains the radical cure of
chronic eczema where it occurs in isolated patches on
the upper extremities and so rebellious to the ordinary
method of treatment, as follows: after having washed
thoroughly with soap and water the part and dried it,
he rubs in vigorously a 50 per cent, solution of caustic
potash by means of a plug of cotton tied to a rod; he
then washes the spot freely with water, and, finally,
paints it over with a 50 per cent, solution of nitrate of
silver, and envelops the whole in aseptic cotton. This
dressing is left in place until the cicatrix has formed
beneath the slough, or from one to two weeks. The
itching ceases immediately after the application of the
caustics. Out of thirty cases thus treated, only one
required the operation a second time.
Herpes Zoster.
Every one knows what a painful affection herpes
zoster is, and how numerous are the local applications
prescribed as affording the best relief. It being due to
in flamma tion of the nerve supply of the region, quinine is
the natural internal remedy, but externally absorbent
powders and ointments have been plentifully advised
with more or less success. Dr. Bleuler says an ointment
composed of equal parts of lanoline and vaseline with
1 per cent, of cocaine provokes almost immediately
regression of the eruption, causing it to disappear
entirely in a few days.
A Travelling Needle.
A girl of seventeen presented herself to a doctor
in a locality well known to ire, complaining of
pain in the left breast of acute description. On being
examined a small tumour was felt which on pressing
gave the sensation of a foreign body with a sharp point.
The doctor recognised a needle or a pin, and cutting down
on it had the satisfaction of withdrawing a fine needle.
Questioned as to how it got there, the girl said that she
remembered having swallowed a few months previously
a needle by accident, but as it gave her no trouble she
had forgotten all about it.
(Hermans.
[from our own correspondent.]
Berlin, November 25th, 1899.
At the Medical Society, Hr. L. Landau showed
Two Extirpated Tumours.
One was a multiple fibroid removed by laparotomy*
The whole uterus, collum included, was removed'
During the operation it was seen that the cervix was the
seat of a carcinoma, which had not been and could not
have been recognised before. The hemorrhage and
emaciation did not point to it, as they were caused by
the fibroma. This carcinoma must have spread further
if supravaginal amputation had been performed, and
then it would have been thought to have developed in
the stump after operation. The case therefore showed
in a striking manner, like the seven earlier cases in
which operation had to be performed on account of
development of carcinoma in the stump, that supra¬
vaginal operation should be dropped and that total
extirpation was preferable. The second was a tumour
removed from a lady of 50, who two years ago had a
tumour the size of a child’s head, and which grew
rapidly. The emaciated lady presented the symptons of
a simple ovarian sarcoma. Whilst carcinoma was
generally two-sided sarcoma was usually unilateral and
the prognosis much more favourable, so that definite
recoveries had been observed in bilateral cases when the
sarcoma of one side only had been removed.
Hr. James Israel showed a
Malignant Tumour
from the inner inguinal ring, springing fiom an
undescended testicle. The patient, set. 30, had suffered
a year before from an attack of pain in the right
inguinal region, and noticed a swelling in the loins. The
speaker found a prominence of the lower abdomen;
taking in both halves, stronger in the right than in the
left, and on that side the testicle was absent from the
scrotum, and in place of it a sausage-shaped hydrocele.
The margin of the tumour was at the level of the
umbilicus upwards and below Pouparf s ligament to the
Digitized by LjOOQle
562 The Medical Press.
SOUTH AFRICA.
Nov. 29,1899.
left, four fingerbreadths beyond the mid line, the right
side taking in all that part of the lower abdomen. The
operation was difficult. The tumour was retro-peritoneal,
the lower surface in close connection with the iliac
vessels. Below there was contact with the bladder,
above the large intestine was displaced upwards, and
attached to the neighbouring parts, on the left the tumour
touched the sigmoid flexure. The extirpation was so
difficult from the fact that simple enucleation was not
sufficient, but it had to be carefully separated from its
attachments. Another great difficulty lay in sufficiently
protecting the large remaining cavity, the surface of whioh
was raw and not covered with peritoneum from infection.
The raw surface was united to the margin of the anterior
parietal peritoneum, so that the intestine was com¬
pletely protected, and could not come into oontact with
the wound. The tumour covered the tunica vaginalis
communis over the whole extent, and showed itself
microscopically to be an alveolar sarcoma, that on hasty
observation might easily be mistaken for a carcinoma.
Jluetria.
[FROM OCR OWN CORRESPONDENT.J
Vienna, November 25th, 18tt».
Tabic Arthropathia.
Schnabel exhibited a young man, set. 33, at the last
meeting of the “ Gesellschaft der Aerzte” with tabic
arthropathia of both ankle-joints.
In 1890 he suffered from an ulcer on the frenulum
preputii accompanied with other specific phenomena.
Three years later he suffered from severe lancinating
pain in both legs. Four years ago for the first time a
swelling commenced to form on the left foot followed in
a short time by a similar enlargement on the right, but
with no special history of severe pain. Since the com¬
mencement of the present year the position of the
feet has rapidly changed, and they are now twisted
outward at the ankles, having every appearance of
talipes varus, more particularly the left. The bony
swelling of the lower end of the tibia and os calcis is the
cause of the displacement.
The tabic symptoms are to be found in the lancinating
pains, the Westphalia phenomena, and the minimum of
pain in its production. Against this, however, there is
no ataxia, nor pupillary symptoms. Syringomyelia may
be excluded, as there is nothing present to support the
hypothesis.
Lupus and Rontqen Rays.
Thumwald brought forward a young man whom he had
treated with Rontgen rays for lupus on the face with the
best result. It had originally been treated in the
orthodox surgical manner without effect; it was scraped
and painted with an 80 per cent, of laotic acid with do
benefit. After a short term of treatment with the rays,
the disease has quite disappeared.
Poliomyelitis in the Adult.
At the “ Medical Club ” Redlich showed a patient, cet. 49,
who earlier in life bad been in charge of a railway station,
but recently had been a tramway conductor. About a
year ago he had a sharp pricking pain in the right foot
which soon passed off but left a weakness behind, this has
gradually increased and extended up the leg till February
when he found he could no longer perform his usual du ty
In July the same weakness oommenoed in the right leg,
gradually increasing with the same wasting of the
muscles. Patient had always been healthy up to the
pain in foot; no evidence of syphilis; a non-Potus; and
no trace of injury to be discovered.
His present appearance when standing has a waving
character, not ataxio, but rather due to the weakness of
the muscles. The atrophy since July has been very
marked, with fibrillary contractions in the muscles of
the thigh. He still has a little power in the lower and
upper part of the left leg, but the foot is quite paralysed.
The patellar reflex is active; the Achilles tendon reflex
in right absent, in left present; sensibility intact; de¬
generation extensive; while there is no bowel or bladder
disturbance.
The first thought in this case would be alcoholic poly¬
neuritis, but the usual pain and paraeesthesia, as well as
the historical “ Potus,” are absent. Again, toxio agents
such as lead and diabetes, might produce similar effects,
both of these, however, were absent. It was finally left
to distinguish between muscular atrophy and chronic
poliomyelitis. Against the first is the localisation, the
comparatively rapid course and the complete atrophy of
the muscle; while in muscular atrophy, the degeneration
would be in bundles and the course would be slow and
gradual.
Although the symptomatic diagnosis may be thus
easily differentiated the pathological anatomy cannot be
so readily defined, as both are due to a degeneration of
the ganglionic cells in the anterior horns of the cord.
Raynaud’s Disease.
Neurath exhibited a five-year old boy who has suffered
for the last two years from attaoks of cyanosis in the
distal parts of the body, such as the fingers, ears, and
point of the nose, which is accompanied with swelling
and blisters. Neurath stated that he had observed these
attacks personally, and on many occasions they had lasted
for days at a time. He is of opinion that they have
some connection with the effects of cold on the system,
and believes that thiB case has now reached the second
stage of this complex disease. The third stage usually
ends in gangrene and death. The prognosis in such
cases is very uncertain, as no drug has hitherto been
effectual in warding off the danger of subsequent
gangrene. Iron and arsenic seem to be the principal
agents held in respect, but their action has seldom been
successful.
§mith Jlfrica.
[from our own correspondent.]
THE TRANSVAAL WAR.
Our Special Correspondent at Cape Town sends us
the following interesting summary of events. His
letter is dated November 12th, and states that
everything has been put aside in medical circles in
order to provide in every possible way for the care and
comfort of the sick and wounded■
The only general hospital that had been fixed upon
at the time of writing was that at Wynberg, a suburb
of Cape Town, where the whole of the barracks have
been utilised for hospital purposes, affording accom¬
modation to about 600 men. The hospital is excellently
fitted up with every modern appliance. Colonel Anthones
Digitized by LjOOQle
Nov. 89. 1999.
THE OPERATING THEATRES.
Thi Medical Pbim. 563
is in oommand , with Colonel Grier as secretary and
registrar.
As at present arranged, all the sick and wounded from
Natal are to be brought there, a very wise determination,
as the ooast climate of the Garden Colony is most
depressing at this time of the year. The Wynberg
Hospital is in a most healthy situation, well up the side
of Table Mountain, and tbe climate in the Cape Peninsula
is, even in the midst of summer, never oppressively hot or
damp. A batch of sick and wounded have already
arrived, and are doing well. The * Spartan,’ which has
been entirely reconverted for hospital ship purposes, has
just gone to Natal for another consignment.
It is possible that one or two more General Hospitals
may be established, perhaps at East London and Port
Elizabeth, but that depends upon the General’s line of
advance. Station Hospitals will, of course, be fixed at
various points up country.
Surgeon-General Wilson has taken over the chief
command from Colonel Supple. Two well-equipped
ambulance trains have been constructed locally, and will
be used for conveying sick and wounded down the line.
Detachments of the St. John’s Ambulance Association,
Cape Town Centre, will take charge of these trains from
De Anar downwards. These detachments are under¬
going drill in train work daily at the Station Hospital.
The same Association will take charge of sick and
wounded from the Cape Town Docks to Wynberg.
Dr. Hoffman, Member of the Assembly for the Paarl,
a very active Bond politician, has joined the Free State
forces with an ambulance party of ten, all laymen, one,
however, being an ex-medical student. At the last
moment, he applied to the local St. John’s Centre for
permission to go under its authority. After some con¬
sideration due to the fear that the mission might be in
some way a political one, the permission was granted on
the distinct understanding that the party was to be
absolutely bound by the Geneva rules, and by the regu¬
lations of the St. John’s Association.
Abundance of civilian help, both professional and nurs¬
ing, is being offered to the military authorities, but
owing to the large number of medical officers, civil sur¬
geons, and nurses sent out from England, it has not
been made use of as yet.
In Natal, however, civilian aid is well in evidence,
likewise at the beleaguered towns of Mafeking and
Kimberley.
Dr. Buntine, surgeon to one of the Natal Volunteer
Corps, greatly distinguished himself at Elands Laagte,
and, it is said, is to be recommended for the Victoria
Cross.
(Dptratmg theatres.
GREAT NORTHERN HOSPITAL.
Operation for so-called Fibro-Lipoma of Nose.—
Mr. Pbyton Beale operated on a man, tet. 45, whom he
saw at the request of Dr. Whitfield. The patient had
been attending Dr. Whitfield’s dermatological clinic
suffering from large pendulous deformity of the nose,
commonly described as fibro-lipoma. The man being
very anxious to have the disfigurement remedied, Dr.
Whitfield had advised him to become an in-patient,
and had suggested to Mr. Beale that he should
shave off the pendulous masses. The patient was
ansesthetised and the noee cleaned as far as possible.
The pendulous mass os were then shaved off with a
sharp scalpel until the noee was reduced in size and
appearanoe to that of the normal organ. Some of the
pieoes removed were three-quarters of an inch in thick¬
ness ; the bleeding was, of course, very profuse, but no
vessels which oould be clamped were visible. The nose
was dressed with layers of oyanide dressing
(on the removal of this the next day, a
layer of protective and gauze was substituted,
the nose was dressed daily, and by the fifth day the raw
granulating surface was found to be studded all over
with islands of epithelium, these gradually coalesced,
and on the tenth day the nose was almost entirely
covered with new skin). Mr. Beale remarked that these
so-called fibro-lipomata of the nose were in reality large
masses of hypertrophied sebaceous glands with some
fibrous tissue between them. On microscopical
sections this tumour was found to consist almost
wholly of sebaceous glands and large circular
spaces lined with apparently normal stratified epithe¬
lium. This condition was present even in the very
deepest parts of the growth. It was thus evident that
the only treatment required was free removal, subse¬
quent skin-grafting by Thiersch’s method being in no
way neoessary. During the process of shaving off the
tumour he said it was advisable to feel for the cartilage
with the finger, so that a small amount of tissue might
be left covering the cartilage.
Supra-Pubic Cystotomy for Calculus. —The same
surgeon operated on a man, ®t. 60, for vesical calculus.
The point of interest in the case was the absence of sym¬
ptoms of stone. The patient came to the hospital com¬
plaining of blood in the urine from which he said he had
suffered on two occasions previously during the last year*
The blood appeared in large quantities, and was persistent
for a few hours only. The presence of the blood was not
influenced by movement or exertion, but had appeared on
each occasion after a night’s rest. He was admitted as it
was supposed he had a papilloma of the bladder. A sound
was passed, and it only detected what appeared to be a
large stone lying at the base of the bladder. This was re¬
moved by supra-pubic cystotomy, and was found to be
triangular in shape with rounded edges, 2} inches in its
largest diameter, 1 inch thick, the greater part phos-
phatic in nature, but the centre composed of urates.
Mr. Beale said it was a curious fact that the
presence of blood was the only symptom of so
large a stone; moreover the blood had only ap¬
peared three times and the surface of the stone was
fairly smooth. He supposid that the stone had been
partially encysted at the base of the bladder, and that
the hemorrhage occurred when for some reason or
another the stone had slightly shifted its position. The
interior of the bladder was thoroughly examined at the
time of operation, and nothing but a slight roughness
of the mucous membrane at its base oould be detected.
ROYAL EAR HOSPITAL.
Removal of the Membrane, Malleus and Incus
for Chronic Non-8uppurative Middle-ear Disease.—
Mr. Arthur H. Cheatlk operated on a man, ®t. 20,
who for some years had suffered from gradually increas¬
ing deafness in both ears, and who once previously had had
adenoids removed but with no good effect to his hearing.
On examination of the ear it was seen that the mem¬
brane and malleus were retracted, and on applying
Digitized by t^,ooQle
LEADING ARTICLES.
564 Thb Mxdical Pares.
Siegle’e exhausting speculum it was seen that they
were closely adherent to the promontory, thus account*
ing for the non-improvement after the previous removal
of the adenoids. Inflation through the Eustachian
tube produoed no improvement in hearing nor in the
position of the membrane, but the tone conduction
was good, and the patient desired everything possible to
be done to improve his hearing for the purposes of his
work, therefore it was decided to remove the membrane*
malleus and incus, and so to expose the head of the
stapes to the direct influence of sound waves. The
auricle'and meatus having been thoroughly purified, espe.
cially the cartilaginous portion of the meatus, the patient
was placed under chloroform, the ear again purified (the
man being laid prone turned three-quarters to the
right side under a good reflected light), an incision
was carried round the periphery of the membrane
with a sharp pointed knife, and the malleus freed
from its adherence to the promontory. Delstanche’s
ring knife was then looped over the handle of the
malleus, and passed upwards in order to divide the
tendon of the tensor tympani; the malleus was then
extracted by means of a strong pair of forceps as high up
as possible, being first pulled downwards to free it from
the attic and then outwards. The incus was then turned
out of the attic into the lower middle ear by means of a
Lake's incus curette, and removed with forceps. The
middle ear was then gently mopped out and the canal
plugged with double cyanide gauze wrung out with 1 in 40
carbolic solution, an outside dressing and bandage being
applied to the auricle, which would remain in situ for a
week. Mr. Cheatle spoke of the great importance of
antiseptic precautions, which did away with all risks
they being as applicable to the auditory meatus as to any
other part of the body ; for the purification carbolic lotion
1-20 was especially useful as it penetrated greasy sub¬
stances. The cartilaginous meatus, he said, required
thorough scrubbing with a strong mixture, that is, 1-20
carbolic acid, in which is 1 in 600 part of
perchloride of mercury ; the 1 in 20 is instilled into th e
meatus for 15 or 20 minutes before the operation ; no
evil effects are produced by these strong solutions beyond
slight desquamation. "With regard to the prospects of
improvement in hearing following the operation, it had
been pointed out to the patient that no good results
might be obtained. If when healing had occurred at
the end of a fortnight or three weekB, no improvement
was noticed, the effect of an artificial membrane placed on
the head of the stapes would be tried, and if no improve¬
ment then occurred, it would be inferred that the stapes
might be bound down by adhesions round its crura or at
its base which would require subsequent deal¬
ing with. The importance of excluding any
internal ear complication by means of the tuning fork
was, he said, of the utmost importance, as any signB of
internal ear impairment contra-indicated operation. He
remarked that sometimes there is difficuly in removing
the incus; in using any form of incus hook it was im¬
portant to place it well into the cavity of
the attic in its anterior part and to rotate it
backwards and downwards on its own axis. Difficulty
may be experienced too in finding the incus after it has
been turned into the lower middle ear, on account of the
bleeding obscuring the ossicle; syringing, he said, may
remove it in such a contingency.
The patient subsequently had no pain, no temperature;
Nov. 29, 1S99.
on removing the dressings in a week it was too early
to judge of any improvement in the hearing. The im¬
portant point was the absence of any sign of infection.
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8ALC8 POPCLI SCPREMA LEX.”
WEDNESDAY, NOVEMBER 29, 1899.
MEDICAL POLITICS AT NEWCASTLE-ON-
TYNE.
The meeting organised by the North of England
Branch of the British Medical Association, which
took place at Newcastle on-Tyne on Wednesday last
may be interpreted as a sign that the medical pro¬
fession is awakening to the imperious necessity of co¬
ordinated action with the object of improving the
status and safeguarding the privileges of medical
practitioners, not only in regard to the public
but also in respect of their domestic arrange¬
ments. The addresses of the three direct repre¬
sentatives show that although they envisage the ques¬
tion of reform from different standpoints they are all
convinced of the urgency of taking concerted
measures to remove, at any rate, the more salient
abuses. Some of these, it may reasonably be sup¬
posed, may be overcome by steady pressure brought
to bear on the governing bodies, but others, not the
least important, will probably require legislati re in¬
terference. Mr. Victor Horsley, with characteristic
vigour, attacked the actual constitution of the
General Medical Council, but he shifted the onus
from the Council on to the shoulders of the “ extra¬
ordinary series of little oligarchies ” who appoint
by far the greater number of the members of that
Council. Without going so far as to allege that
the councils of the various licensing bodies
have “ usurped ” the right to speak and act os the
representatives of their corporations, it is evident
that in exercising that power they arrogate to them¬
selves a position and influence out of all proportion
Digitized by v^.ooQLe
_ Not. 29, 1899. _ LEADING ARTICLES. Th Xtdical Pbbu. 566
to tbeir intrinsic importance, seeing that their titioners are at present left free to ally them-
alamni have, for the most part, no voice or influence with these medical aid societies, but he
in directing the course of events. Even if the apparently pins his faith to the Conciliation Board,
functions of the Council were limited to regulating a £aith which ig apparent i y not shared by the bulk
medical education the presence on that body of such of hig constituents. Doubtless this Board may
a crushing preponderance of representatives of purely enable the Council and the societies to tide over
examining bodies would be objectionable because their pre8ainf? difficulties, but we do not believe that it can
interests do not favour a high standard of medical ^ trU8ted to place the matte r in a position
education but, on the contrary, entail the qualification wbich ^ fche ^e nera i petitioner. It
of a maximum number of candidates. Of late years, ifJ rather odd thftt none of the 8pe akers seem
however, the other functions of the Council have to have dealt with the que8 tion of hospital abuse
intruded themselves more and more on the attention which) all ia a gre&t and preB9 ing evil;
of the profession, and under pressure of public in deed, between the open doors of the charity-
opinon those functions tend more and more to occupy 8Upported hospital and the omnivorous maws
the time and energy of the Council, thanks especially of and medica i aid the general pruc
to the vivifying influence of the direct representa- titioner daily finda h i 8 sphere of activity circum-
tives who, whatever may be asserted to the contrary, 8Cribed and his means of gaining a livelihood
are indisputably more in touch with the aspirations and reduced. Still, we are glad to bear witness to this
needs of the profession than their academic colleagues, exhibition of interest ia matters which so intimately
From this point of view we share with Mr. Horsley the concern the gravest interests of the profession, and
regret that “ our unfortunate profession sbould be we trust that this meeting may prove epoch-marking
doubly governed by a series of Bmall oligarchies in the movement for the consolidation and advance-
who regard themselves as entirely irresponsible ment of the medical profession.
to the great body of practitioners, their colleagues in _
the profession to which they have the honour
to belong." The alleged apathy of the general THE LONDON CONJOINT EXAMINATION
practitioner in voting for direct representatives, . AND THE L.S.A.
which is made use of as an argument for refusing to I T niust be rather difficult for many London students
countenance any addition to their number, is very to decide which of the qualifications to choose, the
possibly attributable to the consciousness that the M.R.C.S, L.R.C.P., or the L.S.A. The course of
presence at the Council Board of a sprinkling of 8tudy required to be followed during the five years
direct representatives cannot avail much against the which must be passed between the dates of registra-
interested opposition of a large majority of the dele- tion and qualification is the same very nearly for
gates of corporations. Mr. Horsley is especially hard both the Conjoint and the L.S.A.; and, as far as
on the method of conducting the legal business the examinations are concerned, we believe that there
of the Council, and it is generally admitted, is but little difference between them. We are glad
even in the bosom of the Council, that there to see that the rivalry between the corporations
is plenty of margin for improvement in this direction, which have legal power to give diplomas is not so
The time is past, we imagine, when senior members active as it was a short time ago ; and the Society of
of the profession will dare to asci'ibe movements Apothecaries may fairly entertain some hope of
towards reform as the outcome of “an insignificant carrying on its work as an examining body without
coterie of discontented men,” for the questions now fear of extinction in that respect. The old system fol-
before us interest all who are engaged in general lowed by the majority of students when the Society of
practice to a degree which they are only beginning to Apothecaries had no surgical examination was of
appreciate. Mr. George Brown was hardly less course to obtain the M.R.C.S. and L S.A. Now,
decided in his views as to what it behoves the profes- however, that is not possible : and as the L.R.C.P.
sion to aim at, but his panacea seems to be that Will- may be regarded generally as superior to the L.S.A.,
o’-tbe-Wisp one-portal system which has several the conjoint diploma must appear to be superior to
times been apparently on the eve of becoming law, but the L.S.A. alone. Now the question of the difference
is still out in the cold. Much as has the one-portal sys- between the two ought to be considered. The Society
stem to recommend it, and anomalous as is the present of Apothecaries is clearly intended for that great
multiplication and constitution of the various licensing class of practitioners in this country who do not
bodies, these reforms would not seem to be as urgent entrust the supply of remedies to the pharmaceutical
as certain others, notably the increase in the number chemist, but keep in their own hands the dispensing
of direct representatives, the raising of the standard thereof. There are great advantages to the public in
of preliminary education, the better protection of encouraging the continuance of this plan in many
practitioners against the competition of quacks, and parts of the country, partly for the sake of economy,
the regulation of the relationship of medical but chiefly for the security provided for the work
officers to touting medical aid societies. Though being properly and, above all, promptly carried out.
less emphatic in his denunciations. Dr. Glover It seems to us that when the intentions of a student
also recognises the desirability of a revision are to settle down in country practice, or to go abroad,
of the conditions under which registered prac- it is well for him to secure the right to dispense
Digitized by LjOOQle
566 Th* Msdical Pbsss.
LEADING ARTICLES.
Nov. 29,1899.
his own medicines and to obtain the knowledge re¬
quired to do so. We distinguish three very distinct
divisions in the work to which a student must devote
himself when preparing for practice, as well as after
he is qualified. One is the study of diseases, which
of course includes the observation of their symptoms,
and their morbid anatomy or pathology. The
second class is that to which the general term surgery
applies. The third class is the treatment of diseases,
and this of course requires knowledge of the proper¬
ties of agents and their proper use in treatment.
We are right, we think, in assuming that it is the
object of the College of Physicians to encourage the
first class of studies ; of the College of Surgeons to
encourage the second class; and of the Society of
Apothecaries to encourage the third class. But the
question of first importance to decide is whether it is
to the advantage of the public or not for the prac¬
titioner to have the knowledge and right to supply
his patients with remedies without having to send
them with his prescriptions to a chemist. The
Eaglish system differs in this respect from the
continental system; and we are disposed to take the
view that the English system is for the present
best suited to the requirements of the public,
because it makes adequate provision for the
supply of medicines in a multitude of small
country districts in which a dispensing chemist
could not maintain himself. The continental system
gives the chemist more power than is de¬
sirable, and we fear that in this country there is
a growing tendency for the public to resort to the
chemist for advice as well as medicine. If the
London Colleges of Physicians and Surgeons were
united with the London Society of Apothecaries and
had one examination in which the three divisions of
study were equally considered, it would be better for
all concerned, and then their licentiates would have
the right to consult their own interests according as
circumstances and the nature of their practice re¬
quired in dispensing their own medicines or not.
Nevertheless we apprehend that there are many who
hold the view that the dispensing of medicines by
the practitioner, that is an open surgery, must be
regarded as a regrettable expedient, essential but bad
in principle, and to be got rid of as soon as circum¬
stances permit. On the other hand, there are those
who take a different view, and consider that it will
certainly be discreet for the practitioner to arm him¬
self with such qualifications as will enable him to
provide for bis patient’s wants.
ALCOHOL IN WAR.
The practical test of a campaign conducted in a
far distant country has been applied to the British
military system, with results that are not on the
whole unsatisfactory. At the same time it would be
idle to deny that various defects have been brought
into the light of day. The navy commissariat organi¬
sation, for instance, has shown itself worthless so far
as providing sound food for the transport ships, and
it is to be hoped that when the war is over a
searching Government inquiry will be conducted
into this all-important detail of transport work.
Then, again, theutter inadequacy of the Army Medical
Service to the needs of the situation has been proved
to demonstration. A large number of supernumerary
civilian, and of Indian army surgeons have been
despatched to the seat of war, while the army at home
has been depleted of its surgeons. In consequence,
civilian medical men have been engaged to undertake
the regimental supervision of military stations
throughout the United Kingdom. In not a few
instances, these important duties, both at home and
abroad, have been entrusted to newly-qualified men,
who are clearly without the experience necessary to
render them competent for such posts. Indeed, with
a full sense of this responsibility, we do not hesitate
to say that the War Office is not to be envied the
heavy risk it is incurring by handing over whole
regiments of British soldiers to the care of fledgling
medical men, whether the sphere of the latter be at
home or at the Cape. All these straits were pro*
phesied long ago, and the War Office authorities
have only to thank their own system which has been
founded on disastrous lines of social arroganoe and
false economy. No doubt when the piping times of
peace are once more upon us a Government inquiry
will find further material for investigation in Army
medical administration and organisation. The in¬
troduction of aseptic surgery and the perfecting of
the medical branch of the Service, to say nothing of
the latest wonder, the Rontgen rays, have done a
vast deal towards alleviating the horrors of
war, and the saving of life from casualties. Perhaps
one of the most significant signs of the times may be
found in the different place assigned to alcohol in
the conduct of modem British warfare. This subject
was well discussed in the Forum of last May in an
article written by Mr. W. K. Rose, the able Reuter’s
correspondent in the Soudan campaign. In the old
days, when it was the fashion of our forefathers in
every station of life to drink to excess, the practice
was carried into active service, whether ashore or
afloat. Indeed, it was not uncommon for many
battles to be fought by soldiers more or less
under the influence of “ Dutch courage.” But now¬
adays we have changed all that. The modem
general has learnt the lesson that the hardships of
campaigning, however inclement or deadly the
climate, may best be borne without the aid of alcohol.
So long ago as the Indian Mutiny some of the greatest
feats of endurance were performed by Havelock’s
men upon coffee alone as a beverage. In the Red
River Expedition of 1870, under General Wolseley,
no spirit ration was issued, and it is recorded by the
medical authorities that no men could have enjoyed
better health than the troops concerned. In the
tropical climate of Central Africa the use
of mm was formerly regarded as a specific
and necessary precaution against the deadly
diseases of those regions. The old-fashioned
ration of mm, however, was discontinued in the
Ashantee war of 1873; also under the command of
General Wolseley. The result of that omission was
Digitized by Google
Nov. 29, 1899.
ftOTES ON CURRENT TOPICS. The Medical Pbebs. 567
most encouraging, for the total mortality from all
causes amounted to the surprisingly low figure
of 3*14 per cent, of the whole strength of the British
troops. In the Kaffir war of 1877-78 the use of rum
as an ordinary ration was prohibited, and the health
of the force engaged was excellent. In the more
recent campaign in the Soudan the Sirdar wisely
prohibited all alcoholic liquors, and a quantity of
villainous smuggled spirit was summarily dis¬
posed of by pouring it out upon the sands of
the desert. Without alcohol the men engaged
in that expedition quickly grew into fine
condition as regards general health and endurance.
In short, these experiences simply prove that it is not
the climate that is so' deadly to Europeans as their
habits, which, in the case of alcohol, predispose to
disease and lessen the powers of resistance
and recovery. The growing intelligence of
modern times has widely recognised the needlessness
of alcohol in everyday life, although there can be no
doubt as to its value as a stimulant when ad¬
ministered under proper medical control. In this
subordinate and restricted manner alcohol will play
its part in the war now being waged in South Africa,
but it will not be needed to accentuate or to call
forth the splendid and traditional valour which has
long made the British soldier the envy of the world.
on Current topics.
The Present Position of the Vaccination
Question.
The first annual dinner of the Association of Public
Vaccinators, which took place on Saturday evening
last, afforded a convenient opportunity to Mr. Clim-
son Greenwood, the president, to dilate upon the
grievances of public vaccinators, and to Mr. Chaplin,
M.P., to discvss the general bearings of the last Act.
Little had been heard before of the grievances in
question, probably because public opinion was much
more concerned with the question of principle than
with the working details. The insecurity of their
tenure of office, the absence of all control
on their part over the vaccination officer and
their humiliating dependence on the guardians
are so many points calling for reform. The
independence of the Medical Officer is at least as im¬
portant, from an administrative point of view, as that
of the vaccination officer whose position has now been
judicially defined, thanks to the steps taken by the
Local Government Board. The speech of the evening,
however, was that of the President of the Local
Government Board, Mr. Chaplin, M.P., who prefaced
bis remarks with an assurance that if it could be
shown that the position of a public vaccinator had
been prejudiced in any way because he honestly tried
to do his duty he would not fail to come forward
in hiB support. After disposing of sundry critic¬
isms on the lymph supply he proceeded to
compare the position of things at the time of the
passing of the Act, 1898, with that which now
obtains. Before 1898, he observed, at least a third of
the local authorities had virtually declined to fulfil
their duty in reepect of enforcing vaccination, with
the result that some 300,000 children remained every
year unvaccinated. He declined any responsibility
for the introduction of the “ conscientious objector,”
but pointed out that, since the passing of the Act,
children had been vaccinated at the rate of 150,000
more per annum. He defended the action of the Local
Government Board in respect of vaccination officers,
pointing out that many other officials, occupying
more or less similar positions, had their duties
prescribed for them entirely irrespective of the
guardians; indeed, as he effectively pointed out, it is
difficult to see how the public interest could be served,
or public business carried on, if the central depart¬
ment were to have no authority in these matters. This,
indeed, was the only alternative at the disposal of the
Government if the Act was not to be allowed to
prove a disastrous failure. The right honourable
gentleman concluded his remarks with a valuable
hint to the supporters of vaccination, as to the value
of an effectual propaganda. Why, he asked, did those
who were so clamorous against the Government
when the Bill was before Parliament not start an
opposition, a vaccination league, whose business it
would be to explode the fallacies of that other body
which had done, and was doing, its best to prevent
vaccination, adding that such a league would do more
in the cause of vaccination than anything the
Government might do.
The End of a Noxious Trade.
The result of the trial at the Old Bailey last week
of the persons trading as “ Madame Frain ” will, we
trust, have the effect of putting a stop to the practices
of all those unprincipled persons of the same ilk, whose
career so far has been unchecked by the law. In some
respects the trial in question has proved a most
important one. In the first place it was con¬
spicuous for having been undertaken at the
instance of the Director of Public Prosecu¬
tions. This undoubtedly showed that the evil
with which it dealt had at last been officially recog¬
nised, and that the decision had been arrived at to
put the law in force against it. Now that one
prosecution of the kind has terminated successfully
there should not be much difficulty in proceeding in
other cases in which the evil flagrantly exists. But
it was clear from the elaborate and careful statement
of the judge on the law of the case that the legal
points involved were not by any means simple. The
statement in question was made in reply to the
plaint of the defendants' counsel that there was
no case to go to the jury against the defendants.
The claim was that there was no evidence of criminal
attempt. But Mr. Justice Darling took a different
view of the case. “ I have given,” he said, “ my best
consideration to this matter, and I will state a little
fully what my view is, because it is perfectly plain
that this case raises, probably for the first time,
questions on a very difficult branch of the law—ques¬
tions as to what is or what is not, in given circum¬
stances, a criminal attempt to do a thing, and how
Digitized by Google
568 The Medical Press.
NOTES ON CURRENT TOPICS.
Nov. 29, 1899.
far a person inciting is or U not criminally
responsible. The conclusion I have come to is this>
that if the woman, believing that she is taking a
noxious thing within the meaning of the statute,
does, with intent to procure abortion, take a thing in
fact harmless, she is guilty of the attempt to procure
abortion within the meaning of the statute. I have
also come to the conclusion that if the person inciti¬
ng the woman to take the noxious drug himself
believed that thing to be a noxious drug capable of
procuring abortion, he would be guilty of inciting her
to attempt to commit the crime, although, owing
to facts being otherwise than he believed, the com¬
mission of the crime in the manner proposed was
impossible.” The jury presumably could not fail to
be impressed with this expression of opinion, more
especially since the evidence showed that the pills
sold by the defendants were of a noxious character,
and would act as abortive agents if taken in the
quantities recommended. In the end a verdict of
guilty was returned, and substantial terms of
imprisonment meted out to the guilty principals.
A second point of great importance in connec¬
tion with the trial was the deliberate warning
given by the judge to all those newspaper proprietors
who publish advertisements of the kind which
made the business of “ Madame Frain.” Mr. Justice
Darling pointed out that if this practice were
continued, the owners of the journals in
question might find themselves in the same
position as the defendants at the trial. There can
be no doubt that the suppression of these advertise¬
ments will have a most salutary efEect in the preven¬
tion of the evil. Moreover, without such temptations
to resort to criminal proceedings, unmarried women
would be less likely to fall astray; and without such
scandalous incentives to crime there would be less
inducement to the married to interfere with the course
of Nature.
Homoeopathy and Surgery.
It is interesting to note that at least one homoeo¬
path ist recognises that there is something better than
homoeopathy, namely, surgery. In this connection a
curious correspondence recently took place between
Lord Dysart and the Committee of the Grantham
Hospital. Lord Dysart is an ardent homoeopathist,
and, at the same time, he is a subscriber to the
Hospital. In this latter capacity he has offered to
double his subscription if the Committee of the
institution will undertake to exclude all internal
treatment for the patients except in very
extreme cases. The noble Earl intimated
also that he was desirous in every way
of supporting the practice of surgery, but that he
intensely disliked supporting an institution which
adopted antiquated and unscientific methods of
internal medicine, while it was unreasonable to expect
him to support a system of medicine, which besides
not being up to date, was doing much harm to the
public. These are his Lordship's views upon the
practice of medicine in the present day, and to say
the least they can scarcely be described as compli- I
mentary. Most persons, however, we imagine,
instead of agreeing with his Lordship on
the matter would be disposed to hold that
homoeopathy was out of date, and not the present-
day practice of medicine. We fear Lord Dysart is
altogether talking about a subject of which he can
have but little knowledge when he expresses himself
to the effect that homoeopathy is an up-to-date
system of medical treatment. No statement could
be more absurd. If science has proved anything it
has shown that homoeopathy is as unscientific as it
is now antiquated. It is interesting to record, how¬
ever, that the committee of the Grantham
Hospital replied to his Lordship to the effect
that they could not see their way to suggest
any alteration in the existing management of the
hospital, but they gave their assurance that Lord
Dysart's subscription would be devoted entirely to
the relief of surgical patients. Possibly this means
that the money will be expended in purchasing anti¬
septic dressings.
The Lesson of a Small-Pox Epidemic.
The lesson of the last small-pox epidemic in
Warrington has evidently not been lost upon some
of the inhabitants, as the following incident will
show. A man who filled the role of “ conscientious
objector ”—applied to the local bench of magistrates
last week for a certificate of exemption from vaccina¬
tion. He was asked by the Mayor if he had been in the
town during the last epidemic, and to this query a nega¬
tive reply was given. Whereupon the Mayor remarked
that the epidemic had shown that in proportion as
re-vaccination obtained the disease had diminished,'and
the sad experience which they had had of the ravages
of small-pox had taught him that vaccination was a
necessary prophylactic. The Mayor then left the
Bench, stating that he, for one, would not grant the
certificate applied for, but that his brother magis¬
trates could do as they liked. The end was that
eich of the other magistrates followed the Mayor’s
leading, and the “ conscientious objector ” was told
that if he wanted his certificate lie would
have to make an application upon another day. The
incident is a significant one from several points of
view, and more especially as showing how easily the
common sense of these magistrates disposed of one
of the most grievous fads of the present day.
The Mauser Bullet.
It is not unnatural that great interest should now
be taken in the wounds inflicted upon our soldiers in
South Africa by the Mauser bullet. As is well-known,
the Mauser rifle is the weapon with which the Boers
are chiefly armed, and the present war is the
first occasion upon which the effects of its
projectile have been seen in European troops.
Numerous cases are reported of soldiers wounded by
Mauser bullets now lying in the Wynberg hospital.
It is stated that an examination of the wounds shows
that this bullet makes a cleaner track through bone
and soft tissues than the Lee-Met >rd, and that the
aperture of exit is not larger than t.iat of entry. But
Digitized by Google
NOTES ON CURRENT TOPICS. The Medical Press. 569 .
Nov. 29, 1899.
if the objection to the Lee-Metford bullet is that
it fails to stop “rushes,” how does this objection
apply to the Mauser, whose wounds seem to be
less deadly than the former. The rational con¬
clusion must be that the less the injury inflicted
by the projectile the less must be its “stopping"
power, and if the Mauser bullet-wounds are less
severe than those of the Lee-Metford, unserviceable
a weapon as the latter is said to be, the former must
be still more so. It will be interesting, after the war
is concluded, to learn the opinion of experts upon
this matter. It would seem that the modern rifle
has reached bucIi a state of mechanical and scientific
perfection, that its bullet must injure a vital part
before the life of a soldier is endangered. In the days
of “ Brown Bess ” many a trivial wound meant
death to the injured man. So, after all, even if
war in the present day is conducted upon extremely
scientific lines, its effects may be less terrible than in
early days from a humane point of view.
The Dublin Conjoint Examinationa
The report of the July examinations (presented, it
will be observed, four months after date, by the Com¬
mittee of Management) records a decadence in the
number of candidates compared with the same period
of last year— 239 as against 251. An analysis of the
figures explains this falling off and is highly instruc¬
tive for the Dublin teachers. It will be recollected
that the College of Surgeons felt obliged, a couple of
years ago, to take serious notice of the persistent and
excessive rejections in Physiology and Histology at
these examinations, with the result that the rejection
percentage dropped largely. It would appear that
the examiners in these subjects have reverted to their
former policy, for we see that, at the second exami¬
nation in July (at which the subject is predominant)
45‘3 per cent, of the candidates were rejected in these
subjects alone, the average in all subjects of that
examination having been 57 0 per cent. Sixty-nine
candidates offered themselves for this examination
against 90 this time last year, and it is noteworthy
that 9 of these offered themselves in one subject
only, presumably most of them candidates having
been previously rejected in the same subject.
The Subsoil of Guy’s Hospital.
An extensive find of osseous remains was made a
few days since in the “ park ” within the grounds of
Guy’s Hospital in the course of the excavation for a
gallery which is being constructed for the purpose of
providing underground communication between
different parts of the buildings. No one knows exactly
bow these bones came where they were found but not
many years ago a similar find was made, no less than
a hundred skeletons having been unearthed when
digging the foundations for additional buildings.
It is surmised that the hospital must have been built
on a place previously used as a burial ground for the
victims of the plague, and its position just outside
the city boundaries gives some credence thereto.
We are informed that a Dutch auction was held, but
the remains fetched very poor prices, skulls going
for twopence, while the long bones were simply
“ given away.” It is reported that a large number
of short clay pipes were found in the neighbouring
earth, but their presence is as much a mystery as
that of the bones, seeing that a plague victim would
be unl’kely to take his “ cuddy” along with him when
conveyed to his last resting place; or, as it turns
out, his last resting place but one.
A Medical Hero in the Transvaal War.
Surgeon-Captain R. A. Buntine has recently
performed a valiant deed under Boer fire. He was with
the Natal Carabiniere who were patrolling the Free
State border when the party was surprised by
ambushed Boers at Bester’s, near Yan Reenen’s
Pass, under the towering peak of the Drakensberg.
The Carabiniere had to retire, leaving a wounded
trooper on the ground. Dr. Buntine, inducing his
trooper servant Duke to accompany him, rode back
and having dismounted, placed the severely wounded
man on his own horse, and then, in spite of the rifle
practice, clutched hold of his servant’s stirrup leather
and ran back to camp, all three men getting in safely.
For this conspicuous deed of courage in the face of
the enemy he has been mentioned indespatches, and
is likely to get the much coveted V.C. Our special
correspondent informs us that Dr. Buntine is in
private practice at Pietermaritzburg, joined the
volunteers with his partner, Dr. Currie, and has been
attached to the headquarters’ staff of the Royal
Army Medical Corps at Ladysmith. He is an Aus¬
tralian, born at Melbourne, and is of Scottish
extraction.
We are requested to inform our readers that the
Conjoint Diploma in State Medicine heretofore
granted by the Royal Colleges of Physicians and
Surgeons, Ireland, will, in future, be styled the
“ Diploma in Public Health.”
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570 The Medical Press.
NOTES ON CURRENT TOPICS.
Nov. 29, 1899.
The Small-pox Epidemic at Hull.
In spite of the greatest activity the sanitary
authorities at Hull cannot as yet be congratulated
on having circumscribed the epidemic of small-pox
which has been raging there for some weeks past.
The number of cases under treatment up to the
present is not far short of 500, and the evil is not
limited to the town itself, the existence of such a
large focus of infection constituting a standing
menace to the neighbouring country with its
many agglomerations of human beings, as the 1
returns already show but too plainly. One
satisfactory feature is the readiness with which per¬
sons of all classes of society avail themselves of the
facilities for revaccination, some forty thousand
having already been revaccinated. It could be wished,
however, that people would adopt this very useful
precaution beforehand, without waiting to be scared
into compliance by the presence of the disease in
their midst. It is impossible to over-estimate the cost
to a seaport or manufacturing town of such a wide¬
spread epidemic, to say nothing of the suffering and
misery which it entails far beyond its own limits.
We shall be in a better position to discuss this point
when we are in possession of the Government report.
Just at present we are more concerned with the
means of preventing its extension, and the public
may feel assured that nothing that can be done with
this object in view has been left undone.
The General Medical Council.
The autumn session of the General Medical
Council was opened yesterday (Tuesday) by the usual
presidential address. It is anticipated that the
duration of this session will display the same ten¬
dency to prolongation as its immediate predecessors,
many matters of considerable importance to the pro¬
fession being comprised in the agenda drawn up by
the Executive Committee.
The Princess of Wales’s Hospital Ship.
The inspection by the Prince and Princess of
Wales of the hospital ship which bears the Princess’s
name was naturally the occasion of a popular demon¬
stration on Wednesday last at Tilbury. The well-
known tourist steamer “ Midnight Sun ” lias been
transformed beyond recognition. Her white sides
bear the large red cross of Geneva, and the sign is
reproduced on the smoke stack and bows. Down
below, the cabins and saloons have given place to true
hospital wards filled with rows upon rows of suspended
beds soon to be filled with their burdens of wounded
and suffering soldiers. The nursing sisters and assis¬
tants were paraded, and the Prince in afew well-chosen
words wished them God-speed on their mission of
humanity. The medical visitors could not but admire
the perfection of the arrangements made for the
reception and treatment of the victims of duty
Every appliance known to modern medical and sur¬
gical science has been pressed into the service, of
which steam disinfectors, an electric laundry.
Rontgen ray apparatus, and a mo of elsbnre+e and
complete installation for the electric light are but
outward and visible indications, showing the care,
skill, and thoroughness with which the hospital ship
has been fitted up.
A Student Blackmailer.
A Foreign exchange relates an instance of what
we may term up-to-date blackmailing. A student
was recently arrested at Gratz on a charge of
endeavouring to obtain money by menaces from an
old lady whose dwelling he threatened, failing cash,
to inundate with a selection of pathogenic microbes.
It is even stated that when searched the ingenious
but indelicate student was found in possession of
cultures of cholera, tetanus and typhoid fever
bacilli. This is. quite a novel application of bacterio¬
logical knowledge but hardly one which can be com¬
mended for imitation.
“ Grammar School” Education in
Professional Education.
The attempt on the part of the London Colleges
to evade the regulations of the General Medical
Council by recognising the sham instruction given at
grammar schools in chemistry, physics, and biology
is likley to occupy the attention of the General
Medical Council at a prolonged debate at the session
which opened yesterday. It is unnecessary to dis¬
cuss the merits of this question, considering that the
Education Committee of the Council has already
pronounoed twice, and the Council itself once, that
these grammar Bchool courses are a palpable evasion
of the regulations, and it is not likely that they will
go back Irom that pronouncement; but it is as well
to say that we believe that, if the London colleges
are permitted to accept suoh courses, the Irish and
Scotch colleges, which have hitherto rejected them,
will receive certificates from any Bohool which pur¬
ports to give instruction in these subjects, and, i n
that case, the Medical Council may as well strike
them out of the curriculum altogether, a consumma¬
tion, indeed, which would not distress us very much.
The Dublin Preliminary Examination.
In our last issue we referred to the excessively high
standard of the Dublin conjoint preliminary, which
the General Medical Council is seeking to orush out,
as compared with other examinations, which it
readily accepts. We have since made inquiries, and
are in possession of the name of at least one candi¬
date who, having tried the Dublin preliminary four
times, and made overtures to another body which
would not be accepted, went down the street to a
university close-by where he paid £15, and passed
the examination recognised by the Medical Council,
and is now inscribed on the Students’ Register. The
theory of the Medical Council that, outside the
universities, there is no educational salvation is not
sustained by the facts.
Anti-Typhoid Inoculation in the Army.
Despite the fact that the South African climate in
which the war is now being carried on is the best in
Digitized by LjOOQLC
Nov. 29. 1899.
NOTES ON CURRENT TOPICS.
the world, and the risks of typhoid infection corres¬
pondingly slight, nevertheless, many thousands of our
soldiers have wisely submitted to inoculation against
typhoid. This is as it should be, for even in places
where this fatal disease is least to be expected, as, for
example, in the open veldt, it is well to be on the safe
side, and be prepared for any infection that
might be present. So far, we believe, the death of
only one private has been reported from typhoid, and
this occurred in an up country station before the
inoculated troops were sent out. Upon the whole
then, although for the reasons above given, the
present occasion cannot be regarded as one in which
the antityphoid inoculations will be likely to be put
to a satisfactory test, nevertheless after the war is
over some facts will probably be forthcoming to show
to what extent they have been useful.
The Medical Advisers of the Czar.
A French contemporary draws attention to the
number of medical advisers “ engaged ” by the
Czar of Russia. They number in all no fewer
than twenty-seven, thus forming a veritable
medical body-guard. There is first a physician-
in-chief ; then come the honorary physicians,
three surgeons, and four honorary surgeons; two
ophthalmic surgeons, a chiropodist, and honorary
chiropodist; also two court physicians and three
specialists for the Czarina. This goodly array of
medical talent, for it represents the best that Russia
can produce, should make the Czar happy in his
mind so far as his medical requirements are con¬
cerned. There is said to be safety in numbers, but
this old saying is thought not to apply to cases in
which many medical men assemble around the sick
bed of a patient.
Nursing in the City of Dublin Hospital.
Our advertising sheet informs us to-day that the
City of Dublin Hospital has decided upon a change
in its nursing system. Heretofore, its nursing has
been done by an institute, which may be said to have
been proprietary located close by, but the Governors
have now decided to have a nursing establishment of
their own, and they are now making provision for the
accommodation of the staff by temporary, and after¬
wards by permanent, extensions of the hospital
buildings.
PERSONAL.
Sir William Banks will preside at tho annual dinner
of the students of University College, Liverpool, on
December 2nd.
Profkssor Koch, who is now in Batavia, is reported
to be in good health. He will continue bis observations
on malaria a few months longer, and will then proceed
to New Guinea.
Dr. Frank J. Wetherhed, late Medical Registrar
and lecturer on Medical Jurisprudence at the Middlesex
Hospital has been elected Assistant Physician to that
Institution.
The Medical Press. 571
Dr. Carstaibs Cumminq Douglas has been appointed
Professor of Medical Jurisprudence in Anderson’s College
Medical School, Glasgow. Dr. Douglas is a graduate of
Edinburgh University, where he took his degree in
medicine with first-class honours and the Etches scholar¬
ship in 1890, and his degree in Science (Department of
Public Health) in 1891.
Our Continental correspondent informs us that King
Alexander of Servia is at the popular winter health
resort of Meran, South Tyrol, Austria. His Majesty
resides at the Schlo3s Rametz, in the elevated Obermais
suburb of Meran, and is accompanied by General
Solarovich, Major Wassies, Colonel Androvitch, and
Doctors Weljkovics and Michel.
THEGerman Empress Frederick (Princess Royal of Great
Britain), with her daughter, Princess of Saxe-Meiningen,
is at the Imperial Hotel Trento, Trient, South Tyrol. Her
Majesty frequently visits Meran, Arco, Riva, Gardone-
Ri viera, and other places of interest conveniently near
Trient. Our correspondent understands that she intends
building a chAteau on the Cap 8an Vigilio, Lake Garda.
Sir Wm. MacCormac, Bart., and Mr. Makins, of
St. Thomas's Hospital, London, have arrived in South
Africa, and after a thorough inspection of the hospital
arrangements for the sick and wounded at the seat of
war, have pronounced very favourably upon the energy
and foresight shown by those in charge of the hospitals
and with the work already accomplished by the Army
Medical Corps.
Dr. Jame8 Alexander Lindsay, of Belfast, who has
been appointed to the chair of medicine in Queen’s
College Belfast, is an alumnus of the college, and he
secured many distinctions there. After leaving Belfast
he studied in the leading schools of London and the
Continent. He is a member of the more important
medical bodies, and a much-esteemed medical writer.
His “ The Climatic Treatment of Consumption ” is re¬
garded as a text-book.
Dr. Emily Winifred Dickson, being engaged to be
married in the early part of December, has resigned her
position as gynecologist to the House of Industry
Hospitals, Dublin, and Dr. Thomas Henry Wilson has
been appointed as her successor. Dr. Wilson has
recently occupied the position of Senior Assistant Phy¬
sician to the Rotunda Hospital. Dr. Dickson has also
lately resigned her office of Assistant Physician to the
Master of the Coombe Lying-in Hospital.
•Scotlani).
[from our own correspondent.]
University Jottings.—Glasgow.
The number of students matriculated at Glasgow
University this season iB 1569, an increase of 38, as com¬
pared with the preceding year.
In the Randolph Hall on Thursday evening, 24th
inst.: Principal Story gave an “ At Home.” This step
is quite an innovation, as no former Principal ever used
the building for such a function. On this occasion fun
and frivolity assumed the place of serious faces and
palpitating hearts. Gilmorehill did not quite under-
Digitized by LjOOQle
572 The Medical Press.
OBITUARY.
Nov. 22. 1899.
stand or know itself; tea and claret cap were in evidence
instead of pens and ink. Sach functions, it is said, will
be given by the Principal during the session. In fact,
the session has begun with a series of festive gatherings
A short time ago the students were at loggerheads
with Professor Ramsay, who magnanimously apologised
to them, and since then has entertained them
to tea in the Examination Hall of the University.
On another evening Professor Murdoch Cameron gave
a “ smoker at home ” to the medicals in the Union, which
was no doubt immensely enjoyed, and if the “ going
home ” at an early hour be regarded as a reflection of
the gathering, then it is safe to say it was very lively.
Brother Pelican says Dr. Cameron is a born storyteller ;
this statement is a fact, and the professor would
thoroughly enjoy himself, as he would be in his “ ele¬
ment ” while giving utteranoe to his stories, especially
those of a cerulean colour. After enjoying such a feast
of light things, the students were further treated on
another evening to hear Dr. McVail, Health Officer for
the counties of Stirling and Dumbarton, read a paper on
"Municipal Duty as to Prevention of Tuberculosis.”
While such things were going on at the University the
members of the Glasgow and West of Scotland Agri¬
cultural Discussion Society were treated to a lecture by
Dr. Robert Bell on “ Potato Disease ” It is to be hoped
that the “pregnant week ” was safely delivered of its
weighty burden, and was satisfactory to all concerned.
Glasgow Hospital Sunday took place on the 26th
(Sunday) inst., and, as usual on such occasions, the day
was wet and stormy, preventing many charitable souls
from going out and giving their support. Last year
866 churches gave collections, an increase of eight on the
year previous, and the total (including Sunday schools)
amounted to JJ4.388 16s. lid. The circular issued states
that the three principal infirmaries treated 12,991 patients
in their wards and 45,188 in their dispensaries, a total of
66,179. On such Sundays when the weather prevents a
full congregation, the public are reminded that their
subscriptions can be sent to the Secretaries, which, no
doubt, will be the case this time.
MEDICAL 60CIETY OF LONDON.
The meeting on Monday evening last (November
27th) was devoted in its entirety to a paper by Dr.
Cayley on “ Prognosis in Appendicitis, with notes of
200 Cases,” and the discussion thereon. He discussed
prognosis according as it bore on (1) recovery, and (2)
recurrence. He admitted that statistics were misleading
in the aggregate, the prognosis having more to do with
the special form of the disease. The two essential factors
in prognosis were (a) the nature and course of the appen¬
dix lesion regarded from the point of view of relative
infectivity, and ( b ) the extent and nature of any
resulting peritoneal infection which depended for the
most part upon the actual lesion of the appendix, in
part also on its position and on certain special modifying
conditions. The most important direct prognostic I
factor was the peritoneal one. Of 200 cases at St. I
Mary’s Hospital, 99 were simple appendicitis, i.e., \
localised and non-suppurative, all of which recovered ; 31
were cases with localised suppuration, of which number
29 recovered; 23 were complicated by general peritonitis,
of which 20 died ; 42 were examples of relapsing chronic
appendicitis, in 37 the appendix was removed, and
all the 42 recovered. In the other 6 cases there were
special complications, and of these three died. These
cases show the great fatality of appendicitis with general
peritonitis, the small mortality of appendicitis with
localised abscess, if properly treated, and the almost
uniformly favourable course of mild cases, which con¬
stitute the majority of all cases of the disease. The
special prognostic indications for clinical consideration
were (1) local symptoms, with special reference to pain
and vomiting ; (2) general symptoms, with special
reference to temperature, pulse, respiration and general
condition; (3) local signs on physical examination ; and
(4) the progress of the case. Persistent, severe pain
suggested a severe lesion, and a sudden increase of pain
an unfavourable turn. Vomiting, when persistent and
severe was always a significant symptom. The temperature
chart by itself is a fallacious guide, but taken in con¬
junction with the pulse, respiration, Ac., it possesses
considerable prognostic import. A high pulse rate is of
bad omen, as is also a bad general condition. The
character of the local signs is also of considerable import¬
ance. Above all we must note the progress of the cas©
during the first twenty-four hours in acute cases. In
respect of recurrence this may be expected in fully
a third of the cases, most commonly within a year of the
initial attack, and it amounts to a practical certainty if
there is persistent pain, tenderness or local thickening
indicative of chroi - appendicitis.
In the discussion that ensued Mr. Edmund Owen
agreed that suddenness of onset was of grave signifi¬
cance, and urged that the sooner these cases came into
the surgeons’ hands the better. He dismissed
McBurney’s point as utterly misleading and useless.
Dr. F. Smith pointed out that the cardinal point to
investigate was the occurrence or not of suppuration,
and in its absence be thought it might be safe to tem¬
porise. Mr. Carless urged that surgeons ought not to
wait for, but to anticipate, suppuration, thereby obviating
the risk of peritonitis. This plan, moreover, enabled
them to remove the appendix, which was’often impossible
in presence of abscess.
Mr. Mansell Moullin thought that in all cases of
appendicitis, if no improvement took place within the
first thirty-six hours, it was time for the surgeon to
intervene, inasmuch as either suppuration had taken
place or adhesions were forming which would render
relapse inevitable.
Mr. Berry said he had changed his views, and was
now an ardent advocate of the more expectant treatment.
He adduced some very telling figures showing the results
of the various methods of dealing with the disease, and
among them he mentioned thirty-three cases of acute
appendicitis treated by free incision and washing, of
which number twenty-six died, while of forty-one dealt
with by limited incision through adhesions only two
died. He protested energetically against the fatal prac¬
tice of washing out the abdomen, which, he thought,
was responsible for many of the fatal results, and he
pointed out that in the majority of cases an incision
through the linea semilunaris would fail to open an
appendicular abscess. The incision adopted in the
majority of the successful cases was one perpendicular
to, and just above, Poupart’s ligament.
The President said he had seen a very large numb9r
of such cases recover under common-sense medical treat¬
ment, but he always called in a surgeon to have the
benefit of his opinion.
Dr. Cayley then replied, admitting that early opera¬
tion had much to recommend it if one could be sure of
getting the cases early enough and of operating at the
right moment, but he asked whether an operation at an
injudicious moment might not have for effect to convert
a local into a more general infection.
(Dbituani.
DR. JOSEPH 8AMUEL PRENDERGAST.
Dr. J. S. Prenderoast, the son of the late Francis
Prendergast, for many years Registrar of the Court of
Chancery in Ireland, was born in 1810,entered the Army
I in 1836, and retired in 1863 with the honorary rank of
Inspector-General of Army Hospitals. He was attached
to the 77th Regiment. He served in the Crimean cam¬
paign upon the personal staff of the Field-Marshal Com-
manding-in-Chief, Lord Raglan. He was present at the
battles of Alma, Inkerman. and Balaclava, as well as at
the siege of Sevastopol. He attended Lord Raglan in
the field until his death, when he accompanied his body
to England. He received the Crimean medal with four
| clasps and Turkish medal (Sth class of Medjidieh).
MR. W. I. WHEELER. B.A., F.B.S.C.I., OF DUBLIN.
The grave illness of this surgeon, which we reported
in our last issue, ended on Saturday last when he died at
his residence, Merrion Square, Dublin, of a complication of
diseased conditions of which typhoid was the most mani-
DigitizedbyLiOOgle
* Nov. 29, 1899.
CORRESPONDENCE.
Tine Medical Press. 373
feat. Mr. Wheeler has been a leader in Dublin surgery
for many years. He received his first qualification from
the Colleges in 1866, and became Fellow of the College
of 8urgeons in 1874 and M.Ch. of the University
of Dublin in 1879. Having served as Resident in
the City of Dublin Hospital he became a Demonstrator
in the School of the College of 8urgeons, and afterwards
entered the Army Medical service and saw service in the
Abyssinian campaign. He, on his return home started
practice in Dublin, being elected as Surgeon to the City
of Dublin Hospital, a position which he held until his
death. He also served as Examiner in Surgery in his
College, and became its President in 1883.
MR. FRANK 8HAPLEY, M.R.C.S., OF SIDCUP.
The death of Mr. Frank Shapley took place on the
16th inst. from typhoid fever. He had been suffering
from a severe attack of rheumatism for a month past,
but was progressing favourably until the beginning of
November, ;when typhoid supervened, to which he
succumbed at the early age of 42. Deceased was a
student of the London Hospital, took the L.8.A. in 1878,
and the diploma of M.R.C.S Eng. in 1879. He was
senior house surgeon of the London Hospital, assistant
medical officer to the Wonford Hospital for the Insane,
Exeter, and later senior assistant medical officer at the
Glamorganshire County Asylum. In 1884 he commenced
private practice at Sidcup, in Kent, and during his
residence there, of fifteen years, has taken a prominent
part in all local affairs, and it was owing to his exertions
that the present Cottage Hospital, to which he was
attached as honorary medical officer, was freed from
debt.
DR. CAMARA PESTANA.
A correspondent of the Times gives some pathetio
■details of the death of Dr. Camara Pestana, who, it is
stated, actually caught the plague through his anxiety
to learn all that he could about it. He was dissecting
the body of a patient who had died from plague, and in
order to extract the virus more thoroughly for analysis
he put aside his instruments and worked with his
fingers. The poison entered his system under the finger
nails and he was struck down with the terrible disease
which he was investigating. He was at once moved to
an isolated ward set apart for plague sufferers, and there
he set himself to study his own case and to record for
the benefit of humanity his own symptoms and the
course of the disease. He refused to see his brother for
fear of infeotion, and in every way, even in making
arrangements for his own funeral, he took every pre¬
caution to prevent the spread of the plague. His mind
and will conquered his bodily sufferings until the very
-end, and even as he died he was still trying to indicate
to those around him the lessons of his own case. He left
a letter for the Queen of Portugal begging for her
influence in favour of his colleagues at the Lisbon
Bacteriological Institute. So died the heroic doctor,
who, as our correspondent says, “ had toiled for months
amid the horrors of the plague hospital and dissecting
room, and at last gave his life a willing sacrifice for the
benefit of the whole world.”
MR. WM. LEWIS MORGAN, M.A., M.R.C.S.,
OF OXFORD.
News has just reached here of the death at sea about
a fortnight ago, of Mr. W. Lewis Morgan, a well-known
Oxford surgeon, at the early age of 45. Early in the
year his health had completely broken down, and he left
England for the Cape with the hope that the voyage
would lead to a marked improvement in his condition.
While on the return voyage, however, dangerous sym¬
ptoms set in to which he succumbed, and he was buried
at sea. Mr. Morgan was one of the University coroners,
and performed valuable work as an honorary surgeon of
the Radcliffe Infirmary. Before his departure from
England, the Freemasons, in recognition pf his services
as provincial grand secretary of Oxfordshire, presented l
him with a purse of 600 guineas. As a student he greatly
distinguished himself, attaining first-class honours at
Oxford University in Natural Science. Later on he be¬
came a member of the Board of the Faculty of Medicine
and Litchfield Lecturer on Clinical Surgery in the
University.
domsponOentt
We do not hold ourselves responsible for the opinions of our
correspondents.
INCONSISTENCIES.
To the Editor of Thu Medical Press and Circular.
Sir,— Dr. Edward Berdoe, the medical apostle of the
anti-vivisectionists, attempts to apologise for the
complacent inaction of, his party with reference to the
torturing of tame deer by Her Majesty’s Buckhounds,
by pounting out that an obscure clergyman in an
obscure parish in England, who is an anti-vivisectionist,
has written something against this so-called “ sport,” and
he says, “ tell us what more we (the antis) can do in the
matter and we will do it.” I suppose it is
unnecessary to answer the question. Dr. Berdoe and his
cogeners are perfectly well informed as to what they
might do if they wished. None are better skilled in the
art of working up a semi-political agitation among
benevolent old parsons and impressible old ladies
and carrying that agitation, with their money, into
the constituencies and into the House of Commons, and
it is not at first obvious why they pass overthe atrocities
perpetrated in these Buckhound hunts, in the tranship¬
ment of cattle, and in the marketting of fowl, and many
other every day cruelties, and devote themselves to
mendacious attacks on the medical profession for putting
a hypodermic injection under the skin of a frog, or per¬
forming other equally painless experiments. On con¬
sideration, however, their attitude is not difficult to
understand. Anything associated with Her Majesty’s
name would be unpopular with the old women, male and
female, whom the organisation sei ves, and any agitation
for interference with cattle commercial interests would
be scouted by Parliament, so that Dr. Berdoe and his
friends wisely confine themselves to maligning the
doctors and scientists, who, politically, have no friends.
No one can have any respect for the consistency of a
party who occupy themselves with the endeavour to
swallow camels while they Btrain at gnats.
I am, 8ir, yours truly,
Mawworm.
OPERATIONS AT THE CANCER HOSPITAL.
To the Editor of The Medical Press and Circular.
Sir,— Will you kindly permit an outside general
practitioner to make a few comments on two cases re¬
ported in last week's edition as coming from the Brompton
Cancer Hospital. The first case by Mr. Ryall gives a
history of ten years. Surely this is enough to put it
out of the class of operative cancer cases. The next
case is by Dr. Snow, and gives a history of five to six
years. This surely puts the case of a woman of 38, full
blooded and vigorous, out of the list of cancer patients.
Yet both were operated on at a hospital supported by the
outside public for cancer cases alone. There are many
cases, as we all know, where no one can be quite certain
whether they are malignant or not, but neither of these
cases comes under the category or definition of cancer. I
do not suggest that the treatment, although unsuccess¬
ful, was wrong, but I do most emphatically say that
neither should have been treated at a Cancer Hospital. It
is obtaining money by false pretences to get it from
the public for supporting cancer cases, and then applying
it to myoma and other diseases.
I am, Sir, yours truly,
James Hamilton,
60, Sydney Street, Chelsea, S.W.
November 25th, 1899.
Digitized by G00gk
573 Th* Medical P&bsb
NOTICES TO CORRESPONDENTS.
Nov. 22,189ft.
^lotictg to
(ttorreoponbentB, Short $etter«, &c.
Correspondents requiring a reply in this column are par¬
ticularly requested to make use of a distinctive signature or
initial i, and avoid the practice of signing themselves “ Header,’ ’
“Subscriber,” “Old Subscriber,” 4c. Much confusion will be
■pared by attention to this rule.
Local Reports and News.— Correspondents desirous of drawing
attention to these are requested kindly to mark the newspapers
when sending them to the Editor.
Heading 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 oases 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 afterthey have appeared in these columns oan have them, at
half the usual cost, on application to the printers before the type is
broken up.
A HINT TO SCULPTORS.
A correspondent suggests that the refuge in front of the
Jenner Institute offers a magnificent position for a statue of
“Bacteriology Enlightening Therapeusis," and suggests that
sculptors might give the suggestion their attention. The idea is in¬
genious, but still more ingenious would be the artist who could
work out the suggestion in marble.
THE BITEB BIT.
The following amusing tale was recently told to his class by Pro¬
fessor Comstock, of Cornell, in speaking of the trials of scientists.
It appears that a professor of invertebrate zoology in a sister uni¬
versity wished to procure some trichinous pork for purposes of
experiment. The learned scientist went to his butcher and asked
h'Tn if he ever got any measly pork. “Sometimes,” the butcher
cautiously answered, “ but I always throw it away." “ Well,” said
the professor, “ the next time you have any I wish you’d send me
up some,” meaning, of course, to his laboratory. The butcher,
although somewhat taken aback, said that he would. Three weeks
passed, when the professor, growing impatient, again visited the
store. “ Haven't you found any measly ix>rk yet r' “Why, yes,”
said the butcher, “ I sent np two pounds a week ago.” A sickly
grin broke over the professor’s face. " Where did you send it.
“ Why, to your house, of course,” said the butcher.— New York
Medical Record.
Mr. G. C. Green.—I s thanked for his suggestion, but no useful
purpose l. served by a record of such cases.
Dr. Knott’s paper on “ Lactation in the Virgin, the Old Woman,
and the New-born,” will appear in our next.
AN UNCONSIDEBED THIFLE.
“ Are yon fond of literature ?” he inquired, with assumed care¬
lessness, but he was watching her attentively. “ Passionately," she
replied, "but I get so little time to read anything except the
chronicles of my profession. Ours is a most exacting art, but I love
books dearly.” “ Then yon mist admire Sir Walter,Scott ? Is not
his 1 Lady of the Lake ’ exquisite in its flowing grace and poetic
imageryf” “It is perfectly lovely," she assented, clajping her
hands in ecstasy. “ I suppose I have read it a dozen times. “And
Scott's ‘ Marmion ' he continued. “ It is perfectly grand,” she
murmured. “ And 1 Scott’s Emulsion ' ?” he continued, hastily, for
afaint suspicion was beginning to dawn upon him. “ I think,” she
interrupted, rashly, that its the best thing he ever wrote.”—
Exchamje.
Dr. James Edmunds' paper on “ Alcohol in Medical Practice” is
unavoidably held over.
Dr. Rabagliati (Bradford) —Your paper on “Suppurating Pelvic
Cellulitis, with Remarks on the Occurrence of Low or Sub-normal
Temperatures,” is marked for early insertion.
^fleeting* of the Societies aitb ^Lectures.
Thursday, November 30th.
Central London Throat, Nose, and Ear Hospital (Gray’s Inn
Hoad, W.C.).—5 p.m. Dr. D. Grant : Treatment of Diseases of the
Nasal Sinuses.
Friday, December 1st.
Lartngological Society or London (20, Hanover Square, W.).
—5 p.m. Cases and Specimens will be shown by Sir Felix Semon,
Dr. Powell, Dr. Bronner, Dr. Waggett, Dr. Pegler, Mr. Butlin, Mr.
Houghton, Mr. Wingrave, and others.
Society of Anesthetists (20,Hanover Square, W.I.—8.30 p.m.
Dr. Walter Copestake : A Combined Inhaler for Ether, Chloro¬
form and A.C.E. Mixture.—Clinical Cases by Mr. McCardie, Mr. B.
W. Lloyd, Mr. Tnrle Bakewell, and others.
West London Medico-Chiruruical Society (West London
Hospital, Hammersmith).—8.30 p,m. Cases by Mr. McAdam
Eccles, Mr. Bidwell Mr. Keetley Dr. George Johnston, the Presi¬
dent, and others.
UacartrieB.
Bradford Poor-Law Union.—Two Resident Assistant Medical
Officers for the Hospital and Workhouse of the U nion. Salary
of Senior £150, ana of Junior, £100, with prescribed rations,
washing. Apply to the Clerk to the Guardians, Manor Bow,
Bradford.
County Council of Salop.—County Medical Officer of Health. Salary
£750 per annum, to include travelling expenses. Applications
to Mr. E. C. Peele, Shirehall, Shrewsbury.
Flintshire Dispensary, Holywell.—Resident House Surgeon. Salary
£120 a year, with furnished house and coal, light, and water.
Manchester Royal Infirmary.—Resident Medical Officer for one
year, unmarried. Salary £150, with board and residence.
North Staffordshire Infirmary and Eye Hospital, Haruhill, Stoke-
on-Trent.—House Governor and Secretary. Salary £300 a year,
non-resident.
Parish of St Pancras, London. - Senior Assistant Medical Officer for
the Workhouse. Salary commencing at £125 with residential
allowances. Also a Junior Assistant Medical Officer. Hono¬
rarium £60, and residential allowances. Apply to the Clerk to
the Guardians, Vestry Hall, Pancras Road.
Pontefract General Dispensary and Infirmary.—Resident Medical
Officer. Commencing salary £150 per annum, with furnished
rooms, fire, lights, and attendance.
Queen’s County Infirmary.—Medical Officer. Salary £182 6s. 2d.
per annum. Applications to Chairman of the Infirmary Com¬
mittee. (See advt.)
University of Edinburgh.—Additional Examinerships in Materia
Medica and Clinical Surgery. Salary of the Examiner in
Materia Medica £75 per annum, an 1 that of each of the
Examiners in Clinical Surgery. £50 per annum. An allowance
of £10 per annum given conditionally.
Victoria Infirmary of Glasgow.—Superintendent and Resident
Medical Officer. Sulary £300 per annum, with board in the
Infirmary and a free house.
(SlppointnuntB.
Douglas, Carstairs C., M,D., B.Sc.Ed., Professor of Medical
Jurisprudence, Anderson’s College Medical School, Glasgow.
Fenn, C. E., M.B., M.R.C.S., L.B.C.P., House Accoucheur to King’s
College Hospital, London.
Ferguson, J. M., L.R.C.P., L.R.C.S.Ed., Medical Officer to the
New Sanatorium for Infectious Diseases, Burnley.
Hadley, F. A., M.R.C.S., L.R.C.P., Assistant House Physician to
King's College Hospital, London.
Mackay, Hugh J. D., L.R.C.P., L.B.C.S.Edin., L.F.P. & 8.,
Medical Superintendent of Aston Hall, Warwickshire.
Mayon. S. M. M.R.C.S., L.K.C.P., House Surgeon to King’s College
Hospital, London.
McMullen, W. H., M.R.C.S., L.B.C.P., Junior House Physician to
King’s College Hospital, London.
Roberts, G. A., M.B.C.S., L.R.C.P., Senior House Physician to
King's College Hospital, London.
Savage, W. George, B.Sc., M.B.,L.R.C.P.Lond., M.R.C.S., D.P.H.,
Bacteriologist and Lecturer at the Cardiff and County Public
Health Laboratory.
Stratford, H. B., M.R.C.S., L.R.C.P., House Surgeon to King's
College Hospital, Lincoln’s Inn Fields, London.
Stuart, Hackworth, M.R.C.S., L.R.C.P.. Assistant Resident
Medical Officer to the London Temperance Hospital.
Twenttman, J. M., B. A.,|B.Sc., L.S.A., Assistant House Accoucheur
to King's College Hospital, London.
Vospbr, P., M.R.C.S., L.R.C.P., House Surgeon to King’s College
Hospital, London.
Yardman, W., L.R.C.P.. L.B.C.S.Edin.. L.F.P.S.Glasg., Medical
Officer for the Third Sanitary District of Manchester.
#irih 0 .
Dodd.—O n Nov, 21st, at 14, Goldstone Villas, Hove, the wife of
Arthur H. Dodd, L.B.C.P.Lond., M.R.C.S.,Eng., of a daughter.
Vise.—O n Nov. 20th, at 39 Mount Pleasant Rond, Tunbridge Wells.
the wife of Christopher Vise, M.D., of a son.
Whicher.— Nov. 24tli, at Midsomer Norton, Somersetshire, the
wife of A. Hastings Whicher, M.R.C.S.Eng., of a son.
Woods.—O n Nov. 17th, at Westbury, Hornsey Lane, N„ the wife of
Hugh Woods, M.D., of a son.
4ftarrmges.
Brodie-Hosf.orp.— On Nov. 23rd, at St. Anne’s Church, Eastbourne,
Norman Brodie, M.A. (Oxon) Indian Civil Service, to Edith
Josephine Ainslie, younger daughter of T. Stroud Hosford,
L.R.C.P., M.R.C.S., Eastbourne.
Smith-Pullin'.—O n Nov. 22nd, at St. Augustine's Church, Honor Oak,
Walter H. M. Smith, L.R.C.P., M.R.C.S.Eng , eldest son of Dr.
Smith, Croydon, to Florence Emily, daughter of Joseph
Shurly Pullin, of Honor Oak.
Stath*.
Hicks. —On Nov. 18th, at Hendon, Henry Hicks, U.D., F.B.S.*
aged 62 years.
Lakeman.— On Nov. 14th, at 30, Church Street, Modbury, Thomas
Lakeman, M.K.C.S., L.R.C.P., aged 34.
Shapley. —On Nov. 15th, of typhoid fever, Frink Shapley,
M.R.C.S., L.S.A., of Maisou Rouge, Sidcup, Kent, aged 42.
Walker.— On Nov. 11th, at Margate, Frederick Hanson Walker,.
M.R.C.S., L.R.C.P., of Blagdon, Putney, aged 31.
Digitized by Google
" SALUS POPULI SUPREMA LEX."
Vol. CXIX. WEDNESDAY, D
Original Communications.
A SCIENTIFIC BASIS OF
ORGANOTHERAPEUTICS. («)
By Prof. P. F. RICHTER. M.D.,
Of Berlin.
[FROM OUR OWN CORRE8PONDENT.1
The author connected the new foundation cf
organotherapeutics with Brown-Scquard. It was
based on the assumption that material is furnished
by the individual organs, which taken up into the
blood is indispensable for the organism. Brown-
Sequard's prophecy as to the therapeutical value of
the products of organs had to a certain extent been
fulfilled. But with numerous failures, the enthusiasm
at first excited had subsided, and the strangeness of
the thing, along with other considerations had made
thoughtful physicians sceptical. But exact scientific
inquiry had to search out the healthy kernel from a
mass of outgrowths. In the scientific testing of the
justification of organotherapeutics, it m ust be deter¬
mined by artificial laboratory experiment, what
results will happen when certain functions cease, and
how far the substitute of the missing organ can
remove the symptoms induced by its loss. Organo¬
therapeutics constituted a substitution method,
and furnished a substitute for a definite material
that was missing from the system. That the
incorporation of certain organs did exercise a
certain pharmacodynamic action as tonics, &c.
(nuclein), might well be assumed, but not as organo¬
therapeutics in the sense of Brown-St?quard. Only
thyroid-therapeutics were able to stand up against
this general statement. It was undoubtedly true
that the removal of the thyroid causes serious dis¬
turbances that could be wholly or in part got rid of
by the substitution of the organ removed. The condi¬
tions were more difficult in the case of the other organs :
spleen, bone, marrow, kidneys, supra renal capsules,
pancreas, hypophysis. &c. In contrast to this absurd
employment the use of the sexual glands from which
Brown-Sequard started lent itself more simple and
readily to experimental inquiry. Whilst the re¬
moval of most organs was impracticable and
dangerous, that of the sexual organ was simple,
easy, and free from danger. As regarded the effects
of removal of these organs, there hud been a fulness
of observation for thousands of years, especially in
BCEMBER 6, 18 9 9. No. 23.
the case of women whose ovaries]ceased to functionise
at the climacteric. It was a happy thought of Dr.
Leopold Landau to treat the affection of the meno¬
pause after analogy with the thyroid, with ovarian
substance. The action of the remedy was, however,
tested empirically, the theory was swaying in specu¬
lation and hypotheses. The influence of the ovaries
on the uterus was known, their influence in osteo¬
malacia, on the excretion of phosphovus. Beyond
this the matter was too uncertain for any opinion to
be founded upon it. On the other hand the influence
of the removal of the sexual glands on the deposit of fat
was better known. The connection between embonpoint
and the climacteric wus so striking that it was part of
the folk-lore, and had been made use of for ages in the
fattening of animals. A critical view of the literary
material bearing on natural and artificially antici¬
pated change of life confirmed this assumption of a
connection between absence of sexual function and
development of fat, and this, independent of other
factora, favouring such development. In order to
ascertain if there was any scientific basis for this, the
gases were accurately measured before and after
castration of animals. The experiments were per¬
formed on tracheotomised bitches by Hr. Loewy and
himself, and the observations exter ^ed over several
weeks and months. At first no change was observ¬
able, either in body weight or gas elimination; but
gradually, months after the castration, the weight
increased, and a distinct limitation of the gas ex¬
change pro kilo, took place (up to 20 per cent.).
From four to six months afterwards the gas
exchange remained at its low level. Similar con¬
ditions followed in the male dog after castration. To
see the effect of supplying the missing function,
whether oxydation would be increased, the
animals were now given testicular substance,
and it was seen especially in the female. _ One
bitch was given, 14 weeks after castration, 8
oophorin tablets per day, so that in 12 $ days 100
were taken. The effect was remarkable. The gas
exhange reduced by the castration was not only
raised again, but far beyond the original measure,
and the increase was not limited to the time she
was taking the tablets, but continued for 11 days,
and then gradually fell away again. In the castrated
male animal substituted testicular substance or
Bpermin drove up the lowered gas exchange, but only
to a slight degree. But on the other hand, the action
of the oophorin was extraordinarily extensive. The
maximum of gas exchange exceeded the normal by
24 8 per cent., and that of the castrated animal by
44 5 per cent. Given to healthy non-castrated
animals, oophorin did not increase the gas exchange.
The proof that oophorin only acted as a substitute
after removal of the several organs was of great
value as a scientific basis for organotherapeutics, as
such a substitution therapeutics had never been
demonstrated before, not even in the case of the
thyroid. A castrated bitch given other animal sub¬
stances (sperminum-Pbhl, testicular substance’ 1 showed
no rise of gas exchange.
(o) Read before the Malic S >ciety of Berlin, November, Is;*:*.
Digitized by Google
576 I’m Medical Press. ORIGINAL COMMUNICATIONS.
Dec. 6, 1899.
THE EOLE OF THE BLOOD-SUPPLY
IN MENTAL PLEASURE AND
PAIN, (a)
By WILLIAM R. DAWSON, M.D. F.R.C.P.I.,
Medical Superintendent of Farnham House Asylum, Finglas, Dublin-
After some introductory remarks, Dr. Dawson
■went on to say that a great change had taken place in
the position occupied by the alienist speciality, which
now ranked with the rest of the profession. The
change was due mainly to an altered conception of
mental disease ; this having come to be regarded as
a symptom of physical disease, and to be dealt with as
such. This altered standpoint was rendered tenable by
the more recent results of neurological work, especially
that Flechsig, along with the products of research
conducted by the methods of Golgi and of Nissl, on
which the speaker touched at some length, explain¬
ing the pathological processes known as varicose
atrophy and chromatolysis. He thought that
this mass of observation formed the foundation
for a working hypothesis of mind, and if it were
objected that the connection between matter and
consciousness was unthinkable, a sufficient reply for
practical purposes was, that mind could be pro¬
foundly affected and morbid states of consciousness
produced, by purely chemical means. The clinical and
pathological study of insanity, therefore, became
incumbent, of which the latter was at present the
more promising field.
The first problem encountered by the pathologist
was that of the physical states underlying mental
pleasure and pain. The states themselves, especially
when morbid, were so absolutely different that it was
not surprising that attempts at explanation had been
made, one of which was the now abandoned theory,
that melanchola was due to brain anaemia, and mania
to brain hyperaemia. Yet there was here probably
some modicum of troth, and he proposed to consider
the question afresh. The arrangements for the blood-
supply of the cerebral cortex were then gone into, and
it was pointed out that the area supposed to be
psychically most important, was particularly well
furnished in this respect. It appeared from experi¬
mental research that the cerebral circulation as a
whole was practically at the mercy of the general
blood pressure; but there were facts showing that
this was not always so, and in any case there might
be local variations in different areas of the brain-
cortex.
Coming to the problem under discussion, in
conditions of brain anaemia there was found
as a matter of clinical observation, a group
of symptoms which most typically consisted of
lethargic depression with morbid suspicion and loss
of intelligence, &c. It appeared in more or less per¬
fection in lactational ana phthisical insanity, and in
cases arising from starvation and indigestion; in
chlorosis, pernicious antemia, and syphilitic anaemia;
in mitral valvular disease and emphysema, and in
disease of the cerebral vessels. Both acute and
chronic antemia and want of oxygen had been found
to produce changes (varicose atrophy and chro¬
matolysis) in the nerve-cells.
In ordinary melancholia, reduction in the amount
of hemoglobin in the blood had been found, which
returned to normal on recovery. On the other hand,
high arterial pressure was the rule in all states of
mental pain, both sane and insane, and appeared to
be proportional to the acuteness of the pain, which
was relieved by measures which reduced the tension.
But this, which seemed to indicate an increased flow
through the brain, would only mean this if the venous
(a) Abstract of Inaugural address delivered at the opening meet¬
ing of the Dublin University Biologicul Association, November 28th;
pressure remained low, of which there was no proof,
and, on the other hand, high blood pressure with slow
pulse were symptoms of bulbar anaemia and were
found in general anaemic conditions. Moreover,
whatever the effect within the cranium, the other
organs of the body were rendered anaemic, and thus
the blood was poorer both in gaseous and solid nutri¬
ment. Cases of depression again, where the mind is
excessively active within a very limited range,
generally that of the moral sense, might be explained
by a localised bypenemia of the corresponding area
of the conex, with antemia of all the rest.
Excitement might occur with melancholia (when
the blood-pressure was found to be variable), and was
common in mental exaltation. It was a condition
apart from either, and ought if possible to be eli¬
minated in studying them. When of marked degree
it, like the convulsions with which it was so closely
related, was a “discharging lesion” due to “ irritable
weakness ” of the nerve cells, and was produced by
anajmia of sudden onset or considerable degree. This
was shown by the class of cases in which it occurred,
and by the results of treatment. As might be ex¬
pected the blood-pressure in excitement was low.
Mania meant excitement along with, in most
instances, exaltation, but tho latter symptom pre¬
dominated in certain classes of cases, in whicn it
could be well studied. It was best, however, not to
approach the question from this side, but to inquire
first what would be the effect on the nervous system
of increased oxygen supply.
Inhalation of oxygen under higher pressures than
that of the atmosphere had been found to produce
exhilaration, excitement and feverisness, convulsions,
indications of mental derangement, and even death,
according to the pressure, the period of in¬
halation, and the species ; and appearances
like cbromatolysis had been seen in the
nerve-cells. These results were caused by a mere
proportion to the tension of the oxygen in simple
solution in the blood. There was, however, no
evidence that these conditions could arise otherwise
than experimentally, but at the same time it was
possible that increase of blood-flow and of haemo¬
globin percentage, with, perhaps, other conditions,
might slightly raise the oxygen tension of the blood.
This was all that could be said, and experimental
hyperaemia of the brain had not been found to cause
symptoms.
In mania the haemoglobin was was about normal in
contrast to melancholia. On the other hand the
blood pressure was usually low, but in the absence of
evidence as to the venous pressure, no conclusion
regarding the cerebral circulation could be drawn
from this fact. The general nutrition in the slighter
casesof mania was actually improved, and there was
not improbably more oxygen in the blood. On the
whole the facts seemed to point to a connection,
whether causal or not, between increased or enriched
blood supply and mental exaltation.
Although fresh observation was needed at every
point, the results of the inquiry might be summed
up as follows : —
1. The emotional state produced by brain antemia
when gradual in onset, not too profound, and of
some duration, is depression.
2. Anaemia of rapid onset and considerable degree
tends to produce convulsions and excitement.
3. The characteristic feature of the general circu¬
lation in mental depression is high arterial tension,
which helps to maintain, if it does not cause the
painful mental state; but there is no conclusive
evidence of the condition of the cerebral circulation.
4. In mental depression the blood is impoverished.
5. Under experimental conditions high oxygen
tension in the olood supplied to the nerve-cells pro¬
duces excessive action and possibly exhilaration
y Google
Die. 6, 1899.
ORIGINAL COMMUNICATIONS. Th* M.dical Priss. 577
but there is no real evidence that such symptoms are
ever due to this cause under ordinary circumstances.
6. The characteristic feature of the general circula¬
tion in excitement, and probably in exaltation, is low
arterial tension. Here, again, there is no direct
evidence of the state of the cerebral circulation.
7. This low arterial tension helps to maintain, if it
does not cause, the mental state. The speaker con¬
cluded by deprecating a hard material conception of
psychology except in the limited sense defined at the
beginning of the address, and by urging the im¬
portance of psychological observation on the part of
the general profession.
THE USE OF ALCOHOLIC
BEVERAGES.
FROM THE STANDPOINT OF A MERE
PHILOSOPHICAL EPICURE.
By JAMES EDMUNDS, M.D., M.R.U.P.Lond.. Ac.
There is a standpoint to which I think that no
sufficient prominence has yet been given as a motive
for abstinence from alcoholic beverages. That stand¬
point is neither social, religious, nor political. It is
a purely personal motive, i.e., the motive springing
from a conviction that if one would live the highest,
best, and most effective life, one must discard nar¬
cotics of all kinds. Influenced by that motive, the
abstainer makes no pretences of special virtue, he
charges no sin against those who use narcotics, be
looks on with equanimity, and even with physiological
interest, while his friends subject themselves to a
course of chronic poisoning. He may amuse himself
with Dr. McGee’s claptrap phrase, referred to in your
leading article on November 22nd, and tell his friends
thathewould ‘‘sooner see them free than sober.” When
his friends do him the honour to dine with him, he
can furnish them with wine and cigars, and do all
that is needed to make them comfortable in their own
way, one thing only excepted—he does not poison
himself with alcohol or tobacco—not even to please
his friends. That is what I call the standpoint of the
philosophical epicurean—the man who has arrived at
the intellectual conviction that the use of alcoholic
beverages lowers the level of physical and mental
power, lessens the luxury of living, impairs the out¬
put and the quality of the work done, and shortens
the natural longevity—the man who having arrived
at this conviction makes up his mind to live accord¬
ingly, and lays down for himself the straight line of
total abstinence as more easily worked up to than
the crooked line of “ moderation ” or of occasional
indulgence—just to make one's friends comfortable
or to avoid being peculiar. What I submit is that,
if the philosophical epicurean be not right, there is
no bottom for total abstinence, and the sooner it is
dropped the better. If the philosophical epicurean
be right, there iB no need for any other motive. In
fact, all other motives must be false and misleading.
What Bishop McGee meant by his phrase I have
never been able to make out. Surely a man may be
free as well as sober. There is no sort of antagonism
between freedom and sobriety. In fact, it is only
men who are sober who attain full freedom. Yet
this miserable phrase passes for argument. A gener¬
ation before uttering that phrase McGee took the
temperance pledge at a meeting at Bath. He did
not keep the pledge, and hence, probably, the pun¬
gency of his speech on this point. He must have
thought that he was talking sense when he said that
he would “ sooner see England free than sober.” But
can anyone point out what the sense is ?
If I may descend to my own personal experience
would say that I never in my life was perceptibly
under the influence of alcohol, and that in my stu"
dent days I was, from motives of thrift, practically
an abstainer. In my practice I learnt from my old
master the rule never to take a glass of wine in a
patient'8 house, and I have never on any occasion
varied from that rule. Among patients with whom I
might dine, my practice as a guest was the same as
with other friends, but on no occasion of professional
intercourse did I ever take any alcoholic beverage.
If up at night when doing a large midwifery prac¬
tice I would order tea and toast, ox 1 , in special cases,
a broiled chop with tea and toast. But, when dining
out, for many years I did not like to be peculiar, and
I took wine just as other gentlemen might. And at
my own lunch or dinner at home a glass of ale or a
little wine would generally be taken. Dulling
these years I saw no principle in the matter, and
simply looked with contempt upon men who used
alcohol intemperately. Tobacco I never used in my
life in any shape or on any occasion.
In 1864 I was bothered by one of my patients, who
was secretary to a teetotal society, to take the chair
at a tempei-ance meeting. I had never pi-eviously
looked upon abstainers as anything but fanatics, and
at once declared myself a moderate—a real tem¬
perance man. Howevei - , I could not get away from
my pertinacious patient—a working saddler, who
had pleased me as a foreman in some harness work I
had needed—and I most reluctantly promised to take
the chair for him, although 1 was then surgeon to the
great bi-ewery—Truman, Hanbury, Buxton and Co.
It was undei-stood that I did not go as a teetotaller, and
that I was to say what I chose. I went. I opened the
meeting with an emphatic lecoinmendation of
“ moderation,'’ and an emphatic disavowal of total
abstinence. The temperance meeting listened to me
with pex-fect toleration, and then several working men
got up one after another and spoke. They told a
tale of misery and suffering, and how teetotalism had
rescued them and made them successful and useful
in life, and had made their wives and children happy
instead of miserable. Eveiy word they said went
home to me. and put life into pictui-es which, in
my daily work. I had long seen without seeing. In
fact, those working men fastened this question into my
mind, and made me feel that, in my opening l-emarks,
I had been flippant and wx-ong. I closed the meeting
in a vexy different spirit, and I promised to think
very carefully over the subject.
The result of what I heard at that meeting raised
with me the question of what was right in this
matter, and I left off my own little wine and
beer. I foixnd at fii*st that water was insipid, and
especially at times when I was heavily worked. I got
a shade thinner in person; and at first I missed my
little daily dose of alcohol. But I soon got used to
water, and I found that my quickness and power in
work were, if anything, better and moie uniform
Beyond a few ounces of alcohol in all—taken during
recent jeax-s for experimental purposes—I have never
since taken any alcoholic beverage. I did a very
large general practice for many years, including some
300 midwifery cases a year, and I never allowed an
assistant to give ergot or use instniments without
sending for me. I believe that I have gained every-
thing and lost nothing by my thirty-five years of
total abstinence from alcohol, and by my life
abstinence from tobacco. Now, after fifty years’
really hard medical work in London —often with a
propensity to blow off steam veiy wastefully,
I have perfect senses and still enjoy my work
thoroughly- That is my experience, and I am an
abstainer, not for any one else’s good, but simply for
my own good, and as an epicui-ean philosophei’. The
rule that I think should be laid down as to becoming
an abstainer is that a sound intellectual conviction
is the first stage. Habit must then be cultivated.
OOQ
o
578 The Medical Press ORIGINAL COMMUNICATIONS.__ Dec. 6, 1899.
For every year that a man has drunk moderately he
needs a week of total abstinence before the natural con¬
ditions of palate and digestion can be recovered, and
he is in a position to judge of the effects of the use
and disuse of alcohol. One needs to work on the
old maxim of Pythagoras, “ First find out that
course in life which is best, and then habit will soon
render it the most delightful.” Above all things, no
sneaking out of the puolichouse into the druggists’
shop. No substitutes. If a man wants to drink let
him get drunk honestly at a publichouse, not get in¬
toxicated at the druggist'8 shop.
One word as to the political aspect of the tem¬
perance question. I am not sure that there is much
in it. But as one who believes in local self-govern¬
ment for local affairs, I would deal with drink shops
as local affairs, and leave their maintenance or their
suppression to the votes of the people for whose
convenience the licences are supposed to be granted.
But as to getting an Imperial enactment to
suppress the sale of drink, it seems to me at present
an illusion. We now have 32 of the leading men in the
country constituting our present Government—a
Government second to no Government in the world
for all round ability and character. Now, of those
32 eminent and leading Britishmen only one is a
total abstainer. In the face of such a fact how can
we expect to enact a total prohibition of the sale of
those drinks which so large a proportion of our
leaders honestly believe themselves to require.
The question of using, or of disusing, alcoholic
beverages is a question of medical science. It should
be taken up and seriously studied by the medical
profession. Doctors are the only men who can push
this movement on through its next stage, and by so
doing they can vastly Berve the community. They
can also do themselves and their profession honour
by advancing the public good.
LACTATION: IN THE VIRGIN—
IN THE OLD WOMAN —IN THE ADULT
MALE—IN THE NEW-BORN OF EITHER
SEX (“WITCHES’ MILK”).
By JOHN KNOTT, M.A., M.D.,
Ch.B., and Dip. Stat. Med. (Univ. Dub.),
M.R.C.P.I., M.R.I.A.
The issue of the Medical Press and Circular
for November 22nd, 1899, contains a short comment on
“ Lactation in a Virgin,” for which the “ text ” was con¬
fessedly furnished by a communication made by a
physician to La Aft'decinc Modem-e. The English
commentator justly attributes to the case in question
“ a physiological interest,” and proceeds to add : “We
remember to have heard qf similar occurrences, more
or less well authenticated, in non-pregnant females,
even of advanced years; indeed, an abundant lacteal
secretion has actually been noted in the newly-born,
even of the male sex.” The general tone of this,
the concluding sentence of the article in question,
leaves the impression—at least upon the mind of one
reader of the Medical Press and Circular— that
the phenomena of the physiological vagaries therein
referred to are not quite so well known as I
think they should be. Accordingly, I have thought
that the gleanings of a few pages of my professional
Commonplace Book might not prove uninteresting
to a certain proportion, at least, of the readers of
this Journal.
To begin with the beginning. The fact of the
occasional occurrence of “ lactation in a virgin ” i
mentioned and commented upon by the illustrious
“ Father of Medicine ” himself; and hi9 observations
have been periodically reinforced by new cases in
all the ages down to the present period. A very
interesting instance is mentioned by tne great French
obstetrician, Beaudelocque,—of a girl of eight years
old, who suckled her brother for a month. I have
myself been consulted within the past few weeks by
the nuree (attendant) of a child—suckled by its
mother—who had been greatly distressed by the
appearance of an unexpected lacteal secretion. Dur¬
ing a comparatively slight indisposition of the nursing
mother, tne baby had, by my advice, been placed
to sleep with the nurse; and the attempts of the
latter to keep her troublesome charge in somewhat
better order by encouraging its instinctive attentions
to the mammary glands had led to the unexpected
and unpleasing result. The removal of the stimulus,
followed by appi-opriate treatment, general and local,
soon led to the complete disappearance of the abnor¬
mal phenomenon.
The distinguished American physiologist, Dun-
glison, observed that “ the secretion may arise
independently of impregnation; for it has been
witnessed in the unquestionable virgin, in the super¬
annuated female, and even in the male sex.” Turn¬
ing our attention now to the “ superannuated
female,” I find that Dr. Gordon Smith refers to a
manuscript—one of the rare and interesting collec¬
tion made by Sir Hans Sloane, in which is recorded
the case of a woman, aged sixty-eight, who had not
borne a child for more than twenty years before, and
who had, nevertheless, nursed all her grandchildren,
one after the other. And Professor Hall, of the
University of Maryland, related the case of a widow,
aged fifty, whom he had actually &een in the act of
giving suck to one of her grandchildren, although
she had not borne a child of her own for more than
twenty yeare previously. In this instance the secre¬
tion of milk had been called forth by trying to quiet
the child—during the process of weaning—by putting
it to her breast. Dr. Francis, of New York, narrated
the case of a lady, who had been delivered of a
healthy child, fourteen years before, after a natural
labour. He proceeds to observe that “ since that
period her breasts have regularly secreted milk in
great abundance, so that, to use her own language,
Rhe could at all times easily perform the office of a
nurse.” Dr. Kennedy, of Ashby-de-la-Zouch, has
described the case of a woman who menstruated
during lactation, suckled children uninterruptedly
through the full course of forty-seven years; and, in
her eighty-first year, had a moderate, but regular
supply of milk; and this “ rich, and sweet, and not
differing from that yielded by young and healthy
mothers.”
Dr. Stack recorded in the “ Philosophical Tran¬
sactions ” the case of an old woman whom he had
seen in Tottenham Court Road. She was then aged
sixty-four, and had not borne a child for sixteen
years. He found her “ secreting milk after repeatedly
applying her grandchild to her breasts for the pur¬
pose of quieting it, and continuing to furnish milk in
great abundance up to the time of the publication of
the case—an interval of four years—to the children
of her daughter, who, finding her mother so useful,
‘ was emboldened to bid fair for an increase of issue,
which, till then, she knew not how to nourish or pro¬
vide for.’ ”
Sexual excitement I should gueBs to be the exciting
cause in such cases as the following, mentioned by
Dr. Elliotson : “ I myself saw two married women
with milk in their breasts, one of whom had never
been pregnant, but always menstruated regularly, and
said this had been the case for nine months; the
other had not been pregnant for upwards of six
years, had weaned her child, and at the end of seven
months miscarried, and said she immediately after
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Dbc. 6. 1899 ORIGINAL COMMUNICATIONS. The Medical Press. 579
wards obeeiwed the milk, which had bee a secreted for
six months and was increasing at the time 1 saw
her.”
Ovarian (•• reflex ") irritation is not unfrequently a
cause, and an easily intelligible one. of the abnormal
secretion of milk. The following case, also observed
by Dr. Elliotson, would, I think, be an example: “ I
also attended a young single lady, whom I believe
never to have been pregnant, but who was subject to
amenorrh<ea, and had not then menstruated for five
months, and laboured, apparently, under ovarian
disease; milk oozed very copiously from her breasts,
and the medical attendant informed me that the left
had secreted it for many months.”
From the consideration of the abnormal secretion
afforded by the young unimpregnated and the
physiologically superannuated female, we may pass
to the still more anomalous cases of the establish¬
ment of the function in the male.
When a boy, resident in the West of Ireland, and
long before I had imbibed the most elementary idea
of the meaning of the term " physiology," 1 heard
discussed among some farm labourers the case of a
peasant of the preceding generation, who lived near
the shore of Lough Gara, and who had been left a
widower—with a baby of a few months old. This
had occurred in winter ; and, in order to supply what
care and warmth he could afford, the father took
the infant to his own bed. To quiet its restlessness
at night, he offered his nipple, with the result, after a
time, of the establishment of the lacteal secretion.
During the whole of the following spring, while
labouring at the planting of his potato crop, he used
to “ leave hie loy ” at regular intervals, ana go to his
cabin to “ give the breast” to his infant child.
Professor Hall, of the University of Maryland,
exhibited to his obstetrical class, in the year 1-S27, a
coloured man, fifty-five years of age, who had large,
soft, well-formed mamma, rather more conical than
those of the female, and projecting fully seven inches
from the chest; with perfect and large nipples. The
glandular structure seemed to the touch to be
exactly like that of the female. This man, according
to Professor Hall, had officiated as wet-nurse, for
several years, in the family of his mistress; and he
represented that the secretion of milk was induced by
applying the children entrusted to his care to the
breast, during the night. When the milk was no
longer required, great difficulty was experienced in
arresting the secretion. His genital organs were
fully developed.
In the “Philosophical Transactions ” for 1711
(Yol. XLI., p. 810), we find an Article which bears
this title: “ A Letter from the Right Revd. Father
in God. Robert Lord Bishop of Corke, to the Right
Honble. John Earl of Egmont, F.R.S., concerning
an Extraordinary Skeleton, and of a Man who gave
Suck to a Child.” This letter bears date “ Corke,
Aug. 8, 1738,” and after due consideration has been
iven to the peculiarities of the “ Extraordinary
keleton,” the writer proceeds to the following his¬
tory of the second item of interest:—
“And now that I am engaged in writing I will
venture to give an Account of a Man I met at Inisha-
nan, about 10 miles from this Place. He was an old
Man about 70 years of Age, by Birth a Frenchman,
but was a Refugee on account of his Religion, was
bred a Gardener, and, by all Accounts, had been
industrious till deprived of his Strength by Age.
“ He asked me for Charity, and I gave him half-a-
crown. I mention this Particular, that the remain¬
ing Part of the Story may not seem to be told for the
sake of Gain. After I had done this, and was gone
into the House, I heard a Noise at the Door. The
Man, out of gratitude, had returned to show me a
Curiosity, which was that of his Breasts, with which
he affirmed he had once suckled a Child of his own :
His wife, he said, died when the Child was about Two
Months old: the Child crying exceedingly while it
was in bed with him, he gave it his Breast to suck,
only with an Expectation to keep it quiet; but,
behold, he found that the Child in time extracted
Milk ; and he affirmed that he had Milk enough after¬
wards to rear the Child. I looked at his Breasts,
which were then very large for a Man ; but the Nipple
was as large or larger than any Woman's I ever saw.
Some Ladies were then passing by; so I sent him off
in Haste, and have not seen him since.
“ I have either heard or read of one Instance of
this kind before.”
In Franklin's “ Journey to the Shores of the Polar
Sea,” the author gives an interesting case as an
instance of the unconquerable parental affection of
the untutored Chipewyan. Passing from other sub¬
jects to this, he alludes to the striking example of
which he had recently obtained evidence :—” I shall
venture to give it in the words of Dr. Richardson’s
Journal. ‘ A young Chipewyan had separated from
the rest of his band for the purpose of trenching
beaver, when his wife, who was his sole companion,
and in her first pregnancy, was seized with the pains
of labour. She died on the third day after she had
given birth to a boy. The husband was inconsolable,
and vowed in his anguish never to take another
woman to wife, but his grief was soon in some degree
absorbed in anxiety for the fate of his infant son.
To pi'eserve its life he descended to the office of
nurse, so degrading in the eyes of a Chipewyan, as
partaking of the duties of a woman. He swaddled it
in 8oftmoss, fed it with broth made from the flesh of
the deer, and to still its cries applied it to his breast,
praying earnestly to the Great Master of Life, to
assist his endeavours. The force of the powerful
passion by which he was actuated produced the same
effect in his case ns it has done in some others which
are recorded; a flow of milk actually took place from
his breast. He succeeded in rearing his child, taught
him to be a hunter, and when he attained
the age of manhood, chose him a wife from
the tribe. The old man kept his vow in never taking
a second wife himself, but he delighted in tending
his son's children, and when his daughter-in-law used
to interfere, saying, that it was not the occupation of
a man, he was wont to reply that he had promised
to the great Master of Life, if his child was spared,
never to be proud, like the other Indians. He used
to mention, too, as a certain proof of the approbation
of Providence, that although he was always obliged
to carry his child on his back while hunting, yet that
it never roused a moose by its cries, being always
particularly still at those times. Our informant
L Mr. Wentzel] added that he had often seen this
Indian in his old age, and that his left breast, even
then, retained the unusual size, it had acquired in his
occupation of nurse.”
It is stated, on what appears to be good authority,
that this occurrence of the lacteal secretion in the
adult male is. or was, common in Russia. “ Comment.
Acad. Sc. Petropolit,” Vol. III., p. 278.1 I regret
that I have no later reference on the subject.
With regard to the general question of the occur¬
rence of a mammary secretion in the male mammal,
Blunsenbach published some curious items of informa¬
tion. One case is that of a lie-goat, which its owner
found necessary to milk on every alternate day
throughout a whole year. Commenting on this case,
Dr. Elliotson wittily observes, “ so that, to say with
Virgil, mulgeat hircos is not tantamount to calling a
man a fool. In the “ Philosophical Transactions ”
(1799), there is a case recorded of a bull which had
been put to cows successfully, and had also rudi¬
mentary female organs of generation. According to
“satisfactory testimony,” this animal gave milk.
There is also a case given in the “Philosophical Trans-
P
Diq
3 oo gle
580 The Medical Phess. TRANSACTIONS OF SOCIETIES.
Dec. 6, 1899.
actions ” of a lamb, the property of a Sir William
Lowther, which had lost its dam, and then com¬
menced to suck a wether that grazed in its com¬
pany. The effect of the efforts of the orphan lamb
was that it “ brought him to milk, and was main¬
tained by him all the summer : he had two
considerable teats on his udder, each Bide whereof
was about the bignesss of a hen’s egg.” After the
lamb had been weaned for a whole month the milk
could be made spurt to a distance of two yards.
(To be concluded in our next.)
Clinical Jiccorbs.
DEATH FROM ELECTRIC SHOCK.
By Mr. Percy G. Lodge, L.8.A.,
Bradford.
At the works of Messrs. J. Holden and Sons, Brad¬
ford, on November 20th, E- D-, set. 29, of
Bradford, whilst repairing a lamp, slipped off the hand-
steps on which he was standing, and to save himself
caught at the insulated wires. Eye-witnesses state that
his whole body became violently flexed, his grasp fixed,
and he finally fell. When picked up he was dead.
Dr. S. Lodge, the police surgeon, made a post-mortem
examination on the following Thursday at which I
assisted. The medical officer of health, Dr. Evans, also
assisted in the proceedings, and Dr. Campbell, of the
Bradford Infirmary, was present.
Post-mortem (14 hours).—Externally: Body was not
quite cold. There was a superficial redness over the
axillae and flanks. The eyes were bright, and there was
none of the haziness usually seen after death about the
cornete. The pupils were dilated equally. No bruises
were to be seen, the hair on the inner and outer sides of
the knees was white and frizzled, as though scorched or
bleached. The hands, especially the right, were firmly
flexed. Internally: On opening the head, there was a
bruise beneath the scalp on the right parietal region as
large as a florin, with a few corresponding ecchymoses
on the pia mater more deeply. The brain weighed forty-
eight ounces. It was firm and healthy. There was no
sign of any fracture of the skull. On opening up the
trunk free venous haemorrhage was observed from the
incision, and the blood exhibited a marked fluidity.
The lungs were both healthy. The heart was empty
and free from valvular or other lesion. The pericardium
contained a small quantity of clear fluid. A small bruise
like an ecchymosis was seen beneath the visceral pericar¬
dial endothelium over the ventricle. This was quite
superficial. The ventricular walls were firm and of normal
thickness. The liver was quite healthy, weight 3J lbs.
The kidneys were firm and healthy. Right weighed
4J ozs., left 4£ ozs. 8pleen normal. Dr. S. Lodge
states that the body was that of an exceeding healthy
individual, well nourished and muscular. He was about
5 ft. in height and about 10 st. in weight. The increasing
frequency of death from electric shock and the rarity
of published reports of post-mortem appearances induce
me to present these necessarily brief notes. The most
marked features in the post-mortem appearances are,
the fluidity of the blood and the absence of any form
of physical lesions.
^vaneartions ot ^adcttce.
WEST LONDON MEDICO-CHIRURGICAL
SOCIETY.
At a meeting held on December 1st, the President,
Dr. J. B. Ball, made the following proposal:—That it
is desirable that this Society should join in the scheme,
in connection with the
soldiers’ and sailors’ families’ association,
to afford gratuitous medical attendance in their own
homes for the necessitous wives and families of soldiers
and sailors now serving with the colours. And that a
sub-committee be formed to carry out this resolution.
The proposal was carried unanimously. Mr. C. B.
Keetley proposed that the following should be nomi¬
nated members of the sub-committee to carry into effect
the resolution which had just been passed by the
Society. The President (Dr. ,J. B. Ball), the secretaries
(Dra. G. D. Robinson and G. P. Shuter), the treasurer
(Mr. Gunton Atherton), Mr. F. Lawrance, Mr. W: H. C.
Staveley, Dr. S. D. Clippingdale, Dr. A. H. W. demon,
and Dr. H. Campbell Pope, with power to add to their
number.
Dr. W. H. Waller seconded the motion, which was
carried unanimously.
Cases Exhibited.
Mr. McAdam Eccleb then showed a case of Excision
of Carcinoma of the ascending colon in a woman, set. 45.
The patient was operated on for cystic right ovary which
was removed. On further examination the whole
circumference of the ascending colon was found
to be involved by a large growth. The diseased
portion of the gut was brought to the surface and
stitched to the skin. Eight days afterwards the tumour
was removed with complete success, the woman making
a good recovery. No secondary deposits were found at
the time, and there had been no recurrence since.
Remarks were made by the President, Messrs. L. A.
Bidwell, C. B Keetley, and E. P. Paton.
Dr. George Johnson showed a case of intra-cranial
growth affecting the first eight cranial nerves in a
sister of the last patient. After minutely describing and
demonstrating the patient’s symptoms. Dr. Johnson said
that the lesion was improving under treatment, and that
it was probably of a syphilitic character. Dr. Seymour
Taylor showed a patient who was suffering from injuries
to nerves due to a fall of a few feet. On one Bide the
seventh and eighth were affected and on the opposite
side the eighth nerve alone. The cases were discussed by
the President, Messrs. McAdam Eccles and E. P. Paton.
Mr. L. A. Bidwell showed two sisters from whom
thyroid cysts had been removed. Also a case of
congenital syphilitic synovitis of both knees. The three
cases were discussed by Messrs. W. H. C. Staveley and
W. McAdam Eccles.
Mr. McAdam Eccles showed a case of wiring in an
ununited fracture of the tibia, with skiagraphs by Dr.
F. H. Low.
Mr. C. B. Keetley showed a patient on whom he had
operated for extensive suppuration of the abdominal
wall, and who had attended the West London Hospital
for an offensive purulent discharge from the vagina. An
incision was made in the middle line, a large quantity of
pus and air being evacuated. Another incision was
made to the right of the umbilicus, on passing the finger
through this opening into the pelvis the cervix could
easily be felt; but the body of the uterus had dis¬
appeared. He diagnosed the case as one of pelvic sup¬
puration, the pus having tracked up into the abdominal
wall. Remarks were made by Dr. G. D. Robinson.
Dr. G. D. Robinson showed two skin cases for Dr. P.
Abraham. (1) Case of Condylomata about the anus in an
infant, set. 1. There was no history of syphilis maternal
or otherwise, and the child was rapidly cured by the
external application of zinc oxide and calomel; (2) Case
of pityrasis rosea of Gibert showing points of resem¬
blance to linea circinata as well as to eczema sebor-
rha icum.
SHEFFIELD MEDICO-CHIRURGICAL SOCIETY.
Meeting Held November 27th, 1899.
The President, Dr. Burgess, in the Chair.
Mr. Edw'ard Skinner showed an instrument for
examining throats of cases suffering from diphtheria,
consisting of spoon handle, having a glass disc between
the observer and patient.
Dr. Arthur Hall showed the following cases:—(1)
A young woman with very loud rough aortic systolic
murmur of some years’ duration, in whom a diastolic
murmur has developed during the last month or two.
There is no history of rheumatism, strain, or syphilis.
Up to the present time the obstruction has not caused
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Dec. 6, 1899.
TRANSACTIONS OF SOCIETIES. The Medical Press. 581
any venticular dilatation or hypertrophy. (2) A girl
with keratosis palmaris et plantariB. (3) A man with
multiple soft fibromata varying in size from a pin’s
head up to a marble. Not pedunculated. (4) A case of
favus of the cheek in a child (photograph).
Dr. G wynne showed a case of
PSEUDO-HYPERTROPHIC PARALYSIS.
The patient a boy, set. <5J, began to develop the disease
about 2) years ago. Two of his maternal uncles suffered
from paralysis in early life. There was no mental
deficiency. He was unable to walk, and could not rise
from the stooping posture without the aid of his hands.
The muscles of the calves were enlarged and hard, as
were ulso the erector spina 1 muscles and the infra spinati.
Most of the muscles of the upper extremity were
atrophied, also the muscles of the chest and ribs. The
Faradic current produced no reaction except slightly in
flexor longus pollicis and the adductor pollicis brevis.
The galvanic current (lfi cells) produced no reaction
in the lower limbs except in the tendo-achillis. Most of
the muscles of the upper limb were unaffected by the
current including the supra spinatus and infra spinatus.
The adductor pollicis brevis and the flexor communis
digitorum in the right side showed the R.D. reaction.
He favoured the view that the disease was a primary
idiopathic atrophy of the muscles.
Dr. Robertson gave a demonstration on organisms
isolated from the throats of children attending public
elementary schools during the prevalence of diphtheria,
and contrasted these with typical diphtheria bacilli. He
afterwards read a paper on “ Some Points in the Etiology
of Diphtheria,” in which he dwelt at length on the
number of children attending school—apparently in
ood health, who had in their throats either typical
iphtheria bacilli or organisms which could not by
microscopical method be distinguished from them.
Examination had shown that in schools not attacked
with diphtheria the children did not in any instance
show the diphtheria bacillus in the throat. During the
past twelve months fifty-nine selected children from five
schools had been examined bacteriologically—of these
seventeen showed typical diphtheria bacilli, thirteen
showed an organism very like the bacillus diphtheria?,
while the remaining nineteen gave no suspicious organ¬
ism. All of these children were at school when examined,
and none of them had any typical diphtheritic lesions.
Dr. Robertson gave it as his opinion that the occur¬
rence of such nnrecognised cases was one of the most
important difficulties in dealing with epidemic diph¬
theria, and unless they were recognised other preventive
measures were likely to be abortive.
Dr. Anderson read a paper on
THE SERUM TREATMENT OF DIPHTHERIA.
He gave a brief resume of the results obtained by the
use of antitoxin in different parts of the world, pointing
out that, though generally there had been a reduction
in the total case-mortality by about one-half, the best
results were obtained where treatment was commenced
within the first three days of the onset. In a series of
258 consecutive cases treated by antitoxin at the City
Hospital, Sheffield, where 46 per cent, of the cases were
admitted on the fifth day and after, the case-mortality
was 15 - 8 per cent. In Chicago the mortality in 4,071 cases,
only 11 per cent., and of those which were treated on the
fifth day and after it, was only 6'77 per cent. Early ad¬
ministration was the most important point. It was not
advisable to waste too much time in disinfecting the
skin, and it was bad practice to wait for the results of a
bacteriological examination before using antitoxin. The
enormous reduction in the mortality of post-
scarlatinal diphtheria was due to the fact that
all such cases were injected on the first or
second day. In laryngeal diphtheria, if anti¬
toxin treatment was begun early enough, operative
interference was often unnecessary. Intubation ought
to be given a trial as the primary operation in most
cases. He had never observed any really serious con¬
stitutional disturbances following the injections, though
in a few cases the occurrence of pains in the joints in
patients suffering from cardio-gastric symptoms seemed
to accentuate the tendency to collapse. Antitoxin albu¬
minuria was of no real importance. The dose in a mild
case should be 4,000 unite. In severe cases the best
plan was to give 4,000 units every three hours for three
or four doses and to repeat similiarly next day if neces¬
sary. In his experience this was better than giving one or
two large doses of 8,000 or 12,000 units. Septic complica¬
tions were very infrequent in diphtheria. The associated
micrococci seemed harmless enough, though they had
all the advantages of the situation. Where cervical
cellulitis was present, he had tried simultaneous injec¬
tions of antitoxin and anti-streptococcic serum, but
with no better results than with antitoxin alone. A
perfected serum would no doubt be obtained with a
greater affinity for the toxins and a diminished liability
to the production of rashes and pains, which were often
a source of considerable annoyance and discomfort.
BRADFORD MEDICO-CHIRURGICAL SOCIETY.
Mhktino held November 21st, 1899.
The President, Mr. W. Horrocks, in the Chair.
Dr. Eirich gave an exhibition of pathological speci¬
mens, among them was (1) a specimen of angio-sarcoma of
kidney, (2) primary melanotic sarcoma of spinal
column which invaded the dura mater and destroyed
the spinal cord by pressure. There was no metastasis
except in the lungs. The specimen was spoken of as
one of extreme rarity.
Mr. J. B. Hall showed a popliteal aneurism, the result
of a comminuted fracture into the knee-joint.
Dr. Rabagliati read notes on a case of
SUPPURATIVE PELVIC CELLULITIS,
And made some general remarks on the sequence of
high and low temperatures in inflammatory diseases.
We hope to publish a full report of this case in an early
number.
Dr. Johnstone Campbell related a case of
addison’s disease,
And showed the diseased suprarenal bodies obtained
post-mortem. The patient was a man, a?t. 48, a shoe¬
maker. Nine months prior to admission the illness had
commenced with nausea and vomiting in the morning.
His appetite failed, and bronzing of the skin soon l>egan
to shoYv itself. The fingers and toes became blue in the
cold weather. On examination the patient showed well
marked “ bronzing ” of skin, especially in the folds and
over the points of pressure, e.g., at the place where a truss
was applied. The skin over the terminal phalanges of
fingers and toes was cold and blue, although the weather
was warm. Urine normal. The heart was normal. No
sign of tubercle in the lung3. Examination of abdomen
negative. The pulse was small and feeble, and the
patient very weak. The appetite was bad, and he
vomited occasionally. Patient rapidly got weaker, refused
to take his food, and, passing into a semi-uncon¬
scious state, died on June 19th, 1897, seventeen days
after admission. Post-mortem examination showed exten¬
sive tuberculous disease of the suprarenal bodies.
Dr. Campbell remarked that the case showed the
typical symptons of the disease. The asthenia without
marked wasting, the pigmentation, the persistent
nausea and low blood pressure rendered the diagnosis
easy, and it was confirmed by the post-mortem appear¬
ances. After discussing the history of the disease, and
the experimental work in connection with the supra¬
renal bodies. Dr. Campbell expressed the opinion that
there was a hope of good result in the future from the
treatment by suprarenal extract. He remarked that
intravenous injection'was the ideal method of administra¬
tion, but was not available for prolonged treatment. He
suggested the employment of suppositories, made up
with a neutral fat.
Dr. Kerr showed a patient who had "Embolism of
Central Artery of the Retina,” and who had since been
found to have kidney trouble, and who thirty hours
previously had blindness in the left eye, a small patch
of the field from the fixation point down and out being
preserved. The fundus presented the typical picture of
embolism of the central artery. In two of the vessels
Digitized by G00gle
582 The Medical Press.
GENERAL MEDICAL COUNCIL.
Dec. 6, 1899.
which appeared to be veins, broken up blood columns
were seen slowly progressing, with pulsating movements
in'one case towards, in the other from, the nerve head.
TRAUMATIC HYSTERICAL MONOCULAR DEVIATION.
Dr. Kerr read notes of the case, and presented a
single spare woman, who, as result of a knock on the
cheek ten years previously, had deviation of the eyeball
30 degs. np, and 27 degs out. 8everal operations—
advancement of both in ernal and inferior, and tenotomy
of external and superior recti and of inferior oblique,
had restored her appearance, the deviation with the
Maddox test being now 2 degs. out and 6 degs. up.
There was accommodative asthenopia, contracted field
of vision, and pharyngeal anaesthesia, and after a full
discussion of the features of the case, the diagnosis of
traumatic hysterical contracture was arrived at as afford¬
ing the best explanation.
- 4 -
LIVERPOOL MEDICAL SOCIETY.
Meeting held Thursday, November 16th, 1899.
Dr. Macfie Campbell, President, in the Chair.
Mr. Frank T. Paul related two cases of colectomy.
Mr. Rushton Parker related a case of gastric ulcer in
which perforation occurred, necessitating an operation.
Mr. Paul related a case of
PERFORATING GASTRIC ULCER IN WHICH THE EXTRA¬
VASATION BECAME [LOCALISED, AND THE PATIENT RE¬
COVERED WITHOUT OPERATION.
For three weeks not a drop of anything was swallowed,
and the deprivation was borne without discomfort owing
to plenty of water being injected per rectum. He
thought that as in appendicitis the different degrees of
peritoneal infection called for different treatment.
Mr. Thelwall Thomas confirmed the previous
speaker in the value of injections of water or saline
solution into the rectum for shock or after operation for
perforated gastric ulcer to diminish thirst. He alluded
to two cases (one fatal), in which he had operated, in
one case the perforation occurred when the stomach was
empty of food, yet the whole peritoneum was soiled, the
ulcer being near the pylorus. The other case, which
was followed by recovery, the perforation was near the
cardiac extremity ,of the organ, and occurred when the
stomach was full, yet the extravasation was limited by the
anterior surface of the great omentum. In the first
case abdominal lavage was practised, in the second
merely wiping out the extravasated food and lymph.
Dr. Carter remarked on the apparent frequency with
which, after immediately successful operations for per¬
forating gastric ulcer death resulted from changes in
secondary exudations between the liver or the diaphragm
and the stomach. Such, he gathered, was the case in
two instances alluded to by speakers this evening, and
such was certainly the cause of death in a very difficult,
and what for some time promised to be a very successful,
operation performed by his colleague, Mr. Robert Jones,
some months ago at the Royal Southern Hospital. The
patient, a young woman, rallied well, and continued well
for some ten days, when a tumour which had formed and
presented near the epigastrium, was opened by Dr.
Alexander, in Mr. Jones’s absence from Liverpool, and
gave exit to more than a pint of very foetid pus. She
rallied during the operation in a most remarkable
manner from what looked iike a very moribund condi¬
tion, the result, apparently, of a free intravenous injec¬
tion of a warm saline solution, but succumbed a day or
two later. As to the possibility of recovery, even
without opeiation after the perforation, he had
no doubt whatever, first, because he had seen
S ' ‘ its recover where the Bymptoins left no
that such perforation had occurred, and
secondly, because in one instance a post-mortem exam¬
ination years after such an occurrence proved it to
have taken place. This case was that of a girl who died
of ca'cal disease and obstruction. She gave a distinct
history of a stomach complaint with ha'matemesis.
Severe pain and collapse some years before in which her
life had been almost despaired of. Post-mortem: we
found extensive firm adhesions between the liver and
Btom&ch, with a somewhat cicatricial puckering which
convinced us that perforation had taken place, and that
nature had successfully sealed the orifice. In other
cases even where art has achieved this result, subsequent
inflammatory changes at the site of operation may as
we have heard to-night cause death.
Drs. Abram and Grunbauin also spoke.
Dr. Briggs read a paper on vaginal enucleation and
vaginal hysterectomy in the treatment of uterine
fibroids (not including polypi). The paper was based
mainly upon his own experience in 89 ?ases treated by
the vaginal route, 25 by hysterectomy, i nd 14 by
enucleation. The fibroids enucleated varied in weight
from 2 ozs. to 2 lb*. 15 ozs. The uterus and filroids
treated by vaginal hysterectomy varied in weight from
7 ozs. to 2 lbs. 2? ozs.
The main object of the paper was to show the
advantage of an anterior vertical mesial section of
the dilated cervix, after separating the bladder as
in vaginal hysterectomy, in affording room for piecemeal
extraction and enucleation. Enucleation of submucous
and interstitial growths was, in his opinion, now ren¬
dered as safe as hysterectomy, by the vaginal route.
All the thirty-nine patients recovered, and only one
operation (enucleation) was followed by a complication
(cellulitis) duiing recovery. In only one case was the
enucleation abandoned and hysterectomy substituted.
The author alleged this circumstance was some proof as
to how far the adaptability of the operation could be
gauged by uterine exploration, before enucleation was
commenced, and, if need be, total uterine extirpation
could follow. Opponents of enucleation on account of
fibroids being multiple seem to have overlooked the
complete exploration possible at the close of enucleation.
One patient had eight growths enucleated in March,
1893, and was now still free from symptoms oi physical
signs of fibroids.
The work was in all respects less formidable than the
work of Pean, but it demonstrated that operative treat¬
ment by enucleation by the vaginal route had wider
limits than had been generally recognised. The weights
of the tumours removed in the author’s practice were
net weights, minus blood and serum, yet were larger
than many which had been treated with greater risk by
abdominal hysterectomy.
Dr. Grimsdale thought that there was much to be
done by vaginal enucleation, but considered that the
great difficulty in the application of the operation was
the fact that fibroid tumours, being usually multiple,
the exact relations of all the tumours were often im¬
possible to make out, so that the operation must often
be completed by means of a vaginal hysterectomy. He
related a case where he had removed fifteen fibroids by
vaginal enucleation with the best result, but it was still
possible that other tumours had been left behind, and
that a tecond operation might be required at some
future date. For large tumours he preferred to perform
abdominal hysterectomy.
The I ’resident and Dr. Burton also spoke.
GENERAL MEDICAL COUNCIL
OF
EDUCATION AND REGISTRATION.
WINTER SESSION, 1899.
Sir William Turner, President, in the Chair.
FIRST DAY.— Tuesday, November 28th, 1899.
The Sixty-Eighth Session of the Council was inaugu¬
rated on Tuesday of last week by the usual Presidential
Address. The President informed the Council that the
services of three experts had been obtained to read and
report upon the papers which the majority of the
Examining Boards had placed at the disposal of the
Council in view of steps being taken to raise the standard
| of the entrance examination to the medical profession.
Alluding to a correspondence which had passed be-
Digitized by GoOglC
Dec. «, 1899.
GENERAL MEDICAL COUNCIL.
The Medical Press. 583
tween himself and the Registrar-General on the subject
of the reform of death registration the President
remarked that this official could not himself initiate
legislation, the matter resting with the Local Govern¬
ment Board. The President added that the Council
should not relax its efforts to obtain this much needed
reform and should pass a formal resolution on the
subject.
With regard to the proposal to obtain further powers
from Parliament for strengthening the j>enal and
disciplinary powers possessed by the Council, the Presi¬
dent related the steps that had been taken to bring the
various degree-and diploma-granting bodies into accord,
and this object had been attained. He pointed out that
it lay with the Council to request the Privy Council
either to introduce or, if introduced by a private
member, to support, a Bill to carry out this much-
needed reform, adding that a motion to that effect
would be placed befcre them.
The further steps taken to secure the identification of
persons applying to bo admitted to the Medical and
Dental Registers were mentioned, and it was promised
that the draft report of the Personation Committee
would come up for discussion in due course.
A request having been received fron the German
Ambassador for information on several points regarding
the admission of foreigners to the practice of medicine
in this country, and as to the conditions under which
fo-eigners can be admitted to examination by the
medical authorities in this country, a precis had been
prepared which had been handed to the Education
Committee for their consideration, and this, when
adopted by the Council, would be forwarded to the
German Goverment through the usual channels.
With regard to the agitation in Italy in favour of
restricting the practice of medicine in that country to
persons with native qualifications, the President said
he bad been requested to ask the Council to move the
Government to consult the Law Officers of the Crown in
order to obtain an official statement of the rights to
practise in this country enjoyed by Italian practitioners.
A statement has been prepared by Mr. Muir Mackenzie
on the law with respect to the rights of foreign practi¬
tioners to practise in the United Kingdom, and a report
on the question of reciprocity by the Executive Com¬
mittee would be brought before the Council.
The Society of Apothecaries had written, challenging
the decision of the Queen’s Bench Division in the Hunter
case, and suggesting that a test case should be arranged
with the co-operation of the Council, to be tried in the
Court of Appeal, each party to pay its own costs. The
address concluded with an allusion to the penal cases
and other matters to come before the Council, and after
the usual vote of thanks the Council proceeded to the
first item of business on the programme.
Examinations for the Services.
On the tables of results of the examinations for posts
in the Royal Army Medical Service Corps and the Indian
Medical Service being brought forward Mr. George
Brown pointed out that of six candidates from the Irish
schools only three had been successful, and he suggested
that the reports in question should be referred to the
Education or the Examination Committee for considera¬
tion.
Sir Dtce Duckworth observed that as chairman of
the Education Committee he would not know what to do
with the reports if they came before him, and Dr.
MacAlister pointed out that the candidates in question
appeared under the heading “qualified but unsuccessful,”
which merely indicated that they did not come high
enough up on the list.
Sir Christopher Nixon thought Mr. Brown bad dis¬
covered a “ mare’s nest,” sod he failed to see what good
could come from such a reference.
Dr. Athill pointed out that the Army Medical De¬
partment expected something above a mere “ pass ”
standard, and he suggested that Irish candidates were
placed at a disadvantage in being examined by English
and Scotch examiners, whose methods were different.
Dr. McVail thought these examinations afforded a
means otherwise unobtainable of ascertaining how the
various bodies did their work. He thought, too, the
motion was of the nature of a compliment to the de¬
partments.
Dr. Bruce thought it was a question worth looking
into, but Sir Richard Thorne thought the Council had
enough work to do without going out of its way to seek
additional subjects.
Dr. Little agreed with Dr. Atthill that the Ser¬
vices were not popular in Ireland, and he urged that
the motion should take the form of an instruction
to the Committee to ascertain the circumstances
which led to the unusual success which attended
the efforts of the Irish graduates in the more wealthy
and appreciative English communities, a proposal
which Mr. Brown repudiated.
After some further discussion, the motion was nega¬
tived.
The Apothecaries’ Society of London.
An opportunity was afforded Mr. Brudenell Carter
of replying to certain statements made by a member of
the Council bearing on the constitution of the Society of
Apothecaries and the action of its representative on the
Council. He commenced by observing that his conduct
and opinions had for some years past been adversely
criticised by Mr. Victor Horsley, such criticisms not
always being based on facts. He had thought his fifty
years' experience of medical practice, his life, his acts, and
his writings were sufficient to defend him against these
criticisms, but he now felt compelled to protest against
ce tain acts attributed to him in connection with the
case of the late Mr. Hunter, in deference to the
instructions of the Society he represented. Referring
in particular to Mr. Horsley’s statement that the Master
and Wardens “knew no more about medicine than boot-
making,” and were really a bandful of tradesmen who
“without any medical education, notoriously prescribed
over the counter in the druggists’ shop on the ground
floor of the Apothecaries' Hall in Blackfriars,” and to
the reference elsewhere to himself as "a man who is
sent there (to the Council) by a handful of City grocers
.... and who speaks as though he were the represen¬
tative of a large body of medical men throughout the
United Kingdom, instead of the members of the Apothe¬
caries’ Society,” Mr. Carter remarked that in Mr.
Horsley’s statements there was a singular “ economy of
truth,” indeed, there was not a particle of truth in the
statements. He (Mr. Carter) was not elected by the
Master and Wardens but by the Court, a body of twenty-
four, of whom the Master and Wardens were three.
He commented on the studied insolence of Mr.
Horsley'8 phraseology, and opined that the use of
such phraseology addressed to gentlemen of mature
years and unblemished character might be com¬
pared to the peculiar howl or cry of the variety
of the human race known to modem sociologists as the
“ bounder.” He pointed out that since 1815, no one, who
was not a medical man, was eligible for election to the
court, adding that the Society was mostly composed of
medical men. Alluding to a further statement of Mr.
Horsley’s that the Court of Assistants of the Society
contained several gentlemen who were not on the
Medical Register; he pointed out that this remark
referred to a few gentlemen who, having retired from
active service, had not placed their names on the Register
though they happened to be Fellows or members of
various colleges. Passing on to the statements made
concerning him in respect of the Hunter case, he pointed
out that although he happened to have taken the chair
at the particular meeting of the committee, he was not
the chairman of the committee. At the subsequent
meeting of the committee, he believed they only had
before them the charge made against Mr. Hunter by Mr.
Syme, and they merely had a verbal report that the
solicitor “ had taken steps to carry out the instructions
of the Council.” He said that, personally, he knew
nothing about the Hunter case, and had incurred no
more responsibility than any other member of the
Council. In reference to the statement that he had
opposed Mr. Hors'ev having access to the Council’s
papers, he admitted that he was of opinion that such
access should be regulated, and he had voted for this
modified access. He complained that while the medical
Die
Dec. 6, 1899.
584 The Medical Press. GENERAL MEDICAL COUNCIL.
journals gave publicity to statements adverse to him
they suppressed his replies, and he appealed to the
journals, if they published the attack, to be fair enough to
publish the reply. He denied the right of journalists
to comment upon a speech, no report of which appeared
in their columns.
Mr. Victor Horsley having obtained permission to
reply, apologised to the Society of Apothecaries for
having inadvertently misrepresented their constitution.
He had been informed at the office of the Society that
practically the representative was elected by the
Master and Wardens, and he was also informed
that these gentlemen were not on the Register. He
admitted that when he stated that certain of the
members were not on the Register he was unaware of the
fact that, though not on the Eegister, they were qualified
to be there, and he tendered an apology to them in so far
as he had maligned them. He reiterated his view that
Mr. Carter was not really the representative of the
Society seeing that the licentiates had no voice in the
matter. He would not concede either that the work of
the Society had, as asserted by Mr. Carter, been carried
on without reproach. The reputation of the examina¬
tion of the Society among students bore him out in
the views he had expressed on the Apothecaries
Society as a whole. He failed to see what inaccuracy
there was in describing Mr. Carter as chairman of the
meeting of the Penal Cases Committee referred to (Mr.
Carter pointed out that Mr. Horsley had not said
chairman of the meeting, but chairman of the com¬
mittee). Mr. Horsley, continuing, said he would not
quibble over such a little point. M>-. Carter com-
S lained that he had been blamed for not observing that
[r. Hunter was an L.S.A., but he (Mr. Carter) had had
it before him in print, and he asked whether any of
them would have voted for the prosecution of Mi.
Hunter among a band of quacks if they had been
cognisant of that fact. He maintained everything he
had said about Mr. Carter on that point, and declined
either to withdraw his statements or to apologise there¬
for. He concluded by remarking that he had certainly
been misinformed as to the nature of the present Court
of Assistants, and he apologised for what he had said
concerning that body.
The President then declared the incident closed.
Dea th Certification.
Mr. Carter moved on behalf of the Executive Com¬
mittee that the President should request the President
of the Local Government Board to receive a deputation
from the Council to urge the advisability of early legis¬
lation on this subject on the lines of the recommenda¬
tions of the Committee on Death Certification approved
in September, 1893.
This was seconded by Dr. Glover, and the President
stated that according to one of the latest reports of the
Registrar-Gtn3ral for Scotland showed 3 6 of the deaths
to have been uncertified, and he thought it not unlikely
that in England the proportion was even higher.
Mr. G. Brown observed that in many cases the
registrars of deaths were chemists who had been in
attendance on the patients whose deaths they had to
certify, and he urged that no chemist should hold such
appointments, especially if he prescribed for patients.
The resolution was passed, the selection of the deputa¬
tion being left in the hands of the President.
Illegal Certificates.
On the motion of Mr. Brown, seconded by Dr. Glover,
a communication from the Yorkshire Branch of the
British Medical Association, accompanied by copy of
a resolution expressing disapproval of “ unauthorised
societies or other organisations of registered medical
practitioners arrogating to themselves the right to grant
diplomas or certificates of proficiency in any branch of
medicine, surgery or midwifery," asj being contrary to
the Medical Acts, was received. A similar communica¬
tion was received from the East York and North
Lincoln branch.
Mr. Brown had given notice of a motion to rescind
the resolution of the Council of May 29th, 1895, relating
to the Obstetiical Society’s certificates, but the con¬
sideration of the motion was postponed in order that
its terms might be made conformable to the Standing
Orders.
The Council then adjourned.
SECOND DAY— Wednesday, November 29th, 1899.
Certificates of Proficiency in Midwifery.
Mr. George Bbown moved resolutions (a) that the
President be requested to inform the Obstetrical Society
of London, the resolution of May, 1895 notwithstanding,
that the Council' can no longer assent to the holding of
examinations in midwifery, or granting of certificates of
proficiency therein by any body of persons, unless invested
with legal authority therefore, and (b) that notices be in¬
set tsd in the leading medical journals to the effect that
after January 1st next any registered practitioner who took
part in such examinations . . . would be liable to be
adjudged guilty of “ infamous conduct in a professional
respect," and to have his or her name removed from the
Medical Register. Mr. crown referred to the numerous
petitions that had been brought before Council in respect
of the practice complained of, and he added that
not only midwifery was examined in, but also
massage, ophthalmic work, &c. He refened to
the terms of the Act of 1886, which defined
what was a qualifying examination, yet certain
societies issued diplomas quite outside that Act. He
animadverted on the practice of the Obstetrical Society
in granting these certificates, observing that if the
Obstetrical Society were permited to do this sort of
thing it was open to anyone so to do.
The President pointed out that the certificate
expressly stated that it was not a qualification under the
Medical Act.
Mr. Brown admitted that such was the case, and
said he would not object to this or any other society
issuing a certificate that a person was qualified to act as
midwife or monthly nurse. The holder of such a certifi¬
cate might say that she had a certificate which was
approved by the General Medical Council, and this
was objectionable.
Mr. Victor Horsley seconded the motion on two
grounds, first that the Council as a whole had never
had any opportunity of finally expressing its opinion on
the subject, and he hoped that the Council would now
acquit themselves of appearing in any way to sanction
this certificate. His second point was, that though they
must have every sympathy with the Obstetrical Society
in taking up these examinations, still he thought the
Society was mistaken in issuing any such certificate, the
original objection applying equally to the amended
certificate.
Dr. Glover sympathised with the motion, but urged
that it would place the Council in an awkward position
to have to stamp men like Sir John Williams as guilty of
infamous conduct. The position of the Council was that
they had never sanctioned the certificate, and they were
all agreed that it was objectionable. It was objection¬
able also that the Council should appear to give its
sanction to an examination which had no legal standing,
and he thought they would be doing no harm in with¬
drawing the apparent sanction which it was said had
been given by the Council.
Sir Richard Thorne said the fault, if any, of having
changed the word “ midwife ” into “ midwifery ’’ and of
knocking out the words “ natural labour " was that of
the Council and not of the Obstetrical Society. He had
gone over the resolutions of the Council, and had found
that they distinctly urged that midwives should be
certified. He urged that after having for twenty years
pressed upon the Government the necessity of having
midwives certified they could hardly now fall foul of the
only body that had made the slightest attempt to
achieve what was aimed at. They might as well try to
stop the tide at the Nore as to try to do away with the
midwife and call her nurse. He thought it was
unworthy of the medical profession to say that no
women should go through a perfectly physiological
process without paying a doctor’s fee. If the Council
withdrew its assent the Obstetrical Society could go on
just the same, and he hoped it would.
by Google
Dec. 6. 1890.
GENERAL MEDICAL COUNCIL.
The Medical Press. 585
Dt. Atthill said the greater part of hie life was occu¬
pied i 1 teaching midwives and sending them out to the
public, under a special charter. He had always advo¬
cated the education of these women as midwives, and
midwifery nurses.
Dr. MacAlistkr pointed out that if Mr. Brown with¬
drew his second motion the effect of the first would be
just the same. If they withdrew their consent to the
second certificate, that would be tantamount to declaring
that it was a oolourable imitation of a diploma, and
exposing those who granted it to be brought under the
ban of infamous conduct. He hoped the Council would
be careful what they did in this direction.
Dr. Little thought it would be injudicious for the
Council to adopt the motion. He pointed out that the
Society gave these nurses no legal status.
8ir Christopher Nixon urged that the Council ought
to do all in its power to secure the holding of an
examination of the efficiency of women who practised
midwifery, and he thought it would place the Council in
a false position to ask the Obstetrical Society to abstain
from holding their examinations, though he felt that the
Council Bhould be opposed to the granting of a certifi¬
cate, which was practically used as a diploma.
Dr. Leech said he would have been pleased to support
any resolution to prevent these certificates being granted,
but he did not care to go so far as to say that no
examinations Bhould be held.
Dr. Bruce then handed in an amendment to the effect
that it was inexpedient under existing circumstances to
disturb the present system of examination and granting
of certificates to midwives.
Dr. McVail did not like the wording of the resolution,
but he preferred it to the amendment. That the system
had existed for twenty years was beside the mark. He
pointed out that formerly midwifery was held as being
much inferior to medicine and surgery, but in 1886 the
three branches were placed on the same level, and be
hoped they were never going to hear again of the general
practitioner regarding midwifery as something alien to
his ordinary work.
After some further remarks Sir Richard Thorne
moved “ the previous <iuestion,” which was carried by
fifteen voices to eight. This disposed of the amend¬
ment, whereupon 8ir C. Nixon, with the consent of Mr.
Brown, suggested that the motion should read as
follows:—“ That the Obstetrical Society be informed
that the Council, while approving of the holding of
examinations in midwifery-nursing by the Society, was
adverse to the granting of certificates of proficiency,
Ac.”
This was no sooner settled than, on the motion of Dr.
Brdce, “ the previous question ” was carried. A question
arose whether the loss of the first resolution entailed tbe
loss of the second, but Mr. Brown insisted on the latter
being put to the vote.
The President said he had been actively opposed to
tbe original certificate granted by the Society, but he
felt that the Society had been instrumental in exerting
a beneficial influence in improving the status of mid-
wives, and he thought that the Society should not be
interfered with so long as their certificate did not in¬
fringe the Medical Act.
Mr. Brown said that if the Council did not feel in¬
clined to deal with the matter now he would withdraw
his motion and ask for the appointment of a committee.
After further discussion 8ir W. Thomson moved as an
amendment that the measure be referred to a committee.
He pointed out that the matter was one of considerable
importance to the profession, in view of the practice that
was growing up of getting the stamp of certain medical
and surgical authorities for various purposes, a practice
which was entirely opposed to the purposes of the Medical
Act. He recalled the attitude of the Council last session,
when attention was called to the certificates granted to
spectacle makers, and this, he con'ended, showed that
there was a ground for the charges which were origi¬
nally made. This was seconded by SirC. Nixon.
Dr. McAlister disapproved of the appointment
of what might be called a “ fishing committee,” and Mr.
Bryant thought the matter was not ripe for action.
Sir W. Thomson said he did not wish the committee to
fish for evidence, but there was a feeling that there
existed an evil which required to be dealt with.
The amendment on being put to the vote was nega¬
tived by 14 to 6, and the original motion was also
negatived by 21 to 5.
The Combination of Medical Corporations with
Universities.
Mr. Brown asked leave to postpone a motion which
stood in his name, but this having been refused he
brought forward a motion urging the various medical
corporations in each division of the kingdom to take
steps under Section 8, Clause C, of theJfeciical Act (1886)
to combine with one or other of the universities to form
a conjoint board of qualifying examination.
No seconder being forthcoming, Dr. Bruce kindly
filled the gap.
| Mr. Brown explained the tenour of his motion, which
was negatived without discussion.
The Apothecaries Society and the English Conjoint
Board.
After a brief discussion as to the motion being in
order, Mr. G. Brown moved that the Council “ strongly
recommend ” the Royal College of Surgeons of England,
the Royal College of Physicians of London, and the
Apothecaries Society to combine for the purpose of
holding qualifying examinations conjointly. He pointed
out that it was virtually only asking the Council to
repeat a resolution passed in 1S87. He recalled the
i strenuous efforts made by the then president of Council,
i Sir H. Acland, to induce these bodies to join, and he
thought the time had come when these three corpora¬
tions should be asked to combine.
Mr. Victor Horsley seconded the resolution merely
because it was a step in the direction of the one-portal
system.
Dr. McAlister pointed out that the University of
London Commission Act had for object, inter a/it, to in¬
corporate these very bodies with the University of London.
After some remarks by Mr. Teale, Dr. Ptb-Smith
said he could not vote for the resolution because he did
not think it would achieve the object aimed at, but he
would not vote against it because he was in favour of the
one-portal system. He thought there should be a single
board in each department of the kingdom.
Sir Richard Thorne said he should vote for the
motion as being a step in favour of the one-portal system,
but Sir J. B. Tcke, though in favour of the one-portal
system, did not think the resolution would help them.
Sir Dyce Duckworth urged that it was useless to do
anything at this juncture, and they had better wait the
resolution of the Commission.
Dr. Glover said he should vote for the motion, and
Mr. Bryant regretted that the combination did not
take place when the conjoint board was formed.
Mr. Carter recapitulated what the Society of
Apothecaries had done in the matter, and he hoped that
the combination would ultimately take place, though he
could not vote for the motion.
Mr. Brown declined a suggestion by the President
that he should abstain from putting the question to the
vote, and when put to the vote, 11 voted for, 8 against,
8 did not vote, and 3 were absent.
The Apothecaries Hall in Dublin.
Mr. Brown then moved that it should be referred to the
Irish Branch Council to consider and report as to the possi¬
bility of making arrangements for the institution of a con¬
joint Board for Ireland, to include the royal colleges, and
the Apothecaries HalL If the Council desired that
these bodies should combine, the matter might be
referred to a committee. The reason he had put this
motion on the paper was that he received a report of
the examiners of the Apothecaries’ Hall, Dublin, and he
blushed when he saw so much force was expended for
so little result. The whole staff of examiners were
| brought to Dublin in many instances to examine only
one candidate. It was nothing less than a scandal that
in Dublin an examining body existed when so few candi¬
dates presented themselves. If this went on they would
have to put the powers in force given them under the
Act of 1886, and made representations to the Privy
yGoogle
586 The Medical Press. GENERAL MEDICAL COUNCIL. Dec. 6, 1899.
Council that a certain body had ceased to be of
importance.
Sir C. Nixon seconded the motion, though he feared
in so doing that he was acting in opposition to the views
of the representative of the Royal College of Physicians.
In 1886 he had opposed such a combination because he
had thought that if it could not enter into such a com¬
bination the Hall would cease to exist, but it did not
cease, and they had the miserable spectacle of a com¬
petition, to which, as practical men, he thought they
should try to put a stop.
Sir Philip Smyly did not seo how any recommenda¬
tion could be considered with regard to a re-com bination
of the Colleges with the Hall.
Dr. Little objected to the motion on the ground that
the Irish branch had no money and could hold no
meetings.
Dr. Atthill Baid he had always been an advocate of
the one-portal system, and denied that there had ever
been any competition between the Colleges and the
Hall.
Mr Brown thought as the Branch had no money it
would be useless to refer the matter for their considera¬
tion, and offered to withdraw the motion. Leave to do
this having been refused the motion was summarily
negatived.
The Council then adjourned.
THIRD DAY. —Thursday, November 80th, 1899.
Penal Cases.
Case of Dr. William Stewart, of Denton.
The first item on the programme was the adjourned
consideration of the case of Dr. William Stewart,
of Denton, near Manchester, who appeared at the last
session to answer a charge of having covered one
Burgess, his assistant. The Council on the last
occasion arrived at the conclusion that the charge
brought against Dr. Stewart had been proved
to their satisfaction, but adjourned the further
consideration thereof. A letter was read from the
Ashton Medical Society to the effect that they did not
wish to press the case further since Dr. Stewart had dis¬
charged the unqualified person in question, and had
resigned his appointment in the Denton Provident Dis¬
pensary. and asking the Council to take these circum¬
stances into consideration at the adjourned hearing.
A letter setting forth these facts, signed by
Dr. Stewart's solicitor, was also read, and after a brief
deliberation in camera the Council decided that the
conduct complained of was not “ infamous in a profes¬
sional respect.”
Restoration of Names to Register.
A report of the Executive Committee with regard to
the restoration of names to the Register was brought up,
and the Council deliberated thereon in camera. On the
the admission of strangers it was announced that the
following names had been ordered to be restored:—
Robert Masters Theobald and George Hamilton Wyse.
Adjourned Case of Mr. Clement Maguire Kershaw.
This is the case of a dentist who was charged last
session with employing an unqualified assistant. It
transpired that he had discharged the assistant in
question, and was employing a man who, though qualified,
was not registered. Under the circumstances, the Council
decided that the offence did not amount to infamous
conduct in a professional respect.
Case of Henry Louis Goodman.
This was another dental case, the person charged
having been sentenced to a term of imprisonment for
obtaining money by false pretences, and the Council,
after deliberation, ordered his name to be erased from
the Dentists’ Register.
Case of Mr. Rickard Thomas Williams.
Mr. R. T. Williams, L.R.C.P., L.C.C.S.Ed., of Port
Talbot, Glamorganshire, was summoned to answer a
charge of covering one Davies, an unqualified person.
Mr. Williams was unable to be present by reason of an
attack of tonsillitis, this fact being testified to by the '
doctor who is attending him. He was represented by his
counsel, Mr. Eldon Banks.
The complaint was laid by Mr. James Herbert Powell, of
Cwmavon, who was accompanied by his counsel, Mr.
Arthur Powell. Evidence was given by a detective, Mr.
Oxley, to the effect that the unqualified person was known
in the village as “ Dr.” Davies, that he signed certifi¬
cates for club8, Ac., and visited patients instead of his
principal.
Mr. Powell, the complainant, in reply to Mr. Banks,
the counsel for the defendant, explained that Mr.
Williams was in partnership with Mr. Roberts, with
whom he was not on speaking terms, and it was at Mr.
Roberts’s instigation that the detective was first
employed. It appeared that there was a brass
plate bearing Mr. Williams’s name affixed to
the door of the house occupied by the assist¬
ant. but it was stated that this house was
formerly occupied by Mr. Williams, and the plate had
not been removed. The complainant, through his
solicitor, said that the assistant had since been dismissed
and, so far as he was concerned, he did not wish to
press the matter further, his object having been
achieved. The detective, having been examined by
members of Council as to how he obtained his informa¬
tion, a statutory declaration made by the assistant was
read, setting forth that he was a bona fide medical
student, having done part of his studies at the Middlesex
Hospital. He denied having attended patients in place
of his principal, or, in fact, of having done anything
more than make a preliminary examination of patients
until his principal could visit them. He only signed
certificates when directed to do so by Mr. Williams.
Mr. Banks stated that Mr. Williams had applied to
the Registrar of the Council for information as to what
use he might make in his practice of a senior student,
and had been provided with a copy of the resolutions of
the Council bearing thereon. Mr. 'Williams had adver¬
tised for a qualified man, but in three weeks he had not
a single reply, and, having seen Davies’ advertisment, he
engaged him until he could alight upon a qualified
assistant.
The further hearing of the case was postponed until
to-morrow, and the Council adjourned.
FOURTH DAY. —Friday, December 1st, 1899.
On the Council reassembling, they went into camera,
to consider the Report of the Executive Committee with
regard to the Restoration of Names to the Medical
Register, and strangers were not admitted for a period
of upwards of two hours.
Adjourned Case of Mr. R. T. Williams.
Affer tea the Council resumed the consideration of the
case of Mr. R. T. Williams, of Cwmarvon, Glamorgan¬
shire. His counsel read statutory declarations made by
certain of the patients who, it was alleged, had been
attended by the assistant, denying that such was the
case. It was stated that Mr. Williams was still unable
to be present, and Mr. Davies, the unqualified person
referred to, was put in the box.
Mr. Davies stated that he had not signed a particular
certificate of which a copy had been produced, in which
he was alleged to have signed his name as “ Surgeon.”
He said he had been a medical student since 1889. He
had only signed certificates at the request, and in the
presence, of his principal, merely for convennience. In
reply to Sir Christopher Nixon, he said he had passed
his 1st, 2nd, and 3rd examinations for the M.B. of
Glasgow, and was going in for his final in June. In
reply to 8ir Dyce Duckworth he attributed the delay in
completing his studies to ill-health. Mr. Tomes asked
to see the advertisement inserted by Mr. Williams,
which was produced, and it appeared that it had been
continued even after the engagement of Mr. Davies. He
stated that his age was 30, whereupon Mr. G. Brcwn
asked at what age he had begun his medical studies. As
Mr. Davies seemed somewhat embarrased to reply, the
President pointed cut that this was merely a question of
arithmetical computation.
Mr. Banks then addressed the Council on behalf of his
Digitized by CjOO^Ic
GENERAL MEDICAL COUNCIL.
Dec. <5, 1899.
The Medical Press. 587
client. He pointed out that in the district where the
practice was carried on people employed the term “ Dr. ”
very loosely, even the chemist and veterinary surgeon
bemg thus styled. The incident of the plate bearing
Mr. William's name being attached to the door of the
house where Davies lodged was a simple inadvertence,
the house still belonging to Mr. Williams, the plate
having been left in situ. After some further remarks by
iCounsel for the complainant, the Council deliberated
h camern and, on the admission of strangers, it was
announced from the chair that the charge brought
against Mr. Williams had not been proved to the
satisfaction of the Council.
Case of Mr. William Matthews Jotce.
Mr. Willi im Matthews Joyce, L.R.C.P., L.R.C.S.Ed.,
L.F.P.S., of Cattle Road, Birmingham, was brought
before the Council under the following circumstances :—
That in July, 1899, he had been convicted of being
drunk and disorderly ; and (2) that in November, 1899,
he had been convicted of misdemeanor, riz., of assaulting
one Ellen Simpson.
Mr. Joyce, who appeared in person, admitted the soft
impeachment, but did not appear to be in a position to
ay anything in extenuation of his conduct. The
Council having deliberated on the case in camera, on the
readmission of strangers, the President, addressing Mr.
Joyce, said that although his conduct had obviously
been unworthy of a professional man, the Council had
decided to take a merciful view of his case and had
adjourned the further consideration thereof until next
session, when he would be required to produce evidence
that he bad in the meanwhile behaved himself as a
gentleman. Mr. Joyce then departed.
Case *>f Fredebick William Kirkham.
This was the case of one Frederick William Kirkham,
of London Street, Chertsey, registered as L R.C S.,
L.RC.P.Ed., who in October last was convicted at the
Central Criminal Court of fraud. After a brief deli¬
beration his name was ordered to be erased from the
Register.
The Council then adjourned.
FIFTH DAY.— Saturday, December 2nd, 1899.
L.S.A's and Their Titular Designations.
A communication was read from the Society of Apothe¬
caries in regard to the recent judgment bearing on the
description that may be legally assumed by their
licentiates, remitted by the Executive Committee. In
this letter the 8ociety contend that the judgment
in question is to say the least unsatisfactory. They
have taken the opinion of distinguished counsel, includ¬
ing Sir Edward Clark, who are of opinion that a
licentiate is entitled to describe himself as Physician or
Surgeon, or both, the case of Hunter v. Clare to
the contrary notwithstanding. The Society suggest
that a friendly action should brought before the Court of
Appeal or the House or Lords, each party paying its own
costs. The Society emphatically disclaim any desire to
assist its licentiates to appropriate any title belonging
exclusively to any other licensing body. This letter way
duly received and entered on the minutes.
Mr. B. Carter pointed out that the licentiates must
call themselves by a title of some sort, that of apothecary
being archaic. Physician was obviously the proper
term, it being an old English word, superseding the old
word “ leech,” meaning nothing more than the practice
of the healing art. He moved that the communication
be referred to a special committee with power to take
legal advice and to instruct the solicitor to take such
steps as might be necessary to obtain the decision.
Sir Batty Tuke said he held very different views from
Mr. Carter, but would second the motion because the
question was one that would have to be settled sooner
or later, and it was the duty of the Council to remedy
the confusion they had been the means of creating, a
mishap which he attributed to important matters being
held over to the fag end of the session instead of being
taken earlier.
Mr. Victor Horsley proposed as an amendment
(seconded by Dr. Bruce) that the words after “com¬
mittee ” be left out of the motion. He maintained that
the opinion given by Sir Edward Clarke on the case aa
presented to him by Mr. Upton was valueless, and he did
not think that it was the duty of the Council to spend
money in clearing up the question. The task was one
which would properly devolve upon the society. The
decision might unfavourably affect the number of candi¬
dates for the licentiateship, but that was not the concern
of the Council. He concluded by moving “that the
letter of Mr. Upton on the part of the Society on the
subject of the use of the titles physician and surgeon
be referred to a special committee to report to the
Council.”
Dr. MacAlister expressed his concurrence with the
amended motion, and suggested that they should add
“ with power to take legal advice.”
Sir Dyce Duckworth did not admit that the question
was one of any great importance in view of the fact that
very few men held the licentiateship alone.
Dr. Athill observed that most medical men were
known as “ Dr.”, and that in every profession there must
be different grades. He had great respect for the L.S A.,
but did not think that the Council would be justified in
spending money for this purpose.
Mr Bhown challenged the exclusive right of any
particular class of practitioner to the use of the word
“ physic : an.” He was proceeding to refer to the Medical
Act of isr,s when the President called him to order,
observing that Mr. Brown was entailing great expense
to the Council by his lengthy remarks, it not being the
first occasion on which he had done so.
I Mr. Horsley objected to the introduction of the per¬
mission to take legal advice.” They required time to
consider the point, and the appointment of a committee
would give them the time.
The amendment was then put to the vote, and was
carried by 22 to 5.
1 Dr. MacAi.istfr then moved the addition of the
i words “ with power to take legal advice.” This was
1 seconded by Mr. Carter.
On being put to the vote the amendment was lost.
Mr. Horsley's amendment was then agreed to as a
substantive motion, the nomination of the committee
being left in the hands of the President.
Additions to Penal and Disciplinary Powers.
Mr. Bryant brought forward the report of the Pre¬
sident on the 3teps taken by him to have Section XXIX.
' of the Medical Art (1S.">8) amended so as to secure in-
1 creased powers for penal and disciplinary purposes, and
1 moved that he be requested to forward to the Privy
‘ Council the draft clauses as amended, with the expres¬
sion of a hope that the Privy Council would support a
Bill in Parliament to have them made law. The purport
of this report is to confer on the Council the power to
erase a name from the Register for a specified period,
such name to be restored at the expiration of that period
if such person then possessed a medical diploma. Also
to confer on the various medical authorities the right to
revoke, suspend the use of or cancel, diplomas held
by a person whose name has been erased from the
Register, with power to restore Buch diploma without
the necessity of fresh examination. The report also
deals with the allocation of fines and penalties recovered
under the Medical Acts in the Metropolitan Police
District and elsewhere, and defines the meaning of the
terms employed.
After some remarks by Dr. Bruce and Dr. Pye-Smith,
Dr. Little asked who would take the first steps, whethor
the Council or the licensing body. The President
replied that the body which suspended the diploma
would, of course, take the initiative in restoring it.
Sir Richard Thorne raised the question as to wliat
would happen if the medical authority restored the
diploma and the Council declined to reinstate the name
on the Register.
The motion was then carried.
Reciprocity of Medical Practice.
The report of the Executive Committee on reciprocity
jF 588 The Medical Pbbs<.
FRANCE.
Dec. 6,1899.«
of t medical practice in relation to foreign countries was
received and entered in the Minutes.
This report embodied a statement by Mr. Muir
Mackenzie to the effect inter alia that a foreign prac¬
titioner in the United Kingdom was bound by the laws
in force, and was in the position of a practitioner who
is not registered. Mr. Mackenzie recalled that under
the Medical Act, 1886, the Queen in Council might apply
the part of the Act which related to foreign practitioners
to any foreign country which, in the opinion of Her
Majesty, affords to the registered medical practitioners
of the United Kingdom such privileges of practising in
the foreign country as to Her Majesty may seem just,
whereupon the Council would be empowered to grant
recognition to such medical diplomas of the foreign
country as to the Council appeared to furnish a sufficient
guarantee that the holder of the diploma possessed the
requisite knowledge and skill for the efficient practice of
his profession. These diplomas would then be admitted
to registration. Failing the consent of the Council to
recognise a colonial or foreign diploma the Privy Council
might, if they thought fit, after communication with the
Medical Council, order it to recognise the said diploma.
The Executive Committee recommended:—“ That the
General Council be recommended to authorise the issue
of Mr. Muir Mackenzie’s statement of August 10th, 1899,
as an expression of the Council’s views in regard to its
legal position in connection with the question of
Reciprocity of Practice; and that the Executive Com¬
mittee recommend that the General Medical Council
represent to the Privy Council that the time had arrived
when Her Majesty in Council should apply Part II. of the
Act of 1886 in respect of foreign practitioners to the
Kingdom of Italy.”
After a brief discussion it was agreed “ that the Council
adopt the statement made by Mr. Muir Mackenzie with
respect to the state of the law in England as to recipro¬
city of medical practice in foreign countries, and that it
be introduced into an amended edition of the Memor¬
andum to be reissued. On the motion of Dr. MacAlistee
it was agreed that the statement should be translated
into French.
Sir Dfce Duckworth pointed out that British
practitioners would be shut out from practice in Italy
unless the Council interfered. He Bpoke highly of the
Italian diplomas, and urged that for one Italian practi¬
tioner who would come to this country there would be
ten British practitioners who would desire to practise in
Italy. He concluded by moving the recommendation of
the Committee above.
Dr. Little asked why no steps were taken to induce
other countries to allow British practitioners to practise
their profession, Italy being alone in allowing British
practitioners to practise without obtaining a native
qualification.
Dr. Me Vail pointed out that if the Council granted
reciprocity to Italy, they would be constrained to adopt
a similar course in regard to other countries.
Mr. Horsley urged that if Italian practitioners were
allowed to practise in this country they would compete
with native practitioners, adding that the latitude
allowed by the Italian Government was simply due to
the fact that English visitors were a large source of
revenue to that country.
Dr. MacAlister pointed out that Colonial practitioners
had not shown any great desire to flock to this country,
although they possessed many obvious advantages over
foreign practitioners, in their knowledge of the lan¬
guage, Ac.
Sir Richard Thorne urged that the Council Bhould
make sure of the exact condition of things in Italy
before taking any decided step.
The further discussion was adjourned.
dfrante.
[from our own correspondent.]
Paris, Deember 8r<l, 1899.
COXALGIA.
At the last meeting of the ourgical Society, M. Nelaton
spoke on resection of the hip for coxalgia, and said that
radical operation was not generally practised in such
cases, surgeons contenting themselves with conservative
treatment. Twice he had resected the hip for sup¬
purating coxalgia, and the results were such that he
considered that surgeons should have recourse more
frequently to this operation.
The first case was that of a woman, set. 28, treated for
two years without success by the conservative method.
After the coxa-femoral resection, in the course of which
he had removed a considerable portion of the iliac
bone, the patient recovered completely, and walked
better than could have been expected from any other
method of treatment.
The second was that of a boy, mt. 15, who six months
before was operated upon in a similar manner to the
preceding, and in three months he was able to get
about comfortably, although the hip was ankyloBed.
The speaker concluded by saying that his remarks of
the expediency of the operation referred to adult persons
and not to children, in whom it was right to expect much
from the conservative treatment.
M. Felizet remarked that the history was known of 100
individuals suffering from coxalgia in their childhood,
it would in all likelihood be found that out of that
number not more than a dozen were alive at the end of
twenty years, all the others having succumbed to com¬
plications. Consequently, no one should hesitate to
utilise a radical operation, and the resection should be
practised at an early date of the malady. For his part,
he employed it in children in about 300 cases, and
thanks to the actual cautery he had obtained excellent
results. Generally, he made the first dressing twenty
days after the operation. When the shortening, which
ordinarily was one inch, attained one-inch-and-a-half, or
even more, it was easy to correct it by an apparatus.
Cerebral Hemorrhage and the Sign of Kernig.
M. Widal, in speaking at the Medical Society, said that
he had recently observed in a case of meningeal hemor¬
rhage which had been revealed to him by the existence
of Kernig’s sign. A man of 38 was seized suddenly with
an apoplectic attack. When he recovered consciousness
a few hours afterwards he presented neither fever nor para¬
lysis. He complained only of intense headache, pain in the
back, while the pupils were somewhat dilated. The exist¬
ence of the sign of Kernig was observed, and a lesion of
themening68 was immediately suspected. In the dorsa
position, the man could keep his legs extended on the
thighs, but once he was seated on the edge of the bed,
his legs were drawn towards the thighs. Five days
after the accident the temperature rose somewhat, and
on the ninth day the patient succumbed. When the
cranium was opened a clot of blood was found beneath
the arachnoid and extending down towards the bulb,
while the rhachidian canal was filled with Wood. The
clot then did not intesect either the circumvolutions
of the base of the brain or those of the
covexity. That fact proved that the sign of Kernig
could exist independently of all inflammation of
the coverings of the cerebral circumvolutions, and that
its raison d'etre was rather to be imputed to an irritation
of the spinal membranes. If the sign was more frequently
absent in tuberculous meningitis than in cerebro-spinal
meningitis, the reason probably was that in the first-
named affection, the rhachidian membranes were less
affected than in the second.
Digitize
Google
Dec. 6, 1899.
GERMANY.
The Medical Press 589
Grave Pulmonary Affections.
M. Raynaud communicated several cases of pulmonary
affections treated by him by blood letting, and
the injection of artificial serum, and insisted on
the necessity of sustaining the organism in its struggle
with the microbian poison and to favour its elimination ;
blood letting acted mechanically in that sense, and by
injecting at the same time the saline solution, the blood
withdrawn was replaced, the toxins diluted, the. heart
stimulated, the tension and the diuresis increased. The
amount of blood withdrawn was from six to ten ounces,
and that of artificial serum injection seven ti twenty
ounces.
(Scrmattg.
[from our own correspondent.]
Bkblik, December 2ml, 1890.
Iodine and Its Combinations.
Dr. Hkintz, of the University of Erlangen, has an
article on this subject in a recent number of Virchow's
Archiv . His investigations into the behaviour of iodoso.
benzoic acid and on the influence of the iodine alkalis on
absorption are of special interest. lodoso-benzoic acid
discovered by V. Meyer, possesses the property when
applied locally of splitting off free iodine in contact with
iodine • alkali circulating in the blood. If for
example iodoso-benzoic acid mixed with starch is
injected under the skin of the rabbit, and an injection
of an iodine solution is made into the blood current, the
starch is coloured blue by nascent iodine. By the local
application of iodoso-benzoic acid therefore, and the
simultaneous administration of iodine per os, we have the
means of exciting a lasting action of iodine at the place
of selection, but the iodoso-benzoic acid acts as a power¬
ful irritant. The author attributes the resorptive
properties of iodine to its influence on the leucocytes.
Great proof of this hypothesis has hitherto
not been at hand; the leucocytosis that follows
the introduction of iodine also follows the introduction
of indifferent salts. It might be supposed that the
iodine alkali in the blood or tissues was split up in the
region of greatest tissue change therefore in the leuco¬
cytes, the free iodine then acts back on the leucocytes
and excites them to greater resorptive activity.
The Treatment of Chlorosis and An.fmia.
Few subjects have been more written about
than the one named. Considering the ease with
which such cases are generally improved, this is
perhaps a matter for surprise. But now and then
cases are to be met with that persistently resist
our efforts to improve them, and here it is that
the possible value of a multitude of counsellors comes
in. In view of these difficult cases it behoves us not to
neglect any Bounce of possible aid. A recent writer on
this subject is Dr. Friese r, who devotes an article to it
in the Khn. Thtrap. Wochcntch., 42 99. According to
him treatment must take three directions—the direct
medicinal, the symptomatic, and the hygienic-dietetic,
and he must first of all seek to restore the lost equilibrium
of iron in the system. To this end resorbable and
assimilable iron must be introduced into the system in
sufficient quantify, care being taken not to disturb the
digestion. He would exclude all the inorganic pre¬
parations of iron, as they are inferior to the ferratin an
iron combination made from the animal liver. His
experience with the preparation extends to fifty-nine
cases, thirty-three of secondary and chronic anaimia,
and twenty-nine of chlorosis. In eighteen cases of
anwmia and fourteen of chlorosis ferratin was given ex¬
clusively with specially good results. In two tolerably
severe cases no special result was observed, whilst
in four cases of anaemia with complications, it was not
well borne, but subcutaneous injections of a 6 per cent,
solution gave very good results. In other cases various
preparations of iron were given with varying, mostly un¬
satisfactory, results. The ferratin was generally given
a3 a powder along with a little rhubarb. (Ferratin, 1 to 3
grms., pulv. rhei, 01 to 0’4 grms., two or three times a
day.) No fruit or acid foods were allowed during the
treatment. Quinine iron wine was a useful aid.
The symptomatic treatment wai mostly of the side
of disordered digestion. Absence of appetite was gene¬
rally assisted by small quantities of Carlsbad Miihl-
brunn water drank slowly on the empty stomach before
breakfast. In many cases Penzoldt’s wine was of
service. Lowered intestinal function was relieved by
intestinal infusions with luke-warm water with salt,
or under certain circumstances oil injections. Much
may be expected by appropriate massage and weak
Faradaic cui rents. In cases complicated by chronic
diarrhoea only the most careful regulation of the diet
was of service.
Dietetic hygienic treatment embraced all the measures
necessary for ensuring a well-regulated mode of life.
First of all everything that interferes with the func¬
tion of the bowels must be removed. The food must
be easily digestible, non-irritant, and as varied as
possible. The chief food must be milk, meat roast or
scraped, and soft eggs. But milk cannot always be
taken in sufficient quantity by adults, it sometimes causes
diarrhoea and a constant feeling of fulness. Patients must
be careful, and be protected from overwork, bodily exercise
in the open is of great value, but oftentimes bad cases of
both ana*mia and chlorosis required prolonged rest in bed.
Almost always such cases require an extra allowance of
sleep, and this should be provided for them. Special
stress must be laid on personal cleanliness The mental
and sexual functions must be watched over.
As regards hydrotherapeutics daily rubbings are use¬
ful, and act beneficially on the general health and on
the strength; but a systematic hydropathic treatment
is rarely admissible; but on the other hand massage
and faradisation are sometimes exceedingly useful in
an armies.
At the Mi)dical Society, Herr Virchow opened a dis¬
cussion on Richter’s paper on
Oroanotherapeutics.
He said he remembered Rademacher’s ‘‘Organotherapy,’
and the difference between that and the present; further
his essay “ Specifica and Specifisches” (in his Archiv.)»
wherein he drew attention to the necessity of finding
certain relations between therapy and local pathology
as a matter of fact, certain organs were specially sus¬
ceptible as regarded certain remedies. In the new
kind of organotherapeutics he missed the theo
retical connection between therapy and the
general pathology of the present. The idea
of using a whole organ — an ovary for example, for the
preparation of the desired remedy appeared to him
Digitized by Cj oogle
590 The Medical Press.
A IT STRIA.
D*c. 6, 1899.
monstrous, and corresponded to the first raw beginnings
of “ Koch Kunst.” It was impossible for all the consti¬
tuents of the ovary to come into consideration as active
agents, but only certain groups of cells, possibly the
Graafian follicles. The discovery of the peculiar active sub¬
stances was of the greatest importance in the inquiries
now being conducted. The alleged reimplantation of
already extirpated ovaries with subsequent recurrence of
functional activity we must relegate to the region of the
stories from “ A. Thousand Nights and a Night.”
Hr. Burchardt related again the case of a girl of 20’
who weighed, without clothes, 158 lbs., on whom treat¬
ment by oophorin tablets was successful. She generally
took about fifteen a day, and after taking 1,000 her
weight fell to 142 lbs. (March to July). She increased
in weight again when treatment was interrupted, but
again fell off when it was resumed, but not to so great
an extent as at first. Organotherapy under proper
medical control, was absolutely harmless, and very
encouraging.
Austria.
[from our own correspondent.]
Vikniu, Deeember 2nd, 1899.
THROMBU8 IN TBAN8VER8E Sinus.
At the Gesellschaft der Aerzte, Politzer showed a
boy, Jet. 14, who had suffered from otorrhcea since an
attack of measles when he was six years of age. Five
weeks ago the boy became suddenly ill with vomiting,
vertigo, and headache, for which it was decided to per¬
form trepanation of the mastoid pcrticn of the right
temporal bone. Six days after the operation, when the
patient was recovering rapidly and all anxiety was con¬
sidered over, cerebral phenomena suddenly occurred
which excited alarm. The original wound was re-opened
and extended into the transverse sinus, from which pus
discharged, where a thrombus 4 centimetres (0 39 of an
inch) was found firmly impacted. After careful removal
and washing the patient recovered without a bad
symptom.
Sinus thrombi are not uncommonly found after
chronic discharges from the ears owing to the proximity
of the vascular plexu8 where the inflammation is con¬
ducted to the wall of the sinus and the changes
induced. The site of the thrombus is never constant, as it
may occur anywhere, even in the vena jugularis com¬
munis itself, but wherever situated the prognosis is
always grave. The most effectual method of reducing
the fatality is an early opening into the petrous bone.
Since 1896 70 cases have been published, 41 of which
have recovered In his own cases he had had 15 sinus
thrombi with 10 recoveries, and 14 peri-sinous abscesses,
with 7 recoveries.
Tabic Affections of Both Knees.
Sternberg next exhibited a man with tabic affections
of both kn'es and lower bones. In 1876 there was a
history of a genital affection with subsequent copper-
coloured spots on the arms and legs. Fifteen years
later there were severe pains in both legs and swelling
in both knees, with enlargement of the upper ends of
the tibia and fibula which increased and diminished
temporarily. In 1897 the swelling confined itself to the
left leg, but in 1898 it invaded the right, where it has
remained stationary ever since, while the bones have
become bent in the shaft. Tendon reflex has dis¬
appeared, as we'l as the distinction of heat when rapidly
placed in warm and cold water. The case was generally
diagnosed as one of labes or syringomyelitis with bone
affection.
Lumbar Extravasation.
Lanyer next brought forward a coachman with a large
fluctuating tumour in the lumbar region. According to
his story he was getting down from the box when he
slipped and fell hurting his leg and back. A few days
after the fall a fluctuating swelling was discovered in the
lumbar region. It seems that the fall, with the muscular
movements, had caused a tearing of the subcutaneous
oellular tissue, with an effusion of lymph. Levell^e and
Gussenbauer seem to have been the first to diaw atten¬
tion to these extravasations as being difficult and pro¬
tracted in resolution. Pressure alone will not effect the
object, and even whencombined with iodine injections it
frequently fails in accomplishing a cure. Free incision
and allowing the cavity to heal by granulation is the
most effectual procedure.
Weinlechner remarked that in these cases blood
extravasation co-existed with the lymph.
Schopf challenged this assertion of Weiolechner’s, and
pointed out that there was a vast difference between a
ha'inatic cyst and lymphatic effusion, as the former
appeared rapidly after the injury, while the latter did
not appear for days after, as evinced in the case shown
by Lanyer. He exhibited two cases from his own wards
to prove the differential diagnosis.
ACtiology of Tabes Dorsalis.
Benedikt next read to the meeting a long paper on
the cetiology of tabes dorsalis which he maintained was
purely hereditary in origin. All other causes, such at
exhaustion, violent exertion, illicit excess and colds,
were only immediate exciting causes in persons pre¬
disposed to the disease. What part syphilis played in
the disease was difficult at the prosent time to determine*
but present day statistics were certainly against Erb’s
figures, which he used twenty-two years ago to
vindicate his opinion that syphilis was the sole
cause of this obscure disease. Benedikt then
adduced his own investigations and found that
in every hundred cases examined fifty-irwo were
positively free from syphilis; thirty-four had Deen
infected; while thirteen remained doubtful. It is quite
conceivable, however, that mercury and iodide when
given in large quantities for syphilis will induce tabes
dorsalis in the predisposed.
A large number have syphilis and no tabes dorsalis
follows the disease, while a large number have tabes
dorsalis without any trace of syphilis.
Doctoren Collegium.
This institution will have reached its 500th year on
the 10th of December. To commemorate the occasion a
“ Festrede ” will be given by the Vice-President, Dr-
Svetlin, who will probably tell his hearers how Johnn
Silber opened this institution 500 years ago as the “ Acta
facultatis medic® Universitatis Vindobonesis,” the first
institution formed after the foundation of medicine in
Vienna.
Digitized by LjOOQle
Dec. 6, 1899
LEADING ARTICLES.
The Medical Press. 591
‘(The ©perating ‘(Theatres.
KING'S COLLEGE HOSPITAL.
Cholecyhtotomy. —Mr. Cables* operated on a woman,
set 60, who had suffered from recurrent attacks of pain
in the right hypochondrum for some months. She had
never been badly jaundiced, but the conjunctiva; were
slightly yellow, and after an attack of pain there was a
slight yellow tinge about the skin. The attacks of pain
were of a colicky nature, and so severe as to exhaust the
patient, and she was sent to hospital by Dr. Jardine,
of Richmond, as he feared that after one of these paroxy¬
smal seizures she might collapse. The patient was a fat,
flabby woman, who looked an unfavourable subject for
abdominal operation. She was aniesthetised with A. C. E.,
and, after efficient purification of the abdominal wall, an
incision six or seven inches in length was made parallel to,
and about one inch from, the right costal margin, ex¬
tending downwards and outwards from the middle line
above. After opening the abdominal wall, the liver,
which was somewhat enlarged, came into view, and on
lifting its free border, a few adhesions had to be divided
between the duodenum and the gall-bladder, which last
at once came into view. The fundus of the gall-bladder
was found to be occupied by a hard lump about the size
of a walnut, over which the wall of the vise us was
firmly adherent, the proximal end of the gall-bladder
appeared to be normal. The abdominal cavity was now
shut off by a packing of cyanide gauze wrung out of hot
sterilised salt solution, and the liver with its attached
gall-bladder drawn out of the wound which was in this
way plugged. An incision was now made through the
walls of the gall-bladder, and by this means the hard
mass was exposed, and found to consist of a collection of
small black gall-stones held together by a cement-like
substance, evidently consisting of inspissated mucus and
bile salts; the whole of the stones and the debrit were
removed by means of a lithotomy scoop and a Volk-
mann’s spoon which had to be used somnwhat energeti¬
cally in order to detach the calculi from the gall-bladder
wall. A small communication with the rest of the gall¬
bladder was found, and down this a long probe was
insinuated but no farther calculi were discovered. A
small amount of healthy bile escaped from the wound.
The free wall of the pouch in which the stones had been
laying was cut away. The posterior wall of the pouch
was freely curetted, and the opening closed entirely by a
double row of Lembert’s sutures. The gauze packing
which was scarcely soiled, was then removed, and the
liver replaced in the abdomen; a small lamp-wick
drain of ganze was inserted down to the wound in the
gall-bladder, the whole of the extensive abdominal wound
closed by a double row of buried stitches, and a super¬
ficial continuous suture for the integuments.
Mr. Carless remarked on the extreme simplicity
of the operation in this particular case. The
stones were lying in a part of the gall-bladder
which was practically shut off from the b.liary
passages; the liver was large and could be pulled
out of the abdominal wound, so that the opening of ^he
gall-bladder could be done outside the abdomen. There
was quite sufficient evidence of old peritonitis to explain
the symptoms from which the woman had suffered.
Surgeons, he said, differed somewhat in their method of
treating the gall-bladder after the removal of stone. In
the majority of instances a biliary fistula was established,
and the immediate closure of the wound in the gall¬
bladder was not a favourite proceeding; he had, how¬
ever, followed this practice several times with complete
success, and unless there were some definite reasons
demanding drainage, such as suppuration, he would cer¬
tainly feel inclined to close the gall-bladder at onoe.
In this particular instance it would have been ridicu¬
lous, he thought, to leave a biliary fistula.
It is satisfactory to report that the patient recovered
without a bad symptom, the deep lamp wick drain was
removed in forty-eight hours and replaced by a more
superficial one, which was in turn taken out at the end
of the fourth day. The whole wound was closed in a
fortnight, and the patient was out of the hospital in less
than three weeks.
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‘(The JHebical Jrcss anb Circular.
“ SALCS POP0LI SUPREMA LEX.”
WEDNESDAY, DECEMBER 6, 1899.
THE GENERAL MEDICAL COUNCIL.
When the Council adjourned on Saturday last
there seemed to be every prospect of the Session
extending far into the present week. A certain
amount of work has been got through, including a
number of penal cases, none of which presented any
particular interest, but we fear it cannot be asserted
with confidence that the net result of so much talk
has been to advance medical interests to any material
extent. An interesting little discussion arose on the
large proportion of Irish candidates who were
unsuccessful at the competitive examinations for
admission to the Services. Mr. Brown saw in this
lack of success a proof that the examining bodies
in Dublin were not up to the mark, but the Council,
recognising how fallacious must be a conclusion based
on a single set of results, bearing on some half-a-dozen
candidates, lefused to allow the matter to be referred
to a committee. We decline to believe that the
Services are unpopular with Irish diplomates, and the
explanation, if any lie needed, must be sought else-
Digitized by V3 ooQle
592 ThK McDICAL PbI88.
LEADING ARTICLES.
Dsc. 6,1899.
where. Obviously the Service competitive examina¬
tions afford an excellent opportunity of estimating
the status of the various qualifying boards, and the
Council would be ill-advised not to derive from these
lists such information as may be gleaned. Mr.
Brown’s suggestion, therefore, is right in principle,
and may serve as the basis of future scrutiny.
Something very like a scene occurred in connection
with a speech delivered by Mr. Brudenell Carter
in refutation of certain allegations made by
Mr. Victor Horsley, reflecting on the constitution
of the body of which Mr. Carter is the repre¬
sentative, and on Mr. Carter’s conduct in the
notorious Hunter case. Unfortunately for Mr.
Horsley the very drastic criticisms which he had
made with regard to the constitution of the Society
of Apothecaries of London proved to be grotesquely
erroneous, and although he duly swallowed the leek
and apologised for his misstatements, one could
have wished that he had verified his references
before making them the basis of scathing denuncia¬
tions from the forum. Having exposed himself to
correction he has no right to complain if Mr. Carter,
with studied vindictiveness, availed himself to the
utmost of his opportunity, but if the fond of Mr.
Carter's remarks was good the form left much to be
desired. Mr. Cai ter complains that while the medical
journals give ready publicity to speeches adverse to
himself they usually suppress his replies. We cannot
admit the justice of the reproach as addressed to
ourselves, but when our readers have perused the i
report, published elsewhere, of Mr. Carter's most
recent utterances, they may possibly come to the con.
elusion that the reticence of which he complains was all
to his advantage. Personalities between members
of public bodies are to be deplored, because they
mpede the course of business and import an element
into the debates which is foreign to their intention
and detrimental to their utility. We cannot say
that Mr. Carter has succeeded in explaining away
his behaviour in respect of the prosecution of the late
Mr. Hunter. If he was really unaware of the fact
that Mr. Hunter was a licentiate of the Society of
Apothecaries and a registered practitioner, that
was a serious piece of negligence on his part.
The proposal that the Council should share
with the Society the expense of an appeal with
the view of establishing once for all the titular
position of its licentiates is hardly one that can
commend itself to business men. If, as the legal
advisers of the Society contend, the decision is wrong.
it is open to the Society to take such steps as they
may select to have it redressed, and the most the
Council can be expected to do is to abstain from
active opposition. Mr. George Brown, who has been
very much en evidence this session, brought up the
vexed question of the Obstetrical Society’s examina¬
tion for midwives which we hoped had been laid to
rest by the Society’s acceptance of the amended form
of certificate, suggested by the Council, which com¬
prises a footnote expressly stating that the certificate
in question confers no privileges under the Medical
Acts. However much one may sympathise with
the Obstetrical Society in its endeavour to
raise the educational status of the midwife, the
principle of the granting of certificates of proficiency
is obviously one to be condemned, especially as the
example has been followed by various other medical
and non-medical bodies, in contravention of the spirit,
if not of the letter, of the Medical Acts. Still, as the
Council has inadvertently given a quasi-approval to
the present form of certificate, and as legislation
w'hich will render the exercise of their present func¬
tions as examiners supererogatory, is probably within
measurable distance of becoming law, the oppor¬
tuneness of resuscitating this delicate question may
well be questioned, and the action of the Council in
declining to take further action therein for
the present will doubtless meet with a
qualified approval. One of the most interesting
points brought out in the discussion of Mr. Brown’s
motions in favour of a combination between the
Royal Colleges in London and Dublin and the respec¬
tive Corporations of Apothecaries is the existence of
a strong feeling in favour of the one-portal system
which, just when it appeared to be on the eve of
accomplishment, was relegated to obscurity, but
apparently not to oblivion, by the Medical Act of
1886. So far as the Metropolis is concerned, the
motion was inopportune, seeing that the Commission
entrusted with the organisation of the new University
of London has for mission to consider the means of
incorporating the three licensing bodies in question
with the University. Morever, a mere recommenda¬
tion to conjoin would not be likely to exert greater
influence at the present juncture than did the stren¬
uous efforts of the President of Council after the
passage of the Act of 1886. Even less likely of
success would be a recommendation addressed to the
colleges in Ireland because the waning popularity of
the Apothecaries’ Hall in Dublin encourages hopes,
probably doomed to disappointment, of its approach¬
ing demise. We must comfort ourselves for the
nonce with the reflection that there is a
growing feeling in favour of the unification
of licensing bodies in each division of the
kingdom, a feeling which will doubtless find expres¬
sion when a suitable opportunity presents itself.
Without indulging in unduly sanguine anticipations,
we are entitled to hope that the definite attitude of
the Council in the matter of the much-needed reform
of the present system of death certification will bear
fruit in due season. The Government cannot well
refuse its support to a measure the necessity for
which has been demonstrated over and over again,
and we trust that the next session of Parliament will
provide the public with additional safeguards against
criminal practices which are positively facilitated by
the present slipshod system.
THE USE OF DIPHTHERIA ANTITOXIN IN
AMERICA.
The most recent statistics upon the subject of the
use of diphtheria antitoxin in America are contained
in a report issued by the Department of Health in.
the City of Chicago. Therein it is stated that from
Digitized by Google
Dec. <>, 1899. _ LEADING^
October 5th, 18%. the date of the first administra¬
tion of antitoxin by the Department, to February
28th, 1899, a period of nearly three years and a half,
a total of 6,342 reported cases of diphtheria
were visited by the department inspectors. Of
this number 4,311 were bacteriologieslly verified
as true diphtheria, and 4.076 were treated with anti¬
toxin. the remaining 235 being treated elsewhere.
The results show that there were 3.795 recoveries out
of the total number treated by the department.
The fatal cases, however, numbered 276, and
at the end of February, 1899, there were five
cases still under treatment. Examination of these
figures will show that the mortality rate was 6 - 77 per
cent, in 4,071 cases of the disease verified by bac¬
teriological examination, and treated by antitoxin.
This remarkably low mortality is certainly signifi¬
cant, more especially as we learn that since the anti¬
toxin has )>een used a decline in the death rate has
occurred of 43 per cent. Such a marked improve¬
ment as this in the number of fatal cases is certainly
convincing testimony to the efficacy of the method
of treatment, and whatever tiay be said to the
contrary, the fact remains that only 6 per cent,
of the persons attacked with diphtheria died. But
further points of interest are contained in the report.
It is mentioned that among 355 cases treated on
the first day of the disease only one death occurred;
that is to say, a mortality of 0 28 per cent.; in 1,018
cases first treated on the second day of the disease
there were seventeen deaths, or a mortality -of
107 p**r cent.: in 1,5<»9 cases first treated on the
third day of the disease there were fifty-seven deaths,
or a mortality of 3'77 per cent.. Again, in
720 cases first treated on the fourth day of
the disease there were eighty-two deaths, or a
mortality of 11*39 per cent. Laatly, in 409 cases
first treated later than the fourth day, there were 119
deaths, showing a mortality of 25*37 per cent. Thus
these figures conclusively prove the importance of
using the antitoxin as early as possible. So far,
however, as the latter point is concerned, it has for
some time been known in this country that the
efficacy of the remedy was much greater the earlier
that it was applied. It would have been interesting
to have had some information respecting the fre¬
quency of albuminuria in the cases treated by the
Chicago Department of Health. As is generally
known, Mr. Lennox Browne in this country has
brought out some startling facts in connection with
this part of the subject. If the use of the antitoxin
tends to the development of albuminuria, this would
constitute a very material objection to its adminis¬
tration. But more statistics are needed on this
point.
SINGLE DIPLOMAS.
A fortnight since we corrected a statement in
fhe British Medical Journal to the effect that a
single diploma can be by itself a qualification under
the Medical Act of 1366, and we referred to the
third section of the Act as authority for our asser-
ARTICLES. Tkb Medical Press. 593
tion. Our contemporary pretends to controvert this
statement to which we now, nevertheless, strictly
adhere. The section is, verbatim, as follows
3.—(1) A qualifying examination shall be an examina¬
tion in medicine, surgery, and midwifery lield./orjt/ie
purpose of granting a diploma or diplomas conferring
the right of registration under the Medical Acts, by
any of the following bodies, that is to say :— (a) Any
university in the United Kingdom or any medical
corporation, legally qualified at the passing of this
Act to grant such diploma or diplomas in respect
medicine and surgery: or (6) Any combination
of two or more medical corporations in the
same part of the United Kingdom who
may agree to hold a joint examination in
medicine, surgery, and midwifery, and of whom one
at least is capable of granting such diploma as afore¬
said in respect of medicine, and one at least is
capable of granting such diploma in respect of
surgery; or (c) Any combination of any such univer¬
sity as aforesaid with any other such university or
universities, or of any such university or universities
with a medical corporation or corporations, the
bodies forming such combination being in the same
part of the United Kingdom.
It will l.*e seen that no qualifying Body save a
University can grant qualifying diplomas indepen¬
dently, and that even its diplomas do not qualify
unless they represent medicine and surgery
separately. It is true that under the 5th section “ a
Medical Corporation which represents to the General
Medical Council that it is unable to enter into
such combination” (with another Body) can act alone
if itcausesthe Council to appoint assistant examiners
in the speciality which it does not profess. In other
words, if it be a medical body it must obtain surgical
examiners and vice versa if it lie a surgical body.
Outside these arrangements all qualifying bodies
may grant any diplomas they please. An apothe¬
caries hall might grant a diploma in aeronauts, just
as the spectacle sellers grant one, but such diplomas
are only decorative and have no effect as qualifica¬
tions. The whole controversy arises out of a play on
words which our contemporary has originated. It
tells us that “ the Local Government Board re¬
cognises these single diplomas and its possessor
would thus, if registered, be entitled to hold a Poor-
law appointment," and again, “ a medical body which
fulfils the statutory requirements is able of itself to
grant a single ‘ fully qualifying diploma.’ " Yes ; but
no such diploma, per se, can be registered or can
“ fulfil the statutory requirements." We are quits
well aware that, of his own mere motion and without
any authorisation from the General Medical Council,
or, as we judge from the law, the late President of
that Council ordered the registration of a number of
individuals who presented no other credentials save
the medical degrees of the London University, but
we protested, at the time, that his doing so was a
totally illegal assumption of authority, and we still
believe that anyone who chose to take the trouble
. could cause every one of the entries to be erased.
Digitized by L^OOQle
.*>94 The Medical Press.
NOTES ON CURRENT TOPICS.
Dec. 6, 1899.
on <Eumrtt ^opicB.
Free Medical Aid to Soldiers’ Families.
The proposal that medical men should give prac¬
tical help to the movement for relieving the wives
and families of soldiers engaged in the South African
war is founded on a knowledge of the humane gene¬
rosity that we are glad to believe animates the
medical profession. The gratuitous service already
accorded to the community from that quarter is well-
nigh incalculable, indeed, if we may believe com¬
plaints that have flooded medical journalism for the
past half century or more, the habit has led to a
crop of sorry abuses. From that point of view it
maybe well to utter a word of caution as to the manner
in which this latest military relief scheme is carried
out. The organisers, so we are told by a London
morning paper, have been bombarded with offers
of free attendance from leading practitioners of the
West End. Surely, as regards the honorary surgeons
and physicians of hospitals, dispensaries and other
medical charities, attendance at their institutions
would already provide the aid that is asked for. In
every district there are scores of general practitioners
who would be willing to extend their list of gratuitous
patients so as to include the families of soldiers at
the war. The published method of the Soldiers’ and
Sailors’ Families Association is to look up the wives
of all the soldiera at the front. Should they discover
a case needing medical help they communicate at
once with one of the free doctors, who attends the
patient and sends on the prescription to the free
chemist. Without careful precautions this plan
opens the door to undesirable competition and
jealousy, although at the same time it is impossible
to withhold a cordial approval of the general tenour
of the scheme.
“ Madame Frain.”
We noted last week that the nest of criminal
swindlers who have been making handsome profits
by catering for women (married and unmarried) who
desire abortion have met with condign punishment
at the bunds of Mr. Justice Darling. The fact is
highly gratifying, because a number of pests of
society have been stopped in their pernicious trade,
but the greater satisfaction arises from the deter¬
mination, by the learned Judge, of legal principles
which will be invaluable as governing a multitude of
future cases. Our readers may recollect that the
Medical Press and Circular was the first medical
journal to call attention, some three years ago, to the
advertisements of “ Madame Frain ’’ when we brought
them under the notice of the Public Prosecutor who
favoured us with an explicit statement of his view
of the law to the effect. (1) That the advertisements
were not, of themselves, so obscene as to justify
proseeution. 2. That a prosecution neither under
the Pharmacy Acts for dispensing without qualifica¬
tion nor under the common law for administering
noxious drugs would lie, because, in fact, the medi¬
cines sold to the dupes of the firm consisted only of
dirty water, and had no emmenagogue potency what¬
ever. 3. That the only prosecution which could be
effectually maintained would be one, promoted by a
victim, for obtaining money under false pretences, a
suit which it was very unlikely that any of “ Madame
Frain’8 ” customers would be induced to enter upon
The prosecution now instituted and the judgment of
Mr. Justice Darling have effectually corrected this
view of the law. In the first place it was proved
that the “Frain” medicines contained a pro¬
portion of abortive drugs which might produce
the desired result or, if in larger quantity, might kill
the patient. Next it was ruled by the learned judge
that it was not at all necessary that they should
prove this in order to justify a conviction, inasmuch
as the vendor of and the purchaser of an abortion
medicine were equally liable to the law whether the
medicine was or was not what it professed to be.
Third, and perhaps most important of all, that the
proprietors of newspapers which publish the adver¬
tisements of such medicine would be amenable to the
law as particcps criminis. Considering that it was
stated in Court that some of the newspapers (mostly
the pious ones) which inserted these advertisements
charged at the rate of £7 10s. per inch of space, for
which their legitimate cost would be about half-a-
crown, it appears that the judge’s warning to the
journalists comes none too soon.
Tobacco Pipes and Guy’s Hospital Subsoil.
Referring to our remarks under this heading last
week, a correspondent considers that the presence of
these tobacco pipes is a strong confirmation as to the
conjecture that the bones are those of plague victims.
In the seventeenth century tobacco was regarded as
a powerful prophylactic, and the faculty strongly
recommended everybody to smoke. Thdse concerned
in the burial of plague corpses would, doubtless, be
furiouB smokers, and, probably, as a measure of pre¬
caution, would throw away their contaminated
“ caddies ” before leaving the dismal spot. Dr. Charles
Creighton, in his work on “ Epidemics in England,’’
refers to smoking as a preventive of plague, and
quotes the following quaint extract from Hearne, the
antiquary, who writes :—“ I have been told that in the
last great plague at London ’’ [that would be in 1665]
“ none that kept tobacconists shops had the plague.
It is certain that smoking was looked upon as a most
excellent preservative, inasmuch that even children
were obliged to smoke. And I remember that I
heard formerly Tom Rogers, who was yeoman beadle,
say that when he was that year, when the plague
raged, a schoolboy at Eaton, all the boys of that
school were obliged to smoke in the school every
morning, and that he was never whipped so much in
his life as he was one morning for not smoking.’’
Does this not tend to show that a plague pit exists
beneath Guy’s ? It also demonstrates what a curious
animal is the boy. He is whipped in the seventeenth
century for not smoking according to commands,
whilst now (or, at all events, a few decades ago he
was) flogged for smoking against orders ! This goes
to prove that when doctors deal with boys, they
should prescribe in exact opposition to their wishes
Digitized by Google
The Medical Press. 595
NOTES ON CURRENT TOPICS.
Dec. 6, 1 899.
in order to give a fair chance to the science of
medicine.
*• Floreat Hibernia Semper.”
The above is the motto of the Irish Medical
Schools' and Graduates Association, whose autumnal
dinner, attended by members and guests to the
number of 180, took place at the Hotel Cecil, on
Wednesday. November ‘29th last. Sir William
Thomson, the president, occupied the chair, and he
was supported among others by Sir Walter Arm¬
strong, Sir Dyce Duckworth, Dr. and Mrs. Lauder
Brunton, F.R.S., Inspector-General W. H. Lloyd.
R.N., Sir Christopher Nixon. Sir Philip C. Smyly, Dr.
P. S. Abraham. Mr. and Mrs. Robert O'Callaghan,
Dr. Gilbart Smith (chairman of Council), Dr. Joceyln
Swan (non. treasurer), and the two honorary secre¬
taries Mr. P. J. Freyler and Dr. James Stewart.
After the usual loyal toasts, the chairman proposed
“ Our Defenders,” in which many references were made
to the Irish personnel among the commanders of the
troops now serving in South Africa. The toast
was warmly received and was suitably responded to
by Surgeon-Major-Geneml Rice, C.S.I., and Staff
Surgeon Barrintrton, R.N. “Our Guests ’’ was next
proposed by Inspector-General Lloyd, R.N.,to which
Sir Dyce Duckworth replied. Dr. Lauder Brunton,
in a happy and well-conceived speech, gave the
concluding toast, that of “ Ourselves,’’ and this
was acknowledged by the President. Aftei-wards
an “ At Home ” was held and was attended
by upwards of 400 ladies and gentlemen, consisting
of members and guests of the Association. The
entertainment provided was of an exceptional des¬
cription, including songs by Mr. Franklin Clive, Mr.
William Nichol, and violin solos and recitations.
The whole evening was a great success, and the
reunion was. apparently, greatly appreciated by all
present.
Surcharging of Guardians’ Law Costs.
A case has been recently reported in which
the Guardians were decreed by the County Court
Judge to pay £’8 for the law costs of a suit brought
by the doctor to recover one guinea due to him by
them, which sum he recovered. This is not the first
instance by many in which the interests of the rate¬
payers have been sacrificed avowedly to spite the
doctor, because he insisted upon his legal and moral
rights, and we have before us from day to day news¬
paper reports which record speeches of Guardians to
this effect. We should wish to ask whether, when
the law is clearly against the Guardians, yet they
persist on going into court with a hopeless case-
and are, of course, mulcted in heavy costs, the
Local Government Board considers it right that
its auditors slionld pass such outlay as legi¬
timate. We do not desire to limit, in the
slightest degree the right of guardians to con¬
test a claim which may possibly be bad in law,
but when ttie guardians have been declared by a
judge to be in the wrong, and when it appears that
they, or their legal advisers, should have known that
the law was against them before they forced the
matter into Court, we submit that it is quite un¬
justifiable that a dominant clique should be allowed
to mulct the ratepayers in costs for the wanton
gratification of their own ill-temper. If it can be
done, the auditors should be instructed to surcharge
against such guardians the expense involved unless
he is satisfied that the suit has been undertaken by
the Guardians bona fide, and for the purpose of pro¬
tecting the ratepayer against an illegal demand.
How Irish Poor-law Elections Are
Worked.
Ax inquiry has recently been held by the Local
Government Board as to the circumstances attending
the election of a dispensary doctor for Westport,
There were two candidates, and it is needless to say
that their competency or incompetency had nothing
to say to the case. Had they been stone deaf, blind, or
imbecile they would have been elected if they belonged
to a certain politico religious party, but there was,
not at all for the first time, another element in deter¬
mining the result. Certain of the guardians required
to be paid in hard cash for their votes. One of them
wrote “ several of us will take the money if you cun
see your way to a majority, I will be on your side for
£2," and another, “ It is believed that it is money
that will do it all. and I know five or six that would
sell their votes for very little. There is one doctor
that will sport t'l(K) on the job—it is a fact—and it
is no use for him. He will not be returned, as no
man stands a better chance than a Leaguer.” It
would be pleasant if we knew what the Chief Secretary
thinks of this method of selection of a medical adviser
for the sick poor and whether he thinks of doing
anything to purify the Augean stable. We by no
means expect that he will.
Penal and Disciplinary Powers.
It is satisfactory to find that the majority of the
licensing and degree-conferring bodies have at last
been brought into line in respect of the proposed re¬
modelling of the penal and disciplinary powers which
they possess in common with the General Medical
Council. What the Council requires is the power to
suspend registration for a definite period without
going through the form of erasure of the name with
subsequent reintegration thereof. The licensing and
degree-conferring bodies, on the other hand, require
to have the right to suspend a qualification with the
power to hand back the same without obliging the
delinquent to re-present himself for examination. It
is manifestly absurd for the Council to have, so to
speak, to don the black cap when inflicting punishment
for an offence which is regarded as adequately purged
by a year’s suspension. It is also subversive of
discipline that a man who lias been struck off the
Register should go on practising his profession as if
nothing had happened, a course in which police
magistrates appear to take malign pleasure in back¬
ing him up. If the diploma could be withdrawn for
a time the delinquents would no longer have any'pre-
t for continuing to practise, and magistrates
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596 The Medical Press.
NOTES ON CURRENT TOPICS.
Dec. 6, 1899.
would have no option but to enforce the law. We
are pleased to think that this moderate measure
of reform is now within measurable distance of
accomplishment, and advantage is to be taken of the
opportunity thus afforded to secure that fines and
penalties inflicted for contraventions of the Medical
Acts shall be paid over, as of right, to the General
Medical Council. The appropriation of these sums
by the authorities has sadly hampered the very
necessary work of stamping out certain forms of
illegal practice in the past.
Reciprocity of Medical Practice.
Consequent upon the renewal of the agitation in
Italy in favour of restricting medical practice to
persons possessed of a native qualification, the ques¬
tion of reciprocity in medical practice may be said
to have entered upon an acute stage. Unless ad¬
vantage be taken, and that speedily, of the section of
the Medical Act (1886) to establish reciprocity with
Italy, it may be taken for granted that the Govern¬
ment of that country will be unable to withstand the
pressure which is being brought to bear. Steps have
been taken to define exactly the position of prac¬
titioners with foreign qualifications in this country,
and we presume the next step will be for the Council
to intimate to the Privy Council its wish to be
authorised to recognise and admit to registra¬
tion duly authenticated Italian diplomas. The
question, however, is not as simple as it looks
because such a departure would establish a precedent
which would have to be followed in respect of other
countries. The difficulty, however, is not of the
magnitude which we are asked to believe, seeing that
the General Medical Council will remain master of
the situation, inasmuch as it has the power of
admitting to registration only such diplomas as
appear to offer the necessary guarantee of knowledge.
We have no sympathy with the narrow views which
would prevent reciprocity, merely because it might
bring foreigners into direct communication with
native practitioners. That is precisely the argument
upon which is based the protectionist policy of most
foreign governments towards British practitioners
who wish to exercise their profession abroad. For j
one foreign practitioner who would come to practise
in England, scores of British practitioners would
obtain the right to practise abroad; in fact,
reciprocity must of necessity be all to the advantage
of British practitioners. This question should be
approached from a statesman's point of view, and
not in the huckstering spirit which is better suited
to the small shopkeeper, and although Mr Horsley
has thought fit to make himself the exponent of the
views which we condemn, we prefer to believe that it
was the direct representative who was speaking and
not the fellow of the Royal Society. Fortunately,
even should the Council yield to its conservative
instincts to the extent of refusing to move in the
matter, it is open to the Queen in Council to impose
the recognition of Italian diplomas ; but this is a con¬
tingency which we would fain hope the Council will
not impose on the Government.
Senior Students as Assistants.
The General Medical Council has done much to
stamp out the unqualified assistant, but, jiart passu,
it has connived at the employment of senior medical
students as assistants in medical practice. There
was a delightful ambiguity about this quasi¬
permission which was sure to bring the Council
into difficulties, an instance of which presented
itself during the present session. The difficulty
was surmounted on this occasion by dismissing
the charge, but it will be necessary for the
Council to define with some approach to precision
at what period of study, and to what extent the
senior student may assist a registered practitioner.
Actual participation in medical practice at a period
not unduly removed from the termination of the
curriculum is unquestionably an invaluable means of
acquiring practical knowledge, and, what is even
more important, of learning how to conduct a prac¬
tice, including a much neglected branch of knowledge,
viz., dispensing. If such a man is to be hedged in by
the rigorous restrictions imposed by the Council on
the ordinary unqualified assistant, his object will be
frustrated in great part, and in any event the
position will be unpopular. Why should not the
Council lay it down that only fifth-year students are
eligible for such posts ? Having done this the rules
of conduct might be enlarged in order to allow of
their deriving the benefit of this modified form of
apprenticeship. If the matter be left in its present
unsatisfactory position, the Council will have to dis¬
play an irregular and illogical indulgence whenever
it can be shown that the unqualified person is a
bona fide medical student, irrespective of his grade.
The Practical Value of Sham Diplomas.
Last week the Master of the Spectacle Makers’
Company, Sir Reginald Hanson, M.P., addressing
the candidates for the optical diplomas of that body,
impressed upon his hearers that they should be
cautious never to infringe upon the function of the
ophthalmic surgeon, and that when, in eye-testing,
they discovered some disease apart from refractive
error, they should at once 6end the patient to a
competent oculist. Although the suggestion of the
Master is not in accord with the view of
the Examiner who gave as one of his first
questions the diagnosis of glaucoma, we accept
his intention as honourable and straightforward,
and we are sorry that it is by no means possible for
his Company to give any practical effect to it. The
spectacle makers are in the sime position as the
I Pharmaceutical and the Obstetrical Societies, which
protest their desire to prevent their alumni from
counter-prescribing or from the illicit practice of
midwifery. Once a trader is put in possession of a
j pretentious looking parchment certifying his capacity
; these societies are entirely powerless to restrain him
from turning it to any use which will pay. The well-
meant assurances of the Presidents of such societies
are therefore quite valueless. The medical profession
1 will have to take care of itself, and, if it can, prevent
the authoritative issue of such documents, which, as
Digitized by vjOOQ 1C
Dec. 6, 1899.
NOTES ON CURRENT TOPICS.
The Medical Press. 597
yet, it does not appear to think it worth its while to
do.
Is a Homoeopathic Concoction a Medicine?
Ocr readers are aware that the Apothecaries’ Hall
of London possesses, under its Act of 1815, the power
to prevent any person from practising medicine in
England unless he holds a legal qualification from
the Hall itself or from some other competent body.
"Under this authority a person has been recently pro¬
secuted at Ashton-under-Lyne because he practised
medicine, he being avowedly a homu-opath. An
apothecary, it has been decided, is “ one who judges
internal diseases by symptoms and prescribed medi¬
cines for them.” As it was clear that the defendant
had violated the first part of this definition, he was
driven back upon the defence that the stuff which he
prescribed was not “medicine.” The Judge deferred
his decision, and meanwhile we may ask what the
thing is for which the homoeopaths receive consider*
able sums if it is not medicine?
Then and Now: Crimea and Cape.
A wide gulf divides the lot of our soldiers who
fought in the Crimean campaign and those who are
now showing the Boers that the old British bull-dog
courage is still a characteristic of the insular breed.
In the fi ret half of the century the service medical
organisation, to say nothing of the more general
army administration, was little short of chaos. The
sufferings of the troops from wounds, want, and
exposure were terrible, and called forth the noble
ministrations of Florence Nightingale, who may be
said to have laid the foundations of the modem
military nursing. The introduction of a perfect
system of base and field hospitals, and of an Army
Medical Staff Corps, whereby the wounded are at
once collected and medically treated, in itself con¬
stitutes an enormous advance. Then within a brief
generation soldiers in the field have gained the boon
of aseptic surgery, the greatest saviour of suffering
and life ever introduced to mankind by the intellect of
man. Commissariat has been brought up to a precision
that guarantees good food, clothing, with other neces¬
saries and even comforts to our brave campaigners.
Latest wonder of all, the marvellous Rongten rays
are made to penetrate the bodies of our gallant
warriors with harmless beams that demonstrate the
presence and location of missiles and in some cases
the nature and extent of injuries. Then there are
the sumptuous and perfectly equipped hospital ships
sent out by the Princess of Wales and by our
American “friends across the sea,” besides voluntary
first aid expeditions. All these and other causes
incidental to the Army Medical administration
render the lot of Mr. Thomas Atkins of
to-day a thousand times less toilsome and
terrible than that of his predecessors in the
Crimea. For all that it is a shock to read of
the wounded in some of the recent fights being left ;
out all night in pouring rain. Some of the details
are calculated to fill with horror the imagination even
of those inured to surgical experiences. It is to be
hoped that the nation will insist on the vast sums of
money that have been collected for the relief of
those distressed and bereaved in the present war being
immediately and freely expended. The fact that
several hundreds of thousands of pounds have accu¬
mulated from the Crimean fund appears to reflect
discredit upon the administration of that fund, and
to show that the objects of its subscribers have been
hopelessly and recklessly diverted from their purpose.
The Dublin Student Claes for 1900.
The returns of the Anatomical Committee, made
up to November 25th, show a slightly decreased num¬
ber of Anatomy students in the schools, 423 for this
year as compared with 435 last year. For the indi¬
vidual schools the figures are as follows :—Trinity
College 170, College of Surgeons 130, Catholic
University 123. It should be kept in mind that these
figures represent only the Anatomy students, and
even these not accurately. The duty of the
Anatomical Committee is limited to ascertaining the
number of “ subjects ” which will probably be
required in the coming session for dissection
and for operative surgery. It is, therefore, chiefly
the second year students who are enrolled
in this return, and those entering for other courses
are not counted. Moreover, it is open to a school to
apply for a greater number of subjects than it wants,
in order to secure an abundance of material, and it
suffers no monetary loss thereby because it subse¬
quently obtains a refund of the money paid for the
redundant material. The shortage in the number of
students in the Dublin school for the last year or two
is attributable to the new-born severity of the con¬
joint preliminary examination of the Colleges which
has led to the wholesale rejection of aspirants. At
the recent examination more than half the candidates
were sent away unsatisfied.
Medical Volunteers for the War.
The profession has, we believe, regarded the
appointment of civilians, however distinguished, to
supervise the work of the Army Medical Service in
South Africa with very qualified approval. In the
first place it is questioned whether such supervision
is at all required, implying, as it undoubtedly does, a
doubt on the part of the War Office that the adminis¬
trators of the Medical Department are to be depended
on in emergency, a doubt which the profession at
large by no means shares. Secondly, there is a
feeling that the gentlemen selected are not the best
for the purpose which might be found. The Presi¬
dent of the London College, by virtue of his experi¬
ence of the Franco German War. may be looked upon
as an expert in medico-military organisation, and one
of the others selected is recognised as an operative
surgeon of much eminence, but the third, though
recognisable as an advancing surgeon, has not yet
attained a position to entitle him to check the work
of the campaign. It is to be feared that the appoint¬
ment of these, or any other outsiders, will give rise
to friction with the medical authorities on the
spot. We note that one or two of the
Digitized by v^. ooQle
598 The Me dical Pbssb-
Dublin papers have sought to make an Irish
grievance out of the fact that the tender of their ser¬
vices by certain Irish surgeons was not accepted. Of
the four gentlemen named the President of the Irish
College of Surgeons, who offered himself chiefly, we
believe, with the purpose of demonstrating the
patriotic anxiety of his College to contribute its help,
was entitled to special consideration, and the late Mr.
Wheeler, by virtue of his experiences in the
Abyssinian campaign, would have been regarded as a
useful appointment. The other candidates, if we may
call them so, whose names were quoted by the news¬
papers, are known simply as more or less successful
provincial surgeons who could scarcely be supposed
to represent Irish surgery, and it is possible that they
are not well pleased that their pretensions to such
recognition should be dragged into prominence by
injudicious journalistic friends. In any case we
object to the indiscreet effort to make these appoint¬
ments a question of racial jealousy. The War Office
may or may not have made a wise selection, but with
that selection the question of nationality ought to
have, and probably has nothing whatever to do.
Unsound Tinned Milk.
The trade in unsound tinned milk appears to l>e
flourishing on a large scale, if one may judge from the
disclosures that take place from time to time in police
courts. Last week an enormous quantity of this
particularly undesirable merchandise was condemned,
the evidence showing that most of the tins were
blown, and that the milk was in all cases unfit for
food. The defendant appeai-ed in the witness box
and maintained that some of the milk was fit for
confectionery and “ manufacturing ” purposes. It is
to be presumed that in both events the pestilential
stuff would ultimately be dished up in some more
or less palatable form for human consumption. There
were no less than 181 caseB, each containing four
dozen tins, and the defendant admitted that
he had bought them at a price varying from six¬
pence to half-a-crown a case, a clear testimony in
itself to the value of this precious consignment. The
whole lot, which filled three vestry dust carts, was
ordered to be destroyed. In view of these and
kindred prosecutions it will be well for local
authorities generally to bestir themselves in dealing
with this danger to the public health. Not only is
there the injury to the adult population involved in
the consumption of such articles, but there is the
special damage to the infantile population in those
quarters where the cheapness of tinned milk makes
it popular as a foodstuff for babies. It is to be hoped
that the pathway of the tinned milk offenders will be
everywhere beset with thorns.
PERSONAL.
Latest advices from the seat of war state that Sir
William MacCormac has left Durban and gone to
Pietermaritzberg in order to be nearer the main body of
troops sent to relieve Ladysmith.
Heh Majesty the Queen received the medical staff,
together with the nurses, of the American hospital ship
Dec. 6, 1899.
Maine, at Windsor Castle on Monday, prior to their
departure for the seat of war.
We i egret extremely to hear that Sir Thomas Grainger
Stewart, Her Majesty’s Physician-in-Ordinary for Scot¬
land, is not making that progress towards the recovery
for which his numerous friends and well-wishers
hoped and is still in a somewhat anxious condition.
Dr. F. W. N. Haultain, F.R.C.P.E., has been,
appointed one of the assistant-physicians to the Royal
Maternity Hospital, Edinburgh, in the place of Dr. A. H.
Freeland Barbour, who has succeeded to the post of Full
Physician in place of Dr. Halliday Croom, the latter
having completed his term of office.
Mb. Arthub Chance, Surgeon to the Mater Miseri-
cordia Hospital, Dublin, has announced his candidature
for the seat on the Council of the Royal College of
Surgeons vacated by the death of the late Mr. Wheeler.
Mr. Chance has already served the College as a surgical
examiner and as a councillor.
Mr. George Brown, direct representative for the
General Medical Council, writes:—“ In order to prevent
misunderstanding I will thank you to permit me to
state through your columns that I have resigned all con¬
nection with the editorial department of the Medical
Times and Hospital Gazette, which journal I founded in
1872 under the title. The Students' Journal and Hospital
Gazette.”
JScrrtlaiti).
[from OCR OWN CORRESPONDENT.]
The New Medical Superintendent of the Royai.
Infirmart, Edinburgh.— Managers of this institution
proceeded last week to fill the post of medical superin¬
tendent, vacant through the untimely death of Surgeon-
Major-General Lithgow. After protracted proceedings,
it was announced that Colonel W. P. Warburton,
M.D.Edin., I.M.S., had gained a majority of their votes.
The new superintendent is an Edinburgh graduate, his
M.B. C.M. degree dating from 18(55, hiB M.D. from 1885.
Colonel War burton’s services have hitherto l>een almost
entirely administrative, a fact which augurs well for his
successful conduct of the duties of his latest poet, a post
of considerable difficulty, calling for the exercise of much,
tact, and all-round bonhommie, tempered with discri¬
minating resolution.
Unseasonable Warmth. —The month of November,
1899, will long be remembered in many parts of Scotland
for its phenomenal warmth. In Edinburgh the mean
shade temperature works out at 47 4 degs. F., or 6*5
degs. above the 135 years' mean of 40 9 degs.
for the month. This value is rather above the
average mean for October, as shown by the
records during the 135 years. Zymotic diseases
in Edinburgh have failed to show any autumnal
increase; they have, rather, shown a decrease in con¬
nection with this meteorological abnormality. During
the week ending November 25, only three cases of
measles were notified from amongst a population of over
300,000; the total number of cases of infectious
disease notified being below 40. The latter part
of the month afforded evidence that a form of
influenza had again become prevalent, and as
so often happens when visitations of this scourge
coincide with warm weather, natural or unnatural (as
witness the attack during the unusually warm early
months of 1896), chiefly affected the gastrointestinal
tract. Perhaps a still narrower localisation may with
reason be noted, because in the majority of instances
the large bowel seemed to be selected by the causal
SCOTLAND.
Digitized by LjOOQIC
Dec. H, 1899.
CORRESPONDENCE.
The Medical Press. 599
bacillus for its habitation. Incidentally we may mention
that the village of Braemar has recently suffered exten¬
sively from an inflnenzal epidemic, which - has spared
few of its inhabitants.
Student Niohts at the Thkatbe. —A special form
of entertainment, introduced into student life some
few years ago in an unofficial manner, has more recently
developed in Edinburgh into a recognised and official
custom. Before a student’s representative council ever
was, students’ theatre nights were not conducive to the
comfort of the non-academical members of the audience.
Sinde then the members of the Students’ Council have
taken it in hand ; they secure the entire gallery of the
theatre patronised for the night; provide a piano, often
select the singers, and act as stewards for the night. Friday
evening is usually selected, for there are no lectures to be
listened to next morning; the date and the locus are
posted up on notice boards beforehand, and at least
balf-an-hour before the curtain rises, early comers in
ocher parts of the house ar e entertained with a by no
means unenjoy able concert, provided by the “ gods,”
consisting mainly of would-be eesculapians. Solo is
followed by part song, that in turn by chorus, until the
play begins. Then all is silence, celestial silence, broken
only by applause, the kind of applause to which that of the
Continental subsidised claque is as a whisper The act.
ended, and the curtain down, no need for the orchestra to
while away the time, the gods provide the necessary music.
Altogether, experience of what a students’ night at the
theatre means, not that of pre-council days, but with the
gallery packed with orderly occupants, among whom are
not a few respectable vocalists and who together can
produce a very resonant volume of sound, robust
perhaps, rather than modulated, after the fashion of a
Torkshire’choir at a Leeds Festival—rather induces one
to select Friday nights for one's visit to the play ; the
intervals, often so irksome, bo often passed by men in
refreshing their bodies at the bar, become interesting;
nay, in some instances the entertainment provided by
those above makes a poor play seem doubly poor, a thin
and jejune soore still more jejune.
Glasgow University—Medical Bursaries. —The
following results of the competitions for bursaries open
to students in the Faculty of Medicine are announced
John Macfarlane bursary for second year students
(annual value about .£40, tenable for three years)—
Alexander Mathieson. Lorimer bursaries (annual value
£19 for three years)—Peter L. Sutherland and John M.
Kelly. Jam68 A. Paterson bursaries—one of £30
annually for four years—James C. Pairman ; one of .£15
annually for four years—Carl H. Browning. Senior
Arnott Prize of £25 for an examination in Physiological
Physics, open to third and fourth year students in
Medicine—Robert D. Campbell. Junior Arnott Prize of
about £15, open to first and second yew students in
Medicine for an examination in General Physics —
Malcolm Hutton, M.A. Rainy bursary (£20 for two
years), open to students of the third year in Medicine,
for examination in Anatomy, Chemistry, Botany, Physio¬
logy, and Zoology—David Riddell.
Manchester.
fFBOM OUR OWN CORRESPONDENT. |
Women Students. —Manchester is slow to move, but
once in action acts thoroughly. Owens College
has at last agreed to admit women as medical
students. Arrangements are being made for them
to enter at the commencement of next winter
session. Opportunities for clinical work must be
found, and to this end the College authorities
have approached the Board of the Royal Infirmary.
Such a momentous step needs careful consideration,
and the matter has been submitted to a special com¬
mittee. The rapid development of the medical school
makes the necessity for adequate clinical study a very
urgent one. Perhaps the “ mind of the woman ” will do
something towards solving the problem of the future of
the Royal Infirmary.
Meeting of Medical Association. —A preliminary
meeting has been held to consider the desirability
of inviting the British Medical Association to
Manchester. It is generally thought that at the com¬
mencement of the new century Cottonopolis should
welcome the great body of medical practiti oners in this
country. The representatives of the local branch are
about to summon a meeting of the secretaries
of the various medical societies in the district,
who will doubtless arrange for a fully representative
meeting of all members of the association in Manchester
and the immediate neighbourhood, at which the whole
question will be considered. ’ 1__
-•-
(Eomsponbcitcc.
We do not hold ourselves responsible for the opinions of our
correspondent*.
A SAD AND URGENT CASE.
To the Editor of The Medical Press and Circular.
Sir,— May I through your columns draw the attention
of brother practitioners to a most sad case with which
I am personally acquainted, and which is in most urgent
need of some help and assistance. An Irish practitioner,
for some years holding a good practice in the North of
London, contracted rectal trouble, and had two opera¬
tions performed upon him. This and the consequent
long lying up so deteriorated the practice that he
was obliged te relinquish it, his health being
greatly shattered. After a time he tried to
establish himself in a comparatively poor suburb, but
again his health broke down, and with a young family of
five children he was reduced to sheer poverty. Still,
rather than abandon his wife and children to want by
going again into hospital, he continued to work, often in
great agony, and despite of his disease succeeded in again
getting about him a new connection. Of late, however,
his health has been so completely shattered, that he
could not continue to do his work, and has been forced
again to go into hospital. By interest some provision
has been made for a few of the children, but now
the insurance on his life will be sacrificed
and all his furniture sold unless some help is forth¬
coming for him immediately. I feel certain. Sir,
that you will assist by acting as treasurer for any fund
that may be raised to help in this melancholy case, and
I would, through your columns, ask on behalf of this poor
fellow and his half-starving family some aid at the
hands of his fellow practitioners. Any sum, no matter
how trivial, will be accepted gratefully.
I am. Sir, yours truly,
H. Macnaughton-Jone8.
131, Harley Street, Cavendish Square, TV.
November 29th, 1899.
THE TEMPERANCE QUESTION.
To the Editor of The Medical Press and Circular.
Sir,— In your leader of last week on the temperance
question, you put certain questions which I hope I may
be permitted to answer. The “ teetotalist ”—apparently
the teetotaler under a new name—is asked “ if his views
of fermentation would extend to the making of bread,
and generally to all forms of fermentation, whatever
they may be.” A serious answer seems hardly called
for. We shall object to bread and other “forms of fer¬
mentation ” when we find that bread intoxicates, or that
other forms of fermentation (whatever that may mean)
give rise to about one-twentieth part of the evils pro¬
duced by beer and other intoxicating beverages. The
writer also shows his total unacquaintance with the
literature of the temperance movement, or he would
never have ventured to say that “ it does not appear
easy to find support in the Holy Scriptures for tee-
totalism.” We undertake to prove that both the spirit
and letter of Scripture is in favour of perfect sobriety, and
as alcohol lessens sobriety in direct proportion to
the quantity consumed, we conclude that the lees we
take of such a brain-benumbing drug the better. Our
zed by Google
Diqiti.
600 The Medical Press. LITERARY NOTES AND GOSSIP.
Dec. 0. 1899.
objection to alcohol is not simply because of the evils of
gross drunkenness and its concomitants. We realize
that alcohol is operating from the very first in weakening
the highest and latest developed powers of the mind,
producing progressive paralysis of the judgment and
will, rendering the individual less self-cuntrolled and
more automatic, and hence a prey to any chance sugges¬
tion of evil. As we regard as the special object of
education, both civil and religious, to promote
temperance (».«. self-control), we cannot see the wisdom
or advantage of using, or advising the use of an agent
which acts in exactly a contrary direction, undoing what
we are trying to do.
With all due deference I ask the writer whether he
advises the universal and habitual use of opium. I do
not suppose he is so foolish. But as the consequences of
the social use of alcohol arc said by those who know both
to be much worse than those of opium, I do not admit
myself to be more foolish than he.
I think the writer is mistaken when he says that “ the
tendency shown by many to indulge in excess in the use
of any such agents as opium or alcohol is, in the opinion
of the profession, an evidenoe of disease. 1 ' I should like
to know who has ever committed himself to such a
sweeping statement. It may be granted that there are
some habitual (or, more usually, occasional) drunkards
who have an insane impulse to drink, but by far the greater
number of excessive drinkers a»e simply vicious and yield
to the temptations of others. We have instances without
number that when Buch people are not tempted to drink
they keep sober. In our South African army at the
present time there are thousands of reservists who were
sent off more or less drunk through the foolish kindness
of “ friends ” (! ) but they have been sober ever since,
for the very good reason that they are not allowed any¬
thing which will intoxicate them, to their own advan¬
tage, and everyone else’s. When the nation is wise
enough they will put an end to all intemperance in a
similar way. But “ that is another story.” My letter
is too long already, or 1 should deal with the assertion
that beer is food as well as drink. I will only say that I
have seen several cases of delirium tremens through
trying to live on beer. There may be some food value
left in the soluble extractive, but anyone who wanted
food would prefer the barley in any shape at a penny
a pound to the beer at 2s. a gallon.
I am, Sir, your truly,
J. J. Bidob, M.D.Lond.,
Hon. 8ec. British Medical Temperance
Enfield, Nov. 25th, 1899. Association.
OPERATIONS AT THE CANCER HOSPITAL.
To the Editor of The Medical Press and Circular.
Sib, —Even in the absence of a passing resort to
reflection or common sense, the trifling precaution of
previously ascertaining his facts would, I think, have
sufficed to avert the “ indignatio ” of your correspon¬
dent’s letter thus headed.
Every report or circular issued from the Cancer
Hospital prominently states that institution to have
been founded “for the treatment of the poor afflicted
with canoer, tumours, or allied diseases. Where, then,
are the “false pretences” he so scathingly denounces?
That, however, is a mere technicality. When we
regard the question of principle, very curt reflection will
show the inexpediency of drawing a too rigid line of
demarcation in such matters, even as experience proves
its utter impossibility. Your correspondent may, or
should know that, even when traced by scientists, the
boundary line between cancerous and simple “ tumours ”
is varying and uncertain. That this is especially the
case with the lesions in question, uterine myomata.
That these growths are by no means rarely associated
with cancerous disease, in one form or another. That
they occasionally even generate a special variety almost
sui generis.
Even if practicable would it be advantageous to the
community, or even in accordance with common
humanity, to act on such narrow pedantic lines as
your correspondent indicates ?
At any rate all ‘ outside general practitioners ” are by
no means such purists, as within the past six weeks I have
twice found my beds occupied by patients admitted on tb»
certificate of their medical attendant, with no worse
ailment than the sequelae of a neglected miscarriage !
When once thus taken into the wards, how could one re¬
fuse appropriate treatment ? Mr. James Hamilton Viaa
evidently not yet learnt to realise the vital seivioe which
eleemosynary hospitals in general render to the average
medico, viz., the relieving him of his non-paying patients.
The total impossibility under somewhat similar cir¬
cumstances of drawing this hard and fast line has evi¬
dently been felt by our neighbour, the Hospital for
Consumption. I have myself casually met with cases
of mitral disease, chronic bronchitis, asthma, Ac., which
were receiving treatment there, and I presume that
most, if not all, maladies of the thorax would fall within
its “ sphere of influence.”
Lastly, may I point out that the Canoer Hospital
specially commends itself to the outside general prac¬
titioner,” on several other important grounds than the-
above ? Among these I need only mention two. It
takes all reasonable precautions to exclude any but the
“ deserving poor.” It never exacts a single penny from
its patients ; and thus lies wholly free from the imputa¬
tion of intercepting moneys to which the struggling-
outside general practitioner might lay legitimate claim.
I am, Sir, yours truly,
Herbert Snow.
6, Gloucester Place, Portman Square,
December 2nd, 1899.
To the Editor of The Medical Press and Circular.
Sir, —Not long since I was surprised to see an in¬
teresting account of uterine tumours removed in the
“ Cancer ” Hospital, though nothing cancerous had been
diagnosed! Like many others, I have laboured under
the delusion that special hospitals only took in special
cases; but I hear it is now notorious that none of the
special hospitals stick to their speciality.
May I ask what would be thought of the specialist in
private practice, who would monopolise the cases of the
general practitioner in addition to his own. I imagine
it would soon be made too hot for him, and I consider it
most unjust both to the general practitioner, and a fraud
on those leaving money in their wills to a special
hospital (for a special purpose) to treat all comers, as I
know is the case, at least, in the out-patient depart¬
ment of the special hospitals in London. Surely
there is quite enough special material to supply
the hospitals aspiring to that name. Without defraud¬
ing the general practitioner of a great portion of his
income, hard earned as it always is, the Medical Council
might devote a little of the time wasted by that
ornamental body in looking into the abuse of the special
hospitals (so called).
I am, Sir, yours truly,
Alexander Duke, F.R C.P.I.
Cheltenham, Dec. 2nd, 1899.
^Citeran) ^otcs anb dosstj).
Still another illustrated handbook on the diseases of
women is in preparation, the author being Dr. Jellet, of
the Rotunda Hospital, Dublin, a’ready well-known as
the author of a “ Short Practice of Midwifery.” The
publishers will be Messrs. J. and A. Churchill.
v
Mr. W. R. Hughes, whose death is announced, was
one of the best-known figures in the literary and intel¬
lectual life of the Midlands. He was a devoted disciple
of Herbert Spencer, and at Mason College, Birmingham,
he instituted the firet Spencer Society in this country.
• •
«
It is now pretty generally known that English copy¬
right does not hold good in America, unless an author
prints his work in that country. A case, however, has
just been decided in the High Court at Toronto, which
shows that the product of an author’s brains cannot be
pirated in Canada so long as the Dominion remains part
of the British Empire.
oogle
Dec. 6. 1899.
MEDICAL NEWS.
The Medical Peers. 601
W e are asked to announce by the publishers, Messrs.
Balliere, Tindall and Cox, that a considerable number
of the new edition of Dr. Walsh’s work on “ The ROntgen
Rays in Medical and Surgical Work,” and “The X-ray
Case-book,” have been sent out in H.R.H. the Princess
of Wales' Hospital ship for use with the Rontgen-ray
apparatus in the Transvaal war.
%•
Mb W. G. Black, F.R.C.S.E., has in the press a
work by his UbcIo, William Black, L.R.C.S.E., Surgeon
H.M.S. Chanticleer, “Narrative of Cruises in the
Mediterranean during the Greek War of Independence,
1822 —1626.” Offioial visits to various ports are des¬
cribed. and scenes of operations of war precedent to the
naval battle of Navarino in the Morea. It will be pub¬
lished immediately by Messrs. Oliver and Boyd,
Edinburgh.
• •
•
The Leisure Hour in its new dress promises to become
even more popular than its previous series, which has
been running consecutively for nearly half a century.
It is now published in a more handy form, is full of
entertaining reading to suit all but depraved tastes,
has a new serial story by Sir Walter Besant of absorb¬
ing interest, and should form one of the most accep¬
table of magazines for the waiting-room tables of medical
men.
• •
•
The fourth volume to hand of the second series of the
Index - Catalogue, Surgeon-General’s Office, United
8tates Army, contains 9,682 author-titles, representing
4,1.32 volumes and 8,503 pamphlets. It also contains
8,828 subject-titles of separate books and pamphlets, and
8,316 titles of articles in periodicals. This great Index-
Catalogue may be said to have restored to use, the
medical literature of the past, and to keep us abreast of
that of to-day. It is a great gift to medicine, worthy
of the greatRepublie.
• •
•
Thebe is a great need for information upon the
subject of the existing sanatoria for the open-air
treatment of tuberculosis at the present time. The
reprint, therefore, from the West London Medical Journal,
entitled “ British Sanatoria,” published by Messrs.
Bale, Sons, and Danielsson is very opportune and is
likely to prove highly useful. The publication is fully
illustrated and gives descriptions in detail of all the
known sanatoria now open for the reception of patients.
The December issue of the Cornhill Magazine contains
many entertaining articles, which appeal to a variety of
readers. “ Eagles and their Prey ” is one, however,
which will afford interest for all The idea that these
remarkable birds attack their prey first by tearing out
the victim’s eyes is quite true, for witnesses to the act
have recorded the game. Again, it seems that golden
eagles can carry in the air as much as eight pounds,
but smaller-sized eagles have been observed to reduce
this weight by tearing off an animal’s head, when they
found that they could not carry their prey to the nest.
The Sanitary Association of Manchester is about to
issue a series of health publications, including the
following.—1. “Consumption: Its Causes and how
Spread,” by Dr. Arthur Ransome. 2. " Ventilation and
the Curative Effects of Pure Air,” by Professor J.
Dixon Mann. 3. “Colds and their Consequences,” by
Professor Dreschfeld. 4 “ Personal Habits,” by Professor
Leech. 5. “ Feeding and Care of Children," by Dr. Henry
Ashby. 6. “ Causes of Dia»rhu?a in Children and
Adults,” by Dr. H. R. Hutton. 7. " Food and Drink,”
by Dr. R. T. Williamson. 8. “ Exercise and Recreation,”
by Mr. W. P. Montgomery. 9. “ Causes and Prevention
of Infeccions Diseases,” by Dr. R. W. Marsden.
10. “ Vaccination,” by Dr. J. W. Hamill.
The following new books in medicine and allied
sciences have been received during the past few days :
—A translation of Thoinot’s “ Outlines of Bacterio-
logy,” by Mr. 8t. Clair Syminers (Chas. Griffin and Co.);
the second and concluding volume of De Meric’s
“ English-French and French-English Dictionary of
Medical Terms” (Bailliere, Tindall, and Cox); "The
X-ray Case-Book,” by Dr. Walsh (Baillieie, Tindall, and
Cox) ; “ Welloome’8 Medical Diary for 1900 ” (Burroughs,
Wellcome and Co.); the late Prof. Charteris’s “ Practice
of Medicine,” eighth edition, revised by his son Mr. F. J.
Cliarteris (J. and A. Churchill); Part II. of Cheyneand
Burghard’s “ Manual of Surgical Treatment ” (Long¬
mans Green and Co ) ; Tillman’s “ Descriptive General
Chemistry ” (Chapman and Hall); “ Medical Annual
Synoptical Index, 1887 to 1898 (Bristol: John Wright
and Co.); Vols. I. and II. of Stonham’s “Manual of
Surgery ” (Macmillan and Co.); and " Renal Cases and
Surgical 8tudies,” by Dr. D. Newraan|(Jas. Maclehose and
Sons).
,4fftebkal
Ths Chelsea Hospital for Women.
The Chairman of the hospital. Lord Gienesk, held a
reception at the hospital last week of the members of
the committees and friends who had interested thorn-
selves in the important alterations which have recently
been carried out, including an enlarged operating
theatre and new sterilising and ansesthetio rooms, new
hot water service, installation of electric light, electric
lift. In a brief statement of what had been done he
referred to the greatly increased number of patients and
consequent growing demands made on the resources of
the hospital ns necessitating the perfect working of all
departments connected with the treatment of the
patients in order to maintain the excellent results
which had attended the skill of the medical staff. The
extremely low rate of mortality, of little more than 1 per
cent., had for some time past been a feature of the
statistics. 8ome of the patients themselves had volun¬
tarily come forward with small contributions towards
the work by which their successors were to benefit, and
the generous gift of wealthier friends, like the late
Baroness de Hirsch Gerenth and Mrs. 8ington, had pro¬
vided half the .£3,000 required to defray the coat, and
Mr. Passmore Edwards, with his wonted generosity, had
just given them a donation of 100 guineas. On the
invitation of the Chairman the visitors then inspected
the wards and operating theatre, and great satisfaction
was expressed with the thorough manner in which the
work been csrried out.
Death Under Chloroform.
An inquest was held at Kidderminster on the 30th ult.
on the body of William Lloyd, aged 12, who died while
under chloroform at the infirmary. Dr. Stretton said it
was one of the unaccountable cases of heart failure from
chloroform. AH the organs of the body were healthy.
The operation was for infantile hernia. The jury returned
a verdict that death was due to misadventure, and that
no blame attached to anyone.
Bt. Thomas's Hospital.
The following gentlemen have been selected as House
Officers from Tuesday, Dec. 5th, 1899:—House Phy¬
sicians : F. H. Ellis, B.A., M.B., B.C., Cantab., L.R.C.P.,
M.R.C.S.; A. H. Greg, B.A., M.B., B.C., Cantab., L.R.C P„
M-R.C.S. (Extension); A. Bevan, L R.C.P., M.R.C.S.
(Extension); B. F. Howlett, L.R.C.P., M.R.C.S. As¬
sistant House Physicians : H. R. Beale, L.R.C.P.,
M.R.C.S.; L. 8. Dudgeon, L.R.C.P., M.R.C.S. House
Surgeons : H. J. Phillips, L.R.C.P., M.R.C.S, P.
W. G. Sargent, M.A., M.B., B.C. Cantab.,
L. R.C.P., M.R.C.S., S. A. Lucas, L.R.C.P., M.R.C.S.,
H. T. D. Acland, L.R.C.P., M.R.C.S. (Extension).
Assistant House Surgeons : A. Webb Jones, L.R.C.P.,
M. R.C.S.; E. A. Gates, L R.C.P., M.R.C.S.; E. C Bour-
das, L.R.C.P., M.R.C.S.; N. Unsworth, L.R.C.P., M.R.C.S.
(Extension). Obstetric House Physicians: Senior—
G. B. Thwaites,M.B.Lond.,L.R.C.P .M.R.C.S.; Junior—
H. H. R. Clarke, L.R.C.P., M.R.C.S. Clinical Assis¬
tants: Throat—A. J. B. Adams, L.R.C.P., M.R.C.S. ;
S. H. Belfrage, M.D.Lond.; Skin—T. Perrin, L.R.C.P.,
M.R.C.8. (Extension); Y. Takaki, L.R.C.P., M.R.C.S.;
Ear—Y. Takaki, L.R.C.P., M.R.C.S. Electrical Depart¬
ment: E. F. Buzzard, M.A., M.B., B.Ch.Oxon., M.R.C.P
Lond.
Digitized by GoOglC
602 The Medical Press NOTICES TO CORRESPONDENTS.
Dec. 6, 1899.
Notices to
CorospottbentB, Short %zttzxz, &t.
Correspondents requiring a reply in this column are par¬
ticularly requested to make use of a distinctive tipnature or
initiate, and avoid the practice of signing themselves “ Reader,”
“Subscriber," “Old Subscriber," Ac. Much confusion will be
spared by attention to this rule.
WEARY OF NOURISHMENT!
The little maid had been ill and had struggled through the early
stages of convalescence She had taken “nourishing" broths and
“ nourishing ” jellies until her soul was weary within her. One
morning she electrified the family by sitting bolt upright in bed and
saying : “ I want you all to take notice, I am not going to take any
more nourishment. I am hungry and I want my meals, and not
another mouthful of nourishment will I take."—Medical Brief.
Dr. D. W. is thanked for the information, which will be ntili3ed
in due course.
A CYCLIST'S DIAGNOSIS.
Thr scorcher, who thought of nothing but his bicycle caught a
cold which left him with a very sore throat. He decided to see a
physician. "Well," said the doctor, cheerily, “ what seems to be
the matter?” "I can’t say exactly.” was the reply, in a heavy
whisper, “ but it feel and sounds as if I had a puncture in my inner
tube! ’’
Esmond. —We can only sympathise with our correspondent. He
might submit the facts of the cose to his legal adviser, but we fear
there would be no grounds for redress.
Lonsdale B.—Garrulousness in a patient, whether old or young,
is not neces8»rily an indication of nnything more serious than
eccentricity.
House Surgeon. —No fees are recoverable, and no legul claim can
be made.
Dr. Berdoe and Mr. Stratton.- Your letters are unavoidably
omitted for want of space.
BRASS SCREW SWALLOWED BY AN INFANT.
To the Editor of the Medical Press and Circular.
Sir.—A n interesting notice under above heading appeared in one
of your contemporaries last week, in which it was stated an infant
of fifteen months swallowed, and subsequently safely passed, a screw
of considerable size, the wonder being the child showed “ no sym-
toms of discomfort” after screw had reached the stomach! I
should have thought any young child having swallowed a Bcrew
(over an inch in length, judging by illustration) must have suffered
excruciating pain. However, the sequel shows the screw was safely
passed on the fifth day “ without any difficulty,” fortunately
detected, may we add, by the close scrutiny of the nurse or
attendants.
Query. What was the nature of food given to child which acted
so well as a screw propeller ?
I am. Sir, yours truly.
Interested.
Jfoetittgfi of the Societies mb lectures
Wednehdat, December 6th.
Obstetrical Society oe London.—8 p.m. Specimens will be
shown by the President, Dr. Blacker, Dr. Tate, Dr. Spencer, Dr.
Robinson, Dr. C. Keep, and Dr. J. Phillips. Paper:—Dr. J.
Phillips : On a Case of Acute (?) Idiopathic Peritonitis complicating
Pregnancy and Labour.
Central London Throat, Nose, and Ear Hospital (Gray’s
Inn Road, W.C.).—8 p.m. Clinical Evening. Dr. P. Jakins : Demon
stration of Cases of Operation on the Mastoid Process, Cerebrum-
and Cerebellum for Post-Otitic Suppuration. ,
St. John’s Hospital por Diseasbs of the Skin (Leicester
Square, W.C.).—4.30 p.m. Dr. T. D. Savill: Herpes and other
Dermato-Neuroses. (Post-Graduate Course.)
Thursday, December 7th.
Harveiak Society op London (Stafford Rooms, Titcliborne Street,
Edgware Road). — 8.30 p.m. Prof. Watson Cheyne: Surgical
Tuberculous Diseases. (Harveiun Lectures No. 1.)
Neurological Society of London (11, Chandos Street, W.).—
8.30 p.m Dr. F. E. Batten and Dr. J. S. Collier: Spinal Cord
Changes in Cases of Cerebral Tumour. Dr. W. J. Harriss: An
Experimental Investigation on the Decussation of the Optic Nerves
in various Animals, and on the Path of the Reflex for the Contrac¬
tion of the Pupil to Light (Meynert’s Fibres). Dr. Mott and Mr.
A. F. Tredgold. Hemiatrophy of the Brain and its Effects upon the
Spinal Cord. Each puper will be illustrated by lantern slides and
microscopic specimens.
Central London Throat, Nose, and Ear Hospital (Gray's
Inn Road).—5 p.m. Dr. D. Grant: Treatment of New Growths in
the Nose and Naso-pharynx.
Friday, December 8th.
West Kent Medico-Chirurgical Society (Royal Kent Dispen-
sary, Greenwich Rood, 8.E.).— 8.45 p.m. Mr. Victor Horsley : The
Treatment of Trigeminal Neuralgia (illustrated by lantern views).
(Purvis Oration.) Followed by a Conversazione.
Clinical Society of London (30, Hanover Square, W.).-8.30
p.m. Papers: Mr. A. E. Barker: Remarks on Twelve Cases of Per¬
forating Gastric Ulcer treated by Oi>eration. Mr. J. Hutchinson,
inn.: Two Cases of Successful Primary Resection of Gangrenous
Small Intestine. Dr. A. F. Voelcker : A Case of Arrested Develop¬
ment of the Speech Centre.
ItecatmcB.
Fisherton House Asylum.—Assistant Medical Officer. Salary £150
per annum, with board, lodging and washing. Apply to Dr.
Finch, the City House. Salisbury.
Guest Hospital, Dudley.—Senior Resident Medical Officer. Salary
commencing £100 per annum, with l«oard, residence, attend¬
ance. and washing.
Lincoln Lunatic Hospital.—Assistant Medical Officer. Salary £100,
with bonrd and wishing.
Middlesex Hospital. W.—Assistant to the Can '“r Research Labora¬
tories. 8alary £100 is?r annum, with an > on warium of £50 after
his second year of office if re-elected. Also Medical Officer and
Registrar to the Cancer Department. Salary £100 per annum,
with board and residence in the College.
Norfolk and Norwich Hospital, Norwich.—House Plivsician for two
years, unmarried. Salary £80 a year, with board, lodging and
washing.
North Staffordshire Infirmary and Eve Hospital. Hartshill. Stoke-
on-Trent.—House Governor and Secretary. Salary £300 a year,
non-resident.
Pontefract General Dispensary and Infirmary.—Resident Medical
Officer. Commenting sulary £180 per annum, with furnished
rooms, fire, lights, and attendance.
Queen'. County Infirmary.—Medical Officer. Salary £182 6s. 2d.
per annum. Applications to Geo. Dimond, Secretary. (See
advt.)
South Devon and East Cornwall Hospital. Plymouth.-House
Surgeon. Salary £100, with board and residence.
Three Counties Asylum.—Second Assistant Medical Officer. Salary
commencing at £i50 per annum, with board, apartments, wash¬
ing. Applications to the Clerk. St. Neots, Hunts.
University of Edinburgh.—Additional Bxaminerships in Materia
Medics and Clinical Surgery. 8alary of the Examiner in
Materia Medina £75 uer annum, and that of each of the
Examiners in Clinical Surgery, £50 per annum.
Victoria Infirmary of Glasgow.—Superintendent and Resident
Medical Officer. Salary £:i00 per annum, with board in the
Infirmary and a free house.
Appointments.
Bloxam, G. E.. L.R.C.P.Lond., M.R.C.S., Medical Officer for the
Western Dispensary. Bath.
Braithwaite, James, M.D.Lond., M.R.C.S., Consulting Obstetric
Physician to the LeeilR Infirmary.
Coane, Jam es. L.R.C.P Ed., L.R.C.S., Visiting Surgeon to the
District Hospital, Beechworth, Victoria, Australia.
Connal, James Galbraith, M.B., Lecturer on Auril Surgery in
Anderson’s College Medical School, Glasgow.
Crosthwait, W. S.. L.R.C.S.. L.R.C.P.Irel., Civilian Surgeon by the
War Office on the hospital ship ‘ Princess of Wales ’ proceeding
to Cane Town.
Farmer, W. H., M.R.C.S., L.R.C.P., Civilian Surgeon by the War
Office on the hospital ship ' Princess of Wales ’ proceeding to
Cape Town.
Hardy, L. E..M.B., C.M.Edin., Civilian Surgeon by the War Office
on the hospital ship ‘Princess of Wales’ proceeding to Cape
Town.
Hopkins, J. J., L.R.C.P., L.R.C.S., Medical Officer for the Castlebar
No. 1 Dispensary District.
Kelykack, T. N.. M.D., M.R.C.P., Assistant to the Professor of
Medicine at Owens College. Victoria University.
Phelps. J. H. D., B.A.Oxon., M.R.C.S., L.R.C.P., House Surgeon
to the Buenos Avres British Hospital.
Rouse, R. D., L.R.C.P.Lond., M.R.C.S., Medical Officer of Health
for the Madron Urban Sanitary District.
Ryan, Perceval Cecil Hardinge, M A., M.D., B.Cli.Dubl., Public
Vaccinator for the city parishes of Bath.
Taylor, Frank E., M.A., M.Sc., M.B., B.Ch., Senior Resident
Medical Officer toQueen Charlotte’s Lying-in Hospital, London.
Warburton, Colonel W.P., M.D.Ed., Superintendent to the Royal
Infirmary, Edinburgh.
Williamson, B. T., M.D.Lond.. M.R.C.P., Assistant Lecturer in
Medicine at Owens College, Manchester.
#irths.
Abernethy.— On Dec. 1st, at 10, St. Coline Street, Edinburgh, the
wife of Robert Abernethy, M.D., F.R.C.P E , of a daughter.
Hbdges. —On Nov. 28th, at. Newport, Salop, the wife of C. E.
Hedges, M.D.Cantab., of a daughter.
Rattray - On Nov. 30th. at 17, Pemberton Gardens. London, N.,
the wife of P. Whyte Rattray, F.K.C.S., of a daughter.
Senior.— On Nov 28th, at Herne Bay, the wife of E. W. Senior,
M.B.C.S., L.R.C.P., of a son.
Carriages.
Reid—Baring.— On Nov. 28th, at SC Paul's, Knightsbridge, Sir
James Reid, Bart., M.D., K.C.B., Physician in Ordinary to the
Queen and to the Prince of Wales, to Susan, daughter of the
late Lord Revelstoke.
Scaths.
Cooper.— On Nov. 28tli, at his residence, Kfng Street, Leicester,
Charles William Cooper, M.B., aged 57 years.
Digitized by CjOO^Ic
®lw IgMical 'fgms anil Similar.
M 8ALU8 POPULI SUPREMA LEX."
Vol. CXIX. WEDNESDAY,
Clinical Xccturt
ON
INTERLOBAL PLEURI8Y.
Delivered at the H6tel Dieu.
By Professor DIEULAFOY,
Of the Pari* Faculty of Medicine.
The patienfc I am going to present to yon to-day
-will fnrnish ns an opportunity of studying interlobal
pleurisy. But first of all let us define what is meant
Dy interlobal pleurisy. It is pleurisy which develops
and becomes encysted between two lobes of the lung.
The lungs, as you know, are divided into several
lobe8. two for the left lung and three for the right.
Examine a lung removed from the thorax and you
-will see that its surface is indented with fissures
which penetrate right to the hilus, dividing the lung
into distinct lobes. The visceral pleura enters these
fissures and clothes their surfaces corresponding to
the lobes of the lung; it is for that reason that it is
called interlobal pleura. When adherences close the
lips of an interlobal fissure, the interlobal pleura no
longer communicates with the large pleural cavity, and
a pleural sac is the result, favouring the development
of encysted pleurisy. This pleurisy, hidden in
the recesses of the lung is almost always purulent, as
was notioed by Laennec long ago.
Interlobal pleurisy can extend a considerable dis¬
tance occupying a whole interlobal space; in such
cases the neighbouring lobes are strongly compressed
and the liquid attains a quart or more. At other
times, on the contrary, adhesions circumscribe the
cavity, and the purulent liquid imprisoned in this
limited space does not exceed eight ounoes. The
topography of the interlobal pleurisy is in itself very
variable. The liquid is not always confined to the
horizontal fissure at the back of the thorax; it occu¬
pies sometimes the axilla in the region of the oblique
fissure, and may descend to the base of the chest. Do
not suppose that the anatomical and normal situa¬
tion of the interlobal fissures is of great help in the
exact localisation of the pleurisy, for the relations of
the fissures are singularly modified by the effusions
and by the retraction of the lobes of the lung. Con¬
sequently, the pathological topography does not
always correspond with the normal topography.
These general notions laid down, I will proceea to
disruss the clinical aspect of the question.
The man before you, now in perfect health, entered
the ward in the first days of October. On his arrival
we were struck by his facies and his almost cachectic
aspect. He had considerable dyspnoea but no fever.
His history was as follows:—Enjoying usually
good health, he was suddenly exposed in a moment
of profuse perspiration, to a draught on Sep¬
tember 25th, while washing the yard of the house
where he was a janitor. He dined without appetite,
complained of rigors, and passed a restless night.
The following day he felt better, but on the third day
DECEMBER 13, 1899. No. 24.
the shiverings returned with fever and pains in his
limbs. Towards nine o’clock that evening he com¬
plained of acute pain in the left side, which no nibbing
allayed. An incessant dry cough set in with fever. A
doctor called in diagnosed pulmonary congestion with
commencement of pleurisy in the left side, and pre¬
scribed a blister and a sedative mixture. The
following days the pain and the cough persisted,
expectoration was insignificant, prostration was
marked, and the general condition bad. After a
week or so the patient complained of a bad taste in
his mouth, and his wife remarked that his breath
had a foetid odour. A vomica was doubtless in pre¬
paration. From that moment the man’s condition
grew worse, the weakness increased, profuse sweating
took place at night, the cough became more and
more frequent, ana whatever expectoration there was
had a foetid odour. It was under these conditions
that he entered the hospital. Close examina¬
tion showed that the left side of the thorax was
affected, principally behind, towards its inferior two
thirds, the lesion also extended towards the axilla
and to the anterior thoracic region. Here and there
were found rales and a souffle as if congestion was
present, while percussion revealed a zone of dulnees
extending from the fifth to the eighth intercostal space
behind, and continued up to the axilla. Above and
below this dulness percussion gave tolerable reso¬
nance. Vocal fremitus, absent over the seat
of dulness, was present everywhere else. On aus¬
cultating the patient no vesicular murmur, souffle,
tegophony nor bronchophony could be perceived over
the dulness. Higher up sibilant and muoous r&les
were heard. A diagnosis had to be made. What
was this acute thoracic, unilateral affection, with a
dull and silent zone surrounded by nllee and a souffle,
with foetid breath and expectoration ? Was it a case
of pneumonia terminating in abscess or by gangrene,
or was it an encysted pleurisy tending to a vomica '*
To pronounce in favour of pneumonia, with abscess
and vomica, the initial phase of that affection was
wanting. The patient, as we learned from his history,
had not the rusty sputa of pneumonia, nor was the
cough followed by expectoration of any kind : further
auscultation ought to have revealed to us many other
signs; exaggeration of vocal fremitus, broncho¬
phony, bronchial souffle, Ac. Nothing of all that
could be found. It was consequently very probable
that we had to do with an encysted pleurisy, which
commenced to open into the bronchi under the form
of fcetid expectoration.
The patient was put under a regime of expectancy
until a decision could be arrived at. The following
days the temperature rose to 104 degs. F., the
dyspnoea increased, and the expectoration did not
cease to be foetid. On October 13th the man was
seized with violent fits of coughing, during which he
expelled a large quantity of purulent matter, the
smell of which was so offensive as to fill the ward
and incommode the other patients. Immediately a
change occurred in the signs furnished by a usculta-
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ORIGINAL COMMUNICATIONS.
Dec. 13, I89fr,
tion; the silent zone was replaced by a zone of soft
souffle, confirming thus the diagnosis; the patient
had emptied through the bronchii an interlobal
pleurisy. I waited a few days before interfering, in
the hope of a spontaneous cure, hut no improvement
took place in the condition of the patient. The foetid
expectoration continued, as well as the night sweats,
and the man was still losing strength. Under these
circumstances I decided to wait no longer, and on
October 20th, or eleven days after the man entered
the hospital, I handed him over to my colleague of
the surgical ward, who immediately proceeded to
open largely the seat of the infection. An incision
was made from the external border of the scapula to
the fifth rib, and then obliquely down and outwards
to the axilla. The costal periosteum was detached
in the usual manner, and two inches and a
half of the sixth rib removed. Through the window
thus made the pleura appeared adherent, thickened
and of whitish colour. The blade of the scalpel was
passed in, and gave exit to a quantity of foetid pus
indicating that the seat of the abscess had been
reached. The operator passed his finger into the
aperture and assured himself that the cavity was
clearly limited above and below, and was prolonged
to the hiluB of the lung in the direction of the inter¬
lobal fissure. After placing two drainage tubes in
position, the wound was sutured; no syringing out
was deemed necessary. The day following the
operation, the man’s condition had already con¬
siderably improved, and each day the symptoms got
better, so that at the end of a fortnight he was
sent back to us as convalescent, and to-day, or six
weeks after the operation, I present him to you in
perfect health.
Let us now pass to another case of the highest
interest. On July 5th I was called by Dr. Carron
de la Carriers to a child of ten-and-a half, on the
fourth day of her illness. The girl had been seized
with a pain in the left side, with difficulty of
breathing and high fever. When we saw the patient
on the third day of her malady it was really impos¬
sible to form an exact diagnosis. The pain in the
side had decreased, the breathing was laboured, the
cough gave no special indication, expectoration
was absent, although she knew how to expectorate;
the fever ran high, and pulse was very quick,
percussion revealed a loss of resonance behind,
and at the left in the region of middle third of the
thorax, while auscultation showed in the same region
a souffle and a few disseminated rales. This souffle
was not tubal nor muffled. There was consequently
no absolute sign of pneumonia or of pleural effusion ;
the rales were few, subcrepitant, with some friction
sounds over the affected zone. The right lung was
entirely free, while the same could be said of the
heart, as well as all the other organs. It was certainly
not a case of pneumonia, nor could we be sure that
there was pleural effusion; the lesion presented all
the signs of pulmonary congestion, with more or less
involvement of the pleura. Consequently the dia¬
gnosis of pleuro-pneumonia seemed justified. M.
Jules Simon, who had seen the patient the previous
evening, came to the same conclusion. For some
days the condition remained unchanged: the fever
remained high, oscillating between 102 and 104 degs.
F. The dulness covered a larger surface, the souffle
and the rales maintained their primary character. I
However, a new sign attracted our attention, the |
heart was somewhat displaced towards the right as
frequently occurs in pleural effusions of the left side.
Nevertheless, we could discover no certain sign of
pleurisy, segophomy, pectoriloquy, and aphonia were 1
absent, while the dulness was incomplete, and
the thoracic vibrations were clearly felt. The
general state of the patient was satisfactory enough.
The cough was moderate, the nights fairly good, but
respiration was forty to the minute. We were now
at the eleventh day of the malady and nothing
announced an abatement in the symptoms; not only
did the hoped for defervescence not arrive, but the
temperature attained and exceeded in the evening
104 degs. F., and we even suspected tuberculous
infection. The right side of the chest remained free
from lesion. The following day, however, the signs
became somewhat modified ; the dulness disappeared
along the spine and at the base of the thorax, whilst it
revealed itself under the form of a dull zone in the
axilla and the anterior portion of the thorax; the dis¬
placement of the heart was more pronounced, and it
could be felt beating on the right of the sternum;
the resonance of the space of Traub maintained
its integrity. The idea of purulent pleurisy came
into our minds, and we asked ourselves if it
might not be a case of pleurisy of the whole cavity,
or limited to the lobar fissure. The walls of
the thorax did not present the slightest (edema, but
the violence and persistence of the fever were for us
an indication of suppuration, and we acquainted the
parents with our conclusions, and the necessity of mak¬
ing an exploi’atory puncture so as to be fixed on the
nature oi the process. It was at this moment that
the mother remarked to us that the child’s breath was
very foetid, a precursory sign of a vomica, and we
immediately concluded that the case was one of
intralobar pleurisy. The following day a consulta¬
tion took place, and while we were preparing in
another room the instruments to tap the abscess,
the patient was seized with a violent fit of coughing and
brought up some very foetid matter which the mother
brought to us in a handkerchief; it was the com¬
mencement of a vomica. We postponed our interven¬
tion until the following day, hoping, as has frequently
occurred, for a spontaneous cure oi the vomica. But
the fever was in no way abated, and the general
condition having in no wise improved, although
during the night about six ounces of pus were expec¬
torated, we decided on delaying no longer, and
M. Tuffier, who was invited to join us, proceeded to
resect the fourth rib for about an inch ; the pleura
was found thickened and adherent, and when the
canula was pushed in about eight ounces of exceed¬
ingly foetid pus spurted out. There was no longer
any doubt about the case: it was one of intralooal
pleurisy; the finger passed in through the wound
could feel the superior and inferior lobe; the
pleurisy occupied the entire fissure even to the
mediastinum, thus explaining the displacement of the
heart to the right of the sternum. The case of this
little patient, examined day by day, I might also say
hour by hour, shows you how difficult is the diagnosis
of interlobar pleurisy. At the outset, nothing precise;
during several days, signs and symptoms vague and
uncertain. I will insist more particularly on this
point by-and-bye, when tracing the debut and the
evolution of intralobar pleurisy. After the operation
the cavity was filled with sterilised gauze, and tbe
following day the temperature fell to the normal, and
recovery was uninterrupted. After citing several
other cases borrowed from different authors, Prof.
Dieu said : “Intralobar purulent pleurisy, like puru¬
lent pleurisy of the entire cavity, may be primaiy or
secondary; it is called secondary when it is con¬
secutive to pneumonia (metapneumonic). But
although the fact may appear paradoxical, I am of
the opinion that the affection is usually primary.
Nothing is more difficult to recognise tnaj the debut
of intralobar pleurisy. The pain in the side, the
fever, the cough, indicate naturally an acute thoracic
affection, but when the question arises to decide
the nature and the seat of this thoracic affection
you have no precise sign to guide you. Is
it a case of pneumonia ? The rigor, the cre¬
pitant rales, the souffle, the rusty expectora-
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Die. 13, 1899 ORIGINAL COMMUNICATIONS. The Medical Pbkss. 605
tion, clear up the diagnosis at once. Is it a
pleurisy P The signs of effusion—dulness, absenoe of
thoracic vibrations, eegophony, Ac., tell you that you
are assisting at the evolution of pleurisy, but quite
■other is the d/but of interlobal pleurisy. The
infection constituting this encysted pleurisy might
be compared to an infection of a closed cavity,
adhesions having suppressed all communication
-with the great pleural cavity. During the flint two
or three days of the encysted pleurisy examine with
care your patient by percussion and auscultation, and
-what will you find ? You will find either behind or
in the axilla, in a region of uncertain limit, dulness,
rides, souffle, in other words, pulmonary and not
pleural signs. Nothing at the other side of the
chest; the lesion is unilateral. Impossible at this
period to make a satisfactory diagnosis, and you
•prescribe according to the urgency of the case,
dry or wet cupping, quinine, antipyrine, sedative
mixture, and you wait. The following days the same
uncertainty, the same insufficiency of signs furnished
by examination of the chest: the pain in the side is
perhaps less acute, the cough less violent, ex¬
pectoration nil or of no account, fever high,
dyspnoea intense, the time passes and you have
not yet made your diagnosis. You nave pro¬
nounced it to be a case of pleuro-pneumonia,
and yet you are beginning to fear the presence of
tuberculous infection. It is thus that you arrive
at the tenth or twelfth day of the malady and still
defervescence has not set in. At this point the
tableau is about to change. If the quantity of
liquid accumulated in the intralobal fissure
is sufficiently large, a pint in the adult,
-eight ounces in the child, you perceive either
behind, or in the axilla a zone of dulness corres¬
ponding to the fissure. If the liquid occupies the
oblique fissure of the left side, a considerable aisplace-
ment of the heart towards the right side is the result,
as we have seen in the case of the little girl. Then
the idea of encysted pleurisy gains ground in your
mind. Percussion limits the dull zone, either to the
middle third of the thorax, or to the region of the
axilla. You make your diagnosis, and pronounce the
case to be one of encysted pleurisy.
Among the possible symptoms of encysted
pleurisy there are two to which I particularly desire
to call your attention. Haemoptysis has been several
times remarked in the course of encysted pleurisy.
Thishajmoptysis was particularly described by Pailhas
in his thesis (1889). The first idea, when it occurs in
a pleurisy patient with fever and purulent expectora¬
tion, is that the man is tuberculous, but such an
interpretation would be erroneous. Numerous are
the cases of encysted pleurisy in which haemoptysis
took place, either before or after the formation of a
vomica, which is the second symptom I alluded to.
In a general way, the opening of an abscess into the
broncni is much more frequent in encysted pleurisy,
than in purulent pleurisy of the great pleural cavity,
which lasts months and years without ending in a
vomica.
I have been able to predict several times the vomica
twenty-four and thirty-six hours in advance, thanks
to a sign which I described long ago, and that is foetid
breath. The liquid of encysted pleurisy is almost
always foetid. Long before the opening of the abscess
into the bronchi is Targe enough to give passage to the
ns of the vomica, small cracks occur, through
which escapes the fcstid emanations of the cavity. Do
not forget this sign ; it will permit you to foretell the
vomica, and aid you in your diagnosis.
I arrive now at the treatment of encysted pleurisy.
I may say at the outset that the medical treat¬
ment is ml. You are in presence of an infected
cavity filled with liquid, which must be evacuated. In
iortunate cases, the vomica operates the evacuation
alone, and in a few weeks all the symptoms dis¬
appear, and spontaneous cure is obtained. But if the
fever persists, if the symptoms of infection become
accentuated, do not wait. Advise surgical inter¬
vention, and if the operation is done in time, and
according to the rules of the art, success is certain. Of
the eight patients whose history I traced before you,
six were cured by operation; the other two were not
operated upon and died.
A CASE OF SUPPURATING
PELVIC CELLULITIS:
WITH SOME REMARKS ON THE OCCUR¬
RENCE OF LOW OR SUBNORMAL
TEMPERATURES, (a)
By A. RABAGLIATI,
Honorary OyntBcologiat, Bradford Royal Infirmary.
The following case of suppurating pelvic cellulitis*
faecal fistula and (as the event showed many months
afterwards) of undiagnosed accompanying suppurative
salpingitis is exceedingly interesting. I showed the
specimen, as some members may remember, at our
last meeting but one last year, and proceed to
describe the case now. Perhaps some may recollect
that I showed an opening in the ileum which was
glued up to the abdominal wall in the right ileo-
inguinal region. I showed also a fistulous tract
which had dissected its way down behind the pubic
ramus, and between that and the bladder; and I
showed lastly an empty sac which was the right
salpinx, and which, at the post-mortem examina¬
tion, had been about the size of a hen's egg, and
h id been full of stinking pus.
The account of the case is as follows :—Mrs. H. M.,
let. 27, became in-patient in the Bradford Royal
Infirmary, December 7th, 1897. It will perhaps save
time if I say here also that after being discharged
cured, as we thought, or nearly so, on March 5th,
1898, she came in again on March 14th, 1899, about
a year after, on account of recurring suppuration in
the right ileo-inguinal region, and that she died of
influenza on April 11th, 1899, four weeks after ad¬
mission for the second time.
Condition on admission .—Patient complained of
almost constant pain in the abdomen, all over, but
perhaps more in right ileo-inguinal region than
elsewhere; she had pain in back, thirst, anorexia
and constipation. The abdomen was somewhat
distended, generally tender, but especially in
right iliac, in hypogastric and in left iliac
regions. Resistance to palpation in right iliac
region just above Poupart’s ligament, and following
its direction. Percussion note dull over it for about
one inch above Poupart; clear tympanitic note over
rest of abdomen. Pulse, 112 to 120; temperature,
about 101*5 degs. F.
Previous History .—Had suffered generally from
constipation of bowels. She told us that from the
age of fifteen years, when the catamenia began, she
had suffered from pain before, during, and after the
periods, and that the pain had been much worse
during the four or five months previous to admission.
For last few days had had pain on micturition, and
during last three days had perspired a good deal.
No vaginal discharge. Last catamenial period rather
more than a week ago. Mamed two and a-half
years. No children; no miscarriage. Patient stated
that she had had an operation sixteen weeks before,
of what nature she did not know, but that no anses-
thetic had been administered. Five weeks
(«) Read before the Bradford Medico-Cliirurgical Soc., Nov. 21st,
1896.
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606 i’hb Msdical Psssa. ORIGINAL COMMUNICATIONS.
J)kc. 18, 1899.
before admission she had had an attack of
influenza (she died of another attack). She then had
headache and backache, and felt chilly and had pain
in the lower part of the back and the lower limbs,
Ordered linseed poultices to abdomen. Urine 1025
clear, acid; no albumen; no glucose.
December 9th, 1897.— Dulness and resistance
have extended, reaching 24 inches above line of
Poupart. Less abdominal pain; frequent pain¬
ful micturition. Sol. magnes. sulphate one in
two, in hot water.
10th—Bowels open three times. (The aperient
effect of the medicine is one of the points to be
relied on as assisting us to distinguish between
a diagnosis of peri-typhlitic abscess and pelvic
cellulitis, for should we not expect more vomiting
and quasi-obstruction in peritypnilitis ?)
lltn.—A hypodermic needle was inserted into the
swelling and brought away some drops of stinking pus.
Accordingly at 4.15 p.m. same day, under ether, an
incision about li inch long was maae above right Pou-
part’s ligament, a little to outside of pubic spine. The
muscles were dissected through; the finger being
inserted felt the fluctuating sac, and a hollow needle
being used as a guide, the Knife was driven into the
swelling, when a large quantity of offensive pus
escaped A non-perforated rubber drainage tube was
passed into the cavity after it had been syringed out
with boric lotion. Gauze, wool, and a many-tailed
bandage completed the dressing. On being dressed
on the 11th some jelly-like straw-coloured fluid
(mucus) appeared in some quantity at wound.
12th —Discharge like faeces escaped from the wound.
Abdomen not distended; no pain or tenderness, no
vomiting, temperature 100 degs.; no higher than
usual level since admission.
13th.—Fteces and flatus passed from wound.
The tube was removed, and as it was impossible
to re-introduce it a smaller one was inserted. Patient
feels well.
14th.—Ordinary diet; patient going on well.
16th.—Wound quite open. Large cavity discharg¬
ing abundant fsecal matter. General condition satis-
factory. No abdominal pain, no tenderness, no
vomiting.
24th.—Tube left out. Rectum full of soft faeces.
To have glycerine suppository night and morning in
the hope of causing bowel to resume its natural
function.
January 2nd, 1898.—Patient feels comfortable.
Discharge much less. Wound dressed. Opening
much smaller. Discharge, such as it is. still faecal.
Temperature, 98 8 degs. F. After this time till about
January 20th patient seemed to improve. The dis¬
charge diminished, pain disappeared, temperature
was natural or only slightly elevated in the evenings,
tending to sub-normal in the mornings. About
January 20th, when wound seemed to be closing, and
there was only a faint trace of discharge at the
wound mouth, patient began to complain of pain in
right thigh, which crossed, she said, the upper part
of the thigli to the outer side from region of sinus,
and passed thence down outer side of thigh to knee.
After the thigh had been rubbed with liniment sapo.
co. night and morning for some days without benefit,
a linseed poultice on January 26th, 1898, was ordered
to be applied to the right groin for two hours night
and morning.
27th.—Pam passes from region of sinus to
outer side of thigh, passing thence to right knee.
On examination per vaginam an elastic swelling was
found in right broad ligament close to uterus. This
was thought to be part of the cellulitis already dia¬
gnosed in right broad ligament.
31st.—Pain in right thigh better. Temperature
normal. Wound almost healed. Poultice once
daily.
Februaiy 2nd.—Complained again of a good deal
of pain in right thigh, shooting down to knee.
7tn.—Still a good deal of discharge from the
wound. Probe pastes three inches in oblique direc¬
tion to right side of pelvis. Temperature normal.
Pain in thigh much better.
10th.—Swelling still felt in right lateral fornix,
elastic not tense. Omit poultice. Small mouth to-
sinus. Not much discharge.
I think I may venture here to digress in order to
say that no doubt this elas* ic swelling in right lateral
fornix was the pyosalpinx which was found at the
post-mortem examination. It ought to have been
diagnosed, but as we had found a pelvic cellulitis,
ana as discharge was still coming from the wound,
I thought the elastic swelling was caused by a re¬
curring accumulation of pus in the cellulitic
abscess, aod I accounted for the elastic swelling in
that way. Besides, the temperature was normal and.
subnormal.
9th.—Morning, for instance, 97’8 degs. F.; even¬
ing, 98‘8 degs. F.
10th.—Morning, 97’6 degs. F,; evening 97‘0 degs.
F. This ought not to have misled me, it is true;,
but, having my mind full of the cellulitis, I added
the fact of the low temperature to the other evidence,
thought the whole condition was explained by the
known conditions, and missed the pyo-salpinx. This
state of things emphasises a conclusion which has
often before been forced on my mind, viz., that even
where one finds present a sufficient and a generally
reoognised cause of Bigns and symptoms of disease,
one ought still to go on examining to see if other and
undiscovered causes may not be present also, especially
if any unusual signs or symptoms are also found,
and particularly if symptoms do not subside as they
are expected to do. The presence of the elastic
swelling in the right fornix might have been further
investigated, and one ought not to have let inquiry be
put off with a diagnosis of swelling associated with
the cellulitic inflammation which was known to be
present in that region. But it is easy to be wise after
the event.
15th.— House surgeon’s note. Probe goes three
inches down sinus, and can be felt in vagina anterior
to and lower than the swelling in the fornix.
21st.—Wound almost healed. A few drops of pus
came away on pressure. Patient complains of no¬
pain ; feels quite well.
24th.—Comfortable. Small sinus still present
with little discharge.
28th.—Wound almost healed. Feels very weak.
March 3rd —Sinus closed, but its mouth can be
opened. A probe cannot now be passed readily. It
passes only one inch. Little discharge.
5th.—Patient left for Rawdon Convalescent Home.
Diagnosis .— On hearing the case read, doubts may
arise in the mind as to whether the original diagnosis
ought not to have been one of appendicitis rather
than of suppurating pelvic cellulitis. The ftecal dis¬
charge leading to a necessary diagnosis of fsecal
fistula might seem to point to suppurating appendi¬
citis. But another explanation is, I think, the true
one, viz., that the disease was really pelvic cellulitis,
that this went on to suppuration, and that thinning of
the exudation with pus formation had begun to take
place in the direction of the bowel before I interfered
and opened the abscess externally. Nature, in fact,
was preparing to open the abscess into the
bowel. After I had opened the abscess from
the outside this thinning process still went on
in the direction of the hollow viscus of the bowel, and
the fistula formed. We see similar conditions else¬
where. For instance, a young lady has an abscess
in the cheek, set up by a decaying tooth or teeth.
On being consulted we think an effort should be
made to open the abscess thro igh the mucous mem*
GoogI
e
ORIGINAL COMMUNICATIONS. Th. Mbdicu. Pmsb. 607
Dkc. 18, 1800
brane in order to avoid an outside soar, and we
open on tbe inside accordingly. But in the mean¬
time, Nature had been making other preparations for
opening outside, and tbe subcutaneous and cutaneous
tissues had been thinning in preparation for
the event Although our opening inside had
removed much of the outside pressure, still
the process had gone on so long towards
the outside, and the thinning of the outer
surface of the cheek had proceeded so far that
recovery at that point in the skin was impossible,
and so it was that a day or two after the inner
opening was made an outer one also supervened,
and the opening which we had hoped to avoid in the
skin still occurred. I have no doubt that an exactly
analogous condition supervened in Mrs. M’s. case.
Preparation had been made so long and so com¬
pletely for opening the abscess into the hollow
viscus of the bowel, and thinning had gone so far
in that direction that even after relief to the pus
was afforded outside, the opening still occurred and
caused the fistulous track to form.
This same patient was readmitted in-patieut,
March 14th, 1899, just about a year after her discharge
apparently cured. This incident makes the case
somewhat long in narration. It is really two cases,
but I shall be as brief as possible. Patient said
that the fistulous track in the right groin had opened
and closed intermittently since her discharge, and
she now came in to have it cured if possible, On the
17th I opened up the track, passed a probe down for
five inches to the bottom of it, and then cleared the
sinus out with a Volckmann's sharp spoon, and
packed with gauze, in the hope of getting the sinus
to heal from the bottom. Patient went on pretty |
well, and seemed to be doing well till on April 2nd
she complained of headache, for which phenacetine
was administered. Then the temperature fell to
97 degs., but on April 4th it rose to 102 degs.
Vomiting set in, and all the symptoms of what
seemed an attack of influenza appeared, and on '
April 11th, notwithstanding all that could be done
for her bv the unremitting exertions of tbe house
surgeon Dr. Chapman and the nurses, she died. The
post-mortem examination showed the interesting
facts already detailed.
There is another point which I wish to refer to in this
case, but it is so important that I fear justice cannot
be done to it at the end of a paper, and I hope indeed
to take up and discuss tbe interesting question of
subnormal temperature on an early occasion.
Meantime, let me say, that on H. M.’s first stay in the
hospital, her temperature throughout the month of
February, 1898, was as a rule subnormal. The same
was the case during her second stay in hospital before
the onset of the influenzal attack which carried her off.
I show the chart for February, 1898, and you will see
that out of fifty-six observations taken during that
month on only thirteen occasions was the tempera¬
ture normal or over-normal. On all the others
it was subnormal, varying from 97 degs. F.
to 98 degs. F. or 98 2 degs. F. Out of the thirteen
observations first mentioned, nine were of a tempera¬
ture of 984 degs., and only four were above normal.
The other nine were exactly normal. But on forty-
three occasions out of fifty-six when observations
were taken, subnormal temperatures were registered.
What is the meaning of this P It is a
very common condition. The operation had
been performed in December, 1897, and the
track was still suppurating during the continuance
of the subnormal observations of February, 1898.
Not only so, but although it is almost if not quite
certain that the suppurating salpingitis was present
during the whole time sbe was under observation,
still during a large part of that time the tempera¬
ture was subnormal. That is to say, the presence of
a somewhat severe and serious inflammation was com¬
patible with a subnormal temperature. The same thing
occurred during her second stay in hospital when
I the track of the wound was still open, and when
there can be no doubt whatever of tne existence of
the salpingitis, even if there were any as to its exist¬
ence during her first stay, which I do not think there
is. The first fact then which strikes us in consider¬
ing the presence of subnormal temperatures in this
case is that they were associated with the existence
of chronic inflammation; although in inflammation,
as its name implies, we generally look for the
presence of hyper-normal temperatures. In fact
subnormal temperatures are very common. I have
seen them I do not hesitate to say in hundreds of
cases, and not only so, but in very many of these
cases inflammation of one or more organs was
present.
Tbe next point I shall raise is this. When do we
expect to find sub-normal temperatures as a rule to
be present ? The answer to that question is : we
expect them after a feverish attack, especially after a
sharp and severe feverish attack, and whether the
severe attack be of the nature of an inflammation or
of a fever. At the end of a paper there is
not time to discuss adequately so important
a question as this, for it is really of the
very utmost importance to us and to our
patients, and I think we might do worse than devote
a whole evening or more to this subject; but I am
prepared, if members ask for them, with attempts ah
definitions which shall have for their object; to
differentiate between the two groups of pyrexia!
diseases, viz., inflammations and fevers proper. Let
me content myself now, however, by saying that
after elevated temperature, especially after greatly
elevated temperature, we expect to find subnormal
temperatures. After acute feverish attacks, during
which the temperature is as a rule elevated and
highly elevated, we expect to find, and we do
generally find a period of time during which tho
temperature is subnormal; and after this again there
is usually a slow return to normal. This is of course
only a particular phase or case of the influence of the
general law that action and reaction are more or lesa
proportional to one another, not only in inorganic
nature, where its influence is known and recognised,
but also in respect of its action on organised struc¬
tures, where its influence is not so widely recoguised.
High temperature in animal bodies then is apt to be
followed by low temperature. There is an ambiguity
about the use of the term reaction. It iB usually
employed of the feverish state. I am here using it in
the neutral signification, and only mean that what¬
ever is the primary state, the secondary one is the
opposite of that. Now, in this case we did
have the hyper-normal readings present, which
were followed (and they very likely were pre¬
ceded also, but I cannot go into that) by
these low temperatures, to which I am drawing
attention. If you will look at the chart for December,
1897, when H. M. first came into hospital, you will
find the readings of high temperature, which are
generally associated with the presence of fever or of
acute inflammation. Through the month of January,
1898, these gradually subsided, being still, however,
a little above normal; till in February, 1898, they
reached the more or less permanent subnormal level.
I draw this inference then from this and other cases,
when we find low temperatures ruling in the organism
we may generally believe that periods of high
temperature have preceded them in the history of
that organism. This is my second point, directly
analogous to the occurrence of swelling and shrinking
in the organism, viz., that low temperatures follow high
J temperatures as shrinking follows swelling. High
temperature is not the cause of low temperature any
Digitized by G00gle
608 Thi Medical Press. ORIGINAL COMMUNICATIONS. Die. 13, 1899.
more than swelling is the cause of shrinking, but it
tends to be its invariable consequent or sequent
rather, for I wish to avoid the idea of causation and
■to keep to sequence or succession.
And the third conclusion I draw in this matter is
this. Both high temperature and low temperature
are the marks of the presence of irritation in the
organism, but high temperature is the mark of irrita¬
tion with intolerance (or what is commonly called
reaction ?) while low temperature is the mark of irri¬
tation with tolerance. Hence as childhood and youth
are irritable and impatient we, seldom find low tempe¬
ratures at those periods of life, but in later life, say over
thirty, when the organism has become more tolerant,
we find them with increasing frequency, and with
still greater frequency as age advances. But if I am
right in saying that mutation with tolerance causes
low temperatures, while irritation with intolerance
causes high temperatures, then it follows that the
cause of a low temperature is the same as the cause
of a high temperature. This somewhat surprising
conclusion is again only a particular case of a general
law which m<*y be stated as follows, and of which
very many instances can be given—viz., that the
same causes acting on the organism may pro¬
duce in that organism opposite states. This is,
as it appears to me, one of the two great paradoxes
of medicine which are intensely interesting both as
regards causation and treatment, and to which
as time does not allow of my discussing them at
present, I may perhaps be permitted to return on a
future occasion. Bnt I may say, I think, this much,
that the primary effect of all irritants is depressing
or temperature-lowering or vitality-lowering, while
fever, or elevation above normal or temperature-
elevation or vitality-elevation is always due to the
reaction of the economy from the primary depres¬
sion. But when the primary depression persists, as
it does in many of the izanic states, we have a
low temperature prevailing, just as when the re¬
action comes in the oedanic condition we have a high
one.
LACTATION: IN THE VIRGIN—
IN THE OLD WOMAN —IN THE ADULT
MALE—IN THE NEW-BORN OF EITHER
SEX (“ WITCHES' MILK ”),
By JOHN KNOTT, M.A., M.D.,
Ch.B., and Dip. Stat. Med. (Univ. Dub.),
M.R.C.P.I., M.R.I.A.
(Concluded from page 580.)
I will now proceed to consider the existence of the
mammary secretion in the new-born foetus, the
“ witches' milk ’ of the palmy days of sorcery and
diabolical magic, when it was said to form part of the
contents of many a witch’s cauldron.
When a midwifery student at the Coombe Hospital,
and under the instructive supervision of one of the
most eminent obstetric snrgeons of his generation,
the late Dr. G- H. Kidd, I had an early opportunity
of seeing the senior nurse express milk from the
mammae of a newly-born male foetus. As I was sur¬
prised at the phenomenon, I made every available
effort to satisfy myself on the subject, and was led to
understand that the practice was general, and that
the milk was almost invariably present, especially in
the male ; also that neglect of its removal was some¬
times followed by inflammation and the formation of
abscess. The fact was vividly impressed on my mind
soon after I commenced to practice, when I was
asked by a lady friend to look after a poor protege of
hers in an approaching period of trouble. The lady
also procured a trained and certified nurse. The
labour terminated without difficulty, and as the
patient was a strong, healthy, and experienced
woman — having previously borne a large
number of children—-I saw no cause for anxiety
of any kind. I always inquired after the baby's
health, but was confidently told that every¬
thing was as well as could be: indeed after about
three days it was suggested by the patient herself
that I need not “ trouble myself ” to oome again, she
felt so well, and “ she knew what to do," and promised
to be careful. It so happened that I was then called
to the country, and was not able to return for about
five days. I went to see my patient when I got back :
to find ner in very good condition, physically; but
mentally, in a state of the most vindictive indigna¬
tion towards her “ grand ” nurse, who had
neglected to “ draw the breasts ” of her baby boy,
with the result that one bad become violently in¬
flamed. An abscess had formed, which had been
poultioed, and had opened and discharged its con¬
tents on the morning of the day of my re¬
turn visit. She had actually lodged a complaint
against the nurse in the institution from which the
latter had been sent. This experienced mother
knew all about the importance of attending to the
mammee of the new-boni.
Nevertheless, the knowledge of this phenomenon
does not appear to have been at all generally diffused—
up to, at least, the middle of the present century.
Bonetus (“ .Medicinse Septentrional is Collatitia,”
Genevas, 1684) mentions it, but apparently regarded
it as a rare phenomenon in the female foetus. He
quotes one case from Hieronymus Cardanus, and
another from Joachim Camerarius—both authors of
conspicuously luxuriant imagination. He adds one
case of his own observation: an infant girl of two
weeks old, whose nipples yielded, during a period of
eight days, a fluid rivalling milk, “ liquorem lactis
ffimulum." He gives no case of its occurrence in the
new-born male. The distinguished Dr. Carpenter
— one of the representative physiologists of his day
—states that “ a fluid which is probably mucus may
be pressed from the nipples of many persons." In
discussing the causes of abscess of tne breast of
infants, Dr, Maun sell observes that “ the breasts of
infants, both male and female, contain at birth a
secretion somewhat resembling milk. Accordingly,
I the attendants frequently set about pressing the part
until inflammation and occasionally an abscess is
produced.”
Blumenbach in his Institutiones Physiologic *
| (trans. by Dr. Elliotson) mentions that “ Occasionally
I . . . . new-born infants of either sex .... have
| been known to furnish milk," but gives no illustra¬
tive cases.
So far as I have been able to ascertain, the first
systematic effort to bring existing information on the
subject to a definite focus was in a communication
made to the “ Surgical Society of Ireland,” on April
6, 1850, and published in the pages of the Medical
Press and Circular on April 17 of the same
year. It bears the title: “ An Interesting Case of
Milk in the Breasts of a Male Infant. By Francis
Battersby, M.B., Surgeon to the Institution for
Diseases of Children." The author, who had evi¬
dently taken great pains in the investigation of the
literature of the subject states that, “ I believe the
common impression amongst medical men of the
present day ... is, that this secretion is not milk,
but merely resembles it.” The child in that case had
been brought to Mr. Battersby, when aged three weeks,
by a nurse who had received him from his mother
eight day8 before. “ She then found the breasts swollen
and hard, and with milk in them. She obtained from
them * the least little drop,’ she stated, which had
the taste of milk. The breasts have since become
Digitized by VJ
Dac. IS, 1899.
ORIGINAL COMMUNICATIONS.
Ths Midical Puss. 609
smaller, but are still tbe size of large walnuts, with
the soft baidnees peculiar to breasts full of milk.*’
For some days afterwards—the limit is not stated,
as it oould not be definitely observed—some milk
could be pressed from the breasts in this case. The
baby had been first shown to Mr. Battemby on the
'3rd of the previous May, and on the 12th he
reports:—“ I withdrew by gentle pressure on the
breasts nearly a drachm of milk. It was precisely
similar in appearance to woman's milk. Having
left it with Mr. Moore, I received from him the sub*
joined note: —
“ ‘ My dear Sir,—Many thanks for the specimen of
milk, which is most interesting, as it closely resembles
that from the adult female. It is alkaline, throws up
a cream, is not rendered viscid by caustic potash,
nor does it ooagulate when heated. Viewed under
the microscope, it is seen to consist of normal milk
globules of various sizes; on the whole, smaller than
those contained in ordinary human milk, floating in
a colourless fluid. It contains a few colostrio bodies,
and some epithelium.—Yours very truly,
Wm. D. Moors.’
‘ F. Battersby. Esq., M.D.’ ”
The author of the communication here goes on to
observe that: “ It is to be regretted that the presence
of caseine was not here determined. Tbe quantity
of milk submitted to examination was so small that
many experiments oould not be tried, and Mr. Moore,
convinced from its microscopic characters of its
being milk, directed his attention to ascertain
whether the colostric bodies seen under the micro- ,
scope were sufficient in amount to give the fluid the
chemical properties of colostrum. The fact of heat
producing no coagulation, and of the fluid remaining
unaltered on the addition of caustic potash, proves
the absence of tbe colostric character. Of the fact
of its having been true milk, Mr. M., from extensive
observations on the subject, has not the least doubt.
“ I was not again allowed to express any more
milk. The breasts soon subsided, no abscess ensued,
and he was growing up a healthy little child when I
last saw him.
“ This case is extremely interesting from its being
the first in which the milk of an infant has been
proved to be identical in composition with woman's
milk : and the established fact of adult males, as well
as male infants, secreting genuine milk, proves that
the action of the uterus is not essential to that of the
mammae, as is generally believed.”
In the discussion which followed the reading of this
communication, the principal speakers gave a very
good summary of the then existing state of general
public professional opinion on the subject. The
remarks of three of those are well worth quoting in
full—as reported:—
“ Dr. Geoghegan was quite certain that in one case
he had seen milk extracted from the nipple of a new¬
born male child, and he believed he had met it also in
other instances. On the occasion referred to, he
examined the supposed milk and found it to contain
the oil globules and granular bodies observed in the
colostrum, or first milk after parturition, but he did
not submit the specimen to a chemical analysis.
Nurse-tenders, who consider themselves conversant
with the details of the personal care of infants, look
upon the thing as by no means uncommon ; and are
in tbe habit of rubbing the swelling surrounding the
nipple to facilitate the escape of tbe fluid.
“ Dr. Darby said that within the last six months
he saw a child which gave milk, or something like it.
when only eight days old. The nurse-tender, who
was an Englishwoman, asked him to examine the
breasts of the child, and when he did so he found
them in a state of inflammation. On inquiry, he dis¬
covered that the nurse was in the habit of milking
the infant. He did not happen to see any of the
secretion in this case, but an abscess had formed on
both breasts, produoed, as he believed, from mal¬
practice on the part of the nurse; she, however, said
she deemed it a part of her duty, and that when
acting as nurse-tender in England, she had always
been in the habit of doing the same thing.
“ Dr. Churchill Baid he had met with many similar
cases, where inflammation, and not unfrequently
abscesses, were produoed in consequence of the mal¬
practice of nurses. If the patients were let alone,
and their breasts stuped, the inflammation generally
subsided. He looked upon Dr. Battersby’s case as
cne of great interest, because it went far to establish
the identity of the secretion of milk in the infant with
that secreted by the adult female.”
It is interesting, in the light of our present know¬
ledge, to note that so hign an authority on the
special functions and diseases of both women and
children, as Dr. Churchill, entertained, as well as did
Dr. Darby, the idea that the mammary inflammation
and absoess were always the result of meddlesome
interference.
Another speaker on that occasion (Dr. Corbet) sug¬
gested that the substanoe observed by Dr.
Geoghegan might have been vemix caseoaa, but the
objection was efficiently dealt with, by pointing out
that the fluid contained both the oil globules and the
peculiar bodies of ordinary milk, and in no wise
resembled the vemix caseosa.
To the present writer it is peculiarly gratifying to
have the opportunity of oalling attention to the fact
that the first appreciable advance on medieval
knowledge regarding the interesting subject of the
secretion of “ witches’ milk ” was made in Dublin;
and that the first approximation to a complete
chemical analysis was carried out in our city by
the accomplished father of his friend. Dr. John
William Moore, President of the Royal College of
Physicians of Ireland.
Thanks to the better organisation of clinical
observation, and the rapidly improving methods of
chemical analysis, I am now able to lav before the
reader a very full table of analyses of human milk
both adult and infantile.
The chemical composition of (ordinary) human
milk has been investigated with great care by
Becquerel and Vemois, who have tabulated the
following results:—
In 1,000 Parts.
Age.
15 to 20
years.
20 to 25
years.
25 to 30
years.
30 to 35
years.
35 to 40
years.
Water
869-86
886 91
892 96
888-06
894-94
Solids
13016
11809
107 04
111-94
105 06
Casein
5574
38-73
36-53
42-33
4207
Albumin
—
—
—
—
Butter
37-38
28 21
23-48
28-64
22.83
Sugar of Milk
35-23
44 72
45-77
3963
39-60
Salts
1-80
1-43
1-46
1-44
106
In contrast with the above series of analyses we
can place the three subjoined ones of the milk
obtained from the mammte of new-bora infants :—
Quxvbnnk.
Gensib.
Fate
W ater .
894 00
957 05
_
Solids .
106 00
42-95
—
Casein .
2200
6-57
6-60
Albumin.
—
490
490
Butter .
1400
14-56
14-60
Sugar of Milk ...
62 20
9-56
9 60
Salts .
340
8-26
8-30
P
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610 The Medical PbESS.
TRANSACTIONS OF SOCIETIES.
Dec. 13, 1806.
The milk of new-born infante ie stated by Beaunis
to resemble colostrum : it presents a dull white or
yellowish colour, and contains fat globules and
granular corpuscles. The peculiarities of the small
proportion of casein, and the presence of a consider¬
able fraction of albumin, are shown in the analyses
of Genser and Faye, with which, I believe, most
subsequent observers agree.
The above summary will, I hope, be found to
contain tbe most important items of our knowledge
on the subject of abnormal lacteal secretion—as
hitherto attained by scientific and clinical research.
Illustrative oases might be multiplied in large num¬
ber ; but the amount of novelty would hardly com¬
pensate the reader who has carefully noted those
collected in the present communication.
QTlnrical JRccovbe.
CASES OF CEREBRO-SPINAL DISSEMINATED
SCLEROSIS, (a)
By James Craig, M.D., F.R.F.p.
The first, a man, set. 34, is suffering from insular sclerosis,
and displays the classical symptoms of that disease as first
described by Charcot—(1) There is defective vision,
o.d. ;lj, o.s. ; the vision is not contracted ; the optic
papilla? have a dirty white complexion ; there is nystag¬
mus and defective power of consensual, lateral, and
upward motion of the eyeballs. (2) Intention tremors
are very evident. (3) Scanning speech is fairlv charac¬
teristic. (4) A spastic condition of the lower extremities
exists, with increased knee-jerks, rectus and ankle-clonus,
weakness and rigidity of the muscles, and the toe phe¬
nomenon ” of Babinski. (5) Considerable delay precedes
the act of micturition.
The next case is that of a boy, who, at the age of 9,
was found to be blind of the right eye, with atrophy of
the disc, which seemed to Dr. C. E. Fitzgerald to be
congenital. Right eye was normal. Three years after
the lower extremities became spastic, tenotomy was per¬
formed in London to correct the talipes equino-varus,
and shortly afterwards the sight was lost in the right
eye. Nystagmus, intention tremors, and slow mono¬
tonous speech had all developed. A probably specific
origin, the youth of the patient, the completeness of the
optic atrophy, and the surgical interference were the
points of interest.
The third case mentioned was that of a young lady
who, at the age of 17, developed symptoms of an appa¬
rently hysterical character.
In 1882 there was transient blurring, defective vision,
with hazy disc in the right eye, and recovery in a
month.
In 1884 left optic neuritis, with right hemiparesis,
occurred, followed by recovery within a few weeks.
In 1885 there was again transient dimness of the
right eye.
In 1888 there was transient blurring in both eyes, but
discs were normal.
In 1889 there was transitory blurring in left eye, with
vision and discs normal.
In 1890 there was numbness in right leg, weakness in
both, giddiness, diplopia, blurred vision, defective lateral
movement, and, for the first time, nystagmus in tbe left
eye. Delay preceding micturition, with excessive secre¬
tion of urine, wns noted.
In 1891 there was apparently complete recovery from
all the symptoms, save very slight nystagmus. Patient
felt quite strong and weil.
In 1896 patient became unsteady in walking, and was
easily fatigued; knee-jerks were increased, but no ankle-
clonus and no tremors existed. Diplopia, blurred
vision, and nystagmus were present. Physical dis¬
turbances and alight blunting of mental faculties were
observed.
In 1898 intention tremors first appeared; legs became
quite rigid; ankle and rectus-clonus and toe phenomenon
were present; loss of muscular sense in both upper and .
lower extremities was very manifest; control of bladder
was weak; vision o.d. o.s. T \; hazy discs and
nystagmus, but no distinctive syllabic speech.
If only the classical symptoms were to be relied upon
in forming a diagnosis the facility for making mistakes
become very evident. In this case—1. Nystagmus did
not manifest itself for six years after the initial sym¬
ptoms. 2. A spastic condition of the extremities was
fourteen years in making an appearance. 3. Intention
tremors appeared after the lapse of sixteen years.
4. Syllabic speech cannot be said to exist at all. The
difficulty in arriving at a diagnosis was, therefore, chiefly
limited to the earlier years where tbe transient, ocular,
and paretic symptoms might have been considered to be
of a functional nature.
^ransacticmB ot ^ociettce.
CLINICAL SOCIETY OF LONDON.
Meeting held Friday, Dhckmber 8th, 1899.
Sir R. Douglas Powell, Bt., President, in the Chair.
Mr Arthur Barker gave a review of
TWELVE CONSECUTIVE CASES OF PERFORATING GASTRIC
ULCER, ON WHICH HE HAD OPERATED DURINO THE
LAST FEW TEARS.
They were all treated as nearly as possible under the
same conditions, and, for this reason, offered an oppor¬
tunity of contrast with other series in which the pro¬
cedure was undertaken on different lines. The im¬
mediate results were that five out of twelve were saved.
Two of the fatal cases lived for fifteen and fourteen
days respectively, the first dying of subphrenic abscess
and consequent pleuro-pneumonia, the second of
bleeding into the stomach from the ulcer, the
conditions following the operation being otherwise
singularly favourable. The first of these two cases sug¬
gested an improvement in technique which favourably
affected the subsequent cases. The second case sug¬
gested the propriety of excision of the ulcer in certain
cases as the only means of preventing subsequent
hemorrhage from it. But in none of the other cases
was the ulcer excised, and in none was there any
secondary bleeding. In all the twelve cases mopping
out of the abdomen was preferred to flushing, the
author’s previous experience having satisfied him that
tbe latter practice is undesirable in these cases. Drainage
was only employed in one case, and was then shown to
have been unnecessary. In none of the other cases
would it have improved the patient’s chancee. The
bearing of the following factors in similar cases were
briefly reviewed “ early recognition of perforation,”
“ sex,” “ symptoms,” “ previous symptoms,” “ duration
of symptoms of perforation,” “liver dulness,” “ last
meal,” “ conditions found at the operation,” “ dry
mopping versus flushing,’’ and their influence on the
series in question. Finally a note as to the remote
result in the five successful cases was added. From this
it appeared that all were well for a considerable period
(amounting to years in some cases) after the operation.
Only one case had a threatening of a second perforation
which was happily nut by rest in bed and careful
dieting, the patimt being now quite well thiee years
after operation.
Mr Warrington H award commented upon the
author’s statement that many of these cases occurred in
apparently healthy people with few, if any, symptoms,
a class which he confessed had not come under his (the
speaker’s) personal observation. He regarded the extreme
amemia as very typical of such cases. He did not think
the character of the extravasated material had as much
bearing on the future of the case as the time that
ela; sed before operation. He thought that subphrenic
abscess was especially apt to occur when the ulcer had
leaked a little, though not to Buch an extent as to cause
Digitized by Google
(a) Bead before the Boyal Academy of Medioine in Ireland,
November 17th, 1890.
Dec. 13, 1899.
TRANSACTIONS OF SOCIETIES.
The Medical Press. 611
urgent symptoms. A more frequent danger, with uloer
of the front of the Btomach, was basal pleurisy. He was
pleased that the author preferred sponging to flushing
the abdomen, for he himself held that though flushing
might be neoeesary in cases of some standing with exten¬
sive contamination, sponging was generally sufficient.
Mr. Wallib referred to the case of a male seen
upwards of twenty-four hours after the onset of the
symptoms. There was much peritonitis, but he was
quite unable to find any perforation, though there was
some induration. He therefore opened the stomach and
found two uloerous patches nearly through, but poet
mortem they held water very well.
Mr. Bowlby, alluding to the symptom pain, said that
many of those cases were overlooked because everyone
expeoted pain, and he mentioned two cases recently seen
by him, in one of them the pain was all in the pubes,
and in the other in the lumbar region. In a great
many of these cases the pain was limited to the lower
part of the abdomen. He pointed out the liver dulness
might be present without any perforation, and he
instanced a case of intestinal obstruction with consider¬
able distension, in which it was absent. It was the size
of the perfoiation, and the amount of extravasation that
determined the acuteness of the symptoms.
Mr. L. A. Dunn said that he had operated upon six
cases of perforated gastric ulcer and one duodenal ulcer,
the last was a man, and of the others, four were men
and two were women. Two men recovered and one
woman. In one case he had to operate again a week ago
for intestinal obstruction. He referred to a case in
which there was loss of liver dulness, but on operating,
though the peritoneum was full of gas, there was no
fluid, and the most careful examination of the stomach
did not reveal any perforation.
Mr. C. S. Wallace thought flushing the abdomen was
a much more satisfactory measure than mopping, but to
be efficacious the injection must be large and the intes¬
tines should be allowed to float out of the body. He
concurred in the view that loss of liver dulness was an
unreliable sign.
Mr. F. Eve urged that in these caseB they must not
wait for particular symptoms. In respect of pain, he
alluded to the case of a young woman who had had sym¬
ptoms of ulcerated stomach and was one morning seized
with the typical symptoms of perforation. When he saw
her several hours later there was no pain or tenderness in
the epigastrium, the only symptom being slight rigidity
of the recti rad a rise of temperature. On examining
the posterior surface of the stomach, he found a pin-hole
perforation. He also referred to two cases of young
women with gastric uloer. One of them was suddenly
seized with collapse, pain, retching, and tenderness over
the epigastrium, yet the stomach was found perfectly
healthy, but pneumonia developed the next day from
which she died. With regard to liver dulness, he agreed
that it was an absolutely futile aign, and he referred to
the case of a young man who had received a blow on the
abdomen in whom liver dulness was absent, but on
operation nothing was found. He thought most surgeons
would prefer flushing to mopping in these cases, and he
advocated making a hole between the pubes and um¬
bilicus for the escape of the fluid.
Mr. Bidwell had collected 53 cases of perforation, in
33 of which the time before operation was mentioned.
One third of the recoveries had been operated within
six hours, and five others within twelve hours. All the
cases which were operated on within twelve hours were
successful, and half of those operated on between twelve
and tw enty-four hours. Mr. Comte had collected notes
of sixty-five cases with nineteen recoveries, eleven of
these having been operated within the first ten hours.
With regard to flushing and mopping that must depend
upon the case. In one case he had operated within two
hours, and in another within eighteen hours, the pelvis
being full of stomach contents. He did not see bow it
would be possible to remove that simply by sponging.
Mr. Bruce Clarke agreed that liver dulness per se
was a symptom of doubtful value, but in no disease •
would they rely on any one sign or symptom. He 1
referred to a case where liver dulness was almost absent '
from extreme distension. The pain might be almost ' ■
' anywhere, or indeed absent, of which he mentioned an
instance. He pointed out that as a general rule the
further down the intestinal tract was the perforation
the lees fatal it was, or at any rate the less acute were
the symptoms. Something also must be allowed
for the kind of fluid that was extravasated. He
agreed with washing out the abdomen, turning
out the intestines, and washing out the pelvis,
but he admitted that this wan not necessary in all cases.
He related a case in which he was unable to suture a
perforation on the under surface of the stomach, so he
simply washed out the cavity and put in a drainage
tube with complete success. In some cases he would
put in more than one drainage tube.
Mr. Bkrrt preferred mopping to washing out. He
had seen about 12 cases of perforated gastric ulcer,
and he had not seen a case recover after washing out,
while, on the other hand, the majority of cases treated
by mopping recovered.
Mr. Barker, in reply, speaking in relation to the
previously healthy condition of some of these patients,
Baid he had known one of them for some months before
the operation and a more wholesome and healthy looking
young woman he had never seen. She had told him
that she had had no symptoms beyond slight indigestion.
It was certainly very important to get these cases early,
but it was the character and the amount of the fluid
quite as much as the time that determined the result.
In three of his cases there was evidence of irritation of
the pleura, in one decided subphrenic abscess, and in
two, symptoms of sub-phrenic abscess; in one of these
there was serum and in the other not, but there was
pleurisy. He himself had been greatly addicted to
washing out in years gone by, but had been gradually
weaned from it. Even when the extravasation nad
reached the pelvis it could be removed by mopping. In
conclusion, he spoke highly of the value of saline
infusion made into the areolar tissue.
A CASE OF ARRESTED DEVELOPMENT OF THE 8PEECH
CENTRE.
Dr. Arthur Voelcker showed a girl, a?t. 7i, who was
unable to speak. The child was the elder of two chil¬
dren, her brother being healthy. The father’s sister
had a child, a*t. 11, who was said to be similarly affected.
There was no family history of insanity, epilepsy,
alcoholism, syphilis or rheumatism. The previous
history of the child was that she was quite well till six
months of age, when she had a series of general con¬
vulsions ascribed to dentition. These fits recurred
occasionally up till the age of three, when they dis¬
appeared. She walked at twelve months, but had never
spoken. At one year she had a severe fall on her fore¬
head, followed by suppuration but no discharge of bone
At four years she had measles. She had never been
violent, passionate or emotional, and had been
clean in her habits, though she occasionally soiled her
clothes. Though unable to speak, she appeared quite
bright and intelligent, and heard well. On admission
her present state showed her to be rather small, but well
formed. Maximum head circumference 1975 inches.
Forehead scarred in the centre, but no depressed bone
felt. Palate high and rather narrow. Motion and sensa¬
tion were natural, and there was no muscular wasting.
The superficial and deep reflexes were natural. Co¬
ordination good. No tremor of limbs. The child was
rather left-banded. She was intelligent, understood
what was said to her, and did what she was told readily.
Her hearing was normal Spontaneous speech was
limited to a few monosyllabic utterances, chiefly “ Eh.”
Imitative speech included “Eh,” “Bee,” “Bye.”
“ Baa,” “ Gee,” “ Tick,” and she repeated sounds with
a numerical, though not a phonetic, accuracy,
thus her repetitions included the same number of
syllables as the word she attempted to repeat. The
ticking of a watch did not evoke a rhythmic response.
She could sing, but no recognisable tune, nor did she
sing scales in unison with the piano. There was no
attempt to continue the serial production of sounds as in
counting, saying the alphabet, &c. Yes and no were some¬
times accompanied by their usual affirmative and negative
head gestures. The siffht was natural. She could not
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*12 The Medical Press. TRANSACTIONS OP SOCIETIES.
Dec. 13, 1809.
seeegnise printed or written words, numerals, or letters,
)nt readily recognised pictures of objects and objects
themselves. She had no recognisable appreciation of
oslour bat distinguished large from Bmall objects. She
was unable to write letters, words, or numerals or to
eepy them. She oould, however, copy straight lines and
strclee with either hand, preferably with the left, but
eeuld not make a cross. When writing with the left
hand she frequently made her marks from right to left.
The case he observed was interesting from the fact that
it differed from cases of deaf mutism and from cases of
aphasia occurring in mentally deficient children, and
from those in whom aphasia developed after the
power of speech had been aoquired. Dr. Bastian
had pointed out in the development of the power
*f speech, the first stage consisted in learning to
associate particular sounds with particular mental
impressions, and this stage had evidently been reached
hy the ohild, but the second stage in which the power of
articulating the sounds which have been used as mental
symbols is aoquired had not yet been reached
by the child. Accepting the existence of a
visual and an auditory perceptive centre and a
gloesokincesthetic and cheirokimesthetic centre as
maintained by Bastian, it appeared that the two former
centres were intact, but that the two latter, or their
commissural connections with the first two centres
were involved. The observation that the child often
wrote from right to left was explicable if it was
remembered that movements in the right hand of
supination result in a clockwise movement of the thumb,
while in the left hand supination results in a oounter
clockwise movement, and that in movements simul¬
taneously performed in the two upper limbs it was
easier to excite corresponding muscleB than to make the
movements of one side maintain a parallelism with
those of the other. Thus it was easier to simultaneously
describe two circles with the fingers of the
right and left hand respectively—one clockwise
and the other oounter clockwise—a fact which
was also confirmed by the results of an attempt
to describe a circle with each hand rapidly,
while trying to maintain a parallelism of the two hands.
This would tend to show that in mirror writing we
have in the left hand represented the move¬
ments of the right, and that such movements
were the result of kinsesthetic and not visual
impressions, and also that it was probable that the
oentre for writing was, as Elder maintained, in
the left hemisphere. The absence of any training in
writing made it impossible to determine the extent to
which the cheiro-kineesthetic centre itself was involved,
and the same held good with regard to speech and the
glosso-kinassthetic oentre. The disease must affect the
region of the posterior parts of the second and third left
frontal convolutions, and was probably not a gross lesion
but due to arrested or inhibited development of function
of the glosso and cheiro-kinaesthetic oentres or their con¬
nections with the auditory and visual perceptive oentres.
The prognosis was favourable and the treatment recom¬
mended was instruction in writing and in the lip
language.
In reply tothe President,Dr. Voxlcker said he thought
they must look to the convulsions as having in some
way damaged the region referred to, producing arrested
development, though the lesion might not be amenable
to investigation.
ROYAL ACADEMY OF MEDICINE IN IRELAND.
Section op Medicine.
Meeting held Friday, November 17th, 1899.
The President, Dr. John W. Moore, in the Chair.
Dr. Craio showed a man suffering from
CERBBRO-SPINAL SCLEROSIS.
The case is published under the head of Clinical
Records.
In the discussion that followed the President
observed that as this disease was so liable to be oon-
founded with hysteria that it was worthy of the atten¬
tion of all clinical and practical physicians.
Dr. J. B. Coleman said that the disease was not very
uncommon, A case which he had under obs e rv a tion at
present did not differ very much from the case exhibited.
Dr. Finny tookexoeption to one of the diagnoetiopoints
Dr. Craig had mentioned as distinguishing disease
from hysteria. The statement he referred to was that
ankle-clonus was not present in hysteria. He had a dear
reoollection of ankle-clonus occurring distinctly inaoaseof
pure hysteria, and ankle-clonus, which was once thought of
great value as pointing to structural changes in the
pyramidal tract and cord, was not now considered so
trustworthy. In many cases of typhoid fever ankle-clonus
oould be found where there was no evidence of hysteria
or structural disease of the spinal cord.
Sir George Ddppey said he oould corroborate what
Dr. Finny had said about the presenoe of ankle-clonus
in hysteria. He remembered a case in the City of
Dublin Hospital which presented peculiar nervous
symptoms, and about which there was great doubt as to
the diagnosis.
Dr. Knott said that Sharpe’s great test was to m v
the patient to shake hands. In cases of chorea the
patient made a series of jerky movements, whereas in
disseminated sclerosis the patient always went in a
curved line. He was struck with the extraordinary
similarity in the way patients suffering from this dinnann
carried their heads. He noticed that the pupils of the
S .tient exhibited were a good deal larger than normal.
e suggested that the peculiar monotone of the speech
oould have been better demonstrated by getting the
patient to recite prose rather than poetry.
Dr. R. Travers Smith mentioned a case of a girl, set.
about 22, who presented the clinical group of symptoms
known as spaa tic paraplegia. The diagnosis between
insular sclerosis and primary lateral sclerosis was at first
doubtful, but the question was finally settled at the end
of a few months by the patient developing an external
strabismus, which he considered was an important sign
in the diagnosis of insular sclerosis. After that other
symptoms of the disease had set in.
The President (Dr. J. W. Moore), referring to Dr.
Finny’s remark, suggested that at a certain period in
typhoid fever there might be structural changes in the
spinal cord. Such changes are, however, of a t ransi tory
nature, and just as the heart suffers in zymotic dismnon
so also the spinal cord may suffer from a purely tem¬
porary organic change.
Dr. Craig, in reply, said that, with reference to Dr.
Finny’s remarks, he agreed that in severe illnees, and,
indeed, in many chronic diseases, structural changes
might take plaoe in the cord and ankle-clonus and other
symptoms be evinced. In answer to Sir George Duffy,
the third case he (Dr. Craig) had referred to often got
perfectly well for two years, and it was sixteen years
before they knew she was not suffering from hysteria.
SENILE DEMENTIA.
Dr. Conolly Norman read a paper on senile dementia.
He dwelt on certain points of clinical interest, emphasis¬
ing the fact, which he held is too often forgotten, that
this form of mental trouble may appear with apparent
rapidity, and often seems to develop after an attack of
acute physical illnees-influenza or the like. Dr. Norman
pointed out that the most typical mental condition in
senile dementia was characterised, not only by a forget¬
fulness of reoent events, but also by an abnormal acute¬
ness of recollection of events long past. He, therefore,
thought that mere amnesia did not cover the field. He
gave a somewhat detailed description of the conditions
of aphasia, paraphasia, and alexia, which we sometimes
met with in cases of senile dementia.
Dr. Ninian Falkiner inquired if there was generally
albaminuria in cases of senile dementia, and asked if it
was a fact that there was a train of mental symptoms
in chronic Bright’s disease closely resembling those of
senile dementia ?
Dr. Law said he had a little experience of asylum
work in England and afterwards in British Guiana, and
a point that struck him when in the latter place was the
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Digitiz
Dec. 13, 1899. TRANSACTIONS OF SOCIETIES. The Medical Puss. 613
large somber of oases of senile dementia in compara¬
tively young subjects, where in this ooontry they would
expect an attack of more active mental disease. He
also noticed that oases of that kind were oommonest in
the lowest race* in the colony.
Dr. Norm ah, in reply, said that albuminuria and bad
kidney disease associated with senile dementia was only
what they might expect. He could not, however, sub¬
scribe to the theory of some nervous pathologists that
senile dementia depended upon arterio-sclerotic condi¬
tions in the brain, although it was undoubtedly true
that gouty kidney and extensive arterio-sderosii was
common in persons dying of senile dementia. Conse¬
quently the two conditions—mental disturbance and
albuminura—co-existing would not surprise him. With
regard to the racial question. Dr. Law’s remarks bore
out his statement that the more the brain was used the
lees the probability of the occurrence of senile dementia.
The Section then adjourned.
OBSTETRICAL SOCIETY OF LONDON.
MEETING H1LD W SDNSSDAT, DECEMBER 6TH, 1896.
Mr. Alban Doran, F.R.C.S., President, in the Chair.
DOUBLE HTDRO-8ALP1NX WITHOUT SALPINGITIS.
Thb Prbsidxnt showed an interesting specimen of
obstruction and dilatation of both Fallopian tubes
without evidence of salpingitis, though there were
perimetritic adhesions in abundance. He recalled
the fact chat ten years ago in a paper on
“ Closure of the Ostium in Inflammation of the
Fallopian Tube,” he applied the term " perimetri¬
tic closure of the ostium ” to this form of occlusion which
had since been observed and described by Dr.
Cullingworth and others. The specimen was removed
from a young married woman who came complaining
of severe pelvic pains in the left iliac fossa, of six
months’ standing. The periods were irregular and clots
passed freoly. She had two abortions the last four
months previously. Temperature was normal. On
opening the abdomen he at onoe came upon the two
dilated tubes which he removed, after breaking down
the adhesions, purposely leaving a little ovarian tissue
on the left side. An uneventful recovery followed. The
tubes were much dilated and sharply bent upon them¬
selves. The mucous membrane was lined with perfect
epithelium which had lost its cilia. The specimen is
now in the Museum of the Royal College of Surgeons.
W ith this specimen he showed two others of obstructed
tube with perimetritic and salpingitic obstruction in
their earlier stages, and a third showing how the
fimbria 1 retract mechanically. He hoped that the
catamenia might continue in this case, but one could not
be sure of this. He justified his removal of the tubes
on the ground that the usual course of such a case
was ultimate suppuration with close adhesions of the
tube to the rectum, small intestine and appendix. He
did not perform salpingostomy because he suspected a
specific origin.
Dr. A. Rolth said he had opened and drained the
tubes per vuginam with good results. One patient had
double pyosalpinx yet subsequently became pregnant
and aborted.
Dr. Horbocks said he had recently operated on a
young married lady in whom, on opening the abdomen.
Doth tubes were found filled with tubercle. He laid
them freely open and a sinus formed which had con¬
tinued to discharge until three weeks ago. They could
not be removed on account of extensive tuberculous
mischief in the pelvis.
The President remarked that no one seemed to have
performed normal salpingostomy. He doubted whether
it was a legitimate operation Beeing that it was liable to
set up pyosalpinx.
COLPOTOM\ FOR REMOVAL OF OVARIAN CY8T.
Mr. Robinson related a case in which he had effected
the removal of an ovarian cy6t containing 81 pints of
fluid through an incision in the roof of the vagina after
tapping through the incision. The result had bean
excellent.
TUBAL PRBONANCT (MOLAR) COMPLICATE® BT
SUPPURATING OVARIAN CTBT.
Dr. John Phillips showed a speoimen removed from
a woman, set. 40, the mother of ten children, who oame on
August 5th, 1898, oomplainingof pain in the left iliao fossa.
The last period was in May. A lump was felt in the left
and posterior quarter of the pelvis. She had a sadden
attack of pain on August 25tn with vaginal hssmorrhaga
which persisted. He was called to her on September flCtn.
The legs moved with difficulty, but were comfortable in
the extended position. Temperature, 100; puke, 108.
Through the hypogastrium he felt a bilobed swelling
occupying the whole of the lower abdomen. There Was a
free hemorrhagic discharge, and tbe uterus was pushed
against the symphisis pubis by a smooth impacted swell¬
ing, occupying the posterior and left two-thirds of the
pelvis. Higher up and to the right the base of a smaller
swelling could be felt. The sound passed tj inohee
into the uterus. He saw her again on OetoW 17th,
when she seemed to have lost ground. He opened the
abdomen and came upon a semi-elastic tumour, gene¬
rally adherent. Deep down on the pelvis floor the
finger passed through an orifioe in the sac-wall, blood
clot and putrid fluid escaping. The tumour proved te
be an extra-uterine sac and a foetus throe inshss long
projected through the wall. The pedicle was ligatured
and the mass removed. The tumour on the right side
contained flocculent pus, and it proved to be a right
ovarian cyst undergoing suppuration. This Was use
removed. The abdomen was washed out, and a
glass drainage tube left in. The patient made a
perfect reoovery after three days’ anadety from
collapse. 8he subsequently had severe epistfUEls at the
menstrual periods. In the specimen the tube Was enor¬
mously distended, measuring 12 ins. in its longitudinal
circumference, 10] ins. in the transverse, an49i ins. in
the vertical circumference. The uterine orifioe was
still patent, but the abdominal end Was oooluded.
The tube had ruptured through the peritoneum. He
referred particularly to the constant haemorrhage, a sign
which, according to Dr. Cullingworth, was present im
nearly all these cases.
Dr. Herman pointed out that in many onset tubdt
moles had been removed which were not oausing any
trouble, and he raised the question whether they oould
be left with safety. He admitted, however, that the
author’s case militated against this view.
Dr. Horrockb said that many of these opses got well
without septic complications, and probably many cases
of ectopic gestation were thus recovered from without;
attracting attention.
Dr. Galabin Baid he had seen a nsxnber of case*
which had not been operated upon in whioh the lump
had gradually diminished in size, and in other oases in
which he had operated he had only found elot with
little chorionic villi. The question of operation would
depend upon the size of the ovum, and wnen under two
months he thought the case might be left to nature.
CA8E OF ACUTE IDIOPATHIC (?) PERITONITIS SOMPLISATINU
PREGNANCY AND LABOUR.
Dr. John Phillips related the case of a woman nearly
seven months pregnant and in good health, who fell
over a chair-back on her left side. Much pain and per¬
sistent vomiting followed. She was found in a very
serious condition, her abdomen distended, pulse 120,
temperature 103 degs. F., and respirations 48. Labour
came on, bat no true pains could be distinguished, and
terminated very quickly. Her condition became rapidly
worse, and she was admitted into King's College Hos¬
pital. After consultation, Mr. Peyton Beale opened the
abdomen, and found general peritonitis, but no apparent
cause. The patient died in a few hours. Full details
of the post-mortem examination were gives. Short
histories of five other cases were related — Matthewa
Duncan (two), Simpson, Romiti, and Gow. The author
pointed to three important points fur discussion, viz.,
(1) the cause of the infection ; (2) the question of
operative interference; (3) the share the blow took im
producing the illness.
Digitized by GoOglC
614 The Medical Fbxbb. GENERAL MEDICAL COUNCIL.
Mr. Robinson admitted that he was very puzzled to
explain the patient’s symptoms when first seen.
Dr. Inolis Pabbons urged that there was always the
possibility of infection by the bacillus coli. He supposed
the author did not really regard the peritonitis as
“ idiopathic.”
The President asked if any one knew of a case of
primary infection of the peritoneum as a result of the
escape of fluid from the tube ?
Dr. A. Routh referred to a paper by Mr. Treves, read
many years ago before the Medical Society, in which he
described peritonitis due apparently to infection by the
bacterium coli, after bruising, Ac , of the intestine, a
possibility which has been proved by clinical and experi¬
mental observation.
Dr. Horrock8 said the term “ idiopathic peritonitis ”
had long been abandoned in its original sense.
Dr. Galabin referred to a mysterious case of perito¬
nitis in a girl, let. 17. whose abdominal cavity was
distended with semi-purulent fluid, the pelvis being free,
and there being no evidence of salpingitis. The patient
unfortunately died under chloroform, and there was
nothing to show where the inflammation had started.
NORTH OF ENGLAND OBSTETRICAL AND
GYNECOLOGICAL SOCIETY.
Meeting held at the Medical School, Leopold
Street, Sheffield, November 17th, 1899.
The President, Dr. Donald, in the Chair.
Dr. J. W. Martin showed a pedunculated subperi-
toneal fibroid removed by abdominal section.
Dr. W. Walter also snowed microscopic specimens.
Dr. W. J. Sinclair related a case of abdominal
pregnancy, and showed the specimen along with draw¬
ings. The fcetus, which was well developed, together
with the placenta, was removed by abdominal section.
The fcetus lay free in the abdominal cavity. There was
no evidence of an amniotic covering. The patient made
a good recovery.
Remarks were made by Dr. Keeling and the President.
I)r. Sinclair replied.
Dr. T. Arthur Helme related two cases of extirpa¬
tion of the uterus for extreme hypertrophy and prolapse.
The patients, multiparse, set. 47 and 52 years, had
suffered for many years from prolapse of the uterus,
along with the anterior vaginal wall and bladder. The
posterior vaginal wall was not everted. The
cervix was extremely hypertrophied, The fundus uteri
was felt in its normal position behind the pubes in each
instance. The length of the uterine cavity measured
ins. and 6J ins. respectively. The operation per¬
formed was as follows : The uterus was removed in the
usual way, by ligaturing the broad ligaments in section.
The peritoneal cavity was completely closed by careful
suturing. By means of buried sutures the large, raw
connective tissue area covering the bladder was dimin¬
ished, and the bladder folded upon itself. The cut edges
of the vaginal walls were then sutured, a broad surface
being united. At a second operation, the perineum
was repaired and the vaginal outlet narrowed. The results
were quite satisfactory, the patients walk well, have no
bladder trouble, and do not require a pessary. Extirpa¬
tion of the uterus alone will not cure complete prolapse
of the vaginal walls which forms a hernia of the pelvic
floor. In these cases plastic operations combined with
ventrofixation of the uterus give goodresults.
Dr. Lea remarked that in these cases it is always
advisable to remove the ovaries and tubes, inasmuch as
they often became prolapsed and painful. This might
necessitate their subsequent removal.
Remarks were made by Dr. Sinclair and the President,
and Dr. Helme replied.
Dr. W. K. Wells related a case of double ovarian
abscess with purulent salpingitis in which the uterus
and appendages were removed by the vaginal radical
operation. The patient, a multipara, had pyrexia and
pelvio inflammation. Whilst under observation rapid
enlargement of each ovary was detected. Ovarian
Dec. 13, 1899.
abscess was diagnosed, and the operation at once per¬
formed. Each ovary was a thick walled sac of pus.
Both Fallopian tubes were swollen and infiltrated. They
contained purulent secretion, but the fimbriated
extremity was not occluded. The patient made an
excellent recovery.
The President (Dr. Donald) related two cases of
unusual abdominal tumour. Case J. A tumour of the
suprarenal capsule. The patient, set. 37, married, had
an abdominal swelling which was the size of a foetal
head at term. It was very mobile and fluctuant, and
could not be pushed down into the pelvis. A diagnosis
of cyBt of the kidney or ovarian cyst with a long pedicle
was made. On opening the abdomen the tumour was
found to be retro-peritoneal, and crossed by the descend¬
ing colon. The peritoneum was divided and the cyst
enuoleated. There was no pedicle. The cyst lay imn ©-
diately in front of the left kidney, which was normal.
The patient made a rapid recovery. On section the
tumour contained blood and dots. The cyst wall
showed fibrous septa enclosing polyhedral granular
nucleated cells closely resembling the “zona glome-
rulosa” of the normal suprarenal capsule. Case II.
Cystic sarcoma of the pelvis.—Patient, u*t. 26, single,
had a symmetrical cystic tumour springing from the
pelviB and reaching the level of the umbilicus. The
uterus was small and separate from the tumour. An
ovarian cyst was diagnosed. On opening the abdomen
the cyst was found to be retro-peritoneal. The peri¬
toneum was incised, and the cyst punctured. Three
pints of blood-stained fluid were evacuated. The cyst
was not connected with the uterus or appendages, but
was found to grow from the connective tissue near the
left sacro-iliac joint. The tumour was shelled out with
difficulty, and the patient made a good recovery. Micro¬
scopically it was a round-celled sarcoma with cystic
degeneration. These cases were striking examples of
the difficulty of accurate diagnosis of abdominal
tumours.
GENERAL MEDICAL COUNCIL
OK
EDUCATION AND REGISTRATION.
WINTER SESSION, 1899.
Sir William Turner, President, in the Chair.
SIXTH DAY.— Monday, December 4th, 1899.
The President announced that the Committee on
Mr. Upton's letter would consist of Mr. Bryant, Dr.
Pye-Smith, Dr. MacAlister, and himself.
Reciprocity of Medical Practice.
Speaking to Sir Dyce Duckworth’s motion Mr. Tomes
moved as an amendment “that the Privy Council be
requested to obtain information (a) whether any change
in the regulations affecting foreign practitionei s in
Italy had been made since the communication received
in 1898; ( b ) whether any such change was in contem¬
plation by the Italian Government. He justified his
amendment on the ground that the Council ought not to
proceed on private information when official information
was procurable. The Council ought not to act without
some sort of pledge on the part of the Italian Govern¬
ment that they were not going to depart from the present
order of things. He did not think the Italian Govern¬
ment would act precipitately while official communica¬
tions were passing on the subject.
Sir C. Nixon seconded the amendment in order to gain
time, and in the hope that the matter would not come
before them again. He deprecated altering existing
reqnirments for the convenience of foreigners.
In reply to Sir Dyce Duckworth, Mr. Tomes declined
to allow his amendment to be added as a rider to the
motion.
Sir Dyce Duckworth read a letter, dated December
2nd, from a trustworthy source, to the effect that our
Government had in some way led the Italian Govern¬
ment to understand that they declined reciprocity.
Digitized by GoOgle
GENERAL MEDICAL COUNCIL. The Medical Press. 615
Dec. 13 , 1899.
thereby cutting the ground from under the feet of those
who were seeking to secure for British medical men the
privileges at present enjoyed by them in Italy. He
pointed out that Italy was now the only country to which
that section of the Act could apply. Under the circum¬
stances he was willing to withdraw his motion in favour
of the amendment.
The amendment thus became the motion before the
Council.
Dr. McVail regretted that the Act did notallow them
to limit the practice of foreigners to their own
countrymen, and he proposed that the Privy Council
should be asked to hare the Act amended in this
direction.
The motion was then agreed to.
Education Committee.
The President laid before the Council the pricis drawn
up for transmission to the German Government in
reference to the admission of foreigners to examinations
tor British registrable qualifications, and on the motion
of Dr. MacAlister it was received and entered on the
Minutes, the same to be transmitted to the Privy
Council as an answer to the questions contained in the
dispatch of the German Ambassador.
Mr. Victor Horslbt moved that the report be sent
back to the Education Committee for reconsideration of
the circumstances under which certain qualifying bodies
admitted foreigners to their final examinations. On ;
the suggestion of the J ’resident he promised to give
notice of the motion.
Finances of the Irish Branch Council.
Sir C. Nixon asked whether the Council would have
an opportunity of discussing the opinion of Mr. Muir
Mackenzie with regard to the financial position of the
Irish Branch Council.
Dr. MacAlister observed that the document was
strictly confidential, but it would be in order to move
that the Council should go into camera for that purpose.
The English Colleges and the Council.
On the motion of Mr. Brtant, two communications
from the Royal Colleges of Physicians and Surgeons of
London were received and entered upon the Minutes,
declining to recognise the Council's requirement that
scientific institutions where medical study is commenced
should be approved by the General Medicil Council.
Sir William Thomson regretted very much that this
matter had come up again. He reviewed the history of
the matter, and maintained that if the Colleges were
allowed to challenge the authority of the Council
on this particular matter, itself possibly of small
moment, the Council would have no authority
in any matter over them, and if this posi¬
tion were acquiesced in they would not have long to
wait before all the other Colleges and Corporations and
Universities would defy the Council. Referring to
8ection XX. of the Act of 1858. he insisted on the right
of the Council to intervene, and in support of this view
he quoted certain clauses from the report of the Educa¬
tion Committee of May, 1894. He insisted that the two
colleges had not only departed from the original
arrangement as to the five years’ course, but that they
had also failed in their duty in their own arrangements
for inspecting these first-year scholars. He men¬
tioned that in the discussion at the College of Physicians
in London last year two of the members of Council,
Fellows of the College, took the same view. He main¬
tained that it was the duty of the Council, at whatever
cost, if it wished to retain the regulation of medical
education, to assert its authority. He concluded by
moving that the Registrar be directed to inform the
■Colleges that the Council adhered to its resolution.
This was seconded by Dr. Bruce.
Dr. MacAlister thought the effect of the resolution
would be very small, remarking that the only result
would be a hardship on the students who had been mis¬
guided enough to seek registration without having ful¬
filled the proper conditions. These would have to go
back to the Colleges or enter some recognised science
class, and the Colleges would make nothing of then-
refusal to comply with the Council’s regulations.
Dr. McVail asked whether they were to understand
that the resolution as to the registration of medical
students was a farce. He complained that the Colleges
did notenter into the merits of the question, but simply
defied the deliberate opinion of the Council.
Sir Philip Smtlt said he had already brought the
matter before Council, but it had been shelved.
Sir Richard Thorne thought the action of the
Colleges deplorable.
Dr. Atthill observed that if the Colleges would not
reconsider the question the Council would have to put
the subjects of chemistry and physics after biology, in
the preliminary examination, return to the four years’
course, or appeal to the Privy Council.
Sir J. Batty Tuke thought their contention would be
maintained by the Privy Council.
Mr. Bryant repudiated any desire on the part of his
College to place itself in opposition to the Council, but
it was felt that the Colleges had their own responsi¬
bilities and duties. He maintained that they had done
much good by encouraging the teaching of scientific
subjects in the big schools. He asked how the Council
could select schools and places of scientific instruction.
Dr. Payne did not think the question was arguable,
and moved as an amendment that the right of the
Council in respect of the matter at issue should be
referred to their legal adviser.
Dr. MacAlister said an opinion had already been
obtained to the effect that the Council had an inferential
right to enforce conditions of registration, though there
was no specific clause in the Act referring to it.
Sir Dyce Duckworth observed that the Council must
keep within the four corners of the Act, and they would
only be justified in appealing to the Privy Council if of
opinion that the curricula were not such as to secure
adequate teaching, and this, he asserted, had not been
shown to be the case.
Mr. Carter did not think the Council was to be
altogether confined within the four corners of its
statutory powers, but ought to be regarded as a means
of enabling them to meet and discuss matters and
principles of education. He hoped the Royal Colleges
would come into line and endeavour to carry out the
wishes of the great majority of the members of Council.
Dr. Pettigrew urged that if the views of the Royal
Colleges were adopted, they would be the means of intro¬
ducing a disastrous element, and he hoped the Colleges
would reconsider the matter.
Dr. Leech thought the question depended on whether
they thought the teaching school was satisfactory or not.
Sir C. N ixon denied that it was a question of sufficiency
or insufficiency, the real test being whether the authority
of the Council was going to be recognised by the Colleges
or not.
Dr. Heron Watson observed that no objection had
been made to the Council’s regulations extending the
period of medical education until now.
At the suggestion of Dr. MacAlister, Sir William
Thomson agreed to make his motion read as follows :—
“ To invite the Colleges to take the matter into fresh'con-
sideration in view of its important bearing on the main¬
tenance of the standard of study and examination in the
country at large.” Sir William disclaimed any personal
feeling in the matter, observing, however, that if the
Colleges declined to obey they would have to go to the
Privy Council.
On the motion being put to the vote, 22 voted for,
1 against, 3 did not vote, and 4 were absent.
Finances of the Branch Councils.
After considering in camera Counsel’s opinion on the
financial position of the Irish Branch Council, the
President announced that a resolution had been agreed
to that the whole question of the funds of the Council
and its Branches should be referred to the Finance Com¬
mittee and respective trustees to take legal advice and
report next session.
Report of Personation Committee.
The report of the Personation Committee was received
and entered upon the Minutes, but on the motion of Dr.
McVail the discussion was adjourned until next
session.
ed by Google
Diqitiz.
616 The Midical Pbb8s. GENERAL MEDICAL COUNCIL.
Dec. 13, 189©.
Preliminary Examinations.
Sir J. Battt Turk brought forward the report of the
Education Committee on the question of raising the
minimum requirements of the Council in regard to pre¬
liminary examinations. The report recapitulates the steps
that have been taken in regard to the appointment of
experts. In regard to the substitution of the senior and
higher grade, for the junior, examinations, the experts
were unanimously of opinion that, taking into account
the present state of secondary education in the oountry,
no such requirement could possibly be enforced. They
point out that a demand of this kind would certainly
result in defeating? the end which the General Medical
Council have in view. Either it would diminish to an
indefinitely large extent the number of candidates enter¬
ing the profession, or it would compel the examiners to
a laxity of marking and a depreciation of the standard
of questioning whioh would merely have the effect of
lowering the senior papers to the level of the junior
papers. The standard of the Medical Preliminary
Ex amin ation must depend upon the general standard of
the secondary education of each oountry in whioh the
examination is held, and a standard too high for one
might be found too low for another. They, think, how¬
ever, that the immediate object of the General Medical
Council would be gained by the gradual raising of the
standard of the lower “Junior” examinations to the
level of those “Junior” examinations which, in their
opinion, rank highest.
In view of this opinion, the Committee maintained
their view that a number of the junior examinations
must, for a considerable time yet, continue to be recog¬
nised. They propose, however, to give effect to the
specific recommendations of the experts in regard
to enlarging the scope and raising the standard of these
examinations, with which object in view, the Committee
ask authority to retain the services of the experts, and to
have allocated a further sum of .£100.
Sir J. Batty Tok* pointed out that the opinion of the
experts coincided with that expressed by the Education
Committee in June last, and must be accepted as final
for the present.
Dr. MacAli8ter thought these opinions deserved the
Council's gravest consideration.
Sir Richabd Thorne said they were asked to adopt
the report without seeing on what it was based, and he
moved as an amendment that the reports should be
circulated among members of Council. He thought it
was the most “ staggering ” conclusion he had ever
heard, and he thought the Council should not take a
tremendous leap in the dark.
Dr. Reid seconded the amendment.
Dr. Leech said there were many questions on which in¬
formation was required before the report could be passed.
Dr. Pye-Smith said he knew from experience that the
standard was lamentably and disgracefully low, and he
hoped the Council would be able to refuse to accept the
report.
Mr. Horsley said that he and his fellow representa¬
tives had an absolute mandate to raise the standard of
preliminary examinations by all means in their power.
As for the report, it simply baffled him. He concluded
by observing that the opinion of these experts was not
only a disappointment, but a very expensive disappoint¬
ment.
The further discussion was adjourned.
SEVENTH DAY.—Tuesday, December 5th, 1899.
Adjourned Debate on Preliminary Examinations.
Sir Richard Thorne, in resuming the discussion,
repudiated the least desire to convey anything that
might hu't the feelings of the Education Committee,
whose labours he admitted had been great. Nevertheless
he felt that they ought to have before them the reasons
on which was based the report which practically put an
end to their aspirations and which, if fulfilled, would have
done more than anything else to raise the status of the pro¬
fession from its, in many respects, deplorable condition.
He had read the report with the keenest disappointment
and he did not think the Council could deal with the
subject on the materials at present before them. He
therefore proposed, as an amendment, “ that the Educa¬
tion Committee obtain from the experts a report setting
out in full their reasons for the conclusions they had
arrived at with regard to the adoption by the Council of
the senior and higher grade standard of preliminary
examinations, and that the sum of £5100 be placed at th»
disposal < f the Committee for that purpose.”
Sir J. Batty Turk accepted the amendment on behalf
of the Committee.
Dr. MacAlistbr recalled what took place last year
when a clear line of work was indicated for the future.
Dr. McVail suggested that if the Council laid dowm
and rigidly enforced the minimum examination require¬
ments, the schools of the country would respond loyally.
There might be a temporary decline in the number of
students, but after that they would get a superior class
of men.
Sir Richard Thome’s amendment was, by consent,
substituted for the original motion.
Dr. Glover pointed out that the .£100 was intended
not only to enable the Committee to justify the report,
but for further services. He shared in the disappoint¬
ment at the report.
Sir C. Nixon remarked that it was obvious that it
would bs impracticable to adopt the senior examination
as their standard, this examination corresponding to the
first examination in arts at the Royal University. Ha
thought the Council would act wisely in leaving the
matter in the bands of the Committee and the experts.
The motion was then agreed to, the concluding word*
“ for that purpose ” being deleted.
The Apothecaries’ Hall of Dublin.
Sir Dyce Duckworth read the report of the Examina¬
tion committee on the examinations of the Apothecaries’
Hall, Dublin, held in July, 1899. The examiners direct the
attention of the Council to the lack of general education
evinoed by one of the candidates, but the preliminary
e xamina tion passed by this candidate is not mentioned.
The Inspector reports that the final examination
will bear favourable comparison as a test of fitness with
any of the ordinary pass examinations of the United
Kingdom The Surgical examiners were satisfied with
the way in which the examination was conducted and
with the standard of knowledge required. The Com¬
mittee recommend the Council to ascertain the par¬
ticular arts examination which the imperfectly educated
candidate had passed. They suggest that a copy of the
report should be sent to the Privy Council, and that the
inspections should be continued.
Mr. Tichborne objected to individual allusions in the
report and criticised the wording thereof in other
respects. He concluded by proposing as an amendment
that the words complained of should be left out.
Mr. G. Brown seconded the amendment with the hope
that the Committee would aoquiesce in the suggestion.
The suggestion was acceded to, and the motion was
then agreed to.
Pharmacopceia Committee.
The Report of the Pharmacopceia Committee was re¬
ceived and adopted, and the Council then received ia
camera a report from the Penal Cases Committee. The
Report of the Public Health Committee was received
and entered on the Minutes, and the Report of the
Students’ Registration Committee in Exceptional Cases
was also received and entered on the Minutes.
Unqualified Dispensers.
A report from the Unqualified Dispensers’ Committee
was received and entered on the Minutes. The con¬
clusions arrived at by the Committee are that they d#
not see their way way at present to recommend any
course to be taken by the Council, but they endorse the
reply sent by the Executive Committee to the Privy
Council.
Companies’ Act Amendment Committee.
The report was received and entered on the Minutes.
The Committee urge that the words “Medical Practi¬
tioner ” ought to bo added to the clause, adding that both
medical and dental companies were still actively pursu¬
ing highly objectionable forms of practice.
Digitized by VjOOgl
Dk. 13, 1809.
GERMANY.
Th» Medical PuK8 617
Medical Aid Associations.
The Committee report favourably on the constitution
of the proposed Conciliation Board, and it was hoped
that a bettor understanding would be arrived at with
the Societies.
Loss or Right to Practice.
Sir O. Nixon brought forward a motion to the effect
that when a practitioner’s name had been removed from
the Rtgitier he should be officially informed that he had
forfeited the legal right to practise, but, at the sugges¬
tion of the President, he consented to withdraw it.
Admission or Fobrionxbs to Bbitish Examinations.
Mr. Victor Horslet moved that the Education Com¬
mittee be asked to consider the circumstances under
which foreigners obtained exemption from some of the
conditions of education and study. He urged that
foreigners should be required to produoe evidence either
that they were qualified to practise in their own country
or that they had followed out the five years’ curriculum
of this country. He mentioned that at some of the
Scottish Universities—Aberdeen, for example—a student
was allowed to pass three years of his curriculum else¬
where.
The motion was carried by 10 votes to 8.
The Rhodesian Medical Ordinance.
On the motion of Mr. Carter it was resolved to
forward to the Secretary of State a copy of a resolution
to the effect that the memorial drawn up by medical
practitioners in Southern Rhodesia against the validity
•f the Ordinance under whjch they acted was justified,
and indicated a serious grievance of which they were
warranted in complaining.
The first year’s examination of the University of
Adelaide was ordered to be recognised as qualifying for
registration for medical and dental registration and,
after a vote of thanks to the President, the Session came
to an end.
cfran tt.
[FROM CUR OWN CORRESPONDENT.]
Pabis, De«ember 9th, 1888.
Arsbnic in Animals.
At the Academie d# Medecine M. Gautier said that he
made resea) ches which permitted him to affirm the
constant presence of arsenic in the thyroid glands of all
herbivorous and carnivorous animals, and in man him¬
self, but in very small quantities. In all the other
organs except in the thymus, the brain and the skin
where it existed in smaller quantities than in the
thyroid gland, no aisenic was found. The same
might be said of the blood. In the thy¬
roid gland of man he found one milligram
(fiftieth of a grain) of arsenic for 127 grammes
«f gland. This arsenic was furnished by a certain
number of aliments, and was carried, probably by the
white csrpuscles to the nucleus of the cells. A point
which the speaker considered worthy of attention on
acoount of the consequences which might result from a
therapeutic and pathological point of view was that the
presence of arsenic was as neoessary as that of iodine to
the proper function of the thyroid gland.
M. Brouardel remarked that from what bad been
said, they should not oome to the conclusion that the
presence in the normal state, of arsenic in any appreci¬
able quantity in certain organs, affected medico-legal
examinations, in which that metalloid had been met
with, the quantities of arsenic, on which were based the
oonclusions of the examinations being always much
greater than those indicated by the first speaker as
existing in the normal state. M. Gauthier replied that
the facts he had related established on the contrary that
arsenic was only found in the normal state in the thyroid
the brain and the skin. Arsenical poisoning conse¬
quently might be inferred where the metalloid was
found in the liver, spleen, muscles, blood, Ac.
Coxaloia.
M. Kirmission referring to the communication of M.
Nelaton at the previous meeting, anent the treatment
of hip-joint disease by resection, said that although he
might be a partisan to active interference in the adult
he was decidedly conservative in the coxo-tuberculosi
of children, so long as the skin remained healthy oon
aervative methods might be pushed very far.
Injections of a solution of iodoform and ether (1-10)
frequently brought about a cure in suppurating ooxalgia.
Even in cases complicated with fistula excellent results
might be hoped for from this treatment.
As regarded the curative value of resection for
coxalgia, it should be admitted that many of those
operated on had fistula tracts resulting from the fact
that it was not always possible to remove the fungosities
completely. He had the opportunity of examining
ten patients who had been operated on ; three presented
fistulae and four had the limb in a bad attitude, while the
shortening varied from 1J ins. to 4 ins.
Incomplete Consolidation op Fractures.
M Potheral related two cases of incomplete consolida¬
tion of fractures treated successfully with the adminis¬
tration of thyroid gland. The first case was a comminuted
fracture of the leg treated by the stiff bandage and
massage. At the end of eighty days, no consolidation
having taken place the thyroid gland was prescribed,
and after fifteen days the desired result was obtained.
The second case was somewhat similar, but on the
eleventh day of the administration of the gland, the
patient was seized with cerebral htemorrhage, and pre¬
sented symptoms of danger.
The results obtained, said M. Potheral, by thyroid
medication in the treatment of retarded consolidation
appeared to have given satisfaction in a certain number
of cases. However, it should not be forgotten that the
medication was attended with more or less danger.
(Sermaitg.
[from our own correspondent.]
Berlin, December 8th 1898.
At the last meeting of the Society for Innere Medic in
Hr. J. Boaz read a paper on
Expbriencbs in Cancer op thb Colon.
He had a material of fifteen cases (twelve in men,
and three in women). In eight cases the tumour
was demonstrable, in six its seat was the ctecum,
and two, the hepatic flexure of the colon Twelve
cases were treated by operation. He divided
the cases, according to the subjective symptoms,
into four groups. (1) Only slight gastric disturbances, and
here the diagnosis was difficult. (2) More precise sym¬
ptoms that fixed the attention on the disturbed intestinal
function, the symptoms not being very characteristic.
(3) The history and subjective symptoms directed the
attention, from the first, to the bowel, and were indica¬
tive of the nature of the trouble. The history here was
of a stereotyped character. The patients had had ne
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618 The Medical Press.
Die. 13, 1899.
A U STRIA.
previous trouble in the bowels, or only Blight. Suddenly
severe symptoms supervened, with paroxysmal pain,
nausea, and vomiting. The attacks then became fre¬
quent and more severe, from a stenosing carcinoma;
if the disease was seated in the sigmoid flexure, there was
tenesmus in addition to the other symptoms. (4) In
the midst of seeming good health ileus came on, without
distinct indications as to the nature of the disease. On
careful inquiry earlier indication will be brought to
light. Sometimes errors in diet have been blamed
as the cause, sometimes not.
The existence of a tumour was more important as
regarded diagnosis. Of the eight cases in which the
tumour could be felt, in ,only two could it be
distinctly moved, and these tumours were in the caecum
with a short mesentery. The temporary di« appearance,
sometimes for two or three days, was of importance, ny
this was shown the importance of repeated examination,
both with the bowel full and empty, in order to protect
against errors of diagnosis. In order to test the
movability of a tumour, artificial blowing up of the
bowel was of importance, and also palpation in the warm
full bath.
It was important to distinguish between innocent and
malignant tumours, and especially 1 etween tumours on
ciecal and perityphilitic exudates. The speaker had had
two cases in which it was very difficult to distinguish
such tumours from tuberculous ileo-ca?cal tumour. The
diagnosis was facilitated by indications of tuberculosis
in the fa'ces, and by the musical intestinal Bounds said by
Konig to be heard when the stenosed part is of
length. One especially good means of distinction lay in the
diazoreaction observed in tubercle. It had been confirmed
in recent times that this was always absent in the case
of malignant tumours. A valuable sign was furnished
by the BymptomB of stenosis. Subjectively, there was
8 evere colic with nausea and vomiting, and objectively,
independent of meteorism, tetanic peristaltic movement.
The symptoms often receded for a time with careful
dieting. Repeated tension of a small coil of intestine
with subsequent relaxation was an important sign. All
cases exhibiting such symptoms should be taken to the
hospital for further observation. Hehadseen hajmatemesis
in two cases, in which the blood regurgitated from the
lower segments of intestine. As regarded the feeces, th e
presence of blood and pus was important. Serious
bleeding was only seen in two of the fifteen cases. He
had never seen particles of the tumour in the stools
except after washing out. The general condition
sometimes oscillated more than might have been
expected; he bad seen an increase of weight of three
kgms. in a week. As regards diet, some kinds of food
should be avoided—skin fruit, Graham bread, and
asparagus—they might originate an attack of ileus. In
attacks of stenosis purgatives were generally useful, but
in some cases opium was the best.
Of his twelve operation cases five were resection, with
two deaths. One being still alive and well after four
years, four well after being operated on five months. In
four cases enteroanastomosis was performed. (One death
from perforation, one patient living after nine months,
two after six months.) In one case an anus prater-
natural is was made—death after four months.
The results of operation were not very encouraging.
Most of the cases were operated on too late. With
early diagnosis and operation.the result would have been
better.
Operation was indicated in movable tumour and good
general condition. The form of operation could not be
decided before the abdomen was open. As metastases
generally took place late, extirpation afforded tolerably
favourable chances. Further, operation should be per¬
formed even when no distinct tumour could be felt, if
symptoms of stenosis were marked, and also in the case
of ileus.
JlttBtria.
[from our own correspondent.j 1
Viebkx, Deeember 9th, 18S9.
Stri noo-Ctst-Adenoma.
At the “ Gesellschaft der Aerzte,” Neumann showed
two cases of syringo-cyst-adenoma originating in the
sweat glands. It was present on the antenor and lateral
surfaces of the thorax over the mammae, down the
back, on the flexor aspects of the extremities, on the
face and eyelids, in the form of small tubercles ranging
in size from small shot to peas, granular on the surface,
and varying in colour from a bright red to a dark brown
or purple colour.
In both cases the history and appearances were the
same. This condition had existed more or less sinoe
early childhood, but had increased in extent of late,
decidedly so since they had entered hospital; some of
the tubercles becoming flat and cystic during this
period.
In many respects this affection resembles xanthoma
or dermatomyoma, but differs from both in colour
course, and distribution. In diagnosis, another error
must be avoided, viz., that after injections of pilocarpine
a spurious form of Byringo-cyst-adenoma may be
induced.
The microscopic appearance is peculiar. The mass
appears to be composed of a number of tubercles formed
of solid nests of epithelium, cysts with glairy homogeneous
fluid contents.
The degeneration of the cysts and solid contents of
the nests finally form a colloid substance which may
contain many of the epithelial cells with granular con¬
tents. The first cellular nests and columns seem to arise
from a thickening and hardening of the sebaceous
glands and sweat ducts. From the pathology of the
disease Neumann thinks the correct terminology is
syringo-cyst-adenoma. He also emphasised the fact
that the origin in his cases was not due to an abnormal
or degenerate embryonic tissue, as many other observers
had affirmed, but from primarily healthy tissue.
The notes in these cases were well illustrated by
photographs as well as wet and dry microscopic
preparations.
Gastro-Entero8tomy
Ullmann next exhibited a female, set. 35, on whom he
had performed gastro-enterostomy for a tumour in the
pylorus. He connected the small bowel of the mesentery
with the stomach, and closed the proximal end of the
alimentary section. To the small intestine, which he
connected with the stomach, he laterally connected
the lower part of the duodenum to conduct
the products of the pancreas and liver into
the alimentary canal, so that digestion might not
Digitized by v^.ooQle
Due. 13, 1899. THE OPERATING THEATRES. The Medical Press. 619
suffer. The operation fulfilled the most sanguine ex¬
pectation, and the patient recovered rapidly, and since
the operation had increased in weight 171 kilos, or 38 - 5
pounds. Microscopical examination of the glands taken
from the neighbourhood of the pylorus showed inflam¬
matory infiltration. He compared these specimens with
others taken from the neighbourhood of the cacum,
which he had removed for carcinoma, thus proving the
carcinomatous condition of the remaining pylorus. He
thought the success of this case disproved the opinions
of Schuchard and others, who have affirmed that re¬
covery is protracted in such cases, even if successful,
when the carcinoma and glands are left behind.
Direct Examination of Larynx.
Schrotter demonstrated Killian's methodof examining
the larynx and trachea as well as the bronchi by means
of a tube directly, and not with the laryngoscope as
hitherto. The part to be examined is lighted by means
of a small electric lamp with a lens carried in the instru¬
ment itself. His object in using this instrument was an
immediate one. He brought in a boy, set. 12, who had
the head of a pencil lodged in the left lung which could be
seen by the Rontgen ray6, but was beyond the reach of all
instrumental arrangement. By cocainising the trachea
and bronchie and inserting this instrument he is hopeful
of reaching the, at present, inaccessible fragment.
Concretions in the Urinary Tract.
Zuckerkandl showed a few concretions taken from
-different parts of the urinary tract. The first were
three stones removed from the urethra of a child set. 3J.
The second was a preputial stone taken from an old
man. 73 years of age, who ten years previously was
stung on the organ by a wasp, which produced a phleg¬
monous condition of the penis, with subsequent
hardening of a small tumour about the size of an apple.
The operation revealed two phosphatic stones in the
preputial sac.
The third was a stone occurring in a female, ait. 55.
For a longtime this stone was caught in the lower end
of the right ureter, where it formed a sac, it ulti¬
mately burrowed its way into the bladder, whence it
was removed by crushing.
Whatever be the primary origin of these para-urethral
stones, Zuckerkandl is firmly convinced that many of
these crypts and fistula; furnish the initial history o*
many of the nephritic and cystic stones met with in
daily practice, which often reach a gigantic size before
removal.
^ht (Dptratiitg ^heatrw.
WEST LONDON HOSPITAL.
Nephro-Lithotomy. —Mr. Bidwell operated on a
man, set. about 40, who had been admitted to hospital
suffering from acute pemphigus. A sinus discharging
pus was found in the left loin, and the patient gave the
history that seven years before he had been operated on
for renal calculus, but the wound had never healed. The
present operation was undertaken when the acuteness
of the attack of pemphigus had subsided. The kidney
■was exposed in the ordinary way by an incision of which
the sinus was the centre, and seven calculi were
removed from the body of the o*-gan, not from the
pelvis. A drainage tube was inserted, and the wound
closed. Mr. Bidwell said the interesting point about
the case was the probable origin of the pemphigus from
infection depending on the sinus in the loin ; the infec¬
tive origin of pemphigus, he said, was now well
recognised, and an important point of its treatment
should be the cure of any suppurating point.
It is satisfactory to note that the patient progressed
satisfactorily both as regards his kidney trouble and the
pemphigus.
Arthrectomy of Knee.— The same surgeon operated
on a boy, set. 19, who had been admitted to the hospital
with tuberculous disease of the knee. At first he had
trouble in his knee ten years ago. This had subsided
under rest and splints, leaving a perfectly useful joint.
Eighteen months before admission the knee again
became swollen, the swelling being most marked on the
outer side. It had persisted in spite of treatment by
splints and strapping. As the swelling was principally
on the outer side of the joint, the inner side being
seemingly not involved, the incision was made along the
posterior border of the biceps tendon, and a cavity con¬
taining broken down cheesy material and granulation
tissue opened up ; the walls of this were dissected away,
and the deeper parts scraped; it was then foimd that
the cavity led directly into the knee-joint and that the
cartilage at the lower end of the internal condyle was
separated. A semilunar incision was therefore made in
front of the knee-joint, its centre being below the lower
border of the patella, and the skin flap dissected up as
high as the upper border of the bone. The patella
was then drilled vertically, was divided transversely
with a saw, and the knee-joint opened up. The
synovial membrane, whioh was infiltrated with tuber¬
culous granulations, was dissected away from the
external condyle and outer head of the tibia.
The loosened cartilage over the external condyle
was removed, and the bone scraped; nothing was
done on the inner side of the joint as the synovial
membrane had been replaced by cicatricial tissue, and
there was no tuberculous deposit. The joint was
thoroughly flushed with perchloride, and a stout silver
wire was passed through the holes which had already
been drilled in the patella, and tightened, bringing the
edges of the divided bone in apposition, the ends of the
wire being then twisted at the upper border of the
patella. Both skin incisions were closed with horsehair,
and a few points of silkworm gut, and the limb put up in
plaster of Paris splints. Mr. Bidwell said the first point
of interest was the relapse in the knee after apparent
cure eight years before, showing that there was
always a risk of return of tuberculous disease when
it is not removed, and the case treated by rest alone.
Another point, he remarked, was that, as the principal
swelling was on the outer side of the knee, he had
hoped that this was tuberculous infection of the bursa>
and had no communication with the joint when he
found that the articulation itself was affected he naturally
decided to do an arthrectomy since the whole of the
diseased area could not be removed by a lateral incision*
He drew attention to the fact that the division
! of the patella gives excellent access to the joint,
and ensures a perfect power of extension after
I wiring. He said he always drills the bone before
| dividing it, as this ensues accurate apposition of
, the two fragments. In wiring a patella, it is always, he
j said, advisable to twist the wire at the upper border of
the bone, so'that the resulting prominence afforded by the
twist is well out of the way of pressure in kneeling. He
Digitized by CjOO^Ic
620 The Midical Press.
LEADING ARTICLES.
Dec. 13,1899.
remarked that probably the case would not be dressed
for three weeks, when the stitohes would be removed,
and the limb would be put up in plaster of Paris for
another month; afterwards a moulded leather splint
would have to be worn for about a year.
Bhutuid roa Tbaxskissi * Abboad.
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“ SALC8 POPOLI SUPRIMA LEX.”
WEDNESDAY, DECEMBER 13, 1899.
THE COUNCIL AND THE PRELIMINARY
EXAMINATIONS.
The attitude of the General Medical Council
during the last two or three years in regard to the
proposal to raise the standard of preliminary ex¬
aminations had raised hopes on all hands that at last,
after many weary years of half-hearted tinkering,
we were within measurable distance of an improve¬
ment. Last session, the expediency of forthwith
substituting the senior or higher grade examinations
for the second and third-rate tests at present re-
oognised as sufficient for purposes of registration by
intending medical students, was referred to the
Education Committee, with instructions to enlist the
services of three experts in matters educational, and
to report to the Council thereon. Early last week the
anxiously expected Report was brought forward, but
the conclusions therein arrived at will assuredly dash
the hopes of all who take an interest in the problem
of raising the status of the profession by ensuring
that its members shall be persons of fair general
education. It is well-nigh incredible, but we are
assured on the authority of the three experts in
question that the substitution of the higher grade
examinations is at present impracticable “in view
of the present state of secondary education in this
country.” The Committee endorse this report, and
calmly ask the Council to acquiesce in conclusions
which, if accepted, must inevitably have for effect to
maintain the present miserably inadequate standard
for an indefinite, but certainly protracted, period.
Is education then at such a low ebb in this country
that schoolmasters cannot undertake to provide
their scholars with a standard of general education
superior to that exacted for the second class of the
College of Preceptors or the junior local examina¬
tions of Oxford and Cambridge P Why, this admis¬
sion justifies the harshest criticisms that have bean
passed on our national system of education by critics
at home and abroad. It amounts to a confession of
educational bankruptcy! From all corners of tbs
Council Board arose cries of astonishment, die-
appointment, and dismay; indeed, Sir Richard
Thome was not wide of the mark when he described
the report as “ staggering,” an adjective in the use
of which Mr. Victor Horsley concurred. The Report
gives no hint of the data on which these three
experts arrived at their lamentable conclusion, fortu¬
nately perhaps, because the Council was manifestly
unable to accept such far-reaching conclusions in
the absence of any justificatory information. Are
we then to consent to abandon for the present
idea of eliminating from the ranks of medical men
the flagrant examples of illiteracy to whose existence
attention has so often been called in connection with
the competitive examinations for appointments in
the Services, and also at the final examina¬
tions for diplomas? To deter the Council from
entering upon any experiment of the kind, the
experts threaten us with an immediate and consider¬
able reduction in the number of candidates for regis¬
tration, not perhaps an unmixed evil, even if their
Cassandra-like utterances were fulfilled. The matter
has been referred back to the Committee with instruc¬
tions to furnish the data on which these conclusions
were arrived at and to further consider the matter ae-
a whole. We trust that before it again comes before
them for discussion members of the Council will
pluck up courage to do their duty to the public and
to the profession in this matter ruat cslum.
THE HOUSING OF THE POOR.
There is no problem in the whole field of preven¬
tive medicine that demands more careful and
immediate solution than the housing of the poor in
our great cities. The rapid increase of population
and the exodus of labourers from country to town
has taxed existing urban dwelling space to its
utmost capacity. The natural result is overcrowdings
with all its attendant evils, a state of affairs that
demonstrates among other things the urgent need
of drastic land legislation. It has long been known
that the rate of mortality has a close relation to the
density of population, as shown by Dr. Ogle, when the-
number of persons to the square mile reaches or exoeeds
400. On the other hand Dr. Newsholme insists with great
reasonableness that the true density to be considered
is the number of persons per room. So far as London
is concerned it has been estimated upon the basis of
the last Census that considerably more than half a
million of the working classes, and about an eighth
of the whole population, live in one- and two-room,
i tenements, while the average occupiers per room i»
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Dae. 13 , 1899 _ LEADING
three. In the parish of St Pancraa it has been
-officially stated that upwards of 60.000 persons are
living more than two in a room. Bad as this state of
things undoubtedly is there can be no question that it
Is surpassed in many provincial towns especially in such
manufacturing districts a«. Lancashire and the Black
Country. The brunt of tb resulting mischief falls
upon the producers of the national wealth, and in
-this way undermines one of the chief foundations of
the prosperity of Great Britain. It may be argued
that the local authorities are armed with sufficient
means of coping with the evil, an assertion that goes
beyond the facts of the case. It is true that there are
considerable powers both as regards the control
of overcrowding and of providing fresh housing
accommodation. Against these potentialities, how¬
ever, must be placed practical drawbacks that
in no small measure render special legislative
powers abortive. For instance, if vestries were to
attempt to enforce the law against overcrowding,
they would simply turn into the street whole families
who would be unable to find other accommodation.
So too with closing orders against insanitary
property. Where the vestry does its duty as often
as not landlords leave the condemned property
alone and do not attempt to rebuild, because the
source of their profits lies in the overcrowding, and
the original tenant cannot afford to pay a high rent
unless he is able to rack-rent the sub-tenants at a
figure that can in turn be made up only by over¬
crowding. Indeed, with a knowledge -of the fact
that there is no accommodation available for
displaced inmates magistrates often refuse to make
-closing orders, that is to say, admittedly insanitary
premises are allowed to be crowded to excess in the
heart of the greatest and richest city in the world
and that, moreover, by express legal sanction and
in contravention to the written law. For all that
one cannot quarrel with the common sense humanity
that guides the action of the magistrates, it is rather
to the state of the law and the action of the local
authorities that one must look for future reforms.
As already said the laws relating to the tenure
and sale of land lie at the root of a great deal
of the evil. The want of cheap transit pre¬
vents the migration of workmen to outlying
districts where land is cheap. The London County
Council has the power of demolishing insanitary
areas and providing for the displaced population.
Unfortunately the new houseroom may be pitched in
any part of the metropolitan area, however distant
and there is no obligation to furnish interim accom¬
modation while the fresh buildings are being erected.
This difficulty, however, is only one of many that
beset the whole problem. For instance one of
the means by which vestries evade the regula¬
tion of houses let in lodgings is to fix a low
maximum price, which they are entitled to
do, at which control shall be exercised. Sup¬
posing half a crown be fixed as the limit then it is
clear that the majority of lodgings in that particular
district will be at once excluded. Then, again, a fact
that must be faced is the decrease in common
ARTICLES. _ Tmb Msdical Paisa. 621
lodging houses, and the rapid increase of ill-regulated
shelters, neither of which should be wanted to any
great extent were casual Poor-law relief administered
in a broad and liberal spirit. Another point is that
excessive hours of labour add to the pressure by
making residence on the spot a necessity. Coming
to remedies, the vestries should be urged to do their
duty in enforcing sanitary standards and in regulating
houses let in lodgings. Municipal bodiee should follow
theexample recently set by the London County Council
in closing unhealthy areas and b uildin g houses to
aooommodate the displaced population. A great
impetus might be given in that direction if the
Government would advance at a low rate of interest
and a long term of repayment the money necessary
for rehousing schemes. Nor can it be doubted that
the general education and enlightenment of the
people on these matters must precede any great
measure of reform. Lastly, the reconstruction of
the laws affecting land seem to be an imperative con¬
dition. Of anything like a thorough handling of this
question of the housing of the poor, and certainly not
the least important of the points that demand atten¬
tion in that quarter is the taxation of ground values.
THE LONDON COLLEGES AND THE
COUNCIL.
The uncompromising attitude of the London
Colleges in regard to the authority of the
General Medical Council to control the recognition
of schools and other teaching bodies by the
Colleges as suitable for imparting scientific teach¬
ing to intending medical students, gave rise last
week to an animated debate at the Council, in which
the representatives of the Colleges were obviously at
variance with the great majority of their colleagues.
It will be recollected that the London Colleges had,
for three years past, accepted us qualification for
their examinations courses of “ instruction ” in
physics, chemistry, and biology, delivered to school
boys in grammar schools and other non-medical
schools long before the boy became a medical
student, and they claimed that a year supposed to
have been occupied with such courses should be
accepted as one of the five years of medical study
enjoined by the Medical Council. That Council and
everyone outside these Colleges regard this
proceeding as a palpable attempt to evade
the regulations, and the Council has said so
in no uncertain terms; but it has been met by the
Colleges, not to say with hostility, but with truculence
and discourtesy. Their answer to the Council is that
they “ decline to recognise the requirement that
scientific iustitutions, where medical study is com¬
menced, should be approved by the Medical Council.”
This is an ultimatum which it is quite obvious the
Council cannot put up with, because it amounts
to a deliberate repudiation of its authority to
supervise study, not in these subjects alone,
but in any of the subjects of the curriculum.
, The ground taken by the Colleges in justification
of their refusal to admit the authority of the
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622 The Medical Pbess. NOTES ON CURRENT TOPICS. Dec. 13. 1899.
Council to intervene in this matter is based
on the fact that no clause in the Medical Act specifi¬
cally gives tbis power. If, however, the sciences are
admitted to form part of medical education the con¬
ditions under which they are taught must obviously
fall within the competence of the Council. It seems
absurd to pretend that the Council does not possess
the right to specify the conditions under which
they will recognise particular courses of study,
for, were it otherwise, the whole system of
examination would be reduced to a farce. It
is to be presumed that the Colleges have had good
legal advice before assuming this, but certainly, we
fail to find any legal justification for the position
which they have assumed. As to the power of the
Medical Council to define the sort of instruction
which it will recognise, the 4th Clause of the Medical
Act of 1886 says :—“ If at any time it appeal's to the
General Council that the standard of proficiency in
medicine, surgery, and midwifery, or in any oj those
subjects or any branch thereof, required from the
qualifying examinations held by any of the Bodies
. . . is insufficient, the Council may make a representa¬
tion to the Privy Council ichich . . . may by order
declare that the examinations of such Body shall not be
deemed qualifying examinations for the purpose of
registration. ' The only question which can be dis¬
cussed seems to be whether Chemistry, Physics, and
Biology form part of the subjects essential to com¬
petency in medicine, surgery, and midwifery. If notit
is competent for every licensing Body in the King¬
dom to wipe these subjects out of the curriculum,
and we have no doubt that they will do so. The
Council, however, possesses ample means of enforcing
\ts resolutions, and should the matter ultimately be
referred to the Privy Council there can be little doubt
as to the result. As, after all, the Colleges do not
stand to gain anything by protracting their obstinacy,
we may hope that wiser counsels will prevail, and
that they will avail themselves of the earliest oppor¬
tunity of abandoning an untenable position. They
may, perhaps, feel themselves strong in the
letter of the law, but it is manifest that they have no
support in public opinion considering that, in the
division which was taken on this Council, they scored
but one vote—that of the representative of the
London College of Physicians—against twenty-two
votes cast in support of the policy of the Council.
-+-
iiotee on <£umni topics.
A Magistrate upon Medical Certificates.
The Stipendiary of Cardiff, Mr. North, may be
congratulated upon having the courage of his
opinions so far as the value attachable to medical
certificates produced in defence of School Board
prosecutions for non-attendance. The exciting cause
of his remarks upon a recent occasion was the
putting in of an undated certificate stating that a
child who failed to attend the Llanwonno School
was suffering from bronchial catarrh. The magis¬
trate thereupon said that doctors’ certificates given I
in certain cases were simply waste paper. Without
a detailed knowledge of the facts it is impossible to-
form a sound opinion as to this extreme attitude r
but if it were dependent on the absence of a date
from the document, then we think the medical
man who signed it should .iave been afforded
a n opportunity of offering an explanation.
8 ome clue to the inwardness of the matter may per¬
haps be obtained from the request of the prosecution,
which asked his worship to say that certificates
delivered for the first time in Court should be taken
no notice of. If these certificates, it was urged, .vere
delivered at the schools or given to the attendance
officer they would receive due attention, and the
parents would not be summoned. There seems to be
reason in this view of the question. It will be well
for medical men to grant certificates only where a
case is absolutely above suspicion, and to refuse
altogether where the document is required simply to
spring in Court upon a prosecuting Board. Members
of the medical profession are apt to act from the-
heart rather than the head, but it would be a thousand
pities if from abuse of sheer good nature they were
to destroy or lessen the value of medical certificates
produced in Court for various purposes.
The Way the Juvenile Student Has.
Every one must thankfully acknowledge the great
improvement which the last quarter of a century has
witnessed in the demeanour of the student. Bob
Sawyer and Ben Allen, who were very trying realities
in the early fifties, have become extinct, and, as a
rule, students are now endowed with sufficient
intelligence and self-respect to feel that there
is no fun in making fools of themselves and
bringing their class into public contempt, although
even those who preside over them like to see
them good humoured and hilarious. We sug¬
gest that, as a reform in the conduct has been
voluntarily effected by the great majority of students,
it is time that the rowdy minority should be restrained
from making nuisances of themselves by disturbing
important public functions. We say unhesita¬
tingly that the system of converting such a
function into a disreputable bear garden is played
out and ought to be stopped by thoRe in authority
out of respect for their own offices and for the prestige
of the institutions over which they preside. The
idiotic pandemonium which marks the conferring of'
degrees in most places is confessedly a nuisance to
every one, so much so that many thinking people
stay away to avoid it, but it is tolerated as
many other abuses now departed were tolerated
because it is an old custom, a reason which in these
days has ceased to have any force. We urge that it
is a most distressing sight to see an honoured old
gentleman attempting to address such an assembly
while he is bombarded with peas and crackers, and
his voice drowned by the screeching rowdyism of a
number of the audience who can think nothing
interesting save their own inane jokes and howls.
These observations are evoked by the stupid and
annoying conduct of some of the students of tbo
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Dec. 13, 1899.
NOTES ON CURRENT TOPICS.
The Medical Press. 023
Queen's College, Cork, on the occasion of the recent
triennial visitation of Mr. Justice Holmes, Sir
Thornley Stoker, and Dr. Moore. We are told
that the baby-minded men students converted
the notice boards into banners, and, having prooured
a garden hose, saluted the President's residence,
where the visitors were lunching, with dis¬
charges of water. A hunt was then organised, a
stuffed tiger belonging to the natural history museum
being commandeered for the purpose, and during the
sport several botanical specimens were uprooted. An
empty prison van was next uttacked, overturned, and
the driver serionsly injured. In the evening these
students diversified the entertainment by getting up
a street riot in which they were compelled to fly
ignominiously before the incensed mob. We submit
that, if this sort of contemptible rowdyism cannot be
avoided, visitations and capping ceremonials should
be held in camera , or that only carefully selected
ticket-holders should be admitted thereto. Really it
is desirable that the feelings of the respectable people
amongst the audience on such occasion should be
consulted. .
^he Reciprocity Question.
With a dilatoriness to which the Council has
accustomed us the pressing question of recip¬
rocity of medical practice in regard to Italian
practitioners has again been postponed, under
the fallacious protest of ascertaining whether
the Italian Government contemplates any change in
existing arrangements as regards the practice of
medicine in Italy by British practitioners. In the
interest of the not inconsiderable number of
British practitioners in that country some
action on the part of the Council was im¬
peratively called for, but in deference to
the natural distaste for hypothetical foreign com¬
petition action has been postponed. This is the
more regrettable seeing that Italy is alone in accord¬
ing generous treatment to our fellow countrymen in
this respect, and the opportunity of cementing an
accord on this point may at any moment be lost.
We have no sympathy with those who, like Sir
Christopher Nixon, deprecate any alteration in exist¬
ing regulations “ for the convenience of foreigners."
He and they lose sight of the fact that reciprocity is
a measure which must always tell in favour of the
ubiquitous Englishman. We must deprecate also
the narrow-minded suggestion to introduce a clause
into the Medical Act to restrict foreign medical men
to practice among their own countrymen, a provi¬
sion which could not possibly work well and would
be virtually impossible to enforce.
American Army Surgeons’ Grievances.
The assistant surgeons of the United States army
who served during the war with Spain appear to
have some grouud for complaint as to their treat¬
ment by the Government At any rate, they have
called a mass meeting in New York for the purpose
of forming an organisation and of obtaining legisla¬
tion from Congress fixing their legal status as officers
of the army. It is claimed that the burden of the
medical and surgical work of the Spanish war fell
upon about a thousand acting assistant surgeons,
who were exposed to all the dangers of wounds and
disease incurred in that campaign. They were over¬
worked, and had only the shadow of rank and
authority, while a part of their already scanty pay
was withheld by the rulings of treasury officials.
The main ground of complaint, however, relates to
their present standing in the army. They say that
in accordance with an agreement made at the time
of their enlistment, the acting assistant surgeons
were t> have received the rank and pay of first lieu¬
tenants on the stafF when mustered out, but that this
has never been accorded to them, and their legal status
as officers in the army has, in consequence, been left
undetermined. At the forthcoming meeting it \»
proposed to ask of the legislature that each acting
assistant surgeon receive preference for appointment
over those who have not had previous service in the
medical corps of the army or navy or the marine
hospital corps. Without hearing the arguments on
both sides of the question it is impossible to form a
sound judgment, but it certainly appears that in the
present instance the United States Government have
not acted generously to the medical men who so
freely offered their services in time of need. Jealousy
of the medical branches of the military service is
not unknown in other countries, but it is to be hoped
that the United States will not allow her laurelstobe
smirched with black ingratitude to the men who did
their duty as heroically as any who graced the
annals of their country during the late war.
The London School Board and Underfed
Children.
Fok some time the London School Board have had
under discussion the subject of providing meals
for the young scholars, who are considered
to be underfed. The idea, of course, may be re¬
garded as excellent from a philanthropic point of
view, and upon this basis we should like to see it
accomplished But it is quite another matter to look
to the ratepayers for the means of carrying out the
scheme. This was entirely the view taken at the
last meeting of the Board, and it has now been
decided to reconsider the question for the pur¬
pose of seeing what can be done by voluntary
effort. Clearly, there would be great danger of abuse
if free meals for underfed children were promis¬
cuously provided by the ratepayers. Much as we
may sympathise with the poor little mortals who
have to work hard at school without having enough
to eat, we nevertheless think that it is not the duty
of the Boaid to deprive the parents of the responsi
bility of providing dinners for their offspring. With
free education and free dinners, generously afforded
by public money, poor parents at this rate will soon
be able to bate children who will cost them nothing.
On the other hand, we doubt whether any self-re¬
specting parent would permit a child of his to accept
a free meal; consequently the free meals would pro¬
bably be given to the children of parents who would
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624 The Medical Press.
NOTES ON CURRENT TOPICS.
Dec. 13, 1899
be only too glad of the opportunity of shirking their
parental duties. By this means worthlessness would
be encouraged, and a premium placed upon idleness.
More Influenza.
We learn with regret that there is every probability
of a renewal of the influenza outbreaks which for
years past have exacted a heavy toll from the
population of the United Kingdom. Numerous
reports of attacks in schools and elsewhere have
come to hand from both London and the provinces.
Fortunately, the epidemic seems to be, on the whole,
of a milder type than in former years. Although
influenza does not confer subsequent immunity from
the disease, it nevertheless seems to modify the
course of the malady in later attacks. It is difficult
to judge of the extent or severity of an epidemic of
this most subtle and infectious complaint from
mortality statistics, because many of the resulting
deaths are due to remote and indirect causes. From
a recently- issued bulletin of the Health Department
in Chicago, we learn that this pest of mankind has
been “ permanently domesticated ” since 1891. It is
to be feared that the epidemic wave of influenza has
not yet rolled away from our own country. Indeed,
in the face of the present somewhat alarming signs
of recrudescence, it has been suggested that the Home
Office should be asked to take into careful considera¬
tion the advisability of requesting the local authorities
throughout the country to add influenza, for the time
being, to the list of notifiable diseases.
The Decadence of the Army Medical
Service.
Last week Surgeon-General Hamilton, lately
P.M.O. for Cape Colony, gave, when distributing
prizes at the Volunteer Ambulance School, some in¬
structive facts as to the decadence of the Army
Medical Service. He said that when he entered the
Service forty years ago the total strength of medical
officers was considerably over 1,100. At present
the executive ranks barely numbered 800, a long way
short of the recognised establishment. During the
same period the European Army of England had
been increased by some 70,000 men, so that with this
large increase in strength we had 300 fewer officers
to do the work. Out of this number of 800 medical
officers there were 408 on ordinary foreign service,
240 in South Africa, and about 100 effective officers
in the United Kingdom. When the two further divi¬
sions now being mobilised were provided for, the Royal
Army Medical Corps would have closely approached
its vanishing point in the United Kingdom. It bad
been already found necessary to supplement the
medical staff in South Africa by 70 civil surgeons,
and he believed all, or nearly all, of the available
retired pay officers had been called back to duty.
It was quite evident there was no lack of military
ardour among the members of the medical profession
as was proved by the fact that seventy civil surgeons
were now serving with our troops in the field, but it
was equally evident that the Royal Army Medical
Corps was not popular in the medical schools This
falling off in the strength of one of the most
important departments of the military service of the
nation is, obviously, due to the policy of “ snub ”
adopted by the “ my military advisers ” towards the
medical officers. Surgeon-General Hamilton said
that there was satisfactory proof that everything that
was possible was done in South Africa for the care
of the sick and wounded, the medical staff working
most heroically in the field under the greatest
difficulties. Sir George White had spoken most
kindly and sympathetically of the labour of medical
officers in the late Frontier War in India, and said
he had seen reason to recommend more of the
medical officers for the Victoria Cross than all other
branches of the Service put together. This gallant
officer’s recommendations, Surgeon-General Hamilton
observed, were set aside by those in power in our War
Office, and the many acts of valour performed by
medical officers in that campaign had gone un¬
rewarded.
The Surgeoncy to the City of Dublin
Hospital.
The succession to the surgeoncy of this hospital,
vacated by the death of Mr. W. Wheeler, is the
subject of speculation among Dublin hospital
surgeons. It is rumoured that three former house
surgeons of the hospital will be candidates, besides
others, and that there is also a proposition to appoint
an assistant surgeon, either in addition to or in sub¬
stitution, temporarily, for the surgeon. As we have
always been strongly in favour of the system of
promotion from the ranks in hospital appointments,
we think that the candidate who had served the
hospital in the minor capacity should have a prior
claim to the higher position, if Mb record, in the
minor rank, has been good, and we strongly object
to the pitchforking of any untried competitor into
the responsible charge of cases and the performance
of operations. PerhapB it may occur to the adminis¬
tration of the institution that the sick poor who enter
the hospital ought to be thought of when a prac¬
titioner competent to treat them is for selection.
The Harvest of the War.
The first arrival of sick and wounded from
the seat of war by the Sumatra last week in
eluded two wounded officers and 126 invalided
men, who were mostly the victims of some tropical
disease, such as dysentery and malaria. But light in
casualties as this preliminary batch is, we, neverthe¬
less, shall have to be prepared for some very heavy
consignments of wounded men later on. The Boer
marksmen have not come up to the standard expected
of them, so far as the accuracy of rifle fire is con¬
cerned, otherwise it is certain that the casualty lists
for the various engagements already fought would
have been greater on our side than they have proved
to be. From all accounts,'.however, there seems to be
every probability that the war will yield an enormous
total of wounded soldiers which will tax the
resources of the hospital accommodation in South
Africa to the fullest extent. Hence, no
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NOTES ON CURRENT TOPICS.
The Medical Press. 625
doubt the authorities will endeavour to help
lessen the pressure on the beds by regularly
transferring as many of the wounded as possible to
this country. Of the two wounded officers already
referred to, one was injured in the head by the burst¬
ing of a Boer shell early in the battle of Elands-
laagte, and the other was suffering from an injury
to the right arm caused by a Mauser bullet. The
latter case will presumably require some surgical
treatment inasmuch as very acute suffering, showing
some nerve lesion, is still being experienced by the
officer.
Senile Parotitis.
It is said by some antbors of text-books on medi¬
cine that parotitis in old persons may occur, but it so
happens that medical literature contains the records
of only one case, referred to by Pepper. Another
case, however, has just been published by Walcott in
the American Journal of the Medical Sciences. The
patient was a retired practitioner, aged ninety years
and a-half, and the attack began to develop one
day after he had been working in hu garden.
The right parotid became rapidly swollen,
and exceedingly painful. The swelling ultimately
extended to such a degree that the right ear was
completely closed, and the ear occupied the centre of
the inflammatory enlargement. Despite active treat¬
ment delirium supervened; tbe heart also began to fail,
and on the fourth day of the commencement of the
attack the old patient died. The fatal termination in
this case is significant when compared with the other
recorded case, which also proved fatal, in an old lady
of eighty-four. The typical signs of parotitis were
present in both, and there seemed to be no grounds
for doubting the correctness of the diagnosis. It is,
however, impossible to believe that cases of tbe disease,
other than these two, have not been met with.
Rare in old age as the affection undoubtedly is, it
must nevertheless be true that tbe disease has
occurred upon former occasions, but without the
cases having been placed on record.
Unsound Fruit Prosecutions.
The seizure last summer of large quantities of
fruit at certain South London jam factories always
seemed more or less a counsel of perfection. From
what we know of the process of manufacture of the
wholesome edible concerned it may fairly he pre¬
sumed that sterilisation of all harmful microbial life
is connoted. That view of the case, however, did not
commend itself to the prosecuting sanitary
authorities, and to the magistrate and the judge who
tried the case. The sequel to the heavy penalties
then exacted has come in further legal proceedings
against the Covent Garden merchants who consigned
the fruit in the first place in an unsound state to the
jam factories. The practical outcome of these
prosecutions has been to place a serious check on a
large and flourishing branch of local industry,
while, on the other hand, it is doubtful
if the public is a penny the better off.
Tbe zeal of tbe sanitary inspectors and of the Medical
^Officers of Health, who are nominally in charge of
these matters would be more wisely directed, in our
opinion, against the thousand and one adulterations
that cheat the pockets and undermine the health of
the community on all hands. Yet the prosecutions
for this class of offence are ludicrously inadequate.
The very terms of appointment of the public analysts,
as we have recently pointed out, in many cases
emphasise the act that any extensive analysis of food
and other adulterations was never contemplated by
the appointing authorities. Otherwise no sane
vestiy would hand over this exacting work to a man
who held similar posts in connection with, perhaps,
two or three civilian and half-a-dozen distant county
districts. Where are the Home Office and the Local
Government Board, who share the responsibility of
the present arrangement ?
School-Life and Constipation.
The want of consideration shown by careless and
bashful schoolmastere and mistresses to the physical
needs of their scholars is doubtless responsible for
the constipation which, we are assured, is so pre¬
valent in schools. No special measures are taken to
ensure attention to these fundamental details of life,
the closets are for the most part cold and decidedly
uncomfortable, and every difficulty is plaoed in the
way of scholars who experience a desire during the pro¬
gress of the lessons. A French practitioner, Dr.
Gripat, recently published an article insisting on the
necessity for greater attention on the part of those
who have charge of young persons in this respect, and
he goes so far as to suggest that a reeister should be
kept, in which every scholar would be constrained to
record the working of his economy. Certainly a
little systematic drilling would greatly tend to
regularity of the intestinal functions, and much
time would be saved by accustoming children to
avail themselves of the intervals between lessons,
instead of waiting until class time for the need to
become imperative. It is obviously as important,
from the point of view of scholastic hygiene, to ascer¬
tain the integrity of these functions as to examine the
throat or the eyes, for unless these functions are
regularly and adequately discharged, tbe capacity of
the student to profit by the teaching must be greatly
impaired.
Medical Practitioners in Japan.
It seems almost inconceivable that a dearth of
medical men should exist in any pai*t of the world
save in parts far removed from civilisation. But
the curious fact is that in Japan the number
of medical men available for the population is
far below the requirements. In discussing this matter
the last issue of the Sei-i-Kwai Medical Journal
remarks as follows :—“ At a time when the numerical
insufficiency of medical practitioners haB become a
chronic complaint in this country it is gratifying to
find that their number has been appreciably
on the increase during tbe past few years.” Tbe
journal in question, however, subsequently shows
that the returns for the last five years only show an
average annual increase of 50 qualified men. It
seems remarkable that more young men are not
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626 The Medical Pbks8. NOTES ON CURRENT TOPICS. Dec. 13, 1899.
induoed to join the medical profession in Japan.
The question of any natural incapacity for the work
cannot be one which acts as a deterring element, for
Japanese medical students are by no means unknown
in the British medical schools, and it is also tolerably
well known that some of these students hare dis¬
played more or less brilliancy in their work. How
is it, then, that Japan suffers from a dearth of
medical men ?
Unqualified Dispensers.
As we foretold, the Council have not thought fit
to take any action in regard to the employment of
unqualified dispensers by medical practitioners. The
special committee appointed to investigate the matter
simply endorse the reply already forwarded to the
Privy Council by the Executive Committee, thereby
intimating that they do not consider the subject to
be one calling for any special action. The
question is one of far-reaching import&noe, but
we can quite understand the reluctance of
the Council to intervene, unless constrained
thereto. The whole fabric of medical practice is
based on the employment of unqualified dispensers,
and any modification of existing arrangements
would entail what would almost amount to a dis¬
location. We doubt whether public opinion is, as
yet, sufficiently alive to the drawbacks of the present
system to insist on a change. The bogey of acci¬
dental poisoning, trotted out by pharmaceutical
agitators for trade purposes, has not had the desired
effeot, and, as far as one can judge, practitioners are
not likely to be molested in this respect for some
time to come.
“One Man—One Billet.”
Under this heading the Australasian Medical
Gazette offers some remarks in its October issue
respecting some recent appointments conferred upon
Dr. Leith Napier, who was at one time well-known in
gynaecological circles here. The South Australian
Government, in addition to the posts already held
by Dr. Napier, have just appointed him Assistant
Colonial Surgeon, and Senior Assistant Medica*
Officer at the Adelaide Lunatic Asylum, and have
also made him a member of the South Australian
Medical Board. These additional marks of favour
seem to have caused some resentment in the Colony,
which our contemporary takes upon itself to voice.
But it is only natural that the Government should
avail itself of opportunities to show its appre¬
ciation of the services which Dr. Napier at one time
rendered it; and if he is now a pluralist, it is not
improbable that a good many of his profession in the
Colony would only be too glad to be in his shoes.
The Branch Councils.
Unless the Branch Councils are to become inani¬
mate bodies it is evident that steps must be taken to
rehabilitate their financial position, a contingency
which has never been favourably entertained by the
General Council. The matter, however, is forcing
itself on their attention, and a slight step in the
direction of redistribution has just been taken by
referring the matter to a committee for future report
No good can come of taking further legal opinion
thereupon. The Council must by this time be per¬
fectly cognisant of the situation, and it only remains
for them to agree to proceed to draw up a plan pro¬
viding funds for transacting business in the two
departments of the kingdom, in which the Branch-
Councils are specially afflicted by impeounioeity.
The Plague in England.
The introduction of the plague into Great
Britain dates from medieval times, and it was most
likely identical with the terrible scourge known as the
“ Black death.” It was epidemic in this country for
centuries until its last great outburst in 1665, after
which it retreated to the European continent, where
it lingered fitfully in certain countries until 1841. In
Asia it has always been endemic with constantly
recurring epidemic outbreaks. The mortality from
plague in the 17th oentury was terrible, as shown by
following figures
of mortality:—
taken from
the London bills
Plague deaths—Total.
Deaths per 1,000*
from all cauese.
1603
... 30,561
. 819
1625
... 35,417
. 652
1636
... 10,400
. 445
1665
... 68,596
. 705
The cessation of the scourge in England was no doubt-
due almost entirely to the disinfection of the chief
centre of population by the Great Fire of London. The-
march of science, however, has made it practically
impossible for the plague to get a foothold in any
country that maintains a decent average of general
sanitation. The increase of knowledge regarding its
etiology has been well expressed by an authority upon,
these matters, Dr. Newsholme, who says: “ Plague
is an infectious filth disease, fostered by destitution r
overcrowding and lack of ventilation, and due to a
bacillus which lives in the soil, and attacks lower
animals; mortality in rats has been often observed,
before outbreaks.” In the disappearance of plague
we find an object-lesson of what will one day occur
with all infectious diseases. Nothing in that direc¬
tion is impossible to the energy and resource of
modem prevention.
A Medical School for Assam.
By his will the late Brigade-Surgeon John Berry
White left 50,000 rupees for establishing a medical
school for the Assamese students. It- is expected that
the school will be opened in June next.
Preservatives in Pood.
It will be observed that almost all the evidence
given before the Departmental Committee on food
preservatives turns upon the fact that boric or
salicylic acids or other similar preservatives are
present in most of the preserved foods which the
public consume. The sophistication is now confessed,
but it does not seem to us that it touches the real
question, which is whether these preservatives are
present in any quantity sufficient to injure the health
of anyone who consumes a leasonable amount of
the food. We should like to know how many pounds
of butter, or gallons of milk, or hams it would be
necessary to consume if one wanted an injurious dose
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Dec. 13, 1890. MEDICA L SOCIETY OF LONDO N. Tun Medical Pbbss. 627
of any of these preservatives. It is a very “ white j to study the question of the prevention of malaria. They
lie ” to say that a food is not adulterated if it work under the auspioes of the Liverpool School for
contains no more than a homoeopathic dose of Tropical Diseases.
an almost inert preservative.
Prom Sewage to Peppermint.
The cultivation of peppermint on sewage farms
seems to be a profitable undertaking, as proved by the
experience of the Sutton Urban District Council-
Nothing, however, could more eloquently—or satisfac¬
torily—show the marvellous concatenation of changes
which Nature can effect, that that by means of foul
smelling sewage, an odorous product can be evolved
which enjoys several spheres of popularity. The
authority above mentioned, will by next year have
six acres of their sewage farm under peppermint
cultivation.
Inebriate Asylums.
Foe the present it appears that the provision of
asylums under the Inebriate Act of last year must
devolve upon the wealthy English communities, and
we observe with satisfacfion that the London County
Council has appointed a special committee to organise
the system. In Ireland, as yet, there is but one such
asylum, situated at Ennis, and to it there is no
admission save for a criminal sent in by the magis.
trates. Everything must have a beginning, and we
expect that these beginnings will eventuate in the
general adoption of the principle of the Act and its
system.
War Supplies.
Some idea of the vast proportions of the supplies
required by the War Department for a campaign like
the present may be judged from the fact that it has
provided on the basis of a four months’ campaign for
6,000 lbs. of carbolic powder, 20 tons of chloride of
lime, 10,000 gallons of Izal, and 10 tons of Macdougal’s
disinfecting powder.
The treasurers of the Middlesex Hospital have
received £100 from “ Research ” in response to their
appeal for the establishment and maintenance of the
New Cancer Research and Laboratories, recently
instituted for the investigation of the cause of cancer.
PERSONAL.
V iscocnt Pobtman has contributed a further donation
•f .£ 1,000 in aid of the building fund of Queen Charlotte’s
Lying-in Hospital.
The Eabl of Lbicbstbb, President of the Norfolk and
Norwich Hospital, has promised a further sum of
jE 10,000 in aid of the funds of the institution, making in
all .815,000.
Thk Council of King's College, London, have appointed
Professor N. J. C. Tirard, M.D., to the Chair of Medicine
vacant by the resignation of Professor J. Burney Yeo,
M.D.; and Dr. W. A. Turner to be an Assistant Phy¬
sician at King’s College Hospital.
Da. Christopher, accompanied by Dr. Stephens and
Mr. A. Pichels, having been selected by the Royal Society,
have left by the s.s. Bakana for the West Coast of Africa
j Mb. J. 8. Wood, formerly Secretary to the Chelsea
I Hospital for Women, has given a donation of .£100 to
name a bed “ In Memoriam,” and the council, being in
' urgent need of funds, suggest the naming of beds in
memory of those who have fallen in battle in South
Africa.
A correspondent informs us that Dr. C. A. Stark,
who was recently killed at Ladysmith by a Boer shell,
was a graduate of Edinburgh University, and had been
in practice at Cape Town for the last twelve years. On
the outbreak of the war he at once volunteered for
medical service, and was among the last batch of officers
to enter Ladysmith before the investment.
Dr. Morgan Dockbell was last week presented with
a service of silver plate and an illuminated address,
which had been subscribed for by a large number of
medical men in recognition of his action in the Law
Courts to prevent the unauthorised use of his name in
advertisements, and as a solatium in the heavy expense
incurred in connection therewith, as recently set forth
in these columns.
In addition to Mr. Arthur Chance, whose candidature
for the seat on the Council of the Royal College of
Surgeons, Ireland, vacant by the death of the late Mr.
Wheeler we announced last week, Mr. Charles Bent
Ball, Regius Professor of Surgery in the University of
Dublin and Surgeon to Sir Patrick Dun’s Hospital has
offered himslf to the Fellows as a competitor. Mr. Ball
has served reoently as a Councillor, and retired from that
position in order to seek the Vice-Presidency of the
College.
MEDICAL SOCIETY OF LONDON.
At the meeting on Monday evening last, Dr. Rolles-
ton and Mr. Turner contributed notes of two cases of
ascites due to hepatic cirrhosis treated by the artificial
production of peritoneal adhesions, a method introduced
by Dr. Drummond and Mr. Morison, of Newcastle.
| Case 1. A man, aged 52, had been twice tapped for
ascites. The abdomen was opened in the right semi¬
lunar line, and the opposing surfaces of the cirrhotic
liver and the diaphragm rubbed and scratched, the liver
being then fixed by a kangaroo tendon to the abdominal
wall. The patient recovered from the operation but no
improvement followed. Case 2 was that of aman of 45, who
suffered from hsematemesis with ascites and oedema of
legs. The liver was exposed by a 5 inch incision parallel
to, and 1 inch below, the right costal margin, the surface
was set aped and the omentum was brought up between
the diaphragm and the convexity of the liver, and fixed
in position by a kangaroo tendon iucluding the edge of
the liver, the omentum, and the parietal peritoneum.
This patient steadily improved and had had no further
ascites. The author pointed out that the benefit of the
operation was not due merely to reducing the portal blood
pressure by opening up a collateral circulation (for this,
if carried to its logical extreme, led to an ura?mic state),
but to an improved blood supply to the liver via the
adhesions.
Dr. Weber thought a high specific gravity of the fluid
might indicate the presence of inflammation, in which
case tapping might effect a cure.
Dr. F. J Smith advocated laparotomy in place of the
ordinary brutal paracentesis. He mentioned two cases
in which the fluid was blood-stained and asked what
this might mean.
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628 The Medical Press.
CORRESPONDENCE.
Die. 13, 1899.
Mr. Bidwell mentioned two unsuccessful cases of
operation for oirrhotio ascites, and Mr. Wallis mentioned
a case of enormous ascitee in which permanent relief had
followed several tappings.
Dr. Ewart said they required to know how to tell
beforehand whether the case was one of cirrhosis or not,
and mentioned a case of ascites supposed to be cirrhotic
which proved to be due to calcified pericardium.
Mr. John D, Maloom read notes of “Fifty Successful
Consecutive Cases of Ovariotomy, recorded three years
after the operation.” He commented on the difficulty of com¬
paring statistics, 25 of his patients were in almost perfect
health, 7 could not be traced, 7 others had little to com¬
plain of, and three were dead. He urged that an early
operation should be performed whenever possible, delay
not being justified by present good health of the
patient. He attributed most of his fatal results directly
to delay in operating.
(lomsponbcncc.
We do not hold ourselves responsible for the opinions of our
correspondents.
MR. BRUDENELL CARTER—AN EXPLANATION.
To the Editor of The Midical Press and Circular.
Sir,— I find certain statements in your journal of the
6th inst, the correctness of which I am compelled
to question, and which are made with reference to
a speech which I addressed to the Medical Council on
November 28th. You say I complained of the “ medical
journals ” for habitually suppressing replies to speeches
adverse to me, and you deny the justice of this reproach
as applied to yourself. If you will refer to the Lancet
report of my speech, in the number for December 2nd,
page 1,661, at the foot of the first column, you will
find that charge did not extend to you. You say also
that I did not" succeed in explaining away my behaviour
in respect of the prosecution of the late Mr. Hunter, and
that if I were really unaware of the fact that Mr. Hunter
was a licentiate of the 8ociety of Apothecaries that was
a serious piece of negligenoe on my part.” If you will
refer to the Lancet report, in the upper portion of the
column already reported, you will see that I made no
attempt to “ explain away my behaviour,” in relation
either to the Hunter case or to anything else. You will
also see that everybody concerned was perfectly
aware that Mr. Hunter was a registered medical
practitioner, and that proceedings against him
were recommended by the Penal Cases Com¬
mittee on the ground that, being a registered medical
practitioner, he had nevertheless used titles which he
did not possess in any registrable form. He asserted
his right to use these titles (those of Doctor and
M.D ), and expressed his readiness to "fight to the
and” in defence of his claim. The proceedings were
recommended by the committee for the purpose of
determining an unsettled legal question, and of deter¬
mining it in the case of a defendant who expressed
his readiness to fight. The question was, whether a
registered practitioner who, in addition to his registrable
and registered qualifications, possessed another which
was not registrable, was entitled to use the latter as
part of his ordinary professional designation. The
recommendation of the committee to the Council was
that this question should be settled by legal proceed¬
ings. If any members of the Council did not know that
Mr. Hunter was qualified and registered, such want of
knowledge was not the fault of the Committee, and
might, perhpas, not unfairly be described as “ a serious
piece of negligence,” with regard to business the precise
nature of which was clearly stated. I presume it will
hardly be contended that, if a practitioner commits an
act of doubtful legality, it becomes the business of the
representative, in the Council, of the body from which
his qualifications are derived, to endeavour to prevent
the doubt from being cleared up. That the proceedings
ultimately took a form not anticipated either by the
Committee which recommended them, or by the Council
which ordered them, was a highly unfortunate occur¬
rence j but it was brought about by the fact that the
legal advisers of the Council acted upon a view of their
instructions, which the Council itself, or at least which
I, as an individual member of it, had not so much as
contemplated.
I am, Sir, yours truly,
R. Brudbnell Carter.
31, Harley Street, W.,
Dec. 9th. 1899.
THE SOCIETY OF APOTHECARIES OF LONDON
To the Editor of The Medical Press and Circular.
Sir,—I was amused to read the report in your
columns of what occurred at the recent meeting of the
General Medical Council, when Mr. Brudenell Carter
and Mr. Victor Horsley were allowed to be heard.
It did not certainly appear very oreditable to Mr.
Horsley to be called to aocount for speaking of the
8onety of Apothcaries in public in the way he had done,
apparently assuming without inquiry that his damaging
statements were facte instead of the fallacies which he
subsequently was compelled to admit them to be. But
now it is evident there is great need for the three great
societies which control the licenses of medicine and
surgery in London, to work in greater harmony than
they have done for some time past In a recent article
you drew attention to the difference between the
Conjoint and the L.S.A. examinations and licences; and
I think that in the interests of our profession, our
students, and the public such rather discreditable
controversies as occurred at the Medical Council should
not be encouraged. It brings the medical profession
into public discredit when such displays occur, and the
impression is produoed that there is a great need of
reform in medicine, as in some other lines of professional
life and business.
I am Sir, yours truly,
F.R.C.P.
INCONSISTENCIES.
To the Editor of Thu Medical Press and Circular.
Sir, —A large number of persons (call them “ bene¬
volent old parsons and impressible old ladies” if you
think it accurately describes our great society) have
united themselves together to oppose what we consider
the cruelties practised in physiological laboratories.
This is a very clearly defined object—in no sense
necessarily involving the work of protecting animals
from ordinary forms of cruelty such as those of
sport or of the cattle-trade. The excellent and power¬
ful Royal Society for the Prevention of Cruelty to
Animals occupies itself with oases of ordinary cruelty.
It was felt that a special organisation was needed
to deal with vivisection, because of the many technical
matters involved, but it is no more the office of our society
to deal with such questions as thoee with which the RoyaJ
Society for the Prevention of Cruelty to Animals con¬
cerns itself than it is the duty of the War Office to
interfere with the adulteration of milk of the spread of
ritualism in our churches. As a fact, a great number of
our subscribers are individually supporters of the Royal
8ociety for the Prevention of Cruelty to Animals, the
8ociety for Prevention of Cruelty to Children, and tee
like. Your correspondent, “Mawworm," says we devote
ourselves to “ mendacious attacks on the medical pro¬
fession for putting a hypodermic injection under the
Bkin of a frog.” Does he really believe that such an
agitation as that of the Anti-vivisection Movement could
be maintained in this country, America, and Germany
on the strength of hypodermic injections on frogs P Has
he read Dr. Crill’s “ Surgical Shock,” or even studied the
“Journal of Physiology”? That physiologists have
done very cruel things in this country was proved by
tbe Royal Commission, that they do very cruel things
in Continental laboratories now is not, so far as I am
aware, disputed by English physiologists. The question
at issue is, does the Yiviseotion Act of 1876 adequately
protect tbe animals ? In a debate on the subject at
University College, London, in which I had the honour
to take part recently an opponent, said, “ I concede yon
) V Google
Dec. 13, 1699
LITERATURE.
The Medical Pbiss. 629
(Dbttuarg.
■even-eighths of jour case,” that ia to say, the pain
inrolved, the paucity of results to practical medicine, Ac.,
“ and I take my stand on the ground that what is useful
to science is moral." This is the dignified attitude of
a competent judge of our question. It is too late in the
day to treat us either with ridicule or disoourtesy.
I am, Sir, yours truly,
Edward Bkbdoe, L.R.C.P.Ed., M.R.C.8.
December 1st, 1899.
To the Editor of Tra Medical Press and Cxhculab.
Sir,—I am a strong anti-viTiaectionist, but I am not
averse to “ Maw worm ’’ pointing out that all those who
object to torturing, in the alleged interests of science,
should openly and uncompromisingly denounce the
cowardly ciuelties practised by sportsmen. Last
Friday, for instance, the Queen’s Hunt turned out a
tame deer at New Lodge, Winkfield, and more than a
thousand people graced the function. This wretched
animal was harried about the country till it actually
fell and died by the bank of Silwood Park Lake,
SunninghilJ, as soon as it got into the water. Such were
its exhaustion and terror.
This sport-torture is infamous, and every anti-
vivisectionist is bound by logic and common sense to
denounce it. I don’t know whether I am Dr. Berdoe’s
“ obscure clergyman in an obscure parish ”; but, if so,
I would ask him not to trouble about my obscurity, but
to give heed to in) facts.
I am, Sir, yours truly,
Wokingham, Dec. 1. J. Stratton.
OPERATIONS AT THE CANCER HOSPITAL.
To the Editor of The Medical Press and Circular.
Sir, —I quite admit that Dr. Herbert Snow has the
best of the argument if it is a fact that the Cancer
Hospital, founded by Marsden, is a general hospital. I
confess 1 did not look up the report, but I have repeatedly
seen appeals in the public Press, and to the public it
was never, so far as I can remember, held out as a
general hospital The two cases that I mentioned
could not by any possibility be classed as cancerous, and it
is a revelation that the sequela; of a neglected mis¬
carriage should be treated at this hospital, as that
could not possibly come under the class of “cancer,
tumour, or allied disease.”
Having lived in this neighbourhood for nearly twenty
years I am not ignorant of the ways of this special hospital,
and I have, I confess, frequently taken advantage of
its lax methods to send a patient for operation who had
nothing cancerous the matter. To this extent the
hospital has been a boon, but, on the other hand, the out¬
patient department has treated cases of syphilitic ulcer
and other similar diseases in persons who could quite
well pay the small charge of a general practitioner.
It is to the credit of tne Cancer Hospital that it is free,
and therefore does not compete with outside practi¬
tioners.
Dr. Snow’s remarks abou‘ the Brompton Hospital are
founded on ignorance. The Brompton Hospital is, as it
always represented, viz., for consumption and diseases of
the chest, and therefore it is quite legitimate in treating
heart disease, although to my knowledge it also treats
cases of dyspepsia. If we are to have special hospitals,
and a great majority of the profession think both the
profession and the public would be much better without
them, they should stick to their specialty, and decline to
treat others.
I am Sir, yours truly,
J. Hamilton, M.D.
6, Sydney Street, Chelsea, S.W.
Dec. 11th, 1899.
Pharmacy m the Isle of Man.
The Manx Legislature has passed a Pharmacy Act
analogous to the Acte of England and Ireland. The new
departure is remarkable in one respect, ».<■., that it for¬
bids unqualified assistants to compound even in associa¬
tion with medical practitioners. Every person to
employed must either possess a recognised pharmaceutic
qualification or a certificate of apprenticeship to an
apothecary or a chemist.
MR. EDWARD HAMILTON, OF DUBLIN.
We report with great regret the death, on the 7th
inst., of this well known and much respected member of
the surgical profession in Ireland, at his residence in
Stephen's Green, Dublin. At his death he was surgeon
to Steven’s Hospital and surgeon to the Lord Lieutenant
and the Viceregal Court, and held many other positions
of emolument and dignity. He was born in 1824, the
son of Mr. William Cope Hamilton, who was well known
to the profession a few years afterwards as medical
attendant on the cholera hospital in Dublin. Mr.
Edward Hamilton graduated in Dublin University as
B A. in 1845, and took his degree in medicine in the
following year. His studies were pursued chiefly in the
School of Physic, and in Dun’s and Mercer’s Hospitals,
and, in succession, he took the Letters Testimonial of the
College of 8urgeons in 1846, its Fellowship in 1852, and
the M.D. of his University in 1860. Finally he became
President of his College in 1875, and again in 1892, and
again in 1893, thus achieving the very unusual honour
of a thrice repeated Presidency. He was elected
as the Professor of Surgery in the College in 18M4.
He also occupied the Presidency of the Irish Medical
Association and of the Dublin Branch of the British
Medical Association. The public and the profession in
Dublin had experience for nearly half-a-century of Mr.
Hamilton’s qualities, his capacity as a practitioner and
as a teacher, and hie character as a man, and we believe
we can say with truth that no gentleman was more
universally respected and esteemed than he was by hie
professional colleagues and his fellow citizens. He was
a most conscientious and careful medical adviser, an
upright citizen, and a kindly and genial friend, and has
left behind him “ troops of friends” to mourn his loss
His College has not been slow to record its deep regret
for his departure, for its Council adopted unanimously
on Thursday last a resolution of profound sympathy
with his family and, out of respect for his memory,
adjourned forthwith without transacting business.
ICiterature.
NEALE’S MEDICAL DIGEST, (a)
Since 1877, when the New Sydenham Society published
Dr. Neale’s great work, we have kept the “ Medical
Digest ” on our study table as the most trustworthy book
we possess. There is an idea among those not familiar
with the book that it is oimply an index of the principal
British medical journals for the past fifty years. But
this does not do anything like justice to the author;
besides being an index for fifty and two years, it affords
a means of ready information regarding such dis¬
coveries, new doctrines, and different methods of treat¬
ment in each department of medical science as are likely
to be of interest to the practitioner. Its pages mark the
steady progress of scientific medicine for over half a
century.
Should the practitioner desire to know the therapeusis
of any disease as practised to-day or in the past, a
reference to the proper section and every shade of
medical thought on the subject is displayed to him.
To the medical practitioner who has been wise enough
to bind his medical periodicals the book is invaluable;
it directs him to the very page where the information
sought is to be obtained. For the many who do not
keep their medical journals the “ Medical Digest ” pos¬
sesses the great value of an exhaustive year-book in
which no medical subject is overlooked, no treatment un¬
recorded, no unforeseen result unnoticed. Its 250,000
references give the pith of the British medical journals
tabulated with the utmost care; easy of reference, rich
in information, and always trustworthy.
To review such a work is a pleasure, and it is even
(a) “ The Medicnl Digest; or, Busy Practitioner’s Vade-Mecum
to the Principal Contribution* to Medical 8cience during t*-e last
Fifty Years.’’ By Richard Neale M.D Lond. Third Edition.
■ With an Appendix including the years 1891 to March, 189®. London:
' Ledger Smith and Co. 1898.
Digitized by vjOO^ 1C
630 Thb Medical Paxst
MEDICAL NEWS.
Dk. 13, 1899.
more so to see that the medical profession appreciate
Dr. Neale's indefatigable industry and neat intellectual
ability in his herculean task of classifying, arranging,
and editing his “ Medical Digest."
CHEYNE AND BURGHARD’S SURGICAL
TREATMENT, (a)
The first volume of this work to be issued in six parts,
has been in circulation for some months. It embraces
the treatment of general surgical diseases, including
inflammation, suppuration, ulceration, gangrene, wounds
and their complications, infective diseases, tumours and
the administration of anaesthetics.
Our acquaintance with the previous writings of Mr.
W. Watson Cheyne on surgical subjects has led us to
anticipate a high degree of merit in the volume before
us, and having given it a careful perusal we can
confidently state that our expectations have been fully
realised. It will, we think, be freely acknowledged that
a work of this class has been badly wanted for
some time, and especially by the younger
practitioners whose necessarily limited experience
has in many instances rendered it particularly difficult
for them to select appropriate treatment out of the
long and often bewildering methods recommended in
many of the standard text-books. The book is well
written, clear and concise, and the rules for treatment
recommended are fully in accord with the present state
of our surgical knowledge. We congratulate the
authors upon the high degree of excellence reached in
this, the first volume of the work, and we look forward
the pleasure to the parts which are to follow.
TWENTIETH CENTURY PRACTICE. (J)
The present splendid instalment of the *• Twentieth
-Century Practice ” contains ten articles by a correspond¬
ing number of contributors:—“ Lobar Pneumonia,” by
Andrew H. Smith, of New York; “Cerebro-spinal
Meningitis,” by Professor A. Netter, of Paris; “ Dyseu-
try,” by Professor A. A. de Azevedo Sodrd, of Rio de
Janeiro; “ Yaws,” by H. A. Alford Nicholls, of Dominica;
“ Inflammation ” by Professor Ernst Ziegler, of Freiburg;
“ Erysipelas,” by Otto G. T. Kiliani, of New York;
" Simple Continued Fever,” by Professor Landon B.
Edwards, of Richmond (Va.); “Relapsing Fever,” by
Professor Leo Popoff, of St. Petersburg, “ Typhoid
Fever (Etiology and General Pathology),” by John S.
Thacker, of New York ; and “ Typhoid Fever (Symptom¬
atology and Treatment),” by John Winters Brannan, of
New York.
The contents of this excellent volume are well qualified
to maintain the high reputation of its predecessors. The
first article—that on “ Lobar Pneumonia,” by Dr. Andrew
H. Smith of New York—occupies 139 pages. It deals
most thoroughly with its important subject, both
clinically and therapeutically. The writers clinical
acumen is peculiarly well illustrated on page 23. " In
pneumonia it is often difficult to auscultate the posterior
portion of the chest. To turn the patient so as to bring
the affected side uppermost, will frequently cause
extreme respiratory distress ; and with a weak heart it
is not wise to raise him into a sitting posture. To
meet this difficulty, I have devised a stethoscope that, by
pressing down the mattress with the left hand, can be
slipped under the patient on the fingers of the right.
The cup of the stethoscope is flat and shallow, in shape
like the cover of a pill box; and the rubber tubes
instead of coming off from the top, come off from the
side at points but little removed from each other.
The thickness of the cup is about half an inch. With this
instrument the auscultatory Bigns can be obtained with
scarcely any disturbance of the patient.” We most
sincerely congratulates Dr. Smith on this ingenious and
(а) “A Manual of Sureical Treatment.” By W. Watson Cheyne,
F.R.C.8., F.R.S., and F. F. Burghard. Burjrhard, M.D., M 8.,
Lond F.B.C.S. Pa»t 1. Price 10s. 6d. (London: Longmans,
Green A Co , 1899.)
(б) “Twentieth Century Practice. An International Encyclo¬
pedia of Modem Medical 8cience.” By leading authorities of
Europe and f merica. Edited by Thomas L. Stedman, M.D., New
York City. In twenty volumes. Volume XVI. Infectious Diseases.
London : Sampson Low, Marston & Co., Limited. 1899.
philanthropic device, which we hope soon to find adopted
by skilled physicians throughout the world.
With regard to pathology, after recognition of the
function of the pneumococcus, the writer reoognisee
“ three types of cases: sthenic, asthenic, and obstruc¬
tive.” Ana later on we are told that “ In addition to the
foregoing types there may be differences in the clinioal
features of the disease depending upon mixed infections.
Other organisms may be present with the pneumococcus
lanceolatus, such as the pneumococcus or Friedlander,
Pfeiffer’s influenza bacillus, the Klebs-Loeffler bacillus,
the typhoid bacillus, the staphylocoocus pyogenes, and the
streptococcus. One or more of these acting with the
diplocoocus proper to pneumonia may modify more or
less the clinical picture.” Surely of the making of
microbes there is no end!
Dr. Netter’s excellent article on “ Cerebro-spinal
Meningitis ” gives special prominence to the diagnostic
importance of Kernig’s sign. He also emphasises the
connection which exists between cerebro-spinal menin¬
gitis and pneumonia. In the bacteriological section he
pursues this point by indicating that relations—probably
impoitant, but not hitherto well defined—exist between
the pneumocoocus and the diplococcus intracellularis
meningitidis of Weichselbaum.
Professor Sodre believes in the amoebic origin of
dysentery. He places 4 per oent. of hepatic abscesses com¬
plicating dysentery in the middle lobe of the liver.
We would like to know where the middle lobe of the
liver is ?
Yaws— granuloma tropicum —here receives the fullest
recognition as an independent disease. The persistent
way in which this malady has been confounded with
syphilis is, of oourse, noticed by the writer, Dr. Nicholls.
The diseases often co-exist. “ In those cases of yaws in
which chronic, intractable, and destructive ulcerations
came on, the explanation lies in the fact that there
is a complication with tubercle or syphilis.” . . “ The
theory advanced by Jonathan Hutchinson that yaws may
be a syphiloid disease produoed by the long influence of
race and locality is disproved at once by the fact that
syphilis in all its typical forms exists now, and has
existed for many generations among the races most
subject to the ravages of yaws. Syphilis is the same
disease among them now as it was then; time, raoe,
and locality not having altered any of its manifes¬
tations.”
The appearance of Professor Ziegler’s excellent
article on Inflammation in the middle of this volume
(pp. 355-402) would appear to be, from the aesthetic
standpoint), an “incident.” We need not criticise it;
it is worthy of its author.
Dr. Kiliani contributes a very thoroughly prepared
article on Erysipelas. A short article on “ Simple Con¬
tinued Fever,” by Dr. Edwards, is followed by a very
elaborate one on “ Relapsing Fever,” by Dr. Leo Popoff,
Professor at the Imperial Military Academy of St.
Petersburgh. As thiB fever was the great “famine fever "
of Ireland, which swept that island after each failure of
the potato crop, we are obliged to the Irish physicians
for the earliest accounts of it. Dr. Popoff makes some
very curious blunders in the historical portion of his
carefully-prepared thesis, which we would recommend
him to correct in any future reprint.
Typhoid fever is very fully and satisfactorily treated
in the closing essays of this important volume. Space
will not permit us to discuss in detail the vast number
of questions which arise in connection with this great
subject. Nor, indeed, is it necessary or desirable that
we should under any circumstanoes make the attempt.
We refer our readers to the volume before us, with the
assurance that they will not be disappointed.
4fUbical
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 at 429, Strand, London,W.C.,
on 24th ult. There were present the Chairman, Dr.
Digitized by GoOgle
Thi Mxdical Peers. 631
Die. 13, 1890.
MEDICAL NEWS.
Havilland Hall, Dr. J. B. Ball, Mr. J. Brindley James,
Mr. Wm. Thomas, Dr. M- Greenwood, Mr. William J.
Stephens, Mr. F. S. Edwards, Dr. F. J. Allan. Dr. J. W.
Hunt, Dr. J. Pickett, Dr. Alfred 8. Gabb, Mr. Edward
Bartlett, and Dr. Walter Smith. The Committee
examined the accounts, and found that the sickness
experienced by the Society during the autumn had been
so much under the expected amount that the extra claim
account of the earlier part of the year wan more than
covered, and the record of 1890 would probably show an
appreciable increase in the financial strength of the
Society. During the fifteen years of its operations and
even in the worst time of the influenza epidemio, the
growth of the Society's reserves has been uninterrupted.
The Committee were able to report every year a sub¬
stantial addition to the funds, which now amount to over
j£ 130,000. Prospectuses and all particulars on applica¬
tion to Mr. F. Addiscott, Secretary Medical 8ickness and
Accident Society, 33, Chanoery Lane, London, W.C.
The Apothecaries’ Hall and the Royal College of Physicians
of Ireland.
Wx are requested to publish the following minute of
proceedings of the Board of Directors of the Hall: —At a
special meeting of the Apothecaries’ Hall on 8th Decem¬
ber, 1899, it was proposed by Dr. Adye Curran,
seconded by Dr. Evans, and passed unanimously :—That
the observations with reference to this body made by Dr.
Atthill at the General Medical Council in London be
considered most unprofessional, totally uncalled for, and
highly discreditable to the representative of the R.C.P.
Ireland.
Uniformity of Preliminary Examinations.
A COBBXSPOKDXNT of the Edinburgh Evening Dispatch
writes:—“It would be interesting to know how Sir
William Turner reconciles his strong advocacy of the
raising of the standard of the preliminary examination in
medicine with the fact that the Edinburgh University
is at present evading the principal rule of the General
Medical Council for maintaining a fair standard. The
rule we refer to is that which insists that all the sub¬
jects of this examination shall be passed at the same
time. The Edinburgh University, on the other hand,
allows candidates to pass the examination at two sittings
which, of course, makes it very much easier to pass.
The University even allows a candidate who failed in
other similar examinations in one or two subjects to go
up for simply the subjects in which he has previously i
failed, and, on passing them, gives him a certificate that
he has passed his preliminary examination. This
anomalous state of matters should be put a stop to at
once, as the status of Edinburgh medical degrees is not
likely to be improved by trying to attract men and
consequently fees by the offer of an easier preliminary
examination than is to be had elsewhere.”
London Cows and Tuberculosis.
By order of the Public Health Committee of the
London County Council, a veterinary examination of all
the cows in London cowsheds, with a view to the dis¬
covery of tuberculous disease, has recently been carried
out. The result of the examination is now reported by
the oommittee. In all, 5,144 cows were inspected, and
of these 4,464 were found to be free from disease or
abnormalities of the udder. Of the remaining 680 caws,
seven were found to have tuberculous disease of the
udder, whilst another five were regarded as suspicious.
Of the seven cows, five have been sold or slaughtered,
and the owners of the other two have undertaken not to
use their milk. Of the five suspected cows, the milk
from three has been sent to Dr. Klein for examination,
and the remaining two have been already disposed of.
The milk of two of the three has been found to contain
tubercle bacilli. One of these cowb has been sent to the
butcher, and the other it was proposed to send to tfc*
market, whence it was to be expected it would be con¬
veyed to the butcher. Of the rest, 241 cows were found
to be suffering from acute mastitis, or affected with
chronic induration of the udder, and these cases, the
veterinary surgeon thinks, require periodical inspection,
as the characteristics of minute deep-seated tuberculous
lesions may possibly escape detection. Having regard
to the importance of these facts, and with a view to the
S rotection of the public, the oommittee intend to ask the
ouncil for the necessary funds for a quarterly veter¬
inary inspection of all the cows in the London cowsheds,
and for submitting 100 samples of milk from various
parts of London to Dr. Klein for bacteriological ex¬
amination. The Committee, however, recognise that
the examination of cows in London cowsheds would be
absolutely futile to prevent the sale of tuberculous milk
so long a* milk from cows outside the county, which
have been subjected to no inspection, is allowed to be
sold in London and mixed with milk produced in London.
If the result of the bacteriological examination of the
100 samples of London milk showed that a large number
were tuberculous, the case for legislation would be
strengthened, and the public would be warned of the
danger to whioh they were subjected.
Housing the Poor.
In the Leisure Hour for December, a writer who has
worked among the poor for twenty-five years, asserts
that not less than 900,000 persons are living in over¬
crowded tenements in London, and of that vast number
about 800,000 are huddled together in single-room tene¬
ments. It is no uncommon thing to find from five
to eight persons occupying a single room, and careful
inquiry appears to have proved that close upon 40,000
unfortunate creatures are living five persons in one room.
As might be expected, the effect upon the physical and
moral welfare of human beings, herded together under
such unnatural, unwholesome, and immoral conditions,
presents one of the most pathetic and ghast'y aspects
of this sombre and formidable problem. With re¬
morseless precision the death-rate increases with density
of population, and in such crowded areas amounts to
double that prevailing over the whole of the metropolis.
When one remembers the importance of bodily health
to the labouring classes it is impossible to withhold
compassion from men and women compelled to live
under conditions which starve and exhaust all staminal
strength. Apart from considerations of humanity, the
slow but sure impairing of the industrial efficiency of so
many thousands of our workers is profoundly to be
deplored. If the physioal consequences are so serious,
what muBt be the effect of all this herding of human
beings on their moral nature ? Imagine the brutal
frankness, the coarse familiarity, the shameless in¬
delicacy which must obtain where all natural reticences
and decencies of domestic life are rendered physically
impossible. Every finer sensibility is blunted, and
habits of thought and feeling contracted which gan¬
grene the soul.
Glanders In Newcastle.
An outbreak of glanders has broken out among the
horses in Newcastle-on-Tyne. and orders have been
given to keep the troughs empty for the present, buckets
being used instead.
University of London.
Thk following is an official list of the candidates who
passed the M.B. Examination during October, 1899,
alphabetically arranged:—
SECOND DIVISION.
Bonnerjee, Susila Anita
Capper, Harold Selwyn
Clifford, Harold
Collens, Edward Howard
Collinson, Harold
Davenport, Edward Charles
Evans Thomas
Everington, Herbert Devos
Ferris, William
Fookvs, Ernest Faber
Gaff, James
Gardner, Thomas Hudson
Gowdey, Annie Chapman
Hall, Edmund Stokes
Harcourt, John Charles
Hartley, Harold
Heath, Phillip Maynard
Hirst, Walter Clapham
Hoban, Thomas
Hooper, George Henry Jas.
Horn, Arthur Edwin, B.Sc.
lies, Mary Muriel Griffin
Laniler. Chos. Llewellyn, B.Sc.
Leah, Thomas Noy
Lovibond, Beatrice Frederica
Martindale, Louisa
Heachen, George Norman
Mills, Herbert Hennr
Murrell, Christine Mary
O’Dowd, John Austin
Osborn, Alfred Gelsthorpe
Pocock, Arthur Robert Geo.
Porter, John Fletcliei
Potter, Bernard Elwell
Reeve, Herbert Midgley
Reynolds, Bryan Ellis
Rhodes, James Herbert
Robertson. James
Stewart, Mary Ariel
Stewart, Walter Grahame
Strange. Robert Gordon
Swift, Eric Wilson Donby
Taylor, Isaac
Thwaites, Gilbert Balm
Turnbull Jane Holland
Turner, Philip, B.Sc.
Unwin. William Howard
Van Praagh, Harold John
Vernon, Ethel Miller
Wallis, James Garfit
Watson, William Bertram
White. Harold Edward
Wlrgman, Charles Wynn
632 Thb Medical Press
NOTICES TO CORRESPONDENTS.
D*c. 13, 1899,
Notices to
(Ecrmepimtiente, Short ^Cettcro, &c.
•V Correspondents requiring a reply in this column are par¬
ticularly requested to make use of a distinctivt tipnature or
initials, and avoid the practice of signing themselves “ Bender,”
"Subscriber,” "Old Subscriber,” Ac. Much confusion will be
spared by attention to this rule.
Local Reports and News. —Correspondents desirous of drawing
attention to these are requested kindly to mark the newspapers
when sendteg them to the Editor.
Beading Cases.— Cioth 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,
prioe 2s. 6d. These cases will be found very useful to keep each
weekly number intact, clean, and flit after it has passe 1 through
the post.
A SAD AND URGENT CASE.
In reply to the appeal in our last issue, we have received a cheque
for £2 from a correspondent who desires its acknowledgment os
from H. S„ and one for £1 from Dr. Jas. Hamilton, of Chelsea.
We think most of our readers must have passed over the appeal
without reading it, or we should have received a different response
from the thousands who peruse our pages weekly. The case is an
exceptionally sad one, and the urgency of the circumstances sur¬
rounding it is our excuse for consenting to act as treasurers, and
for pressing its claims on the attention of our readers. The appeal
will be found in our last week's issue on page 599.
Stockport (M.D.).-We have referred your question to a spe¬
cialist, who says that in the erythematous type of lupus erythe¬
matosus a prolonged trial should be given to calamine lotion and
other soothing applications. Collodion suits some cases. Failing
these measures multiple scarification may be tried The method
of carrying out that simple surgical procee ling is simple Hundreds
of shallow incisions are made in all directions across the diseased
area, bleeding is encouraged for some time, and then styptics are
applied A general auirstbetic is nearly always necessary. The
sebaceous form of the disease requires different treatment.
M.R.W.—Chloroform should not be administered to the snrne
subject twice within a week if it can be avoided, because it lias been
shown that the elimination of the drug is not completely effected
within a shorter period. Sudden pallor with marked dilatation of
the pupil is a dsnger warning, especially if associated with shallow,
sighing respiration, and a rapid and intermittent pulse. Gasping is
a sign that the proportion of chloroform vapour in the inspired air
is too high.
K. S. W.—The question as to the Salvation Shelters is an impor¬
tant one from the public health point of view, and it is to be hoped
that a speedy settlement, of the cuse will be made by the Legisla¬
ture. As things stand these semi-charitable, semi-comuiercial
undertakings are allowed to bring together under doubtful sanitary
conditions large numbers of the vagrant poor, who are practically
outside the control of the local sanitary authorities.
Foreigner. —Official documents will shortly be available setting
forth the exact position of foreign graduates in relation to medical
E tice in this country. Your questions cannot be answered off-
I.
Neo-Practitioner.— The practice of publicly announcing one’s
intention of "settingup in practice ” in a particular neighbourhood
is regarded as absolutely unethical. There are plenty of other wa> s
of disseminating a knowledge of the fact, in'er aim, by calling on
the local practitioners. a step which will go far to secure for you a
courteous if not a coruial reception.
Dr Marris. If you will embody your criticisms in a letter we
shall be pleased to give them publicity. The matter is not one
which we care to deal with editorially.
Jfteetingg of the Societies aitb ■Cectuceg.
Wednesdat, December 13th.
Hunterian Societt. —3.39p.m. Pathological Meeting. Specimen!
will be shown by Dr. Hingston Fox, Dr. F. J. Smith, Mr. Targett,
and other Fellows.
Thursday, December 14th.
Ophthalmological Societt of the United Kingdom.- 8 p.m.
—Patients and Card Specimens. 8.30. Clinical Evening. Mr. G.
Keeling: Congenital Subluxation of Lens.—Dr. C. Shaw: Sympa¬
thetic Ophthalmitis after Enuoleation. Mr. J. Griffith : Cose of
Sarcoma of the Upper Conjunctival Cul de sac.—Mr. A. H. Thomp¬
son: Embolism of the Central Artery of the Retina.--Mr. G £>.
Mayuanl: Nasal Duct Dilator.—Mr. G. Brooksbank James:
Changes in the Macula Area consequent upou Injury.
British Gynecological Society (20, Hanover Square, W.).—
8 p.m. M. Doyen (Paris) will give a Cinematographic • •emonstra-
tion to Illustrate his Operative Procedures on the Abdominal and
Pelvic Organs.
Friday, December 15th.
Epidemiological Society o L indon (11 Chmdos 3tree , Caven¬
dish Square, W.).—8.39 p.m. Meeting.
Uacattrieg.
Bootle Hospital for Infectious Diseases.—Resident Medical Super¬
intendent. unmarried 8alary £190 per annum, with board,
washing, Ac. Applications to the Town Clerk, Bootle. ~“
Dorset County Hospital, Dorchester.—House Surgeon, to reside
and board in the hospital, unmarried. Salary £100.
Gnest Hospital, Dudley.—Senior Resident Medical Officer. Salary
commencing £100 per annum, with board, residence, attend¬
ance, and washing.
Harris Parish Council for the Southern Division of Harris.—
Medical Officer and Public Vaccinator. 8a1ary £90, other
emoluments. Apply to Mr. T. Wilson, Lochmaddy, Clerk.
Kent and Canterbury Hospital, Canterbury.—House Surgeon and
an Assistant House Surgeon, unmarried Salary House Sur¬
geon £90 the first year, with board, Ac. Salary Assistant
House Surgeon £50, with board Ac.
Leeds, Beckett Street Fever Hospital—Resident Medical Officer.
Salary £150 a year, with board, lodging, and washing.
Lewes Dispensary and Infirmary and Victoria Hospital —Resident
Medical Officer. Salary £100 pe- annum, with furnished apart¬
ments, board, coal, gas, and attendance.
Lincoln Lunatic Hospital.—Assistant Medical Officer. Salary £l00 r
with board and w ishing. Apply to the Medical Superintendent.
Norfolk and Norwich Hospital, Norwich.—House Physician for two
years, unmarried. Salary £80 a year, with board, lodging, and
washing.
Parish of St. Mary, Islinrton.—Medical Officer for No. 2 Upper
Holloway Central District. Salary £100 per annum, with certain
extrafees. Apply to the Clerk, Guardians’ Offices, St. John’s
Road, Unper Holloway.
Pontefruot Geniral D spensary and Infirmary.—Resident Medical
Officer. Commencing salary £150 per annum, with furnished
rooms, fire, lights, and attendance.
Queen Adelaide’s Dispensary, Pollard Row, Bethnal Green, London.
—Resident Medical Officer, unmarried. Salary £100 per annum,
with furnished apartments, coal, gas, and attendance.
South Devon and East Cornwall Hospital, Plymouth. - House
Surgeon. Salary £100, with board and residence.
Wexford Union. Medic >1 Officer. Salary £100 per aunnm, and £15
as Medical Officer of Health, with the usual vaccination and
registration fees. Aoplications to Clerk of Union. (Seeadvt.).
York.— Medical Officer of -'ealth. Salary £409 per annum. Apply
to the Town Clerk, Guildhall, York.
^ppointmentB.
Boase, Richard Dcvey, L.R.C.P., M.R.C.S., Medical Officer of
Health for the Madron aod Ludgvan Urban Districts, Cornwall.
Butterfield, Frank, M.D.Lond., Junior House Surgeon to the
Blackburn and East Lancashire Infirmary.
Evans, Arthur H., M.D., B.S.Lond., F.K.C.S.Eng., Senior Surgeon
to the East Dispensary, Liverpool.
Fairweather, Wm. Ernest, L.B.C.P Lend., M.R.C.S., House
Surgeon to the Jessop Hospital for Women. Sheffield.
Gunn, Albert A., M.B., Ch.B.Edin., Senior House Surgeon to the
Blackburn and East Lancashire Infirmary.
Harper, J. M., M.R.C.S.Eng., Police Surgeen for Bath.
Har&ison, Alfred James, M.B.Lond,, M.B.C.S., L.S.A., has been
reappointed Honorary Physician to the Bristol General Hos¬
pital.
Hellier, John B., M.D.Lond., M.R.C.8., Honorary Obstetric Phy¬
sician to the Leeds General Infirmary.
Higgins, Alexander G., M.K.C.S., Assistant House Surgeon at
the West Kent General Hospital, Maidstone.
Nicholson. H. Gilbert, M.R.C.S., L.8.A , Honorary Medical
Officer to Queen Adelaide’s Dispensary, Bethnal Green.
Page, Herbert, W , M.C.Cnntab., Examiner in Surgery in the
University of Oxford.
Syme8, John Odert, M.D., L.B.C.P.Lmd., D.P.H.. M.R C.S.,
Second Assistant Physician to the Bristol General Hospital.
Whitelocke, R. H. Anglin, M B., M.C.Edin., F.K.C.S.Eng., Sur¬
geon to the Radcliffe Infirmary, Oxford.
Wicks James, L.R.C.P.Lond., District Medical Officer for Ward 2
of the Parish of St. Pancras.
#irtho.
Barr.—O n December 7th, a'. Wentworth, Rotherham, the wife of
Horace Chas. Barr, M.R.C S , L.R.C.P., of a daughter.
Broadbent.— On December 3rd, at 35, Seymour Street, London, the
wife of John F. H. Broadbent, M.D.Oxon., of a daughter,
Heywood. —On December 7tli, at Woodside Hitchin, the wife of
Fleet-Surgeon Alex. J. J. Johnson, R.N., M.D., of a son.
McLeod.—O n December 7th, at 89, Ladbroke Grove, London, W.,
the wife of 0. E. A. Macleod. F.B.O.S., of a son.
Turney.— On December 5th, at Portland Place, W., the wife of
H. G. Turney, M D., of a son.
^ftarriages.
Cartwright Giles —On Decomber 7th, at St. Mary Abbot’s
Church, Kensington, Ernest Hy. Cartwright, M.A_Oxon., of
Maidstone, to Dorothv, daughter of the late B. W. Giles, Esq.,
of 60, Nevern Square, London, S.W
Lyon—Russell.— On December 5th, at St. James's, Westminster,
John Lyon, M. D., Fleet Surgeon. Royal Navy, to Josephine H.
Russell, Claremont Drive, Timperlev.
Pilcher-Gardner.— On <‘emember 6tli, at Christ Church, Wan-
stead. Colonel J. G. Pilcher, F.R.C.S., Indian Medical Service,
retired, to Elizabeth Emma, daughter of George Gardner, oi
Fellside, Snaresbrook, Essex.
8tewart—Light. On Deoember 5th, at 8t. Martin-in-the-Fields,
London, Charles Howard Stewart, M.B.C.S., L.R.C.P., L.S.A.,
of Witheradge, North Devon, to Grace, youngest daughter of
Jabez, Light, of Kenley Court, Kenley, Surrey.
Digitized by G00gle
She $§Udiat m and CimiUtr.
“SALU8 POPULI SUPREMA LEX"
Vol. CXIX. WEDNESDAY, D
Original (fommuniatticms.
BECTO-VAGINAL HEMATOMA
FOLLOWING DELIVERY
—INCISION AND ‘DRAINAGE—
RECOVERY.
By ARTHUR GILES, M.D., B.Sc., F.R.C.S.,
M.R.C.P.,
Assistant 8nrgeon, Clielscn Hospital for Women; Gynmcologist
to the Tottenham Hospital.
In July, 1899, Dr. Dodwell, of Battersea, sent for
me to see a patient with him under the following
circumstances. The patient, Mrs. M., jet. 30, was
confined of her second child on July 3rd, between
two and three in the afternoon. The labour was
normal, though a little tardy, the paiDs not being
very strong. The presentation was left occipito¬
anterior, and the child was born naturally, and without
any rupture of the perineum. The patient com¬
plained of pain and soreness immediately after de¬
livery, but nothing abnormal was noticed on washing
and inspection. Pain increased locally, and started
in the abdomen, so that ten or twelve hours after
delivery Dr. Dodwell was sent for. He found that
the pain, which was of a forcing character, was re¬
ferred to the rectum and abdomen, and he ordered a
sedative, which gave relief. The next morning, on
inspecting the vulva, he found the perineum bulging
and distended, and diagnosed hrematoma. After
watching it for a few hours, in consultation with his
partner, he found that the swelling was increasing,
and sent for me with a view to exploration.
On my arrival, at 8 p.m. on July 4th, I found the
patient looking rather ill, and complaining of severe
pain in the rectum and vulva. On inspection, the
perineum was distended nearly to the size of a fcetal
head, and the skin at the most prominent part was
very dark and almost gangrenous. By the vagina
the swelling could be felt to extend up in the recto¬
vaginal septum higher than the finger could reach.
The uterine fundus was higher than the normal, and
was apparently pushed up by the effusion. It was
decided that as tne bleeding was evidently going on,
and was likely to lead to sloughing and suppuration
if left, the htematoma required to be at once evacuated,
packed, and drained, the bleeding point being secured
if possible. The patient was accordingly anaesthetised
by Dr. Dodwell, whilst I had the advantage of the
assistance of Drs. Macrory and Martin. After the
perineum had been carefully cleansed, an incision
2J inches long was made over the most prominent
point, and a large quantity of fresh blood and clots
OEM BEE 20, 1899. No. 25.
was evacuated. The opening-up of the recto-vaginal
septum extended higher up than the finger could
reach, and so a second incipion was made in the
posterior vaginal wall, and through this incision the
neematoma could be explored as far as its upper
limit. No actual bleeding point could be detected;
but it was ascertained that the cellular tissue of the
broad ligaments was not involved in the hematoma,
which was thus limited to the recto-vaginal septum.
After all the clots had been evacuated, the cavity
was freely syringed out with warm iodine lotion,
1 drachm to the pint, and then packed with strips
of double cyanide gauze (John Milne's) some of which
were brought out through the upper, and some
through the lower, incision.
The after-treatment consisted of plugging with
cyanide gauze and douching with creolin. The
plugging was discontinued after the seventh day,
and the douching a week later. The patient got up
about the twelfth day feeling quite well and with the
wound well healed. The perineum looked very well.
Recovery was uninterruptedly good, except that on
the fifth day the patient got up without her doctor’s
leave and fainted. The temperature never rose to
100deg8.
This case has seemed to me to be worth recording
on account of the rarity of the complication, and
because this extensive hfematoma arose without any
apparently adequate cause. A hromatoma of the
labium majus complicating delivery is sometimes met
with, especially wnen there has been a veiy long
tedious labour, or when instruments have been re¬
quired, or when the vulva has been the seat of vari¬
cose veins; but a htematoma of the recto-vaginal
septum is exceedingly rare, and none of the predis¬
posing causes mentioned were present in this case.
The anatomical conditions of this hsematoma are
worth noting; it opened up a space bounded sharply
above by the recto-vaginal reflection of the perito¬
neum, whilst the lateral boundaries corresponded
with the lateral margins of the posterior vaginal
wall.
The treatment adopted does not call for much
comment; in view of the fact that the swelling was
steadily increasing in size, and in view of the
threatening tendency of the skin to slough and
break down, the only possible course was to open,
clear out the slots, and pack. The laxity of the con¬
nective t issue in this situation, and the absence of
any structures that would cause sufficient pressure to
arrest the bleeding, would probably have the effect
in any case of necessitating incision and packing, and
I doubt whether the accepted rule which is given for
hsematoma of the labium, viz., to leave the swelling
unopened except in the event of continuance of
bleeding or of sloughing, will ever be found applicable
in the case of hrematoma of the recto-vaginal septum.
I should say that here the indication will be to mciBe
and pack early. In conclusion, I wish to thank Dr.
Dodwell for kindly furnishing me with the notes of
this interesting case.
Digitized by
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634 The Medical Press. ORIGINAL COMMUNICATIONS.
SUPPURATIVE MASTITIS IN TBE
NEWLY-BORN.
By FRANCIS A. WINDER, B.A., M.B.,
Bathfaraham.
As several instances of abnormal lactation have
appeared lately in the Medical Press and Circu¬
lar, and Dr. John Knott has given us his valuable
hints on the subject, I would like to brinjjj forward
the following cases of suppuration occurring in the
breasts of children after birth, associated, as it always
is, with previous swelling, and what appeal's to be
secretion of milk.
Case 1. —Female child, aged fourteen days, the
mother, a primipara, had a severe and tedious con¬
finement. My notes are as follows:—Transversely
narrowed pelvis, ligaments hard and tense, large out¬
let, but generally contracted laterally. Presentation
R.O.A., large head, elongated antero-posteriorly.
She had been nearly thirty-six hours in labour. I
applied forceps as the waters had all escaped, and
the head was firmly fixed, and delivered her safely
after a hard and tedious second stage.
About ten days after birth, the nurse noticed that
the child’s breasts were swelling, and that she could
squeeze a thick yellowish-white fluid from them. She
told the mother that this was her own milk going
through the child, and that it must be squeezed out.
Also that it was very commonly seen in first-born
children. She vigorously proceeded with her massage, !
using a copious amount of goose grease, not only to
the child’s breasts, but also to her entire body and
head “ to drive the milk down to the breast;" the
breasts became inflamed, and the child broke out in a
general pustular impetigo. I saw the child first on
the fourteenth day and found both breasts enlarged,
conical, soft, and resisting to the touch, the left
breast was but slightly inflamed, the right acutely,
causing great pain, which had kept the child and house¬
hold awake for several nights. It fluctuated, and I
made a radiating incision in the lower quadrant and
there gushed out about an ounce or more of the most
foetid pus I ever had the misfortune to smell I
ordered hot boracic poultices to be applied to the wound,
and put the child on sulphide of calcium in doses of
one-lentil grain. The head seemed inclined to break
out in impetigo, in fact, whether from the effects of
the goose grease or not I cannot say, but the child
seemed to have developed a suppurative diathesis.
The breast healed up slowly and finally closed with¬
out leaving any scar visible.
Case 2— S., Female child, aged 14. days. (The
mother was attended during her confinement by a
midwife, and was almost convalescent when on the
tenth day her left breast became acutely inflamed and
suppurated freely). When the child was some 12 or
14 days old her right breast became swollen, and there
exuded a thick creamy viscid fluid, to all appearances
resembling colostrum, but which microscopically was
seen to consist almost entirely of large epithelial
cells, leucocytes, and a few fatty granules with much
cell debris: in spite of active treatment the glands
suppurated and had to be incised, after which it
quickly resolved. However, no sooner was it well on
the way to recovery before the left breast inflamed
and went through the same pathological stages,
ending in suppuration. The midwife learnedly ex¬
plained that the reason the child's breast suppurated
was that the child sucked the “ matter ” from her
mother’s breast and it settled in her own.
Case 3. —Female, set one month : both breasts
enlarged simultaneously, a thick white creamy fluid
could be squeezed from them tinder the influence of
hot fomentations. Treatment by gentle rubbing and
strapping was adopted with small doses of hyd. c.
creta to keep the bowels free. They subsided without
Dec. 20, 1899. _
suppuration. This child died some two months
afterwards from erysipelas of the vulva.
Case 4. —Male child, one week old; immediately
after birth the child’s right breast became swollen
and secreted a fluid similar to above cases. The
midwife in charge of the case kept squeezing the
breast, which filled again almost as soon it was
emptied. It then became inflamed and distended with
matter, so that when I saw the child first the breast
was enormous, and fluctuated easily. In fact, after
the child moved or cried the fluid could be seen to
“ sog,” as it were. I immediately made a radiate
incision in the lower quadrant, and evacuated almost
three ounces of foetid pus. The cavity was thoroughly
syringed out with boracic lotion, a drainage tube put
in, and pressure applied, with the result that it quicldy
healed up. The other breast became swollen when
the child was about fourteen days old, but did not
suppurate.
Remarks. — Anyone who lias seen cases of infants
secreting milk in thebreasts willobserveasfollows: (1)
It occurs in both males and females. (2) It generally
occurs very soon after birth. (3) The quantity secreted,
is very small and tends to disappear spontaneously; it
never oozes from the nipple, and it takes some
amount of squeezing to cause it to exude, but if it is
“ drawn” more is secreted to take its place (it is this
“drawing” which causes thebreasts to inflame. There
is always a history of interference, squeezing, rub¬
bing, pressing the breast, &c.). (4) It is frequently
an unilateral phenomenon. (5) It is more frequently
seen in the first-born of families.
That the fluid is always of the same nature I
think there iB reason to doubt. The specimen which
I examined microscopically was a very bad specimen
of milk indeed. Or course in the absence of a
definite analysis it would be impossible to decide
definitely, but the small quantity of fat in the shape of
globules was very noticeable, but there is a general
glandular activity after birth, and it is hardly to be
wondered at if sometimes the delicate and so far
untrained nervous mechanism goes slightly astray
(it is now an established fact that female infants
sometimes, though rarely, menstruate), so that conse¬
quently if the mammary gland exudes a secretion it
is more than likely it will take the form of the
ordinary secretion of that gland.
As to treatment, “ Foment and leave alone.” Give
a gentle purgative and your “ Witches Milk ” will
disappear very quickly.
SOME NOTES UPON THE
TUBERCULIN TEST, (a
By EDWARD O. OTIS, M.D.,
Boston.
So long as the tuberculin test has still many oppo¬
nents as well as ardent adherents, all added evidence
is of value in arriving at a final estimate of its worth
in the diagnosis of early or doubtful tuberculosis. I
offer my experience all the more readily from the
fact that no contribution upon the subject has, to
my knowledge, been presented to this Association.
The problem to be solved is a twofold one: First,
is the test injurious as now used ? and, second, is it
trustworthy ?
Those who have used it and still continue to use
it are quite unanimous in answering these questions
in the affirmative, and my experience accords there¬
with.
I cannot help suspecting that those who consider
the test dangerous even in the small dose now used
may be prejudiced by the unfortunate results whioh
(a) American Climuto!< jiicul Association, IKS.
by Google
Digiti.
D*c. 20, 1899
ORIGINAL COMMUNICATIONS. Thi Mbdical Puma . 635
occurred in the earlj history of tuberculin from the
enormous doses then used. We all look back upon
that epoch with a shudder. To pass it by with a
remark “ that its value as a test is not great, as re¬
actions are obtained in several other diseases,” as
Fowler does, it likewise seems to me unfair and mis¬
leading. Further evidence, to be sure, is needed to
establish its exact position as a diagnostic method,
but enough has already been adduced to prove its
success in the majority of cases. Its rival is the
X-ray, but that requires an expert and an expensive
apparatus, which limits its use to the few. Anyone
can use the tuberculin test.
In view of the extremely favourable curative out¬
look the early case of pulmonary tuberculosis offers
from the present methods of treatment, the pro¬
fession has never been so eager to detect the begin¬
ning of the disease as at present, and any aid in
accomplishing this should be welcome, limited though
it may be. We all recognise the fact that ausculta¬
tion and percussion and the sputum examination fail
to do this in seme, we know not how many cases. If
we delay until tubercle bacilli are detected in the
sputum the favourable opportunities of the first stage
may have passed, never to return.
Before an absolute diagnosis has been established
one is naturally disinclined, and lacks the requisite
authority to institute a vigorous plan of treatment.
Certainty of facts venders one resolute and Bwift in
uction. Here, then, is a test which is so simple that
any one can apply it, and yet in the majority of
cases settles the whole question of diagnosis definitely
and at once. If we shall in the future be able to
determine some more exact method of dosage, dis¬
covering some constant ratio between the dose and
the individual, we may find the test to be true in
every case.
In common with others, I have injected cases or
proved pulmonary tuberculosis which did not react,
at least in the general reaction, and. on the contrary,
it has happened to me to obtain a more or less com¬
plete general reaction when I could not feel convinced
that any tuberculosis existed. It may be that above
a certain dose, maximum to the individual in ques¬
tion, what at least simulates a general r eaction occurs
in a healthy person, a temporary poisoning by the
tuberculin and its toxins; further evidence, however,
is necessary to decide this question.
My observations extended over 111 cases, originally
undertaken in an ambulatory clinic for the purpose
of arriving at a conclusion as to the proportion of
cervical adenitis that was tuberculous. While
making these investigations I embraced the oppor¬
tunity to test ail the cases which for any reason
suggested tuberculosis, as well as several cases of
syphilis and a variety of other cases. In the
total number of fifty-six cases of cervical
adenitis taken without selection there were
thirty-three reactions, six slight reactions, and
two doubtful ones. Throwing out the slight and
doubtful ones, we have 58 8 per cent.; including
them, 73 2 per cent., or an average of 66 per cent.,
which would indicate the proportion of cases of
cervical adenitis that were tuberculous, so far as an
inference can be drawn from fifty-five cases and
dependence can be placed upon the tuberculin test;
but of course a larger number of cases and other
methods of investigation must corroborate or dis¬
prove these deductions.
It seems not unlikely, however, that this is not far
from the truth, for Yolland makes the proportion
68 per cent., and Dr. F. C. Moore, (a) out of twenty-
eight cases of chronic enlargement of the glands,
mostly of the neck, which had to be operated upon
for various reasons, found that 73 per cent, were
l b) “ Dineuaes of theLuugs,"’Fowler nnd Godlee, 180S,
tuberculous. In eight cases of syphilis and one
doubtful one there were four reactions. One of
these cases was injected for cervical glands, and
reacted moderately after five milligrammes and
markedly after ten milligrammes. A few days later
evidence of secondary syphilis appeared. Another,
of chronic enlargement of the metacarpal bones of two
fingers of the left hand, which was diagnosed by
one surgeon as syphilis and by othera as tuberculosis,
reacted after 5 milligrammes, still leaving the
diagnosis in doubt. There does not appear to be
any doubt, then, that a certain proportion of
syphilitic cases will react. This fact, however,
would rarely interfere with the test in its more use¬
ful application, viz., in suspected early tuberculosis.
In seven cases of more or less advanced pulmonary
tuberculosis containing tubercle bacilli in the sputum,
three gave no general reaction after ten or twelve
milligrammes, and one none after five milligrammes.
Unfortunately, the local conditions after the test were
not noted.
Of course, the only deduction that can be drawn
from these few cases is that pulmonary tuberculosis,
when more or lees advanced, will not always give a
general reaction from 5, 10, or 12 milligrammes of
tuberculin ; it is well to remember, however, the fact
to which White calls attention, that the general
reaction is slight, and the local reaction marked
in advanced cases, while in the early cases,
where the test is most useful, the reverse is
true. In the other general cases the results corro¬
borated the clinical diagnosis in the majority of
instances. Whether any reaction occurred without
the existence of tuberculosis one can only conjecture,
but it is rather surprising that atrophic rhinitis and
pharyngitis sicca should give a reaction without
other evidence of tuberculosis. In no case did any
serious result follow, although in several the general
reaction was severe and accompanied with much tem¬
porary depression.
The clinic being an ambulatory one, the subjective
evidence of the patient, together with the objective
symptoms apparent when he presented himself the
next day at the clinic, were mainly relied upon to
determine whether or not a general reaction had
occurred If from six to twenty-four hours after the
injection the patient complaimed of excessive weak¬
ness, sensations of heat and cold, nausea, anorexia,
pain iu the back and limbs, severe headache, sweat¬
ing, either sleeplessness or somnolence, epitomised by
him us feeling • very sick,' “awful bad,' or “miser¬
able,'' and he appeared the next day with coated
tongue, rather a rapid, weak pulse, and a general
appearance of marked depression, a general reaction
was considered to have occurred, even though the
temperature at that time was not much, if at all,
raised. The cases were generally afebrile at the
time of the test.
Objection may be urged as to the accuracy of these
tests when the patient could not be constantly under
observation, as in a hospital ward ; but anyone who
has listened to the graphic recital cf the reaction
cycle and witnessed the evidence of weakness and
depression exhibited by the patient would, I am sure,
be convinced that a general reaction had occurred.
Of course, all reactions were not of the same intensity
or duration.
Moreover, since making my first set of tests, a year
ago, Dr. R C. Cabot, in the out-patient department
of the Massachusetts General Hospital, has followed
a similar plan in tuberculin and other injection tests,
and has satisfied himself also thataccuracy of results
can be attained in an ambulatory clinic. As a matter
of convenience, I gave the injection in the arm,
generally subcutaneously, and the site of injection
(a) Lancet, September 17th, 18S3, p. 734.
636 i'hb Wjdicii Fbxss. ORIGINAL COMMUNICATION^. )kc. 20, 1899.
was swollen and painful for a few days. This annoy¬
ing sequela can generally be avoided by making the
injection deep in the muscles. I confined myself to
the use of Koch’s original tuberculin, previous
experience with which had taught me what to expect
from certain doses.
The medical man is likely to be misled, I think, if he
uses indiscriminately tuberculin of different concen¬
trations. and therefore he can better estimate his
results if he has a single preparation of uniform
strength. I dilute the Kock tuberculin to a 1 per
cent, solution, using either diBtil’ed water or a
normal salt solution. Unless one makes a fresh
solution every day or two. the addition of a few drops
of carbolic acid is desirable. With a pipette
graduated into tenths and hundredths of a c c.
milligrammes can be easily measured.
As to the dose, there is much diversity of opinion.
Some assert that they obtain satisfactory results with
very small doses, as Grnsset, with two to five tenths
of a milligramme for an adult, and Gaffie, one-
twentieth of a milligramme for infants. The
majority, however, use larger doses, from one-half to
ten milligrammes, and occasionally twenty. Prof.
A. C. Klebs regards twenty milligrammes as the
maximum dose which can be injected safely, but he
would not begin the test with this dose. It is not
unlikely that this difference of opinion regarding the
dose is largely due to the difference in the strength of
the preparations used. I have never used over twelve
milligrammes of Koch’s tuberculin, generally from
five to ten milligrammes for an adult, and from $ to
three milligrammes for children.
I would summarise my conclusions as follows,
subject to modification by further experience :—
1. The tuberculin test indicates early tuberculosis
by a general reaction in the majority of cases before
it can be detected by other methods, the X-ray
excepted.
2. The dose to accomplish this is from five to ten
milligrammes of Koch’s tuberculin.
3. No injurious results occur from the use of
tuberculin in these doses
4. Proved tuberculosis in a more or lees advanced
stage may fail to give a general reaction with doses
of ten or twelve milligrammes.
5. Syphilis gives a reaction in an undetermined
proportion of cases.
6. A non-tuberculous person may give a general
reaction with a doBe above the maximum used in the
test.
7. The reaction may be delayed from six to twenty-
four hours.
And as rules to be observed in making the test: —
1. Always use the same tuberculin and of a
standard strength.
2. Use aseptic precautions in giving the injection.
3. Make the injections deeply into the muscles
4. Keep a two, three, or four hourly chart of the
temperature if possible, beginning twenty-four hours
before the injection.
5. Allow several days to elapse before repeating the
test.
6. In early cases depend upon the general reaction;
in later cases, if the general reaction is wanting, care¬
fully look for the local.
The Portland HosDltal.
The medioal staff of the Portland Hospital left London
on the 12th inst en route for South Africa. The staff
consists of Mr. Anthony Bowlby, of St. Bartholomew’s
Hospital (senior surgeon), Mr. Cuthbert Wallace and
Mr. Ernest Cslverley (surgeons), and Dr. Henry Tooth
(physician), the latter being assistant physician at St. Bar¬
tholomew’s Hospital. The departure was witnessed by
a large number of personal friends of the doctors.
^hc Jjarbeian lectures
ON
THE SURGICAL TREATMEI^T OF
TUBERCULOUS DISEASES.
By W. WATSON (HEYNE, M.B., F.R.C.S., F.R.S.,
Professor of Surgery in King’s College, 4c.
Abstract of Lecture I.
Tuberculosis of Lymphatic Glands.
In choosing the treatment of tuberculous diseases as
the subject of these lectures, I proptse to deal with a
group of affections which interest both 'be surgeon and
the physician, and which forms one of the most common
of the more serious diseases which come under the notice
of the practitioner. As a surgeon, I of course limit
myself to those lesions which are accessible to surgery,
and as the various surgical tuberculous lesions are too
numerous for consideration in the three lectures which are
at my disposal, and as I have already fully discussed on
soveral occasions the subject of tuberculous diseases of
bones and joints, I propose to confine my attention to
tuberculous gland disease, tuberculous peritonitis, and
genito-urinary tuberculosis.
Tuberculous disf ase is, in the first place, a local affec¬
tion, and it may be local even though it is situated at a
considerable distance from the possible point of entrance
of the bacilli into the body. From this primary deposit
tubercle bacilli may be disseminated; either in large
quantities along with cheesy particles giv'ng rise to an
acute general tuberculosis, or to acute tuberculosis of
an individual organ; or in small numbers which may or
may not settle in other parts. These apparently
secondary deposits may, however, not arise from the
former one, but may be new lesions originating from
them in the same way as the original one did. It is
also probable that tubercle bacilli may live in the blood
for some time, and unless they meet with circumstances
under which they can grow may remain quiescent or die
out.
Tuberculosis of the Lymphatic Glands.
In all the cases of enlarged glands in the neck it is
very common to get a history of an acute inflammatory
enlargement of the glands in connection with some
acute process at the origin of the l)mphatic vessels,
such as boils, carious teeth, quinsy, eczema capitis,
&o., at the commencement of the trouble, and that as
this passed off the glands began to subside, but instead
of disappearing as would be the case in a healthy
subject, they subsequently enlarged and assumed the
cbaiacters of tuberculous glands. No doubt it might
be that tubercle bacilli entered the glands from the
mouth or other source of irritation at the same time as the
acute inflammation occurred, and that they afterwards
grew and led to the tuberculosis of the glands ; but in
view of the researches mentioned previously and the re¬
markable absence of tuberculous sores at the point
of entrance, even although wounds or abrasions
were present; and in view, further, of the very
frequent occurrence of tuberculous glands in different
members of the same family, I cannot think that this
represents the whole truth. When we remember that
in the case of joints and other deep-seated lesions the
infection must practically always come from the blood,
and that in children the bronchial glands are so fre¬
quently tuberculous, I cannot but think that in the case
of the cervical glands infection often occurs from the
blood also, and, in the absence of a primary tuberculous
focus, I am inclined to think that in many cases we have
to do with a non-specific inflammation of the glands in
the first instance, and a subsequent infection of these
inflamed glands with tubercle bacilli from the blood
Btream.
As regards the clinical characters of tuberculous
glands, we find great variations in different cases as
regards the number and size of the glands affected, the
rapidity in the progress of the disease, and the tendency
to softening and abscess formation. From the point of
Dec. 20, 1899. ORIGINAL COMMUNICATIONS. The Medical Press. 637
view of treatment we may consider the cases under the treatment, but to indicate the cases which require sur-
following five heads.- gical interference and to describe the nature of such
1. In some cases the glands remain hard and small, interference. Medically there is very little to be done
not large enough to produce deformity, and with no actively against this disease. The patient should, of
marked tendency to softeninsr. Here one usually finds course, be placed under the best hygienic conditions—
a number of glands of varying size, but for the most country or seaside air, cod-liver oil, sunshine, and a
part small, hard, movable, and without any matting nourishing diet. Some surgeons place great reliance on
"together. Fresh glands tend tojbecome involved, though arsenic in the treatment of this and other tuberculous
slowly, and if there is no intercurrent trouble, either diseases. Buchner was one of the first to advocate the
local, such as sore throat, Ac., or general, such as measles, use of aroenic in tuberculosis on the supposition that it
chicken pox. influenza, Ac., they tend to disappear led to the development of fibrous tissue around the
gradually as the patient grows older. Where, however, tuberculous lesions, and so encapsuled them or even
intercurrent troubles, such as those mentioned, appear, brought about their disappearance. However that may
suppuration may occur in one or more glands, or the be increasing doses of arsenic not uncommonly lead to
whole trouble may take on a more acute course. diminution in the glands, and should be tried except in
2. In a second set of cases the glands enlarge steadily, cases where immediate operation is imperative. Where
or it may he by fits and starts, attain a large size, and the glands are showing any tendency to enlarge or become
become very numerous, so that by-and-by the whole side matted together, it is well to fix the head, and this can
of the neck becomes a mass of enlarged glands and great be readily done by means of a back splint, which takes
deformity is produced. This condition is usually a purchase around the thorax, with wings coming forward
bilateral, although it may be more marked on one side at the upper part and grasping opposite sides of the
than the other, and it may go on for a long time without head above the ears—practically the splint introduced a
the occurrence of suppuration, the glands also remaining good many years ago by Mr. Treves. Attention should
more or less mobile and discrete. The glandular disease also be paid to all possible sources of irritation ; carious
tends to Bpread to the axilla. The patient frequently teeth should be removed, enlarged or diseased tonsils
has a pasty complexion, feels weak, and the general should beexcised, adenoids should reoperated on, eczema
health is not good. On removing these glands one of the skin should be seen to, Ac.
frequently finds that they have been converted into As regards local applications over the glands—such as
large masses of cheesy material; in other cases, while mercurial or iodide of potassium ointments, iodine, Ac. —
some show only a few caseous or calcareous nodules, they are, in my experience, of little use. Indeed, where
others appear fleshy on section to the naked eye without the gland is large and superficial and on the point of
any sign of degeneration; under the microscope, how- breaking down, the irritation of the skin over it with
ever, one finds that the latter are infiltrated with tuber- iodine may actually precipitate the suppuration instead
cles and tuberculous tissue. of preventing it. Attempts have also been made—and
3. A third variety is where the glandular trouble is I have made a good many myself by injecting materials
more acute and more likely to end in suppuration, into the substance of the glands—to arrest the disease.
Here, in the first instance, the disease may be apparently the materials employed being arsenic, undiluted carbolic
limited to a few glands, which, however, enlarge pretty acid, iodoform, Ac., but none of these have led to any
rapidly. Further, periadenitis occurs, the glands tend- good result, and I cannot recommend them.
ing to become more or less matted together and adherent With regard to these expectant methods of treatment,
to the tissues around, while fresh glands enlarge. > 8 of great importance to remember that they
"Where we have this state of matters we find that the must not be carried too far, and it is of especial
glandR are breaking down, and suppuration will in all importance not to send the patient so far away
probability occur. If left to itself abscess after abscess that he cannot be kept under observation. One is
may form till numerous ulcers are present, often extend- vei T apt to allow the patients to go off to the country
ing round the neck in the submaxillary regions and f °r an indefinite time, and then find when they come
downwards along the triangles. back that suppuration has taken place, and that opera-
4. We mav have to deal with tuberculous glands with tion is imperative; the operation then required will pro-
unopened abscesses. Suppuration in connection with bably be more extensive, certainly it will be more
tuberculous glands may ‘be met with under various difficult and less certain as regards its results, than if it
conditions. Most commonly the ftate of affairs is that had been done earlier. Where there is any doubt about the
described in No. 3, but in some cases the disease may case. aud especially where one sees the patient for the
be much more limited, and only one gland or one or first time, it is better to watch the case for a time rather
two small glands may break down. Again, we may than to send the patient away at once.
divide these cases into thoee where the abscess is still The operative procedures adopted in these cases are
beneath the deep fascia, and those where it has burst two-fold, namely, either excision or scraping. If exci-
through and formed a subcutaneous swelling, often 8 *°n is adopted its aim is not only to get rid of the
with thin skin over it-, Again, in some cases, the gUnd actually enlarged glands, but to remove the disease, if
may be only partially broken down, and a large possible, completely, so as to avoid recurrence. To do
quantity of cheesy material and diseased glandular this it is clear that not only should the large glands be
tissue is found at the bottom of the cavity when the taken away, but also the smaller ones in the vicinity
abscess is opened. On the other hand, the gland may which are likewise infected, and the operation to be
have completely broken down, and we practically have effectual must be pretty extensive even in comparatively
only a bag of pus. The latter condition is seldom limited cases. The sort of operation which I recommend
found except where the abscess has gone on increasing and am in the habit of practising will be presently
underneath the fascia, usually beneath the sterno- described. Scraping, on the other hand, only affects an
mastoid muscle. When the abscess comes quickly individual gland or glands which ere breaking down,
through the fascia it generally bursts before the and leaves any others which may be infected behind,
gland has been completely destroyed. These may subside and not give any more trouble, or,
5. Lastly, we have *o do with cases where abscesses °“ the other hand, especially in the third form above
have burst or been opened and where sinuses remain, mentioned, they may rapidly enlarge, and fresh scraping
In some instances these sinuses may be numerous while ma y be necessary. This method has its uses in certain
in others there may be only one or two. In any case cases, as will be presently pointed out, but must rank
"the sinus leads down through a hole in the fascia to the second in importance and in choice to complete excision,
remains of the gland, and generally there is a quantity As a matter of curiosity I have looked out the last 100
of cheesy and calcareous material and broken-down cases of tuberculous glands in the neck on which I have
gland tissue at the bottom. In addition the skin at the operated, with the view of seeing the >ort of treatment
orifice of the sinus becomes the seat of a tuberculous adopted and the results. Of these 100 cases 30 had
ulcer, so that we may have a large sore in that situation unopened abscesses and 18 had sinuses. In some cases
with undermined edges. scraping and excision were performed in different situa-
In discussing the treatment of tuberculous glands I tions at the same time. The following are the results :
■do not propose to enter into detail on the medicinal “ In 84 cases excision was employed in the manner to
D
Digitized by vjOOQ iC
o
638 The Medical Press
ORIGINAL COMMUNICATIONS.
Dec. 20, 1899.
be presently described. (In 4 of these sinuses in the
neighbourhood were Bcraped). In some both sides were
operated either on the same day or after a week’s inter¬
val ; 19 of these had abscesses, and 10 had sinuses.
In 12 of these cases other glands in the neighbourhood
subsequently enlarged snd required further operation. For
example, where the anterior tri \ngle had been cleared
out glands subsequently enlarged in the sub-maxillary
region or on the other side or in the posterior triangle.
In none did recurrence take place in the area operated
upon.
“ In 20 cases scraping was done either because sinuses
were present or because the « was a single large abscess.
In 11 of these unopened abscesses were present, and in C
sinuses In 9 recurrence took place in situ and further
operation was necessary.”
Let us next consider the treatment to be adopted in
each of the five classes of cases above referred to.
1. These cases may well be watched for a time, treated
with arsenic, country air, good hygienic conditions'and
so forth, and unless the disease becomes active, most
usually as the result of some intercurrent affection, there
is as a rule no need for any surgical interference. There
is no marked deformity iu these cases; there is not as
as a rule much tendency to suppurate, and probably no
great danger of dissemination of the disease. As long
therefore as the glands remain quiescent these cases
may be left alone in so far as active intervention is con¬
cerned.
2 The second class of cases, where there is marked
enlargement of glands amounting to deformity, and
where the glands ate numerous and spreading, gene¬
rally requires operation. A trial of the arsenic treat¬
ment may be given, but if it fails operation had better
be resorted to. It is not advisable to wait too long in
these cases, for the lendency is to progressive infection
of the glands, and country air and other expectant means
have but little influence on them. As h«B already been
said, in many cases these swellings are simply composed
of a mass of caseous material, and while they may not
break down the disease has a great tendency to spread
down the neck into the thorax and axilla, and to prove a
distinct source of danger to the body generally. The
only operative procedure possible here i< excision;
scraping is quite out of the question. The excision, to be
of use, must be especially free, and if it is found that any
glands beyond the area of operation have escaped they
should be subsequently removed.
3. In this group the matting together of the glar ds
as the result of peri-adenitis shows that active inflam¬
matory processes are going on in them ; and while they
sometimes subside after careful treatment, their pro¬
gress must b** especially closely watched, and, if no
improvement billows, operative into ference should be
carried cut before a definite abscess has formed. In
these caseB some surgeons adopt scraping, others free
excision, and I hav« no hesitation in expressing my very
decided preference for the latter course, and that for
the following reasons: In the first place, we seldom
have only one gland en arged, while the scraping onlv
affects the individual gland penetrated by the instru¬
ment. It is, of course, possible to push the instrument
on into other g’and-, but the result is not very sati*-
factory, and th« smaller glands, which are also infected,
are left untouched. Besides, even as regards the glams
which are scraped out, it is often difficult, unless they
are very much broken down, to clear them out com¬
pletely, and thus tuberculous material is apt to be left
behind which rapidly grows and infects the wound, and
i hus recurrence very often tales place. It of'en happens
also that the smaller glands enlarge, and amass quickly
bams as large or larger than the original one, and it
is pr.-bable that the irritation of the Bcraping increases
the inflammation and leads to this enlargement.
Fu'ther, in a certain number of cases acute general
tuberculosis has followed Mich scraping.
The result* of excision in these cases are, as a rule
highly satisfactory. provided that the operation is so
• xtensive as to include the tut and smaller glands in
the neighbourhood and that none of the operation is
•lone hv scraping. Some surgeon-* when the glands are
udhe eiit. t<> the internal jugular »e.n, *8 they of en
are, remove as muoh as they can with the knife and
scrape the part adherent to the vein ; but, aa I shall
state presently, there is no objection to removing tho
vein along w.th the adherent gland, no harm whatever
resulting from this procedure. I have seldom seen re¬
currence after these operations, and this is the ex¬
perience of others, and I have no doubt that in many
instances the patients have been saved from a grave
risk. It is also very important in all cases to look for
and remove a possible primary focus, such as enlarged
tonsils, carious teeth, mastoid disease, Ac., at the time
that excision of the glands is carried out.
4. Suppurating glands. The conditions under which
one meets with suppuration in the glands are various,
and we may arbitrarily divide them into three groups.
(а) The abscess in the gland has burst through the
fascia, but only forms a comparatively limited swelling
under the skin. In these cases I advocat9 complete
excision of glands, abscess, Ac., in the manner to be pre¬
sently described, an oval piece of skin being taken away
over the abscess. In these cases it is usually necessary
also to remove the jugular vein. Care should be taken
as far as possible to avoid puncturing the abscess,
although in many cases, if large it is very apt to burst,
and pus escapes over the wound: even when this takes
place it is very remarkable that I have never noticed
tuberculous infection of the wound. I have, of course,
always washed the pus away immediately, but even
doing that, if we judge from the result when a cancerous
gland burst8, it iB surprising that, in some cases at any
rate, the wound does not become tuberculous.
(б) The abscess in the gland has burst through the
fascia, and formed a large swelling under the skin with
marked thinning of the skin over it. Under these cir¬
cumstances the removal of the whole of the thin skin,
which would be necessary in complete excision, would
leave a gap which it is difficult to close, and the scar of
which would be apt to stretch bfterwards; hence, I
prefer in these cases to open the abscess in the [first
instance, and then later on (in three or four weeks), when
the skin has recovered and only a sinus is left, to carry
out complete excision. In some cases it is well to scrape
out the gland and abscess in the first instance instead of
merely opening it, aDd it may be that this will suffice
for a cure, but if fresh swelling appears excision should
be performed as soon as the skin has recovered.
(c) An a u acesa is present which has not jet burst
through the fascia. Here one may in many cases wait
and allow the abscess to increase till it is probable that-
the gland has become completely broken down, and then
open and scrape out the abscess, inject iodofoim and
glycerine, and stitch up the woundagain. A very small
incision behind the sterno-mastoid frequently suffices in
thesH cases, and the resulting scar is practically invisible.
Cases, however, in which this result cHn be obtained aie
not very common and sometimes a sinus remains,and if
itdoes will not heal, and if fresh glandular enlargement
occurs excision should be pei formed.
5. Enlarged glands with sinuseb Here also excision
is the best tieatment, unless the sinuses are so nurne-
lousihat the operation is not practicable, The opera¬
tion is no doubt somewhat more difficult, but if it h©
carried out in l he systematic manner to be present Ijr
desciibed, I have never failed to complete it. Where
the 8 nu?e8 aie too numerous for excision, ihorough
scraping and the subsequent applicaiiun of undiluted
carbolic acid is the beet treatment.
Excision of tuberculous glands iB an extremely satis¬
factory operation if cariied out sufficiently widely. If
the enlarged glands aloue are removed, recurrence is
very apt to take place, and this is more likely to happen
if suppuration occurs in the wound. Under the latter
circumstances the glands which are infected but not
excised tend to enlarge and uud-rgo suppura’i- n
I have already said-and I cannot emphasire the
point too strongly—that in operations on tuberculous
glands one must not be coi.tent with shelling out the*
infected glands, but must remove the whole of the glan-
uular area, whether the glands are visibly aff-cted or
not. To shell out Ihe enlarged glands is only to ivmovo
the most affected i f the glands 1* aving behind numerous
Othwis which are al-o affected but not mar edly en-
Digitized by 1C
Dec. 20, 1899.
TRANSACTIONS OF SOCIETIES. The Medical Press. 639
larged. It does not, of course, necessarily fo'low that
these glands left behind will enlarge; but they are
more especially likely to do so if the operation has been
an extensive one accompanied by much tearing of the
tissues, and therefore with increased lymphatic flow, or
accompanied by suppuration or even a less degree of
inflammation. Under those circumstances the glands
swell up and the tuberculous disease makes progress in
them and generally forms fresh masses. And it must
be borne in mind that a second operation in the same
region is very much more diflicult than the first on
account of the cicatricial tissue distorting the relations
of the parts. Hence, where glands are removed for
tuberculous disease, one must map out and remove all
the fat-containing small glands in that particular
lymphatic area in addition to the enlarged ones.
The situation where one most commonly has to operate
on tuberculous glands is in the anterior triangle of
the neck, especially towards the upper part, and there
one must remove not only the whole of the fat and
fascia present in the anterior triangle of the neck, leaving
the ves-els, nerves, and other structures thoroughly
clean, but if one is to avoid recurrence one must also
thoroughly clean out all the tissues underneath the
sterno-mastoid, so that the muscles on which the sterno-
mastoid rests are completely bared. This cleaning-out
process must extend backwards into the posterior
triangle and if glands are enlarged there one can very
often, by working from the front, clear out even the
greater part of the posterior triangle. In any case it is
essential in removing glands from the anterior triangle,
whether they be tuberculous or whether they be malig¬
nant, to remove all the material around the vessels,
whether infected or not and all the fat and glands
underneath the sterno-mastoid. Especially with regard
to the latter, the removal muBt extend quite up to the
mastoid process because very often glands enlarge about
the region of the transverse process of the atla«, and the
material there must also be taken away.
(Elmical Jtecorbs.
WESTMINSTER HOSPITAL.
Cates of Atnenorrhaa treated with a New Salt of
Manganese.
Under the care of Dr. Mcrrell.
E.G.,.*t. 25, a nursemaid, was admitted November 9th.
1899, fo>- anaemia and araenorrhoea. f*lie stab-d that, her
illness commenced seven years ago, when she noticed
that she was very pale and was losing strength. 8he im¬
proved somewhat when taking iron pills, but has
suffered from three or four attacks of anaemia every
year since. She was well fed, had plenty of out-door
exercise, and was not overworked. For a fortnight
before admission she had been much more aniemic than
usual, and found it impossible to continue her work
Her menstrual history had been uniformly unsatisfac¬
tory, and it was not unusual for her to go from three to
five months without seeing anything Theie was no
leuoorrhcea; she was not pregnant, and she was not
constipated. Her blood was examined by Dr. Lazarus
Barlow, who found that it was of fair colour, but
appeared to be thinner than normal. The red corpuscles
were 4.520,000 per emm and of normal shape and appear¬
ance, but pale. The colourless corpuscles were 7 500 |>er
cium consisting chiefly of finely granular oxyphile poly¬
nuclear ce'ls and lymphocytes. There was, therefore, no
oligocythaemia, and the condition was one of uncompli¬
cated oligochromtemia. It was thought that if the pitient’s
menstrual condition could be restored her general health
would improve. Gool results would in all probability
hc.ve been obtained from senecio or from binoxide of
manganese or permanganate of potassium. It was
determined, however, to give the manganese in the form
of the new soluble salt, the citrate, a specimen of which
had been placed at Dr. Murrell’s disposal by Messrs.
Burroughs, Wellcome and Co. For the first fortnight
no active treatment was resorted to, in order that the
possible effect of expectation, rest and change of diet
might be eliminated. On November 25th, the patient
was ordered five grains of the citrate of manganese
three times a day. On December 4th, she commenced
menstruating—the first appearance for nine months;
the period was very profuse and continued for two
days and a half. The petient stated that she felt better
and stronger, and a few days later left the hospital.
J. T., a't. 19, a nursemaid, was admitted November
7th, also for amemia and amenorrhoea. Her case was
an almost exact counterpart of the previous one. She
had been very aniemic for nearly two years, and for
eighteen months had been living at home doing nothing.
She had never been quite regular, and for seven months-
the catamenia had been absent.. There was a consider¬
able amount < f cedema of the lower extremities, but she
was not pregnant, and there was no albumin in the
urine. There was no leucorrhcra. Red blood co’puscle6
3,830,000 per cmm. The colourless blood corpuscles were
3,000 per cmm., chiefly lymphocytes and finely granular
oxyphile p»olyuuclear leucocytes. It was a case of
oligocythicmia with considerable oligochromtemia. The
pjatient was ordered five grains of dried sulphate
of iron in pill three times a day, with a drachm
of sulphate of sodium in hot water every'
morning. This was continued for a fortnight, but
although she improved in strength and colour, the
menstrual function was not restored. On November 28th,.
she was ordered five grains of citrate of manganese three
times a day, the dose being gradually increased until
December 8th, when she was given 15 grams four times a
day. On December 13th, she menstruated, the period
lasting for two days Four days later she left the hos¬
pital ar her own request. Dr. Murrell stated that as far
as he was aware these were the first cases of amenorrhoea
treated with citrate of manganese. The effect had been
prompt, and the soluble citrate seemed to have many
advantbges over the insoluble binoxide, and the caustic
permanganate.
transactions ot Societies.
EDINBURGH MEDICO-CHIRURGICAL SOCIETY.
Meeting held Wednesday, December 6th, 1899.
The President, Mr. A G. Miller, in the Chair.
Mr. Wallace showed a woman tet. 44, six months
after pylorectomy for carcinoma of the stomach by
Kocher’s method. She suffered from severe vomiting
for twenty-four hours after the operation, when remem¬
bering Kocher’s advice, Mr. Wallace caused her to lie
on her right side, and the vomiting ceased.
Mr. Stiles showed (1) a child after operation for
severe deformity, following burn of the ankle. The foot
was much deflected inwards, and in order to rectify this
a wedge was cut out of the tibia and fibula. As the skin
on the outer as|>ect of the ankle was redundant a flap
was transplanted from it on to the inner side of the foot;
(2) achild with extensive ventral hernia following opera¬
tion for gangrenous appendicitis; (3) an infant aged three-
months, which was operated on twenty-four hours after
tne onset of symptoms of intussusception. On opening
the abdomen an acutely inflamed appendix was found
and removed. There had evidently been a secondary
intussusception of the colon, which had become-
spontaneously reduced. The origin of the appendicitis
was not clear, since the child had been exclusively
breast-fed. It left the hospital cured on the tenth day.
The incision was made in the middle line above the-
umbilicus; this is always advisable in young children.
Dr. A. A. Scott Skirvixo showed (1) a patient after
removal of a gangrenous app»endix, with general
peritonitis ; and (2; a child after subperiosteal resection
of the lower jaw.
Mr. Wallace showed (1) tumour removed in case of
pylorectomy; (2) tumour of the pituitary b^dy, which
had apparently given rise to no symptoms during life
(3) calcareous nodule from cerebellum; (4) fracture of
skull; and (5) calculus in the ureter.
Digitized by
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640 The Medical Press. TRANSACTIONS OF SOCIETIES.
! Dr. Harvey Littlejohn showed (1) dermoid cyst of
the ovary; (2) a heart which had undergone extensive
calcareous degeneration. The patient was a young girl
who died very suddenly; no cardiac lesion had been
detected during life
Dr. A. D. Webster showed an apparatus for the
application of hot medicated vapours to mucous sur¬
faces. It consisted essentially of an ordinary atomiser
whose body was formed of a large test tube. This was
fitted with a cork or rubber adapter so that it was sus¬
pended in a flask filled with boiling water.
Dr. Gulland gave a microscopical demonstration of
Cohn's method of staining fat in urinary deposits and
other fluids. Films were fixed in 10 per cent, formalin,
stained for ten minutes in a solution of Soudan III.
washed in 70 per cent, alcohol, and mounted in Farrant.
Fat is stained a bright orange; the process is simpler
and cheaper than staining with osmic acid.
Dr. C. W. MacGillivray read a paper on
THE RADICAL CURE OF HERNIA, WITH STATISTICS OF
8EVKN YEARS’ EXPERIENCE IN THE ROYAL INFIRMARY.
In deciding whether to advise a patient to have a
radical cure performed we had to consider hi* age, the
presence or absence of organic disease, his social position,
and the nature of the hernia. Operation* for hernia
might be classed as (1) imperative, in cases of
strangulation, where a radical cure was secondary,
and the operation should be as simple as pos¬
sible. (2) Necessary, as where a truss failed to
keep up the rupture. (3) Advisable, as in the poorer
classes, and those engaged in laborious work. Con¬
genital hernise in children of the lower classes also came I
under this head. (4) In some caseB, as where the rupture
was a bar to entering the Services, the operation was one
of convenience. As regards the danger to life, in the^rat
group the mortality depended entirely on the locaicon-
dition and the general state of the patient. The radical,
cure might well add to the risk of the operation. In the <
last three groups the mortality in young and middle-aged
people was practically nil; in older persons the danger
was often greater. The ultimate result was influenced
by the age of the patient, and, speaking generally,
the earlier the operation was done, the better was it.
So long as the neck of the sac was thoroughly obliterated
there was not much to choose between the different
operations ; personally, he preferred a modification of
Bassini’s operation for adults ; for children the operation
should be as simple as possible. Union by first inten¬
tion was always to be desired; the only two recurrences
of which he was aware were in patients in whom the
wounds had healed by granulation. It was most import¬
ant to keep the patient in bed for at least six weeks; a
truss should not be w< rn afterwards, as it was liable to
cause pressure atrophy. It was, of course, difficult to
speak as to the permanency of the cure, but the two
cases just mentioned were the only ones he knew to
have recurred out of a series of 91. Among these cases
he had only had two deaths - one from chloroform sick¬
ness and one from double pneumonia. Statistics of the
varieties of hernias, &c., were given.
The paper was discussed by Messrs Cathcart, Thom¬
son, Cotterill, Stiles, and the President.
ROYAL ACADEMY OF MEDICINE IN IRELAND.
Section of Medicine.
Meeting held Friday, November 10th, 1899.
The President, Mr. R. L. Swan, in the Chair.
The President delivered an address on “ Venereal
Diseases and their Therapeutics.’’
Mr. Glasgow Patteson read a paper on the
TREATMENT OF FRACTURED PATELLA BY AN IMPROVED
METHOD.
He recommended the use of a t trong silver D-shaped
wire, which necessitated only a single drilling of the
bone, and was sufficiently strong to allow of very early
passive motion of the joint being effected without risk
Dec. 20, 1899.
to the injured fragments. This was an important factor
in early and complete restoration of the function of the
limb.
Mr. Henry Gray Croly was opposed to the risk of
opening tbe knee-joint. He thought ligamentous union
just as good. When last in London he had inquired if
there bad been any deaths from the opening of the
joint in fracture of the patella, and found there had
been.
Dr. Ormsby had seen many cases treated by the
Dublin method with a short ligamentous band, and
frequently, when the patient was afterwards walking
about, people could not say which patella was broken.
The advantages of bony union did not appear to him so
great as those of a short ligamentous band.
Mr. Patteson, in reply, said he had never seen death
follow the modern method of treatment, which, of course,
should be used only in suitable cases. By the open
method, bony nnion and absolute mobility are made
certain within a short time He felt more and more
convinced that, with proper precautions, the opening of
the joint is the best method.
ON URINARY INFILTRATION.
Mr. H. Gray Croly read a paper on urinary infiltra¬
tion, illustrated by a series of cases which came under
his care in his hospital ind private practice. Mr. Croly ex¬
hibited six beautifully coloured drawings taken from the
patients by Dr. Paul Carton. Some were made in the
theatre before operation, others at a later period during
the healing process, and some when the wounds were
healed. Mr. Croly made important reference to the
surgical anatomy of the region involved in cases of
infiltration of urine, including a description of the
attachments of Colies’ middle femoral fascia. All the
cases were very severe. Only one fatal case occurred in
J Mr. Croly’8 list—in that case the patient delayed in
seeking admission to hospital until the local and con¬
stitutional symptoms were far advanced. Mr. Croly
said he had never seen in any surgical work a drawing
of urinary infiltration. The drawings were examined
with much interest by the President, Fellows, and
Members of the Society, and the communication elicited
an interesting discussion. In conclusion, Mr. Croly
described gangrenous erysipelas of the scrotum as an
affection which might be mistaken for infiltration of
urine, and differentiated the cases.
Mr. R. B. M‘Cau8lani> asked if Mr. Croly thought
incision of the testicle in these cases would be dangerous ?
He thought it remarkable that so many patients recover
from injuries of this kind.
Dr. E. H. Bennett had seen a case where a man was
“ butted ” in the belly, and injury to the bladder was
supposed to have resulted. A catheter was passed, and
bloody urine drawn off, but the patient objected to the
passing of the instrument, and afterwards passed water
for himself. He lived for nearly two months and died,
not with urinary symptoms, but of obstruction to the
rectum. At the post-mortem urinary extravasation into
the pelvis was found, although there were no external
phenomena to indicate this.
Mr. Doyle had seen extravasation of urine in a boy,
four years old, who had fallen out of bed, causing injury
to the perineum. He had obtained a satisfactory result
by the usual incisions. He did not see how a difficulty
could arise in the diagnosis.
Dr. Knott said a large majority of strictures occur
immediately in front of the triangular ligament, and
the great trouble in treatment is that injections and
instruments are generally stopped here by the ligament.
Mr. Croly replying to Mr. McCansland, said he did
not think incision would be dangerous if it did not go
through the tunica albuginea. The diagnosis should
present no difficulty, except where infiltration occurs
behind the triangular ligament, but he had already
mentioned a case of urinary extravasation in which the
man’s scrotum was tapped with a trocar and cannula.
The most deceptive cases are those in which abscess of
the perineum exists.
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Deo 20, 1899.
FRANCE.
The Medical Press. 641
SHEFFIELD MEDICO-CBIRURGICAL SOCIETY.
Meeting held Thursday, December 7th, 1899.
The President, Dr. Burgess, in the Chair.
Pk. H ale showed (1) a case of ulcerative syphilide:
(2) a case of eczema of neck, face, arms, trunk, and
popliteal spaces due to paraffin.
Dr. George Wilkinson read the notes of a case of
“excision of a gangrenous umbilical hernia, with secon¬
dary enterorrhaphy.” The patient was a stout woman,
jet. 49, the subject of umbilical hernia for twenty-six
years. When admitted to the Royal Hospital,symptoms *
of strangulation had lieen present foi about forty hours
< nly. The hernial sac was about 5 inches in diameter [
Sac and contents both were gangrenous. The whole was i
excised. The contents of the sac were 12 inches of i
transverse colon, and a large mass of omentum. Paul’s
tubes were fitted to the divided ends of the colon, which
were fixed in the wound. Secondary enterorrhaphy was
performed six weeks later, by means of Murphy’s button.
The patient made a good recovery. A jar preparation
of the sac and contents were shown.
Mr. Dale James showed the painting of a case of
erythema (?) which gained its chief interest from the
diversity of opinions as to its origin The lesions exist
on the chest and right arm, the patient being left-
handed. Each spot begins as an indefinite rose coloured
patch; this increases and developes into a circle, the
centre clearing up. In the circumference minute
vesicles appear and dry up, then exfoliation of the
cuticle takes place. The patient is a single lady, a*t. 30,
is highly neurotic, and has had this trouble for seven
years. It is probably factitious, although this is denied ;
and control experiments have failed to solve the doubt as
to its being so.
A case of “ necrosis of the lower jaw ” was shown,
the patient being Mrs. D., a*t. 35, who was admitted
as an out-patient at the Royal Hospital on November
5tb, 1898. She had l>een suffering from swelling and
pain in the lower jaw for the last three months.
On examination a swelling was found below the
anterior surface of lower jaw. Fomentations were
ordered, but as she did not improve she was ad¬
mitted November 25th. An incision was made, and
pus let out. Subsequently the jaw was scraped,
and extensive necrosis was found. As the disease had
progressed it was thought advisable to attempt removal
of lower jaw as far as the angle on each side, as this
appeared to be the limit of the disease. A skin incision
not being feasible owing to the septic condition of the
tissues the symphysis was divided, and an endeavour
made to saw through the bone at the angle. This was
done, but on seizing one half of the bone with the lion
forceps after a little manipulation the entire half came
out. The other half was extracted in a similar manner.
There was no haemorrhage and the patient made a good
recovery. Owing to the periosteum being left behind, a
new jaw is being formed, but, of course, without the
articulation. The patient can talk well and chew
anything.
Dr. Godfrey Carter showed a girl, a?t. 14, who
was totally blind from optic atrophy, and who was
suffering from the effects of a cerebral tumour, probably
tuberculous in character, and situated in the cerebellum.
Mother and sister died of phthisis, but up to three-and-a-
half years ago patient had been apparently healthy,
though the large size of her head had been commented
upon from infancy. Illness set in with severe frontal
headache. When this had continued for a week, patient
who was standing at her front door, vomited, and fell
down unconscious; there were no convulsions. Con¬
sciousness returned in two hours, but she was blind and
paralysed in face and all limbs. There was also com-
lete anaesthesia of limbs and left side of face,
ensation returned on second day, but power only after
two or three months. Was able to walk in six months.
Vertigo was a prominent symptom. No nystagmus. At
this time there occurred a second attack, something
like the first. Coma lasted one hour, sensation not
affected; there was incontinence of urine for three
weeks afterwards. She was in bed paralysed as before.
this time for six months, and was only able to walk in a
year. From that time improvement has been gradual.
She is intelligent and active, but in addition to being
blind there is paralysis of left sixth and seventh cranial
nerves, and the left side of the body is weaker than the
right. Knee-jerks are abolished, and her gait is
stumbling and uncertain. The head is large, as from
hydrocephalus, and presents a marked rectangular pro¬
minence of occiput. There is also some retraction.
efrance.
[from our own correspondent.]
Paris, December 17th, 1899.
Hemiplegia and Hypnotism.
At the Academic des Sciences a member related the
case of a woman of 28 of a very nervous temperament,
who was seized with a trembling of half of the body
and absolute mutism, followed by syncope, after an angry
discussion with her husband. When she awakened
from her faint the mutism persisted, and the patien^
presented hemiplegia of the right side. After a few'
days speech returned, but the paralysis continued more or
U‘38. Movement, although limited, was possible in the arm,
while the patieDt complained of numbness and prickling
in the leg ; the reflexes were intact everywhere except
in the sole of her foot. The case was evidently one of
hysterical hemiplegia.
The patient was submitted to hypnotism, and the idea
was suggested to her that she did not suffer from the
sensation of numbness in her limbs, and that she could
walk. The woman walked almost immediately and
has remained well ever since (two months).
C'OXALGIA.
M. Schwartz renewed the discussion on the treatment
of coxalgia at the Surgical Society. He said that by the
conservative treatment many cases of coxalgia were cured,
but after a considerable lapse of time. By resection, on
the contrary, the cure was rapid, and if the function of
the limb was not absolutely perfect, it could be much
improved by an appropriate apparatus. As regarded
himself, he resected the articulation of the hip for coxal¬
gia ten years ago, and the patient, who was now twenty-
five years old, was able to compete in 150 mile match of
bicyclists. The shortening of the limb was only a little
Over an inch.
M. Delorme said that ten years age he practiced resec¬
tion of the hip for coxalgia complicated with fistula on
two patients, and both died; he had since renounced
that radical treatment, but from what he had heard from
his colleagues he was inclined to return to it.
M. Felizet thought that when the conservative treat¬
ment produced good effects that the fistulaj closed and
the fever fell, they were all agreed that there was no
hurry about the resection. On the other hand, when
the pain and the fever persisted, and the tuber¬
culous infection was making progress, the radical
operation should be preferred. It was a mistake to con¬
sider resection of the hip as a dangerous operation ; his
statistics of 200 cases were ample proof of the relative
facility of the operation and its successful result. As to
the defective method of walking witnessed in some cases
it could be easily corrected with an apparatus.
Appendicitis and Intestinal Obstruction.
M. Aviragnet related two cases of perforating appen¬
dicitis co-existing with obstruction of the intestine.
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642 The Medical 1 rkss.
GERMANY.
Dec. 20. 1899.
The first was that of a woman of forty, who entered the
hospital with symptoms of intestinal obstruction,
probably due to cancer and meteorism, obstinate constipa¬
tion, fa?cal vomiting, Ac., were present. At the end of a
few days the patient was suddenly seized with violent
abdominal pain and succumbed tepidly to collapse.
At the autopsy a cancerous tumour was found in the
left angle of the colon, and acute peritonitis conse¬
cutive to a perforation of the appendix.
The second patient was a woman of forty-nine, who
■entered the hospital with symptoms like those of sub¬
acute appendicitis. Signs of intestinal occlusion rapidly
set in necessitating laparotomy. On opening the abdo¬
men acute peritonitis due to perforation of the appendix
was remarked. Obstruction of the intestine was also
observed, and the distension of the intestine was so
great that an artificial anus had to be made in order to
close the abdomen. The patient succumbed the same
evening.
These two cases proved to the speaker’s mind that
intestinal obstruction and appendicitis represented fre¬
quently cause and effect.
(Sermang.
[from odr own correspondent.]
Berlin, December 16th 1899.
At a recent meeting of the Society for Innere Medi-
zm Hr. V. Leyden related a case of
Acute Gonococcus Peritonitis
with demonstration of a bacteriological condition of
general interest. A woman, cet. 29, had been in the
1st Medical Klinik for 14 days. She was much reduced,
suffering from high fever and ascites. The diagnosis
was difficult, as there were but few points of indication.
Two years ago the patient was pregnant, then jaundice
came on, and labour was induced artificially by the
medical attendant. Later, swelling of the abdomen
came on, the condition varied, sometimes becoming
better, sometimes worse, without anything giving an
opportunity for a diagnosis; urinary trouble of un¬
certain character was also complained of. The urine
showed no albumen. Puncture of the abdomen was
made twice, the liver after removal of the ascites was
found to be rather indurated, but not enlarged; no
tumour was found in the pelvis. The ascitic fluid
which was examined but not very carefully, showed a
fluid tolerably rich in cells, but nothing abnor¬
mal. The temperature, persistently high, rose to
39 6 degs. C., then there was slight diazoreaction in the
urine, nothing in the lungs. Then the fever got much
worse, with vomiting, and death took place. The
autopsy showed the following: the liver contracted,
nodular, cirrhotic, strong interstitial hepatitis, the
spleen enlarged. Whether the deceased was a drinker
was not ascertained. This condition explained the
ascites but not the continuous fever, but the condition
of the fluid remaining in the abdomen was surprising.
It was markedly purulent, the liver and intestines were
thickly coated with fibrin, there was therefore acute
peritonitis. The question then arose as to the bac¬
teriological cause for the peritonitis, and the bacterium
coli was first thought of. The assistant. Dr. Adam,
examined and found cellR which he declared to be gono¬
cocci. The speaker, and also Dr. Michaelis confirmed
this decision. Cultivation on the ascitic soil showed
pure cultivation of gonococci and nothing else.
The gonococcus had recently been made responsible
for a series of serious affections, whilst formerly its
activity had been supposed to be limited to the urinary
passages. It had been seen that under certain, but not
accurately known predisposing causes, it could spread
itself in the system, and set up serious diseases. Then
in 1893 it was found by the speaker as the sole deposit
in a case of endocarditis, and this discovery had been
later on c<» firmed. Since then the gonococcus had been
diligently searched for; its piesence in gonococcal
joint inflammation was known. Concerning its presence
in acute diffuse peritonitis, there was at present no clear¬
ness of view, although gynecologists had pronounced in
ts favour. Even in the latest works there was no strict
proof that it alone could cause diffuse peritonitis Only
Doderlein with two others had found an exudate with
gonococci in which the germ was proved to be the cause
of the peritonitis; in all these cases, however, proof by
culture was wanting. The case before them was the
first in which this proof had been produced.
Peritoneal Sepsis and Shock.
An address was recently given on thi3 subject before
the Gynecological Section of the Natur foscherver-
sammlung in Munich by Hr. Otto Kustner. According
to the speaker, some abdominal cases ended fatally sud¬
denly after operation, in which the symptoms did not
correspond to the ordinary ones of peritonitis In
extreme cases failure of the heart was the prominent
symptom; but he thought that a deleterious action
of germs was the most probable cause. Such fatal
action of germs under similar conditions bad long been
known to surgeons, and the speaker thought it probable
that germs played the leading part in these unfortunate
cases also. As the action of the poison was shown more
markedly in its effect on the heart, it was at first sight
probable that patients «ith weak and degenerated hearts,
such as were found in myomatous cases, would be
especially endangered. Naturally a seriously degener¬
ated heart would fail more quickly under the influence of
a serious abdominal operation, narcosis and loss of
blood. This ought to be or must be called shock.
It was certainly veiy rare in rapidly and skilfully
performed operations, and also certainly degenerated
hearts bore narcosis and loss of blood badly. On the
other hand, the soundest and most powerful hearts
succumbed to the action of poisons such as could be
observed in sepsis following abdominal operations.
Further, the observation of the writer showed that
the time limits necessary for a fatal termination were
very limited. Sometimes the bacterial growths scarcely
extended beyond the field of infection. He chose the ex¬
pression “ peritoneal sepsis” rather than that of “ septic
peritonitis.” As in the present case the inflammatory
process really stood in the background. If it were
wished to characterise the condition more sharply, it
might be called “ acute peritoneal septic intoxication,”
as not the infection but the toxicity was the marked
feature. He considers the hands of the operator or
of his assistant, or some object coming into contact with
the wound during the operation to be the cause of the
infection, and counsels greater care in sterilisation of
every object that will be brought into contact with the
wound, and limiting as much as possible all contact with
it. He also believes that when the virulence of tne
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Dec. 20. 1899.
THE OPERATING THEATRES.
The Medical Pbess. 643
These cases are shrouded in considerable doubt as to
whether the paralysis has an intra-uterine origin from
■microbes and their numbers are moderate the Mikulicz
tampon will be a protection But if the virulence is
great and the numbers are also great it will be of but
little service.
At the Medical Society, November 20th, Hr. Virchow
showed preparations of
Osteomalacia
from a woman, set. 34, who had been treated unsuccess¬
fully by removal of both ovaries. The woman was very
fat, and at last she died. The uterus was very hyper¬
trophic, the collum long and firm. Mucous membrane of
the interior of the uterus much reddened, just as if a
result of recent irritation The pelvis was deformed, the
ilium bent outwards; the thorax showed fractures of the
ribs on both sides (some of the f r actures appeared to have
been caused by transport of the body), many bones were
completely dissolved, so that nothing remained of their
substance, and red marrow was present throughout their
whole extent. In the last century these sanguinolent
masses would have been put down to scurvy. The
other changes were similar to those which, in recent
times had been observed in pernicous anaemia. The
calvaria had the appearance, and on tapping gave out
the sound, of papier macht 1 .
Jluetria.
[from our own correspondent.]
ViKlflf a, December 16th, 18W.
Scarlatinal (.Esophagitis.
At the Medical Club Knbpfelmacher showed a few pre¬
parations taken from cases of (esophagitis caused by the
scarlatinal virus. He first referred to Eiselsberg’s
reported cases of oesophageal stenosis where no direct
cause could be discovered from the history in the shape
of escharotics, irritants. Ac., although there was suspi¬
cion of the diphtheritic virus in one case. Knopsfel-
macher’s two cases of (esophagitis ended fatally The
macroscopic specimens when hardened did not show
the necrosis so well as under the microscope. This was
coagulated in the thickened mucous membrane and was
well brought out by Weigert’s colouring, as well as the
streptococci and other bacilli; none of Lbtfler’B diphtheria
bacilli were to be found. Angina necrotica is a
typical complication of scarlatina, although it may also
be met with as a prodromal condition of the disease. It
is also present histologically in some forms of diphtheria,
but in this disease as a fibrinous deposit on the mucous
membrane with a similar necrotic effect. In the mixed
state where diphtheria and scarlet fever are combined
Loffler’s bacilli will be found, although often overlooked
in the search.
Infantile Paralysis through Difficult Parturition.
Steiner showed an infant, eight weeks old, with
paralysis in the right arm which appeared after it was
born. The labour had been difficult with breech
presentation and manual relief. Closer examination
revealed paralysis of the light deltoid and biceps,
as well as supinator longus and brachialis intemus in
a lesser degree, and it may be represented as a type of
Erb’s paralysis. Atrophy of the paralysed muscles was also
present, with reduced faradic and galvanic stimuli,
while degenerative reaction and disturbance of the
sensibility observed. The sterno-cleido mastoideus is
hard and ropy to the touch.
cerebral causes, such as porencephalia, atrophy of the
posterior cortex,cerebral degeneration, or haemorrhage, or
whether they have been solely produced in the act of
parturition. In the latter case it may also be of a
cerebral nature caused by injury to the head of the
child, or it may be peripheral by injury to some local
centre which comes under the category of Erb’s paraly¬
sis affecting a muscular group supplied by the plexus
brachialis where the lesion is located to the fifth and
sixth cervical nervec. Budinger has remarked that
great elevation and posterior pressure of the affected
arm may thus act on Erb’s point between the clavicle
and first ribs. He admitted that the pressure
applied in this position may have Deen the
probable cause in the case exhibited, and may thus
be explained by Erb’s paralysis with BUdinger’s assist¬
ance, which he presumes may be induced by the presence
of a hiematoma produced by tearing the muscular
structure of the sterno-cleido mastoideus which would
thus complete the compression on Erb’s point.
In the discussion that followed Neurath described a
case of his own where the paralysis was of a paraplegic
character. The child when born was in a semi-
asphyxiated condition, but after a little perseverance
was reanimated.
Attention was soon directed to the peripheral
paralysis, which was at first viewed with considerable
scepticism. What the real cause could be, till occasion
arose in a similar case from a post-mortem examination,
when htemorrhage was discovered in the lumbar region
of the cord.
Rosenberg was of opinion that pressure by some
morbid deposit was the probable cause of the paralysis,
and according to his own experience the piognosis was of
rather a hopeless character, as atrophy and subluxation
soon appeared.
He proposed early operation in such cases to remove
all morbid deposit and prevent further deformity in the
muscles or joints.
^he (Dperating theatres.
FRENCH HOSPITAL AND DISPENSARY.
Abdominal Hysterectomy.— Mr. R. O’Callaghan
operated on a woman, ret. 50, who had been suffering for
some years from an uterine fibroid which, during the last
year had been increasing and was weakening her entire
system by profuse loss of blood. When admitted her
enfeebled condition was such as to necessitate postpone¬
ment of operative interference for some weeks, but it
was undoubtedly a case in which operation was the only
hope of saving and prolonging life. After the patient
had been ana'sthetised an incision about 6 ins. long was
made'from the umbilicus to just above the pubes, and
the tumour easily turned out. The difficulty that
was at once apparent was that the bladder pre¬
sented high up on the tumour necessitating con¬
siderable care in stripping it off the uterus. The
broad ligaments were tied on each side and divided.
An assistant placed his forefinger on the os uteri through
the vagina (which had been previously washed out
thoroughly with 1 in 1,000 biniodide of mercury), thus
giving a guide to the posterior fornix; this was cut
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down upon and the uterine arteries tied on both Bides,
and thus the whole tumour was removed practically
without any loss of blood. Dry sponging having been
applied to the cavity of the peritoneum the exist¬
ing gap between the broad ligaments in the serous
membrane was brought together by continuous
catgut suture, thus shutting off the peritoneal cavity,
the nl dominal incision was closed in two lagers,
one with continuous catgut for the peritoneum
and the other with silkworm gut, which took up the
layers of the parietes and the skin. Mr. O Callaghan
remarked that this was one of the typical cases of fibroid
uterus (oedematous myoma) that justified an operation,
which at all times he considered to be most serious, not
only on account of the mutilation to the woman but
because of the mortality of the operation itself, this
being in very skilled hands at least 5 per cent, (that is,
he said, taking those cases only in which operation was
really justifiable, and not those in which nothing is met
with beyond a small fibroid or subinvolution of the womb-
designated by some as fibroid thickening). With regard
to the difficulty with the bladder during the operation,
he pointed out that owing to the care which was
necessary to strip off the viscus from the uterus the
operation was prolonged more than he had expected,
although it only lasted an hour. The Trendelenberg
position, he said, was not employed during the operation,
but the bowels were easily kept out of the operative
area by means of thin flat sponges, this he considers
sufficient in ordinary cases of abdominal hysterectomy-
He thought that in a thin walled abdomen, such as in
this patient, two layers of suturing was quite sufficient-
while in a fat patient it was always wise to u»:e three
layers.
It is satisfactory to state that three weeks after the
operation the patient was convalescent, and that she left
the hospital at the end of the fourth week.
CANCER HOSPITAL.
Trans-Sacral Excision of the Rectum.—Kraskk’s
Operation.— Mr. Charles Ryall operated on a man,
set. about 50, who was admitted to the hospital suffering
from constant passage of blood, and mucus, morning
diarrhoea and pain. These symptoms had been present for
six months. There was, too, marked emaciation. On
examination just within the anus and affecting the pos¬
terior wall of the rectum a cancerous growth could be felt
extending upwards for a few inches. There was no
evidence of secondary deposit elsewhere. The patient
was aniesthetised, placed on the left side in a
semi-prone position with the thighs well flexed
on the abdomen. A median incision was made
from the middle of the sacrum to the margin of the
anus, the coccyx and the lower two pieces of the
sacrum were removed, and the rectum separated from
the surrounding soft structures. The peritoneum of
Douglas’s pouch was then incised,and by ligaturing and
severing the meso-rectum, the bowel was brought down so
that a healthy portion could be fixed to the upper angle
of the wound; the periloneum was then closed by
suturing it to the anterior surface of the upper
rectum, and the bowel was divided well above the
disease, and all the lower portion, including the
anus, removed ; the wound was closed partly by buried
and partly by superficial sutures. A dressing was
applied, and the patient removed to bed. Mr. Ryall
remarked that in this case it was impossible to save the
anus owing to the proximity of the growth, and there¬
fore he considered it advisable to give the man a sacral
anus, as this was in abetter position for the application
of a plug. He drew attention to the early opening of
the peritoneum during the operation, which facilitates
the separation of the bowel above and need not in¬
crease the risks if due precaution is taken to prevent
infection, this last being best avoided, he said,
by not severing the bowel until the peritoneal
wound has been closed. The complete closure of the
wound is, he thought, of the greatest importance in
shortening convalescence. It iB necessary to ensure
apposition of the deeper as well as of the superficial
portions so as to prevent accumulation of any exudation,
and this is accomplished by using buried sutures for the
deeper part of tbe wound.
It is satisfactory to 6tate that a fortnight later the
patient was up and about, and by means of a sacral
plug he was able to have complete command over his
motions.
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9Ehc pineal frees attb Circular..
“ 8ALU8 POPDLI 8UPREMA LEX.”
WEDNESDAY, DECEMBER 20, 1899.
VACCINATION IN EXCELSIS.
We doubt not that the anti-vaccinationist party
are always on the look out for well authenticated
cases of small-pox epidemics, for the propagation of
their teaching almost depends upon these. Without
such records it would be impossible for the party in
question to exercise their ingenuity in order to show
that the outbreak and continuance of the epidemics
were entirely independent of vaccination. An
epidemic of small-pox no sooner occurs in a town,
compelling vaccination and re-vaccination to be
resorted to wholesale among the inhabitants,
than the anti-party immediately proceed to argue
against the facts, and endeavour to prove that small¬
pox has broken out as the result of insanitation. For
a time some of those who listen to their unpbilosophi-
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LEADING ARTICLES.
The Medical Press. 645
cal deductions aie impressed. but the progress of the
epidemic upsets all calculations, with the result that
the nnvaccinated community—or those who are left
of it— quickly display an eagerness to take
shelter under the safe protection of vaccination.
In this connection, however, we are glad to
draw the attention of the anti vaccinationist party to
the facts in connection with the outbreak of small-pox
at Puerto Rico when that island was occupied last
year by the American troops. In January. the
American authorities found that in two months no
fewer than J.immi cases of the disease had occurred,
and an order was therefore issued by the Governor-
General that every resident who had not had the
disease was to be vaccinated, and that for the
future every infant was required to lie vacci¬
nated liefore reaching the age of six months.
An interesting detail in regard to this order
was the provision made by the American Govern¬
ment for the supply of the necessary vaccine.
It was found that vaccine forwarded from the
United States lost its virulence on reachingthe island-
and this necessitated the establishment of a vaccine
farm. The farm was conducted upon a most syste¬
matic plan The men engaged in the work were :
divided into three gangs, each in charge of an acting
assistant-surgeon of the army. First, those testing the
cattle for tuberculosis: second the vaccinating squad ;
third, those collecting the virus. By this means, ac¬
cording to Dr George G. Groff, who contributes a
paper on the subject to the New York Medical Neics,
no trouble was experienced in producing about
15,001) points each day. Each animal furnished on
the average 500 points, the maximum being 3,700.
The result of this special effort was that in a few
months, that is to say, between the end of January
and the end of June, no fewer than 790.000 persons
were vaccinated; the authorities consequently
have how reason to believe that Puerto
Rico is protected against smallpox so far
as successful vaccination can effect that
object. It is interesting to learn that the populace
generally accorded » welcome to the vaccinators and
that no disturbance of the peace occurred as a result
of the vaccination order. Moreover, it is highly im¬
portant to note that not a single death ensued which
could lie strictly attributed to the vaccination.
Lastly, at the middle of October following the vac¬
cination campaign, the disease was held to have been
stamped out of Puerto Rico, inasmuch as not a single
case of the disease, at that date, was known either
to the military or the civil authorities. These
facts, t) which attention is here drawn, probably
establish a record in the history of vaccination, and
they form a striking proof of the value of the
civilising influence brought to bear upon this hitherto
Spanish settlement by the Government o. America.
The whole cost of the vaccination campaign amounted
to about i'6,400, an outlay which, as Dr. Groff says,
cannot be regarded as extravagant in view of the
fact that the island has been freed from a loathsome
and very fatal disease.
LEAD POISONING IN THE POTTERIES.
An important step has been taken by the Home
Office with regard to lead poisoning among workers
in pottery manufacture. The magnitude of the evil
was established by Government inquiries, especially
by those embodied in the Report of Dr. Thorpe and
Dr. Oliver. Even now that steps have been taken to
stay the mischief the proportion of sufferers from
plumbistn among the female workers still approaches
•'»<» per cent. There is little need, however, at this
stage of matters, to insist upon the disastrous preva¬
lence of industrial lead poisoning, which has always
been most conspicuous in the districts where the
manufacture of china and earthenware is a staple
industry. The widespread nature of the danger and
its absolutely preveutibility have been urged in the
columns of The Medical Press and Circular
for many years past, and it is therefore with
peculiar pleasure that we hail the approach, if not the
perfect fruition, of a logical preventive policy by the
Home Office, with whom rests the ultimate responsi¬
bility in such matters. Among the inquiries
conducted by that department was a series addressed
to the manufacturers themselves, with results that
are most hopeful for the future, if we may judge from
the tenour of the circular note officially sent to
employers. The Home Secretary has announced his
conviction that leadless glaze can be substituted in
many branches without detriment to the finished
products. That conclusion was arrived at in many
unofficial circles long ago, and its practical outcome,
namely, the prohibition of the use of lead in glazes,
has been warmly advocated from time to time in our
own columns. The Secretary of State appears
not to have had the courage of his convictions
so fur as to add prohibition to his Special Rules
issued last year. It is proposed to extend the system
of medical inspection to the whole of the workers in
lead processes, the advisability of which advance is
abundantly proved by the actual decrease of cases
that has followed partial measures extended over the
extremely short period of, roughly speaking, some
eighteen months A proposal of the manufacturers is
that where the use of lead is permitted it should be
only in a “ fritted ” form, that is to say, fused into
a kind of glass, which is applied either as a dry
powder or a paste. The point of this recommenda¬
tion is that cases of poisoning are either extremely
rare oi altogether absent from the use of a properly
fritted glaze. In applying this principle it is
necessary to insist upon a certain standard
composition, as otherwise safety is not attained.
In order to allow manufacturers to acquire
the necessary experience it is proposed to allow a
period of two years to elapse before any standard is
officially imposed. All these propositions are
encouraging to those who are interested in the
important social question of the prevention of
industrial or trade diseases. They show that the
earnest attention of the Legislature is being given to
the subject, and that there is every prospect of effectual
prevention being carried out with in a not distant future.
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646 The Medical Fhess.
NOTES ON CURRENT TOPICS.
Dec. 20, 18W.
Above all, they serve as a model of official tact in
the way in which the views of workers, of scientific
men and of employers have been collated and diplo¬
matically consolidated. If a criticism might be
allowed it would be to the effect that the total pro¬
hibition of the use of lead in pottery would have gone
to the root of the evil. So far as we have been
enabled to investigate the matter we can find no
valid reason to the contrary. Glazes just as effective,
as lasting, and as cheap can be made without as with
lead. It is apparently to provide for the possibility
of there being some process invented in w liich lead
may be indispensable that the departmental policy
has been provided with a loophole, the exact size of
which time alone will suffice to determine. Mean¬
while, we hail with hearty approval the action of the
Home Office in dealing with a serious industrial
danger, not only on the score of humanity, but also
more generally as indicating a desire to grapple with
many problems of a similar nature that urgently call
for the light of fuller knowledge in order to guide
the iron grip of logical prevention.
THE GENERAL MEDICAL COUNCIL AND THE
APOTHECARIES HALL, IRELAND.
Notwithstanding that the report of the
examiners, inspectors, and visitors appointed by the
General Medical Council to supervise the examina¬
tions conducted by the Irish “ Hall ” were effusively
eulogistic, the Institution has not“ escaped whipping.”
The inspector states that the “ final examination will
bear comparison as a test of fitness with any of the
ordinary pass examinations within the United
Kingdom, and the surgical examiners ’’ (appointed
by the Council itself) say that *• they were satisfied
with the method by which the examination was con¬
ducted. and with the standard of knowledge required.”
There is more in the same strain, yet the observa¬
tions of the Examination Committee of the
Council which presents the report are devoted
to picking holes in the examinations and giving
expression to that manifest partisanship which
has prevented its previous utterances from being
accepted with the respect and confidence with
which they ought to be regarded. The state¬
ments mode by the Committee have been shown
to be, some of them inaccurate, and others biassed
and unjust, and, therefore, they go for nothing, but a
further opportunity was afforded to Sir Dyce Duck¬
worth, who plays the role of the wolf to the Hall's
lamb, to attack it when the proposal was made that
the Apothecaries' Halls of both London and Dublin
should be extinguished by taking them into the
examinational conjunctions of England and
Ireland. This proposition was made for Ireland in
1886 and was energetically supported by the Medical
Council even to the extent that the then President,
Sir Henry Acland, went to Dublin, to persuade, if
possible, the Irish College of Physicians to accede to it.
It wasalso supported by the Irish College of Surgeons,
which was willing to have l>een pariy to the proposed
triune conjunction, and which, when the Irish
Physicians refused to listen to reason, entered into a
conjunction with the Hall, which the physicians in
vain sought to prevent by a suit in Chancery. In
the recent debate the representative of the Trish
College of Physicians raised, for the first time,
certain technical objections to such a conjunc¬
tion. 1. That the Irish Hall is under the
supervision of the College of Physicians with respect
to the inspection of Apothecaries’ shops, and the right
of appeal of candidates rejected by the Hall. 2.
That the College would object to the increment of
the fee of its Licentiates, which would necessarily
accrue from the addition of a third body to the con¬
junction. 3. That, to act with strict legality, the
Hall could not charge more than 10s. for its licence,
and could not dispense with apprenticeship of its
candidates as it now does, and that the College of
Physicians could not co-operate in any scheme
of examination which would not lie strictly
legal. While we do not dispute the validity
of these difficulties, we know that they
have little to do with the real block m- retained
against an Irish tripartite conjunction, for they
would all be got rid of with certainty in a few months
by a short Medical Acts Amendment Bill, such as
has been passed nem. die. for other bodies, if such
Bill were endorsed by the Medical Council, the Irish
licensing bodies, and the Privy Council and the Irish
College of Physicians. The actual and insuper¬
able obstruction to such a reasonable and busi¬
ness-like settlement of a dispute which haB oc¬
cupied the Medical Council for more than forty
years is the morbid respectability of the College
of Physicians. Following the example of a
more ancient but scarcely more dignified body
which has its centre of administration at Rome, it
has, since medico-educational reform began in 1858,
opposed all advancement with the epigrammatic
phrase, non possumus. Ireland, in the race for
medico-educational progress, has had to pull up in
face of this obstruction, and, until some means are
adopted to bring this College to an appreciation of
the fact that the profession cannot afford to stand
still to please it, we do not see what can lie done to
open the impaste which it creates and maintains.
.itotes on Current ‘CoptcB.
The Ready Method in Prescribing.
It is not surprising that the dispensing general
practitioner and the chemist have become excessively
uneasy at the growth of the “ tablet ” system of
medication, to which a correspondent calls doleful
attention, but the observer of the progress of events
for the past few years must have seen very clearly
that the days of universal prescription writing, and the
profits arising therefrom, are numbered. The infinite
variety of coated pills and compressed medicines
which are now at the disposal of the public and the
practitioner, the excellence of their therapeutic com¬
binations and, speaking generally, their trustworthi¬
ness cannot be questioned; and, moreover, these pre¬
parations afford facilities for the administration
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NOTES ON CURRENT TOPICS.
The Medical Press. 647
Dec. 20 , 1899 .
in minute doses of the very active alkaloids which
the practitioner prudently hesitates to order in
a prescription. We recognise, of course, that special
cases require special combinations of drugs which the
skilled physician can prescribe, and the skilled
pharmacist compound, and. for such cases, prescribing
must always be preserved, but the occasions for such
methods are now somewhat exceptional. The dis¬
pensing practitioner and t* e chemist must see that it
has become necessary and will l>e increasingly more
so, to accommodate their practice to the new system,
and no longer place their sole dependence on the one-
and-sixpenny mixture or the shilling box of pills. We
can see. of course, how disadvantageous it must be,
to make every patient his] own prescriber and dis¬
penser, but to a great extent this has been already
done, and it will be quite futile to raise a trade cry
against it.
The Thermometry of Phthisical Patients.
One of the peculiarities of the sanatorium method
of deahng with phthisical patients is the practice of
taking the temperature in the rectum rather than in
the month. This is strongly objected to by some-
who regard it as a needless indignity inflicted on the
patient by a fastidious superintendent. It must be
premised that there iG no sort of relationship between
the rectal temperature and that taken in the usual
way, at any rate in disease. The former may be
two or three degrees above the latter, or it
may be the same, or lower. If that be the case
—and the comparative charts show it to be so—
we must either have both or, if only one, the recta]
temperature. It is amusing to hear it described as an
indignity. Nothing is an indignity if it be for the
benefit of the patient. Do we hesitate to feed a young
lady suffering from gastric ulcer by nutrient enemeta
tinder pretext that it might offend her modesty ? We
trow not, and the physician has to consult, not
abstract aesthetic ideas of what is becoming and what
*8 not, but what is to afford him the most trustworthy
indications of the condition, for ti e time being, of his
patient.
The Influence of Age on the Incidence of
Tuberculosis.
It is a matter of everyday experience that the
incidence of tuberculosis in regard to form and
course varies according to the age of the subject.
Looking at the question from one point of view
we see that while, in the vast majority of cases of
tuberculosis occurring in very young children, the
alimentary tract is the seat of the mischief, the
tendency of the disease to attack the lungs
increases year by year as age advances. This
peculiarity is easily, and probably correctly,
explained by the relative liability to infection,
which, in infants, is assumed to be greater in
respect of their special food, while in adults and
older children the air is supposed to be the principal
vehicle of infection. If this liability in respect
of infants is conceded, it constitutes a crush¬
ing indictment of milk as a food, for it is to
this source that the prevalence of intestinal tuber¬
culosis in young infants is attributed. But there is
another point of view, for we find that most cases of
what is commonly described as surgical tuberculosis,
that is to say, tuberculosis of bones and joints, occurs
in adolescents, though, to a less extent, it is met with
later on in life. Why adolescents should be more
prone to this particular form of the disease is a
problem which has not yet been solved. Bone
and joint tuberculosis is decidedly rare during
middle life, but it undergoes a slight recrudescence
as age advances. It has been remarked that
phthisical patients rarely develop tuberculous disease
of the joints and bones and, conversely, persons
afflicted with the latter manifestations of the disease
are not often phthisical, though tbev may become so
as the result of a generalised infection having for it 8
starting point the disturbed local lesion. There is
much in this distribution of special forms of the
disease at particular periods of life that calls for
further careful observation, though the general
principles of treatment are not greatly modified
thereby.
Craniectomy for Microcephalus.
The surgical enthusiasm with which the suggestion
was received some years ago of treating microcephalio
idiots by means of craniectomy gradually subsided,
when subsequent experience of the operation proved
that the results were unsatisfactory. Consequently
it is now only upon rare occasions that any case of
the kind is recorded. The mortality of the procedure
has been estimated by Keen at from 15 to 20
per cent., but, despite this fact it cannot be
regarded us unjustifiable to operate when the
case selected for it appears to be one in which good
might result. Authorities a»'e generally agreed that
the congenital cases are unsuitable for operationi
while in the late and acquired forms of microcephalio
idiocy the prospect of achieving some good is more
favourable. It is, nevertheless, beyond dispute that
very manifest improvement has been obtained in
some cases, and in a case recorded by Wilson, of
Toronto, in the current number of the Cana¬
dian Journal of Medicine and Surgery, it
would appear that improvement has followed the
operation. The child was five years old, and at the
time of his admission into the hospital he could only
say one word—“ mama,”—and this be indiscrimin¬
ately applied to every person. Moreover, he could
not play with his toys, was very restless, and rubbed
his head a great deal. His body also was much bent
when he walked. The operation was divided into
four stages, with intervals of two or three
weeks between each, and in the end about
four inches of bone in length, by two inches
in breadth, were removed from either side
of the sagittal suture. The result was
that from the first the child became easier to
manage ; he began te play with his toys, and to learn
a great many words and short sentences. It was also
noticed that his disposition became milder, and that
his restlessness at nights ceased. Furthermore, it
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NOTES ON CURRENT TOPICS.
Dec. 20, 1899
648 Thk Mbdical Press.
became possible for him to stand erect, and the
improvement in his gait was most marked. Upon
the whole, then, this case must be classed among the
successes, proving that under favourable conditions
the operation is both justifiable and expedient.
A Distinction or a Difference ?
When an officer dies on the battlefield having
been killed by the enemy, officially his death is
described as “ killed in action.” This latter phrase
is one with which every one is familiar, and its ex¬
pressiveness conveys a great deal of meaning. But
those who for any reason were called upon to peruse
the Gazette of December 5th could scarcely fail to |
have felt surprised at the announcement relating to j
the late Major Gray,R.A.M.C. The public a short time
ago were informed by despatches from headquarters j
in South Africa that this officer was killed while
attending the wounded in the battle at Farquhar's
Farm. Despite this fact, however, in the Gazette
above referred to, while all the other officers men¬
tioned are described as ,r killed in action,’’ the late
Major Gray is announced as “ deceased.” What does
this mean ? Are we to understand that the WarOffioe
have determined that a medicalofficer cannot be‘‘killed
in action,’’ or that if while attempting to save the lives
of wounded soldiers he be killed by an enemy's bullet,
officially he is simply an officer who has “ deceased ? ”
The distinction may, perhaps, be a small one,
but not so small as the little-mindedness which has
probably prompted it. There have been occasions on
which medical officers have had to fight for the
protection of the wounded under their care; but
here again, we suppose, had any of the officers
been killed, the War Office would have returned
them merely as “ deceased.” What is quite evident
is that the bad regime introduced and fostered
by the Duke of Cambridge, while occupying the post
of Commander-in-Chief, of persistently snubbing the
Officers of the Medical Department of the Army,
still obtains at the War Office, and presumably things
will thus remain until the present Commander-in-
Chief makes way for someone else. Meanwhile the
public wonder why the Army Medical Service is so
unpopular with the profession.
Noise and Fresh Air.
A facetious observer, commenting on the pro¬
minence which has been given to fresh air as a
prophylactic against many of the diseases to which
human beings are liable, recently called attention to
the spectacle of the hermetically closed windows
along Harley Street in the early morning as evidence
ot the fact that medical men, even consultants, do
not always practise what they preach. Though at
first sight the closed windows might be taken to
evince a distaste for fresh air during the hours
allotted to repose, the truth is that what the sleepers
dread is not fresh air but noise. The average citizen,
whose nervous organisation has been rendered irri-
tabli by life at high pressure, requires quiet if he is to
have his allowance of sleep, and this is precisely what
cannot be obtained in towns. If we cannot have fresh air
without noise we prefer to shut out both and risk the
consequences. Now that an abundance of fresh air
has been laid down as the indispensable condition of
a healthy existence it may be that the authorities
will become more sensitive in regard to avoidable
noises. There is ample evidence of the fact that this
generation is less disposed to be tolerant in this
respect than were their ancesters. Noiseless pave¬
ments have taken the place of the roaring granite
blocks of former years, and each year adds to the
remedies provided by law for dealing with unneces¬
sary noises. Certain it is that no serious progress
will be made with the fresh air propaganda until steps
have been taken to disassociate it from its concomi¬
tant disturbing influence.
The Bankruptcy of the Irish Branch
Medical Council.
The affaire of the branch Council in Ireland have-
come to such a pass that the aid of the General
Medical Council has been invoked. The Irish Council
commenced in the year 1899 with a balance against
it in the bank of £154—it had to sell £150 worth of
stock in the course of the year, and ended with £124
against it. The total expense for fees to the seven
members who constituted the Council during the
year was £14 14s., and the total number of meetings
held was four which leaves £2 2s. for the year’s work
for each member. It certainly cannot be said that
the Branch Council has “ wasted the substance ” (of
the General Council) “ in riotous living.” So far has
the impecuniosity of the Branch Council gone, that one
member told the General Council that it was useless to
remit any subject to it because it could not meet for
want of funds. The cause of this condition of affairs is
not far to seek, for it was, in fact, pointed out years
ago by Dr. MacNamara, and the result anticipated by
him. The fact is that the Irish Branch suffers from,
two exhausting depletions which no department
could survive. First, a large proportion of the Irish
students do not qualify in Ireland bu t, coming as they do
from the Queen’s Colleges in Belfast, Cork, and
Galway which huve no sympathy with the Irish
licencing bodies, go straight to Glasgow or Edin¬
burgh, where their passing is gazetted, and their
registration money absorbed. Secondly, those who do
pass in Dublin are frequently the sons of people whose
financial possibilities are well-nigh exhausted when
the final examination comes, and the evil day of the
official registration (which costs £5) comes.
Then the new-fledged practitioner has to wait,
and generally fixes his hopes upon an as-
sistancy or some other official employment outside
Ireland, and he postpones the payment of his regis¬
tration fee until he is in a condition to settle down
in such avocation. When he does register, his £5 is
swept into the treasury, not of the Irish Council,
but into that of England. The first of these deple¬
tory influences cannot be counteracted by the General
Council because it is the reasonable outcome of the
excessive cost of the Irish curriculum aud examina¬
tions which the local teachers alone can remedy. The
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Dec. 20, 1899. _NOTES ON CURRENT TOPICS.
second influence it can neutralise. It only needs,
if there be legal power to do it, to order that a
practitioner qualifying in Ireland shall register in
Ireland. The English and Scotch Councils are now
gathering where they did not straw,” and it is but
just that they should take their hands out of the
Irish pocket.
The Medical Aspects of Christmas Fare.
Christmastide, with its host of traditional joys,
has for years untold been the signal of a vast
food orgie throughout the length and breadth of the
United Kingdom. The shops make a brave show of
eatables and every household, however humble, lays
in its store of thing? seasonable for the feast. At
such a time it may seem perhaps a little unkind t)
hint that a skeleton hovers near the banqueting table,
but a little further inquiry will show that the kindly
hand of medical science may bring a certain amount
of protective comfort along with that warning. Does
over-eatiug do any great amonnt of harm at Christ¬
mastide? To a great extent that depends upon the
■eater. That a certain number of gouty and dyspeptic
persons may add to their troubles thereby cannot be
doubted. Further that delicate and unhealthy
■children may injure themselves seriously by
an excess of rich and rare food stuffs no one can
seriously dispute. Fortunately, however, these
weaker vessels constitute a small proportion only
of the population, and the residue may pretty
safely be permitted, if not actively counselled, to
“eat drink, and be merry.” It is not the occasional
indulgence in excess of food or alcohol that sets up
serious mischief in the individual, the damage follows
habitual or frequent abuse. If the fashion of
Christmas fare were extended so as to cover a couple
of months instead of as many days it is certain that
■the Registrar-General would forthwith be called upon
to record a great increase in the mortality of the
United Kingdom. Nor does the occasional indul¬
gence in an excess of food injure children so much as
might be expected. The real injury is done at an
earlier age by feeding babies with patent foods and
stuffs other than milk. After the first two years of
infancy the healthy child becomes curiously tolerant
of changes in amount and nature of food. At the
same time the visit of the family physician may be
here and there required to set right some trifling
ailment due to our national observance of a great
feast day.
The Fighting Qualities of Jam.
The humble “pot of jam” as a feature of cam¬
paigns has sprung into remarkable prominence
within recent times, and immense consignments of
jam, we understand, have been forwarded to the
■Cape for consumption by the troops. Jam may be
described as a humble luxury, nevertheless it is one
which is held in high esteem. Even the school¬
boy in mid-term who receives a consignment of jam
from home has reason to feel its influence from
•the number of friendships that he forms as
long as the stock bolds out. Again, jam has
certainly a moral influence which it imparts. For
example, by adding variety to a meal, which
from the monotony of the food provided might be
dtilne8s itself, it infuses cheerfulness and, no doubt,
more or less contentment, among those who partake
of it. Not much, perhaps, on the other band, can be
said of its nutritive qualities. As a nutrient, per se,
the value of jam cannot be much. In all probability,
+ he sugar which it contains proves to be its most
serviceable constituent in this regard. Indirectly,
however, the desire for eating larger quantities of
bread which the liberal use of jam creates makes up
for any deficiencies in nourishment which it may
happen to possess.
Cork County Council and Lunatic
Accommodation.
We have, on more than one occasion, referred to
the very crowded state of the Cork District Asylum,
and the necessity which existed for further accommo¬
dation. The Asylum Board has been active for some
months in the matter, and has almost come to a point
of decision where the defects should be made up.
Their idea is to havo two Auxiliary Second Class
Institutions for Imbeciles at separate and distant
locations in the county, so as to meet the convenience
of districts. Unfortunately, this decision will not be
arrived at without some little local recrimination, and
a deputation waited on the County Council a few days
ago to urge the particular claims of the Schull
Workhouse as an auxiliary lunatic asylum for
imbeciles. From the newspaper reports it does not
appear clear that any special advantage can accrue
from agreeing to the prayer of the petitioners, one
of whom gave as his argument that as £20,000 to
£30,000 were to be expended, be saw no reason why
his division of the county should not get a portion
of it. With all respect to the reverend gentleman’s
view, actuated no doubt by motives of local interest,
which, in their way, are very commendable, we fail to
see how they can have much sway in view of the
crucial question, what is best for the efficiency and
economy of the whole asylum administration of the
county, and what is best in the interest of the
lunatics themselves ?
Popular Errors Regarding Insanity.
The course of Armistead Lectures which are in
course of delivery at Dundee will conclude with a
lecture on “ Popular Errors Regarding Insanity,” by
Sir John Batty Tuke. The Dundee Advertiser gives
an interesting review of the lecturer’s professional
biography, and suggests two important doubts to be
solved, with the hope that Sir John will attempt to
solve them in the final lecture referred to. The first
is: Can he give a definition of sane and insane ?
The second: Can he throw light on the question of
responsibility of insanity from alcoholic excess ?
These are two very interesting questions, and our
contemporary has given Sir John a rather hard nut
to crack. It may not be his purpose to touch on
these subjects, but they are matters of great interest,
and the latter especially is one of practical import-
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650 The Medical Press. NOTES ON CURRENT TOPICS. Dec. 20, 1899.
ance, the solution of which we are still far from
having reached.
The Loss of Some Portion of the Intestine
and its Influence upon Health.
Nature has provided man with about twenty-five
feet of intestines, from which one may assume that
for her requirements this is the least amount which
she could do with. Since, however, surgeons have
invaded the abdomen and performed a complexity of
operations from time to time, upon the organs con¬
tained therein, Nature has taught us a good many
things. Formerly it was believed that the sacrifice of
a few inches only of the intestinal tract was likely
to be harmful to the processes of nutrition.
But the result of operations upon a large scale
in this regard have undeniably proved the
the contrary. In the Montreal Medical Journal for
the current month, Shepherd publishes a table of
twelve cases showing the recoveries which have taken
place in patients who have lost portions of the intestine
varying from 10 ft. to 30 ins. The maximum instance
was that of a boy, a patient of Ruggi, in which the
intestine was removed for multiple strictures, and his
health was stated to be fair at the end of two
years. Nearly 8 ft. of intestine (92 ins.), again,
were removed by Shepherd in the course of an
operation for tumour of the mesentery, and
the patient was still in good health at the end
of seven months. Also in a case of Kocher's
nearly 7 ft. (82 ins.) were removed in consequence of
a railway injury, and the patient was still in fail-
health at the end of six months. It is interesting,
however, to note that in this latter case a marked
tendency to diarrhoea supervened after the operation,
and in other instances this condition has been
noticed Thus some mount of careful dieting has
been found necessary under the circumstinces in
question. The whole subject is one of considerable
interest, especially when taken in conjunction with
the recorded cases of excision of the whole stomach,
in which life has been preserved.
Leicester Guardians.
The Leicester Board of Gurdians have at last come
within the strong grasp of the law, and they will pass
the festive Christmastide beneath the chilline shadow
of a writ of attachment from the Court of the Queen's
Bench. Whether the law will allow these rebellious
subjects to retain their personal liberty during the
next few weeks remains to be seen, bur, they have
long since forfeited any right to expect further
leniency from the long-suffering hand of the law.
The writ of mandamus from the Queen's Bench
calling upon them to carry out the Vaccination Act
was evaded by the shallow artifice of appointing as
Vaccination Officer a man of notoriously anti-vaccina¬
tionist views. Out of nineteen candidates for the
post the Guardians chose an ex journalist who had
refused to have one of his own children vaccinated,
and who could not by any reasonable probability be
expected to administer the Act efficiently. Before the
Queen’s Bench affidavits were produced from nine¬
teen of the Guardians apologising for their conduct and
saying that although they may have acted mistakenly
they acted in accordance with their views of
public duty in fulfilment of pledges given at the time
of their election. It may be remarked that if they
give illegal pledges to their constituents they can
hardly be called upon to fulfil them, besides, resigna¬
tion is open to them. The judge said the object of
the Court was not to send the Leicester Guardians to
prison, but to make them feel that the law was too
strong for them, and that they must obey the orders
of the Court. The present position is that the
Guardians have to apply within the next five sittings
of the Court for the discharge of the writ by showing
that they have appointed a proper vaccination officer
or else they will go to prison.
The New Vaccination Law and its Cost.
The St Pancras Board of Guardians have been
discussing the cost of the new Vaccination Act and
comparing the outlay with that of the Act which it
succeeded. In the first place they have found that
the sum of £420 more was spent upon vaccination
during the twelve months ending September last
than was the case in the previous year. On the other
hand all that there was to set against this increase
was a saving of £82 in rent of vaccination stations
and other expenses incidental to the old system. It
was pointed out that the official who reaped the-
most advantage was the public vaccinator, for
while his share of the work had only increased
by five cases, his emoluments were £320 more in
comparison with the previous record. This increase
was partly due to the higher fee paid for vaccination
in consideration of the domiciliary visit; and partly
to the new regulation under which the public
vaccinator receives a shilling for every child not
vaccinated before the end of the fourth month after¬
birth. It is evident that the ratepayers throughout
the country will have some grounds of complaint
upon this score. But they have to thank the anti¬
vaccinationist party for the increased expenditure of
public money in this regard. The Legislature passed
the Act of last year merely in response to the agita¬
tion of the busybodies both within Parliament and'
outside of it, and the result is that while medical men
are profiting by an increase in their fees, the rate¬
payers have to find the money.
The University of Birmingham and the-
General Medical Council.
A point of considerable importance to the profes¬
sion is raised in a correspondence recently published
in the Birmingham Daily Pos> in respect of the
representation of the future University of Birming¬
ham on the General Medical Council. Dr. Kirby^
addressing himself to the Council of Mason.
College, calls attention to the anomaly of th *
representative of a corporative body being elected
by such a restricted body instead of by the
general body of graduates, and he ventures-
to suggest that the selection should bs m ide by the
latter, and that the draft Bill should be modified
accordingly. The reply of the Council partakes too
much of the non poseumus character to be satisfac"
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_Dec. 20, 1899. NOTES ON CURRENT TOPICS. The Midica]. Press- 651
tory, though one paragraph holds out the olive branch
in that it states that as the Bill cannot be proceeded
with until after the sealing of the charter, it cannot
well come on before Easter, so that “ there is plenty
of time further to consider the question.’’ We trust
the members of the Birmingham and District
General Medical Practitioners’ Union will take
advantage of the opportunity to bring influence
to bear on those who are responsible for the
draft Bill, and. failing success in their efforts,
we may look to the other medical organisations
to insure that this point is duly brought forward
when the Bill comes up for discussion in Parliament.
We do not despair of the reform of existi g
licensing bodies in respect of their representation on
the General Medical Council, but it is essential, as
far as possible, to prevent any exaggeration of the
anomaly by an addition to the number of corporate
representatives on the Council elected on the “ pocket
borough ” principle. The matter is one which
interests not only the medical inhabitants of Binning'
ham, because the principle involved affects the pro¬
fession as a whole.
A Conflict of Medical Evidence.
It is a well-recognised maxim that medical experts
should take every possible precaution to fall into line
in respect of the fact# of the case which they have
been called upon to examine, though, of course, a
difference of opinion as to the inferences to be drawn
from the appearances is perfectly admissible. Any
conflict of evidence on material points infallibly
tends to bring medical evidence into discredit,
the more so as it is difficult to conceive of any
laterial divergence of views on points of actual
bservation. One expert may. it is true, observe
details which another has overlooked, but this
does not involve any contradiction of terms.
At the trial of a person for murder at Birmingham
last week, a deplorable conflict of medical evidence
elicited animadversions on the part of the judge, and
led to the acquittal of the accused. Dr Parry, on
the one hand, stated that a certain punctured wouna
of the lobe of the left ear Imd penetrated to a depth
of three-eighths of an inch, giving rise t > cerebral
haemorrhage sufficient to cause death. Dr. Hold-
8 worthy. the police surgeon, on the other hand, stated
that the punctured wound only extended to the skin
behind the ear. and had not penetrated the skull.
Now the point at issue is one which ought not to
admit of a- y difference of opinion. It ir. difficult
to conceive of such a divergence except as
the result of separate examination, but we have
no means of know ing whether the examination was
made separately or conjointly. "I he perforation may
well have been overlooked by one witness, but a \
positive statement by the other carries with it j
greater weight. A few moments’ previous conversat'ou
between the medical witnesses would probably have
sufficed to dissipate the obscurity, or still better, au
examination in common. The proper coun-e, if circurn.
stances had ullowedof it. would have been to re erthe
question to an ind pendent expert, w’ho could not have
tailed to establish the actual condition of thing-.
The Army Medical Department.
Lieutenant-Colonel W. Johnston has been
appointed to be Assistant Director of the Army
Medical Department. The selection invites the atten¬
tion of the profession chiefly because he succeeds
Lieutenant-Colonel Gubbins. who has been drafted
off to South Africa, and because he is a retired officer
who has been employed in recruiting The lamen¬
tably derelict state of the Army Medical Service may
i l>e j udged from the fact that not a man can be found in
! Eugland fit to fill this important position without going
, to the reserve for him How extreme must be the
, pressure to provide for the exigencies of the Service
may be judged from the fact that an official who is
busy in performing engrossing functions in the Irish
[ Civil Services has been requisitioned to join because
he happens to b^ a militia reservist, and that a civil
practitioner has been appointed to the charge of troops
who is engaged in “covering” the unqualified
assistants In » shop in Dublin
A Gold Disease.
An American medical journal mentions that two
medical men in Johannesburg have discovered a new
disease to which they have given the name “Rhinitis
specifics acuta.” It is said to be caused by a diplo-
coccus identical with the pneumococcus, but much
more virulent. In thirty-six fatal cases much pus
was found in the sinuses of the brain, and pneumonia
was a frequent complication. The workers in the
gold mines are the chief sufferers.
Tuberculosis and Dairies.
An important step has been taken by the London
County Council with regard to the elimination of tu¬
berculous milk irom the area within their jurisdiction.
It >8 to be hoped that this departure mark- the
beginning of a state of things that will one day cut off
one of the great sources of a pestilential disease
I among the inhabitants of the United Kingdom. The
I Council have decided to submit a hundred
samples of milk t :ken at random to an
eminent bacteriologist for examination for the
specific bacillus. By a recent order of the
Local Government Board. 1899. the Council have the
rigr.t to examine cows, byres, and milk, and to pre¬
vent the sale of tuberculous milk. The Council,
however, once more realised the imperfect nature of
the existing legislation upon the subject. This recog¬
nition was embodied in the adoption of an amend¬
ment whicu sanctioned the sending of a circular
communication to districts supplying London with
milk asking what they were prepured to do
by way of co operation. Some of the statistics
of the cows in London are interesting and suggestive.
Of the total number of 5,144. tlifi udders of 4,464
were found free from disease or abnormality; 7 had
tube rculous disease ot :he udder, and 5 were suspected
of the same; 82 had cute mastitis; 165 chronic
induration, and 214 atrophy of the gland. Without
powers of compulsory slaughter, and without a sound
and loyal co-operation between town and country,
it will l>e impossible to carrj mt any really effectual
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SCOTLAND.
_'652 The Medical Press,
scheme of prevention in our large towns,
can be no reasonable doubt that tuberculous milk is
largely concerned in the causation of infantile
tuberculosis.
Latest Arrangements for the International
Medical Congress, Paris, 1900.
Dr. Chauffard, the secretary-general of the
Congress. has issued a notice spying that the Paris
Executive has been considering the important
question of housing foreign members who attend the
■Congress/ It has been arranged that the Rector of
the Academy of Paris will place at the disposal of
the General Committee 800 beds in the variousLycees
at Paris during the Congress wtek, and it is hoped
that an additional 200 may be obtained, making a
total of one thousand. The price of each bed is
fixed at five francB fifty centimes a day, to comprise
bed, attendance, and the eight o’clock “petit d£-
jeiiuer.” The beds, of course, are in dormitories, and
not in separate rooms, but the Committee think they
may be of service to those who come as bachelors and
with only scantily lined purses. Nothing is yet
.decided about the distribution of these beds,
nor is the Committee prepared to receive
the names of those who wish to take advantage
of them, but due notice will doubtless be given. The
chief Parisian excursion agents are now ready to
receive applications for rooms from intending visitors
.who do not patronise Messrs. Cook and Son,the agents
recommended by the English Committee. The
names of the French agencies are (1) “Voyages
Duchemin,” 20, Rue de Grammont, Paris; (2)
“ Voyages Moderates," Rue de l’Echelle, No. 1
Paris; (3) “Voyages Pratiques,” 9, Rue de Rome,
Paris; (4) “ Agence Desroches,”21, Rue de Faubourg
Montmartre, Paris ; (5) “ Agence Lubin," 36, Boule¬
vard Haussmann, Paris.
To See Ourselves as Others See Us.
We cull from the Evening News the following bit
.of wisdom from the judicial Bench :—
In the Bow County Court a domestic servant
claimed £50 damages from the Great Eastern Rail¬
way for injuries sustained by being knocked down at
one of their stations. The doctor’s bill came to
£3 13s. 6d, the visits being charged at 2s. each.
.Judge French: Preposterous. A shilling a visit is
.quite enough for attending a servant girl. I shall
only allow a guinea for the doctor’s bill, and ten
guineas damages for the plaintiff. Counsel for de¬
fendant company: We offered £20, but they would
not accept it. Judge French: Avery generous offer
indeed.
We should understand the learned (P) judge’s
views better if he would tell us whether he recollects
having ever given legal advice to a servant girl or
anyone else for cn£ shilling or ten times that sum, or
whether he thinks of making a scale for the retail¬
ing of such very uncalled-for advice from the Bench
graduated according to the social position of the
client P It is one of the advantages or disadvan¬
tages of our system that a County Court Judge, like
a curate in the pulpit, may suy anything he pleases
without being challenged by anyone. Such func¬
tionaries are liable to let their tongues run when they
think there is no reporter listening.
1 Mb. Timothy Holmes, M.A.Cantab., FJt.C.S., has
been elected to an Honorary Fellowship in his old
college, Pembroke, Cambridge.
The Times states that Sir William MacCormac and
Mr. Treves, whose assistance was invited by the War
department, have gone up to Frere near Colenso, with
an ambulance party.
Professor Ooston, of Aberdeen, who makes it clear
that he has not been invited, has intimated his inten
tion of going out at his own expense, to see the
medical service of the war and to be of assistance if
asked.
groilani),
[FROM OCR OWN CORRESPONDENT.]
SANATORIA FOR CONSUMPTIVES IN
8COTLAND.
Some months ago we pointed out the antagonistic
positions taken up by supporters of different sanatorial
systems of combating tuberculous diseases, especially
those of the lungs. Apropos of this article, we were the
recipients of several protesting letters and communica¬
tions, all of which came from adherents of one of the
parties, all maiutaining with no little heat that their
opinions on the subject were most catholic, although
ending in dogmatic assertions that the only system of
the slightest value was that to which, individually,
the writers had pinned their narrow faith. Of course,
to vary the methods observed at any one sanatorium
further than those necessitated by intercurrent condi
tions occurring in the patients, would present many
difficulties in management, where the number treated
was large, and the staff small. But an ideal sanatorium
would be one in which the number of patients was not
excessive, or if great, not beyond the powers of the
acting staff to supervise intimately; in which all the
patients were not submitted to one single routine
system, but treated recording to indiosynorasy, result,
and habits.
It is distressing to meet with such strongly rooted
ideas as to the absolute possession of curative powers by
one single method of treatment in highly educated
physicians, so close to the dawn of the twentieth
century. They descend to the level of the herbalist or
homcepathist who believes that one certain drug in one
certain dose is the only infallible remedy for one special
symptom, because of some fancied parallelism,
or from some fortuitous series of successes following
its practical employment. The Glasgow Medical Journal
lately contained a note about aB old medical club at a
meeting of which the principles of the fresh air treat¬
ment of phthisis were adumbrated years ago to meet
only with derision. Dr. Caton’s book upon the Grecian
temples of Aesculapius shows that their priests acquired
very probably much of their success in* the treatment
of disease (ascribing it, of course, to the action of their
deity) from the use of fresh air as the chief factor. The
modern method is but a resurrection, nor does it become
any of the present plagiarists of ancient unappreciated
prophets to dogmatically state that their pet scheme
alone is the proper method at a time when the different
systems are but in the infantile stage, although savour¬
ing of re-incarnation.
Connected with this subject hangs the question of
the possible and probable advantage to be gained from
the establishment of rural sanatoria in our own country.
Several such institutions have already been started. The
Victoria Hospital for Consumption in Edinburgh being,
we believe the pioneer; Nordrach-Mendip in Somerset¬
shire, on the plateau which reaches back towards the
____Dec. 20, 1899.
There
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Dec. 20, 1899.
CORRESPONDENCE.
-east from the summit of the Mendip Hills’ western es¬
carpment; the Bournemouth sanatorium, the recent
small establishment opened to the south of Edinburgh,
and many others, testify to the zeal with which this
method of treatment is being taken up by the profession
and the public. Personally, we have often cast a longing
eye on the high bracing, dustless moors which surround
Breemar and the higher reaches of the Dee. as theoreti¬
cally perfect positions for senatorial treatment, even
though the winters there are cold, and the region
remote. But the public is not yet educated up to the
idea that cold at a bracing altitude at home (whatever
its effect at Davos), is less harmful than lesser degrees of
cold in more relaxing surroundings, or that cold per se
is inimical and i ot favourable to the tubercle bacillus,
so long as the actual or possible victim to the bacillus
avoids a life spent indoors with a minimum of fresh air
and a maximum of artificial heat, with infrequent
excursions into the outside cold and seldom respired
pure air; followed shortly by return to and existence in an
enervating, de-oxygenated, stagnant atmosphere, peopled
if in contact with a case of phthisis, with numerous
germs of infection, and suited precisely to encourage the
growth of the bacilli which have already found a
corporeal breeding place. But it will probably be long
before a sanatorium rises amid the solitary, but as yet
untainted, high grounds of Caledonia.
Although many references have from time to
time appeared in connection with the erroneous ideas
held in the South as to the winter climate of many
parts of Scotland, few appreciate the fact that over a
wide extent of the Northern Kingdom the climatic con¬
ditions in winter are, as a rule, lees rigorous than those
in all but the furthest south west corner of England.
Nor is the reason « f this far to seeb, for Scotland is a
narrow strip of land between the Atlantic and the North
Sea; narrower considerably than England, hence is
blessed with a less continental and a more equable
climate. That of course applies to the areas of land in
both countries of corresponding elevation.
Misty, wet, and stormy it may be, but the mist and
rain generally come from the warm west, directly from
above the warm Gulf Stream. For instance, the mean
temperature of Leith in January for forty years, from
1856 to 1895, comes out nearly a degree above that for
■Greenwich, and the same as that of Lowestoft for the
same month. In December Leith also boasts a higher
■mean temperature than Greenwich. As far north as
Aberdeen the means for these two months equal or
-exceed those of many observed over the midland and
south-eastern counties of England. Similarly the
entire eastern districts of Scotland are by no means so
wet as the usual conception of the country as a whole
•would indicate. The figures given by the Royal
Meteorological Society for the east of Scotland include
Braemar, a station 1,114 ft. above sea level, but even
-with those from this elevated station yield only two
inches of rain per annum in excess of the fall in England,
.south.
Dr. Buchan, in the Journal of the Scottish Meteoro¬
logical Society for 1898, discussing the meteorological
conditions of the British Islands says as follows : The
rainfall of those upland districts of the east of Scotland
is also comparatively small. The admirably bracing
and hygienic qualities of those regions which have
relatively dry climates, and are 700 ft. and upwards
above the sea, are everywhere recognised, and it is these
qualities which give the upper districts of Deeside,
Donside, and 8peyside the finest summer climates any¬
where to be found in the British Islands."
The papers also by Dr. Buchan in same journal for
1892. discussing the temperatute of London for 130 years
(1763-1892), and of the north-east of Scotland for 129
years (1764-1892), show that the coldest December and
January recorded for the north-east of Scotland, were
not bo cold as the lowest mean temperatures for these
months observed in London during that peiiod.
Again, the Gulf Stream more closely affects Scotland
than it does the western shores of England. One winter,
seven or eight years ago the Thames was frozen over,
while in Scotland summer clothes scarcely required a
•rinter addition.
The Kedical Press. 653
These facts snd many more like them can be adduced
in support of the benefits which may accrue from sana¬
toria] methods introduced in the midst of the absolutely
undefiled breezes coming from off the Scottish moun¬
tains and moors. And such should be to the advantage
of the new Nordrach-on-Dee, a sanatorium designed to
ca ry out as fully as possible the systems which have
met with such success in Germany, named with a paucity
of invention, but as an indication of the method to be
pursued.
A site has been obtained near Banchory, 18J miles
from Aberdeen, a district richly wooded with pines, on
which a sanatorium for from thirty to forty patients is
in course of erection, and which, it is hoped, will be
ready for opening by May, 1900. Some there are who
assert that situation has little or no intluenoe upon the
course of the fresh-air treatment of tubercle ; but, other
things being equal, it is surely but rational to suppose
that the purer, more bracing, and drier the air, and the
more attractive the surroundings, the greater the
chance of benefit, the more rapid the reoovery. The
venture will he watched with great interest, the result
of “ guid, shairp, Scotch air ” on the vitality of the
tubercle bacillus can hardly fail to piove as satisfactory,
as it seems to be, upon the character of the Scottish
nation as a whole.
(jTormponbcncc.
We do not hold ourselves responsible for the opinions of our
correspondents.
A SAD AND URGENT CASE.
To the Editor of The Medical Press and Circular.
Sir,— I beg to acknowledge receipt of the following
contributions in answer to my appeal, with many
thanks: —
£ s. d. £ 8. d.
H. S. (London' .2 0 0 Sir FrnncisCruise (Dnb-
Jns. Hamilton, M.D. lin) 110
(Chelsea) 10 0 Dr. J. Cooper Stawell ... i 2 0
R.A.C. 110 Dr. 0. A. Wickham 110
A. A T fLondon) 110 Dr. John W. Martin .110
L.B.O.P.I.(Birmingham) 0 5 0 Dr Arnold Ingle 2 2 0
Dr. Herbert Pulling 1 1 0 Dr. Charles Terry ... 2 2 0
“Wellwisher 1 2 0 0 Dr. Henry Hullgood 010 6
M*s. Swanson 10 0 Dr. J. J. Byrnes . 010 6
Inspec-Gen. Stanistreet 110 By a Lady .. . 8 15 0
Prof. Clifford Allbutt 110 -
Dr. Henry Lupton 1 1 0 Total . . 37 1 0
Dr Charles Coates . 5 5 0
I am Sir, Yours truly,
Macnaughton Jones.
131, Harley Street, London.
December 18th, 1899.
THE APOTHECARIES’ HALL OF DUBLIN.
To the Editor of The Medical Press and Circular.
Sib, —In the last issue of your journal there appears
a paragraph from which I learn that the directors of the
Apothecaries’ Hall of Dublin have passed a resolution
pronouncing my conduct at the recent meeting of the
General Medical Council to be ‘‘most unprofessional,
totally uncalled for, and highly discreditable.” It
seems to me that these gentlemen are quite ignorant
of the true state of the case, and I am sure that with
your usual fairness you will give me space to state the
facts.
I desire, in the first instance, to point out what has
been my conduct with reference to the Apothecaries*
Hall in the past. Thus, when I was elected a fellow
of the College in 1860. if a member of the Apothe¬
caries’ Hall of either London or Dublin desired to
obtain the licence of the College of Physicians, he had
to r* sign thac of the Apothecaries’ Hall, and bind him-
654 The Medical Press.
CORRESPONDENCE.
Die. 20,1890.
self not to engage in the Bale of drugs. This I looked
on as unfair to certain count-y practioners, and, mainly
as a result of my action, these rules were repealed,
and now a member of the Hall can obtain the licence
of the College, and compound medicines if he wishes to |
do so, the restriction not to do so being confined to
" members ” and “ Fellows ” only.
Again, in 1889, when examiners in surgery were given
to the Hall, I moved in the College of Physicians
that the Apothecaries be permitted to conduct pa-t of
the examination about to be carried on by the College
in conjunction with the College ot Surgeons. These
acts of mine show I was not hostile to the Apothecaries’
Hall, nor was my opinion as to the advisability of the
latter course changed till after the revelations made in
the General Medical Council in 1894-5, which ended in
the examinations conducted by the Hall in conjunction
with College of Surgeons being reported to the Privy
Council.
At the recent meeting of the General Medical Council,
Mr. Brown brought forward a resolution to the effect
that it was desirable that the Apothecaries’ Hall of
Dublin should be joined with the two Royal Colleges in
conducting a qualifying examination, and he called on
me to give reasons for the College refusing to do so, and
I felt bound to comply.
A point having been made that the Council had pro¬
nounced in favour of a similar conjunction with respect to
the Apothecaries’ Hall of London and the London Colleges
of Physicians and of Surgeons, I said that the College of
Physicians of Ireland objected to a similar one : 1st, on the
ground of the relative positions of the two bodies ; that
there was no analogy between the Apothecaries’ Hall of
London and that of Dublin, as was very commonly
supposed :—(a) the former by their Act (George III.
cap. cxciv.) were empowered to appoint examiners to
examine and “ ascertain the skill and abilities of such
? arsons in the science and practice of medicine and ” their
tness “to act as an apothecary.” The only powers
granted to the Dublin Hall are contained in the
following George III. cap. xxxv.) :—
“No person shall open shop or act in the Art and
MyBtery of an Apothecary until he shall have been
examined as to his qualifications and knowledge of the
business ” by “ the Governor, Deputy Governor, and
Directors of the Apothecaries’ Hall in Dublin.” You
will observe the London Hall can appoint examiners in
medicine not being members of their body. The Dublin
Hall cannot legally do so Moreover, the Dublin Hall
was expsessly established only for the purpose of having
“medicines of the purest quality prepared under the
inspection of persons skilled in the Art and Mystery of
an Apothecary.”
(6) The master and wardens of the London Hall
were empowered to inspect apothecaries’ shops, while with
respect to the Dublin Apothecaries the College of
Physicians of Ireland were empowered to do so, and till
the establishment- of the Pharmaceutical Society of
Ireland regularly did so.
(r) There is a right of appeal by candidates rejected
by the Dublin Hall to the College of Physicians ; a
right which has been repeatedly acted on, while no such
rights or powers were conferred on the London College
of Physicians.
The Apothecaries’ Hall of Dublin, is therefore subor¬
dinated to the College of Physcians in Ireland in these
and other matters, and College deemed that under these
circumstances it could not asrree to the conjunction.
(2). The College also objected to the increased expense
which candidates would be compelled to pay for a Licence
very few would desire to hold, and many objected to.
There was also with respect to this a legal diffi
culty. The Apothecaries’ Hall charge a fee. I think,
of J510, while by their Act they are on y permitted to
charge a “ sum of 10s. and no more ”; that sum would
not pay the expense of the examination, and if the
College consented to a larger sum being charged they
would be a party to an illegal act.
.3 A further legal question had to be considered by the
College, the Apothecaries’ Act 40, Geo. III., already
referred to, by whioh alone the Hall is constituted, the
governor and directors are striotly enjoined to require
every candidate for their lioence to undergo an appren¬
ticeship for the period of seven years. The directors have
ceased to require this, and the College of Physicians feel
that a serious responsibility would rest on them were
they to ignore this evasion of the statute.
These were the reasons put forward when the subject
was discussed some ten years ago, and all still hold good.
But there are other matters of more recent occurrence
which weigh greatly with me. The Apothecaries’ Hall
of Dublin owes its being, as is stated in the preamble of
their Act. to “the existence of frauds and abuses
practised (on the public) by the ignorance and unskil¬
fulness of persons pretending to the art of an apothe¬
cary to the injury of the fair trader, and the hazard
of life,” and to the Apothecaries’ Company was entrusted
the duty of seeing that pure drugs only were sold in
Ireland. For many years it discharged its functions
efficiently, but it aspired to become a licensing body
similar in position to the London one, though it had
no right under their Act to Buch, and from that time
not alone have the important functions for which it
was established been allowed to sink into abeyance,
but it has connived by participating in itself in *-
scramble fer drug contracts in Ireland, which is pro¬
nounced by The Medical Press and Circular “ to be
in about as corrupt a state as possible,” and to
which it adds, ‘ Wo are obliged to conclude
that the Hall has entered the lists, as one of
the ruck of drug traders who deal with Boards of
Guardians and are willing to adopt their methods. We
do not know that we could say worse” (ride Supplement
The Medical Press and Circular, September 23rd,1896,
p. 21). I read an extract from this article to the Council,
and it w.^s this which was in my mind when I said in my
place in the General Medical Council that the Hall was
not a body with which any of the Medical Corporations
having due self-respect ought to combine.
I am, Sir, yours truly,
Lombe Atthill, M.D.
December 16th, 1899.
PRESCRIBING BY THE READY METHOD.
To the Editor of The Medical Press and Circular.
Sir,—I would like to draw attention to the injury
done to the public and to the profession generally
by the growing practice of prescribing tablet preparations
and proprietary drugs.
We have by our weakmindedness introduced in our
midst a very dangerous element, and it is about time we
woke up to this important fact. We have been cleverly
hoodwinked by tablet makers aDd patent medicine
manufacturers, flattered by their apparent generosity in
keeping us supplied with free samples, diaries, pictures
Ac., have allowed ourselves to drift from prescribing
the well tried drugs of the B P., only to find ourselves
the allies of scientific chemists and experimenters. The
practitioner of to-dav (who does not dispense his own
physic) thinks he is showing a great amount of medical
knowledge by writing on his prescription Liq. So. X.Y.Z.,
or tablets do. ( A.B.C.) but does he stop to think that by
so doing he injures the patient, the chemist, and also-
biniseJi.
Wherever the fashionable physician goes he finds
tablets containing antipyrin, caffeine, sulphonal, thyroid,
Ac., Ac., taken by patients with as little hesitation as
they take their meals.
We have a committee who draw up a Pharmacopoeia for
our benefit, we study materia medica and pharmacy; we
expect our chemists to study the mixing and compound¬
ing of drugs with a skill acquired after years of practice,
and yet we deliberately insult them by writing prescrip¬
tions containing made up mixtures and pocket bottles of
tablets, which might be dispensed, if I may use the term,
by a grocer, with equal safety ; thus we rob the chemist
of his profit and livelihood, making the foreigner rich at
the expense of our own kith and kin.
Week after week we read of people overdosing them¬
selves with cocaine, sulphonal, Ac. -. doubtless in all these
Digitized by GoOglC
Dec. 20, 1899.
LITERATURE.
Thi Medical Press. 655
cases they have to thank their medical advisers for
introducing into their lives a new vice quite as danger¬
ous as alcoholism or the opium habit.
It is time we became alive to these dangers by a closer
study of the B. P. We ought to find everything that is
needed for our daily practice without having recourse
to the tablet system of medication. Every post crowds
our consulting room tables with circulars puffing up new
remedies. If there be any merit in them, why does it not
originate from the proper quarter, the B. P. Committee,
or some of our learned Societies Y
I have made it my business to discuss this method of
modern prescribing with several pharmaceutical
chemists, and the general verdict is that the system is
ruinous to the interests of the doctor, chemist, or
patient, and shows an utter neglect or ignorance of the
medical man of his clinical teaching.
On this subject there is food for reflection, and I trust
something will be done to prevent the sale of dangerous
drugs, which may be picked off the counters of the Stores
without even the authority of a medical prescription.
I am Sir, yours truly,
H. A. D.
(Obituarn.
SIR RICBARD THORNE THORNE.
But a few days since Sir Richard Thorne Thorne
occupied his accustomed seat as a Crown member of the
General Medical Council, and took part, with his usual
zest, in the debates Nothing in his appearance or
attitude suggested that he was otherwise than in the
best health, yet it is now our sad duty to record his
death, after an illness of very brief duration, on Monday
last, at the ea-ly age of 57.
Thus comes to an end an exceptionally brilliant and
successful career. Originally a “Bart's” man. Sir
Richard early turned his attention to hygiene and State
medicine, and his life has been one long series of
valuable services rendered to the State and to science,
cu'minating in his appointment to the post of principal
Medical Officer to the Local Government Board, a post
which he still occupied at the time of bis death, and which
he filled with credit to himself and to his department.
There is hardly a point in preventive medicine which
at one time or another Sir Richard has not dealt with,
and his assiduity was not less remarkable than his
singular lucidity and breadth of view. He is especially
well known in connection with his work on the use and
influence of hospitals for infectious disease, which paved
the way to the system |now generally adopted through¬
out the country, but he was also the author of epoch¬
marking contributions to the study of the prevention of
diphtheria, and later of consumption. Innumerable
reports from his pen, relating to public health, have
appeared in various official compilations, all character¬
ised by the thoroughness and grasp which rendered all
his contributions to science at once interesting and
instructive.
Sir Richard Thorne was a man of singularly unpreten¬
tious and prepossessing manners, and a favourite with
all who were privileged to meet him, either in his public
or private capacity. He only received his knighthood
in 1897, and the news of his death will come as a shock
to all who take an interest in sanitary work.
DR. JOHN FREDERICK HODGES.
The death is announced at a ripe old age of Dr. John
Frederick Hodges, Professor of Agriculture and
Lecturer on Medical Jurisprudence in Queen’s College,
Belfast. Educated at Trinity College and the Royal
College of Surgeons of Dublin, be became, in 1837, a
licentiate of the Faculty of Physicians and Surgeons
of Glasgow, and afterwards studied in Germany,
where in 1843 he graduated doctor of medicine
in the University of Giessen. He then applied himself
to the study of analytical and agricultural
chemistry; and subsequently filled the offices
of chemist to the Chemico- Agricultural Society
of Ulster ; analyst to the City of Belfast and to the
counties of Antrim, Tyrone, and Donegal; Professor of
Chemistry, Royal Belfast College; Examiner, Queen’s
University, Ireland; and president of the Natural
History and Philosophical Society and of the Royal
Academy Institute, Belfast. He was the author of a
number of works bearing on chemistry, especially in its
agricultural bearings, and was for some time the editor
of the journal of Chemico-Agricultural Society of
Ulster.
DR. ANDREW SPEARING, OF RIVERSIDE.
The death of Dr. Spearing took place last week at his
residence. Riverside, Antrim, at the age of 74 He
became a licentiate of the Apothecaries’ Hall. Dublin,
in 1850; M.D. University of Glasgow, 1851; and a
member of the Royal College of 8urgeons, England,
1851 In the early days of his professional career he
settled down in Antrim, where his practice gradually
became extensive, and his relations with all grades and
sections of the community were of the most cordial kind.
He also held the medical appointments to the Dispensary
district and to the Workhouse dispensary at Antrim,
and on the death of the late John Taggart, M.D.,
succeeded him as medical officer to the workhouse.
-♦-
literature.
MADDOX ON THE OCULAR MUSCLES, (a)
No one has done so much to advance our knowledge
in this country of the subject of the working and the
defects of the ocular muscles than has Dr. Maddox, and
for this reason a welcome may be extended to the
present volume, not only for the excellent manner in
which the author has placed his knowledge before us,
but also for the amount of special information which it
contains. “ The subject,” says the author in hiB
preface, is “ not without its interest to physicians
and neurologists, even when treated from an
ophthalmic surgeon’s point of view,” and there is
no doubt that this is correct; “muscle problems ” as the
author describe i them, are now becoming much more
frequent in the practice of general physicians than was
the case a few years ago, for the simple reason that they
are coming to be more generally recognised. Not by any
means the least interesting part of the volume before us
is the description, occupying several chapters, of the
physiology of the ocular motions. This ip itself shows
the painstaking study which the author has expended
upon his subject. Probably, however the chief attrac¬
tion of the work will prove to be the observations upon
heterophoria. These will well repay perusal, giving as
they do an excel'ent re*um4 of the subject. In short, we
think that Dr. Maddox’s book is one which ophthalmic
surgeons cannot well afford to be without -, there is no
doubt that it is a valuable addition to ophthalmological
literature.
MUIR AND RITCHIE'S BACTERIOLOGY, (b)
The second edition of this excellent manual will be
welcomed by those who are interested in the science of
bacteriology. The rapid growth of the subject and the
complicated processes needed in its prosecution have
carried applied bacteriology more and more to the domain
of the expert. At the same time it is necessary for
every medical man, whatever his particular bent, to have
a general knowledge of the principles, methods and
results of the science. The busy practitioner, whether
engaged in general or special practice, is every
day more and more driven to entrust complicated
clinical investigations to laboratory specialists. In
(a) “ Tests an«l Studies of the Ocular Muscles.” By Ernest E.
Maddox, M.D., F.R.C.S.Ed., Ophthalmic Surgeon to the Royal
Victoria Hospital, Bournemouth. Bristol: John Wright and Co.
(b) “ Manual of Bacteriology.” By K. Muir, M D., and J.
Ritchie, M.D.Ed. Edinburgh and London: Young J. Pentland,-
1899.
Digitized by Google
656 The Medical Press.
LITERATURE.
Dec. 20. 1899'
a case of suspected enteric fever he knows that
agglutination of typhoid bacilli in culture is
caused by serum from a typhoid patient. The
actual teat he leaves to the bacteriologist, and all he
wants is a telegram announcing the result. All who
wish to read a systematic account of bacteriology in its
present stage will find what they want in the admirable
volume written by Dre. Muir and Ritchie. Clearness is
an unfailing characteristic of their pages, and in dealing
with specific organisms they have in each case com¬
menced with a concise historical summary. The first
part of the book contains an account of practical
methods, and a full bibliography is appended. There
are 120 illustrations, many of them of great beauty and
delicacy.
TEAITE DE MEDECINE ET DE THERA-
PEUTIQUE. (a)
Without undue delay, considering the scale of the
undertaking, we are now in possession of vol. vi. of this
majestic compilation. The thousand pages or so which
go to make up this portly volume are devoted to diseases
of the heart and circulatory system, of the lymphatic
system and of the blood, a scope which affords ample
material for the writers to whom these sections have
been assigned.
The section on the heart and its diseases is from the
pen of Dr. Pierre Merklen, and extends to close upon
600 pages, yet an attentive perusal leaves the conviction
that the author has not introduced a superfluous para¬
graph It is a masterly monograph which exhausts the
subject without dragging in unnecessary details. The
text is elucidated by a number of carefully selected
diagrams illustrating the seat and extent of the auscul¬
tate'y phenomena to which allusion is made. We are
introduced to anew term in connection with the physical
examination of the heart, viz., phonendoscopy, by which is
to be understood the delimitation of the outlines of
organs by combined anscultation and percussion, a
method of physical investigation to which attention has
been called in this country by l)r. Maguire. In spite of
the fact that by its aid the practised observer can easily
map out the limits of organs so enlarged or to be in
juxtaposition and can even define the position of the
cardiac septum, the method, we are told, is not likely to
oome into general use, on the one hand because it re¬
quires considerable and assiduous practice, and on the i
other because the information to be obtained by simple
percussion amply suffices for ordinary clinical purposes, i
Skiagraphy of the heart is discussed with the remark
that it is more interesting than useful, though it may
assist us in detecting physiological and pathological
variations in the size of that organ in confirming the
diagnosis in obscure cases of aneurysm, and possibly
in the early recognition of the lesions of arteriosclerosis.
The chapter on diseases of the arterial system has been
contributed by Drs. Roger and Gouget, whose special
aptitudes in regard to the subject are fully recognised
by those who are au courant with the progress of medical
science in France. There is not much that is new to be
said on this sub ject,but unless by the designation arterite
noueuse attention is directed to a rare form of acute
arteritis characterised, post-mortem, by the presence of
nodular, fusiform thickenings, of a greyish white or
yellow colour, varying in size from a pin’s bead to a
millet seed, or, in some instances, by small aneurysmal
dilatations which may attain the size of a filbert The
treatment of these various conditions does not offer much
scope to the therapeutist, but the pathological importance
and prognostic value of the lesions confer a special
interest on their recognition.
The chapter on disease of the aorta in particular, is
written by Dr. Boinet, and that on disease of the veins
by Drs. Widal and Bezanqon. Dr. Bezanoon is also
responsible for the chapter on diseases of the lymphatic
system. The last named subject iB one that is assuming
a greater importance than authors in the past have
appreciated, and the role of the lymphatic system in the
In) Trait*} de M&lecineet de Tli^rapeutiqne. Par M VI. Brouardel
et. A. Gilbert. Tome VI. Paris : J. B. Bailliere et Fils 1899.
S tneralisation of infective diseases is a point to which
r. Bezanoon has devoted special attention.
The remaining chapter on diseases of the blood,
written by Dr. Parmentier, is specially worthy of note.
During the last few years a vast amount of information
has been gleaned concerning the chemical, physical, and
bactericidal properties of serums, and the introduc¬
tion of the serum test has opened up a fresh vista in the
recognition of disease. Widal’s reaction in typhoid fever
is declared to have met with universal acceptance, and
we are given the history of the discovery from Pfeiffer’s
early observations on the action of the comma bacillus
under the influence of the serum of an immunised
animal, and the discovery now associated with the name
of Widal. It is interesting to note, on the one hand,
that the characteristic agglutination is also met with in
cholera, plague, pneumonia, and tuberculosis, and, on
the other, that certain chemioal substances are also
capable of determining a reaction, similar to, if not
identical to. that produced by serum. Under the head
of “ blood diseases" we get chlorosis and the various
forms of anaemia, as well as lymphadeemia and leukemia,
though in all probability the disorganisation of the
blood, in the last-named, is rather a symptom of the
disease than the disease itself.
We can speak with special commendation of the
directions for treatment under the various heads. The
remarks are ooncise but they cover the entire field, and
confer a special value on the work as a whole.
FERNIE ON ANIMAL SIMPLES, (a)
This is a companion volume to the author's well-
known “ Herbal Simples,” and the least that can be
said of it is that it is a most entertaining compilation.
Appropriately enough Dr. Fernie introduces his subject
by quoting “ The Witches ” from “ Macbeth.” This forms
the text of his discourse, and very faithfully and fully
does he work it out. Those to whom the subject of
folklore forms an agreeable pastime will find in Dr.
Fernie’s pages a wealth of material to their liking.
Indeed, almost upon every page one comes across
some curious and interesting fact concerning some
old-time remedy. Of course, we know nowadays
that most of the messes and concoctions which did duty
for therapeutic agents in olden times acted more
through the mind than through the body. Who for
example, would in the present day expect to derive any
benefit from taking s ; x dried grasshoppers for an attack
of cold, or to have deafness cured by dried finely
powdered earwigs mixed with hart’s urine, or “ difficult
breathing,” as Pliny savs, relieved by an oily decoc¬
tion of cockroach. Bqt these are only some of the
samples of mediaeval therapeutics to which Dr. Fernie
direots our attention. On the whole the volume is a
fascinating one to peruse, and is at the same times
valuable contribution to the literature of the subject.
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.
Heart Discnsse, with special reference to Prognosis and Treat¬
ment. By Sir William Broadhent, Bart., M. u., F.R.C.P.Lond.
and John Broadhent, M.A., M.D.Oxon., M.B.C.P.Lond. Third
Edition, pp. 420, with coloured and plain illustrations, price
12s. 6d. net.
Rhinoplaatic operations, with description of recent improvements
in the Indian Method. By U. F. Keegan, M.D., P.R.C.S. Pp-
72, with twenty-one photo-type illustrations, price 5s.
A Synopsis of the British Pharmacopoeia, 1898. By H. Wippell
Qadd, M.P.S.. with Analytical Notes and Standards, by C. 0.
Moor, M.A.Cantab., F.I.C Fourth edition, pp. 224, prioe
Is net
Formulaire dee Medicaments Nouveaux pour 1900. Par B.
Bocquillton-Limousin et Henri Huchard. Price 2s 6d. net.
Dictionnaire des Termes de Medicine. Par H. de Meric, M B.C S.
Eng. Vol. II , Franca is-Anglais, p p. 244. Double column,
price 4e.
J. and A. Churchill (London).
The Pathologists' Note-book, for the Post-mortem Boom. By T.
(a) '' Animal Simples Approved for Modern Uses of Cure.” By
W. T. Fernie, M.D. Bristol: John Wright and Co, 1899.
Jiyuizsa uy
oogle
D*c. 20. I8ftft MEDICAL NEWS._ ___ The Aedic'al Press. 657
N. Kelynack, M.D., M.R.C.P. With 126 Illustrations. Pp. 186.
Price 4s. 6d.
The Year-Book of Pharmacy, July 1,1898 to June30, 1899. With
the Transactions of the Conference. Pp. 548.
William P. Clat (Edinburgh).
Clinical Studies in Vice and in Insanity. By George R. Wilson,
M.D. Pp. 234. Price 7s. 6 . net.
Practical Text-book of Midwifery. By Robt. Jardine, M.D.Ed.
Pp. 245. Price 6s.
Lectures on Hemorrhage and Eclampsia. By Robt. Jardine,
M.D.Ed. Pp. 76. Price Is. 6d.
Hisit Kimptoh (London.)
The B ealth Resorts of Europe. By Thos. Linn, M. D.
Ledger Smith ahd Co. (London)
The Medical Digest. Third Edition. By Richard Meals, M.D.
Lond. With appendix to March, 1899.
J. B. Lippincott Compaht (London and Philadelphia).
8ystem of Diseases of the Eye. By various Authors. Edited by
Wm. F. Norris, A.M., M.D., and Chas. A. Oliver, A.M., M.D
Vol. IV. Pp. 942. Price 21s. net.
Lohomams, Greek, ahd Co. (London).
The Diseases of Children, Medical and Surgical. By Hy Ashby,
M-D.Lond., F.B.C.P., and G. A. Wright, M.B.Oxon., F.R.C.S.-
Eng. Fourth edi'ion Pp. 872. Price 25s.
Transactions of the Clinical Society of London. Vol. XXXII. Pp.
296. Pi ice 16s.
Medicine, Old and New. An Introductory address. By W. How-
ship Dickinson, M.D , F.R.C.P. Pp. 46. Price 2s. 6d.
James Maclehose and sons (Glasgow).
Renal Cases ; a Series of Selected Reports and Surgical Studies.
By David Newman, M.D., pp. 151.
Macmillah and Co., Limited (London).
A System of Medicine by many Writers. Edited by Thos. Clifford
Allbutt, M.D., F.R.C.P., F.R.8. Vol. VIII. Pp. 998. Price
25s. net.
Mental Affections, an Introduction to the Study of Insanity. By
John MacPherson. M.D., F.R.C.P.Ed.. Pp. 388. Price 12s..
net.
A Manual of Surgery in three vols. By Charles Stonham,
F.R.C.S.Eng. VoLLandlL Price7s.6d.each.net.
E. Merck (Darmstadt, Germany).
Merck's Manual of Materica Medics. (Free to medical men on
application to E. Merck, 16, Jewry Street, London).
Yocho J. Pentlahd (Edinburgh and London).
The Principles of Treatment and their Applications in Practical
Medicine. By J. Mitchell Bruoe, M.D..F R.C.P. Pp. 614.
Sampson Low, Marston, and Co. (Londonl.
Twentieth Century Practice, an International Encyclopaedia of
Modern Medical 8eience. Edited by Thos. L. 8 ted man, M.D.
New York. Vol. XVIII. Syphilis and Leprosy. Pp. 703.
Shkrkatt and Hughes ( Manchester)
Syphilitic 1 menses of the Spinal Cor By T. Williamson, M.D
Lond., M B.C.P.. I p. 127.
Smith, Eldsr, and Co. (London)
Health Abroad, a Medical Handbook of Travel. By various
authors. Edited by Ed. Hobhouee, M.D. Pp. 372. Prioe 6s.
Wand, Lots and Co., Limited (London).
Illustrated Official Guide to Llandrindod Wells, With medical
notes, Ac. Pp. 100, price Is.
been taken to prevent any spread of the disease in its 7
new quarters.
A Timely Correction.
Dr. Charles Goring, surgeon in charge of troops
on board s.s. 8umatra, writes to the Times contra¬
dicting the silly rumours to which the press have
given currency concerning the pitiable plight of the sick
and wounded recently repatriated in this vessel. He
points oat that most of the invalids were suffering from
chronic diseases not entailing bodily discomfort, and,
save some half-dozen who were landed in cots direct to
the ambulance, they had nearly all recovered, and were
all greatly improved by the beneficial effect of the
voyage. We are pleased to assist in destroying a
mischievous legend which, if left uncontradioted, might
have produced a very unfavourable impression on the-
public at large.
Mysterious Death of a Medical Man.
An inquest was held last week on the body of Thomas
Edward Hughes, tet. 32, of Wandsworth, who died sud¬
denly on the 4th inst. under somewhat remarkable cir¬
cumstances. The deceased was stated to be in the habit
of taking chloral and digitalis, the former in 40-grain
doses, but the gentlemen who made the post-mortem
examination came to the conclusion that death was due
to commencing softening of the brain, with severe
apoplexy associated with heart and kidney disease. A
verdict was returned in accordance with the medical
evidenoe.
Assistant Surgeons for the Army.
According to the Times, the Secretary of State has
had under consideration a despatch from the Govern¬
ment of India dealing with proposals for the creation of
Army assistant Burgeons, the necessity for whom has
been brought prominently to notice during recent cam¬
paigns on the frontier of India. The inoeption of the
| scheme, drawn np by the military authorities at Simla,
has met with Ijord George Hamilton’s approval, subject
to certain minor amendments which will in no way affect
the general principles.
University of London.
At the examination held during the present month,
the following candidates passed in the Honours
division:—
M.B. Examination : for Honours- Medicine.
FIRST CLASS.
Howard, Russell John v Gold Medal), London Hospital.
SECOND CLASS.
Beatty, James, Trinity College, Dublin.
Hilton, Caleb Thomas, Guy's Hospital.
Pugh, Charles Grant, B.Sc.. Middlesex Hospital.
. Scott, Sydney Bichard, 8t Bartholomew’s Hospital.
Thomson, Frederick G.. Uuiv. Cambridge and Middlesex Hosp.
Van Praagh, Harold John, St. Mary's Hospital.
THIRD CLASS.
Cng’s College Tutorial Classes.
The success which has attended the special class for
intending candidates for the Primary F.R.C.8. has led
the staff to organise a class on similar lines for the final
examination for the Fellowship as well as for university
degrees in surgery. The names of the teachers. Mr. M
W a toon Cheyne, A. Carless, G. L. Cheatle, and A. W.
Cad man, constitute a sufficient guarantee of the excel¬
lence of the course, of which advantage is sure to be
taken by those who appreciate the immense advantages
which these classes offer to intending candidates.
Isolation Hospital for Dublin.
The Dublin Corporation has rejeoted a proposal from
the Public Health Committee that temporary arrange-
m nto would be made with Cork Street Fever Hospital
for receiving infective cases, and it has ordered a further
discussion of the matter as soon as a complete return of
the hospital accommodation can be prepared. The
Boards of Guardians do not seem disposed to co-operate,
though they cannot refuse to receive pauper patients,
and it is certain that the hospitals which have attach«d
fever wing* will throw every difficulty in the way of the
establishment of additional isolation hospitals.
Smallpox at Lincoln.
Two caet-s of small pox have occurred at Lincoln,
loth being traceable to Hull. Active measures have
Hirst, Walter Clapham, St. Bartholomew's Hospital.
Stevenson, Mabel Geraldine, B. Free Hosp. A Loud. Sch. of Meil
OBSTETRIC MEDICINE.
FIRST CLA8S.
Billlngton, William (Gold Medal 1, Mason C. and Queen s Hospital.
Birmingham.
lies, Mary Muriel Griffin, Royal Free Hospital.
Thomson, Frederick George, Uuiv. Camb. and Middlesex Hosp.
Unwin, W. Howard (Scholarship and Gold Medal), Cliaring Cross
Hospital.
SECOND CLASS.
Barnes, Arthur Stanley, B.8o., Mason C and Queen’s and Gen.
Hosp. Birm.
O'Dowd, John Austin, Birmingham Medical School.
Scott, 8ydnev Richard, St. Bartholomew’s Hospital.
""Stevenson, Mabel Geraldine, B. Free Hosp. aud London School of
Medicine.
FORSENIC MEDICINE.
FIRST CLASS.
Howard, Russell John (Gold Medal). London Hospital.
SEC )ND CLASS.
Barues, Arthur Stanley, Mason College and Queen's and Generu
Hospitals, Birmingham.
Hartley, Harold, Owens College and Manchester Royal Inftimary
Scott, Robert Gordon, St. Bartholomew's Hospital
StniDge, Robert Gordon. 8t. Thomas's Hospital.
THIRD CLASS.
Hilton, Caleb Thomas, Guy’s Hospital.
Meachen. George Norman, Guy’s Hospital.
Stevenson, Mabel Geraldine, Royal Free Hospital and Lon Ion
School of Medicine.
Turner. Philip, B.Sc.. Guy’s Hospital-
Vernon, Ethel Miller, London Scnool of Medicine and Royal
Fre Hospital.
Digitized by t^.ooQle
, 658 Th* Medical Press
NOTICES TO COBRESPONDENTS.
Dec. 20, 1890.
jftaticee to
Correowmbents, ghort %dttxs, Ac.
SET Correspondents requiring a reply in thin oolumn are par¬
ticularly requested to make use of a distinctive signature or
initial*, and avoid the practice of signing themselves “ Reader,”
•‘Subscriber,’' "Old Subscriber,” Ac. Much confusion will be
spared by attention to this rule.
Local. Reports and News.— Correspondents desirous of drawing
attention to these are requested kindly to mark the newspapers
when sending them to the Editor.
Beading Casb8.— Cloth board cases, gilt lettered, containing
twenty-six strings for holding the numbers of The Medical Press
ahd Circular, may now be had at either office of this journal,
price 2s. 6d. These oases will be found very useful to keep each
weekly number intact, clean, and flat after it has passed through
the post.
Surgeon-Major B.—The matter is hardly ripe for discussion at
present, there is so much to be said on both sides that we prefert
to await an official pronouncement before criticising existing
arrangements. The matter will not be lost sight o-.
X Bay.—A personal interview with the Medical Officer of Health
would probably assist in removing this particular cause of friction.
In matters such as these, the writing of letters often tends to
envenom controversies, whereas mutual explanations usually have
for effect to place matters on a sound basis. If one would only,
eliminate the personal element, the administrative element would
but seldom give rise to conflict of opinion.
Dr. Btan.- You certainly ought to have notified the case,
erysipelas being a notifiable disease, but it remains with you to
avert any trouble on this head by abandoning what, in the light of
your remarks, certainly appears to be a conte*table diagnosis.
AN OPENING !
We cull the following advertisement from the Times of the
11 th inst.
«« r>0ULD any LADY OB GENTLEMAN tell a great sufferer from
(j RHEUMATOID ARTHRITIS of any reliable RELIEF. No
quacks. Baths, drugs, and doctors have fniled. Address Grateful,
A. 9, The Times Office, London, E.C.”
Anv lady or gentleman who knows of a cure for rheumatoid
arthritis should come forward, for a fortune awaits the happy
possessor of the secret.
Mr. J. Stratton (Wokingham). The correspondence is now
closed, we cannot reopen the subject.
Dr Carthsw Davet (Liverpool 1 .—We hope to have space for
vonr instructive case of Gastric Ulcer, Perforation and Ulcerative
Endocarditis in our next.
Dr. Kbstevek.—F rom what you say the growth in the intes tine
is probably benign; 80 per cen'. of such growths spring from the
rectum, and they are for the most part polypoid in form. Occa¬
sionally these tumours, even when of large size, if situated higher
up in the gut, give rise to no symptoms during life. The commonest
signs and symptoms o’ polypi are tenesmus, htemorrhage, difficult
defiecation, sensory discomfort, and prolapsus ani. In all cases it
is necessary to exclude the possibility of malignant disease.
JEectings of the genetics anb lectures.
Wednesday, December 20th.
Royal Microscopical Society (20, Hanover Square, W.>—
8 pm. Paper: Mr E. J. 8pitta: A Review of Photomicrography
and its Different Methods (illustrated by numerous luntera slides).
' * Royal Meteorological Society (Institute of Civil Engineers,
.Great George Street, Westminster, 8.W.J.-7.30 p.m. Ordinary
Meeting. Papers: Mr. B Latham: The Climatic Conditions
necessary for the Propagation and Spread of Plague.—Mr. R. Scott:
Note on a Remarkable Dust Haze Experienced at Tenenffe, Canary
Islands, February, 1898.
Thursday, December 21st.
Harveian Society op London (Stafford Booms, TitchborneStreet,
Edgware Boad ).—9.30 p.m. Dr. Watson Cheyne: Genito-urinary
Tuberculosis.
Appointments.
Jraib, Wm., M.B., C.M.Glasg.. Medical Officer for the Bolton and
Thurnscoe Sanitary District of the Doncaster Union.
Denning, J. V. V., L.K.Q.C.P., L.B.C.S., Medical Officer for the
Christchurch Workhouse of the St. 8aviour's Union.
Sdbn, Thomas Watts, M.D.Edin., M.B C.P.,Lond., Physician to
Out-patients, Queen Charlotte’s Hospital, London.
low, Wm. J., M.B.C.P., M.RC.&, M.D.Lond., Physician to
In-patients, Queen Charlotte's Hospital, London._
Jrigg, Wm. Chapman, M.D.Edin., M.B.C.P.Lond.. M.B.C.S., Con¬
sulting Physician to Queen Charlotte s Hospital, London. .
Iall, B., M.D.Lond., M.B.C.S., Modical Officer for the Third Sani¬
tary District of the Lexden and W instree Union.
Iall, H. 8., L.R.C.P.Lond., M.B.C.S., Medical Officer for the
Workhouse of the Leigh Union. „ . , _ _ . ;
Ianson, B. J. E., M.B., C.M.Camb., Assistant Medical Officer for
the Infirmary and Workhouse of the Parish of Paddington.
Iarper, John iMaurice, M.R.C.8.. Surgeon to the Bath Police
Iehhingham,” W. P., M.D.Oxon., F.B.C.P.Lond., M.B.C.S.,
Physician to Queen Charlotte's Hospital, London.
Hirst, G S. S., M.B.,C.M.Edin., Medical Officer for the Withern
Sanitary District of the Louth Union.
Jaffrey, Francis. F.B.C.8.Eng., Lecturer on Anatomy at St.
George’s Hospital, London.
Newberry, W. J., M.B.C.S., Medical Offioer for the Overton Sani¬
tary District of the Whited lurch Union (Hants).
O'Farrell, H., L.B.C.P., L.RCS.Ire., Medical Officer by the
Guardians of the Portumna Union.
Pollock, Wm. Rivers, M.B.Camb., M.B.C.P.Lond., M.B.C.S.,
Physician to In-patients, Queen Charlotte’s Hospital, London.
Pomfret, Henry waytks. M.D Viet.. F.B.C.S.. Pathologist and
Assistant Surgeon to the Aucoats Hospital, Manchester.
Roberts, Chas. Hubert, M D., M.B.C.P.Lond., F.B.C.S , Phy¬
sician to Out-patients, Queen Charlotte’s Hospital. London.
Stabb, Arthur Francis, M.B, B.C Camb., M B.C.P.Lond.,
M.B C.8., Physician to Out-patients, Queen Charlotte’s
Hospital. London.
Stephenson, Stunet, M.B.. C.M., F.B.C.S.Edin., Ophthalmic
Surgeon to Queen Ch irlotte’o Hospital, London.
Taylor, Seymour, M.D.Aberd., M.B C.P., Physician to the West
London Hospital, Hammersmith.
Wheeler, W. A., M.D , B.S.Irel., Medical Offioer for the Milton
Abbot Sanitary District of the Tavistock Union.
Vaontties.
Belmullet Union. - Medical Officer, £180 per annum as Dispensary
Medical Officer, an* £10 a jrar ss Medical Officer of Health,
together with Vaccination and Registration Fees. Applications
to E F- Flvnn, Clerk of Uuion. (See advt.)
City of York.—Medical Officer of Health. Salary £400 per annum.
Apply to the Town Clerk, Guildhall, York.
Dorset County Hospital Dorchester.—House Surgeon, to reside
and hoard in the hospital. Salary £100.
Kent and Canterbury Hospital, Canterbury. - House Surgeon and
an Assistant House Surgeou. Salary House Surgeon com¬
mencing at £1*0 with board, Ac. Salary Assistant House Surgeon
£50, with board.
Parish of Gairloch, Boss-shire.—Salary from the Parish Council
£200 per annum, besides private practice To reside at Poolewe.
Applications to Mr. Macintosh, Inspector of Poor. Poolewe.
Queen’s County Infirmary.—Medical Officer. Salary £182 6s. 2d.
per annum. Applications to Geo. Dimond, secretary. (See
advt.)
Seamen’s Hospital Society, " Dreadnought," Greenwich.—Senior
House Surgeon for the Branch Hospital, Royal Victoria and
Albert Docks, E. Snlary £73 per annum, with board and resi¬
dence, and an additional £25 per annum conditionally.
Wexford Union. Medical Officer. Salary £100 per annum, and
£15 as Medical Officer of Health, with the nsual vaccination
and registration fees. A pplioations to Nicholas Kelioe, Clerk of
Union. (See advt.)
jCirthB.
Baker.— On December 12th, at 5, Gledhow Gardens, London, the
wife of C. Ernest Baker, M.B.Cantab., F.R.C.8., of a daughter.
Drake.— On December 11th, at Lewisham High R iad, New Cross,
the wife of A. Thomson Drake, M.B., of a daughter.
^Earmges.
For— Montgomery.— On December 14th, at St. Martin’s Chnrch,
Trafalgar Square, London. George Foy, Dublin, M.D., F.B.C.S.,
F.B.A.M., to Mary, daughter of the late Edward Henry
Hellaby, of Botheby, Leicestershire.
Martin-Dickson.— On December 14th, at Ormond Quay Presby¬
terian Church, Dublin, by the Bev. Alex. Hall, M.A., Drogheda,
Robert M. Martin of 5, Ulster Terrace, Stillorgan Park, Co.
Dublin, son of J. B. Martin, J.P., Hellensburgh, Sootland, to E.
Winifred t'ickson, M.D.. F.R.C.H.L, second daughter of the
Bight Hon. Thomas A. Dickson, Drogheda.
Rowan—Hime. —On December 7th. at the Church of St. Mary
Magdalen, Bradford, Major Henry Davis Rowan, Royal Army
Medical Corps, son of the late Lieut.-Col Bowan, 34th Regi¬
ment, to Rosamund Hime, daughter of Dr. Thos. Whiteside
Hime of Bradford.
Richardson—Bowring. —On December 12th, at Emmanuel Church,
Clifton, Charles Boards Richrrdson.M D„ of Hove, Sussex, to
Elisabeth, daughter of the late Benjamin Bowring, of Plash
House, Mark Somerset.
Sawers-Bailey. On December 12th, at St Peter 8 Church, Stoke-
on-Trent, John Lorimer Sawers, M.D., third son of the late
Robert Orr Sawers, of Blackheath, to Charlotte, eldest daughter
of Arthur Bailey, of Stoke-on-Trent.
Vernon—Ewart.— On December 12th, at All Saints Church,
Margaret Street, W , Horace Middleton Vernon, M.A.Oxon.,
M.D., to Katharine Dorothea, elder daughter of the late Rev.
Wm. Ewart. Vicar of Bishop’s Cannings, Wilts.
deaths.
Fletcher.— December 14th, at Ballinasloe, Mary Lynch Blosse, the
beloved wife of N. V. Fletcher, F.B.C.8.I.. and youngest
daughter of the late Very Reverend the Honourable Robert
Plunket, Dean of Tuam. T ,
Frost.— On December 13th, at 30, Ladbroke Grove, London W.,
Charles Maynard Frost, F.B.C.S., aged 85.
Benton.- On December llth, at Shotley Bridge, Co. Durham, Geo.
Benton, M.D.Edin ,oged 56. .. ,.
Jameson. On December 14th at 8t. Catherine s, Blackheath, Geo.
Wm. Jameson, Surgeon-Colonel Indian Medical Service.
Thorne.— On Deoember 17th, at his residence Inverness Terrace,
Hyde Park, London, Sir Richard Thorne, K.C.B., F.B.C.P.
Lond. and IreL, F.B.S., Medical Officer to the Local (Govern¬
ment Board, Aged 57.
by Google
Ibe IgMital gtoss and (Similar.
“SALUS POPULI SUPREMA LEX.*
Vql. CXIX. WEDNESDAY, DECEMBER 2 7, 1899. No. 26.
The Darbciait JCccturcs
ON
THE SURGICAL TREATMENT OF
TaBERCULOUS DISKa>ES.
By W. WATSON CHEYNE, M.B., F.R.C.S., F.B.S.,
Professor of Surfer)' iu Kind's College, Ac.
Abstract of Lecture II.
Tuberculous Peritonitis.—Varieties.
1. The peritoneum may be studded with tubercles
of varying size, some small, greyish and transparent
(the ordinary miliary tubercles), others larger and
tending to become cheesy. These tubercles are scat¬
tered over both the visceral and parietal peritoneum,
and there are frequently patches of iibrinous exuda¬
tion over them which readily peels off, and iu the
early stage there is not necessarily any matting
together of the intestines or shrinking or adhesions
of the omentum or mesenteiy. The peritoneum is
usually markedly hypenemic. In these cases there is
almost always more or less fluid present in the
abdominal cavity, usually of a lightish straw colour,
but in more acute cases somewhat opalescent or
stained with blood. The sensation of putting one's
finger into such an abdomen is the same as if it were
passed into a bag of sago.
The tubercles are not usually distributed over the
whole cavity, but are most numerous in patches, and
this is more especially the case where the origin of the
tuberculous peritonitis is some tuberculous lesion
inside the abdominal cavity. For example in peri¬
tonitis originating from the tubes, the tubercles are
most numerous in the pelvis, and become less
numerous as one passes from it; or, again, in tuber¬
culous peritonitis originating in connection with
tuberculous ulcer of the intestines, the tubercles are
in the first instance most numerous over the intes¬
tines in the neighbourhood and less numerous
elsewhere.
Although, as has been said, in these cases the
intestines are not usually matted together, still in
some instances the fibrinous exudation produces
sufficient adhesion to prevent the free spread of the
fluid over the whole abdominal cavity, and thus we
may have one or more collections of fluid simulating
cystic tumours.
2. In a second set of cases the formation of adhe¬
sions and fibroid induration of the omentum and
mesentery are the marked features. The intestines
become bound together in masses by new fibrous
tissue in which miliary tubercles may be present.
These adhesions are often very firm, and may m parts
constrict the intestines, or in other parts, from their
shrinking, lead to kinking of the intestine, and in
both ways they may cause partial or even complete
obstruction. Further, the intestines are not only
adherent to one another, but they are also very apt
•to contract adhesions to the abdominal wall, and this
forms a great difficulty in performing laparotomy in
these cases, and it is also the great objection to
aspirating the abdomen where fluid is present,
where the whole abdomen is involved, these
adhesions are especially marked between the
liver and diaphragm. The omentum is also
early involved in these fibroid changes, the two
layers of the omentum become matted together, and
the whole structure becomes much thickened and
shrunken, and in an advanced stage forms a thick
rolled-up mass like a sausage lying about or above
the level of the umbilicus, and usually running more
or less transversely across the abdominal cavity ; it is
generally adherent to the abdominal wall at this
part. This thickened omentum contains numerous
tubercles in its substance and scattered over its sur¬
face. The mesentery is also markedly affected with
similar changes, and becomes thickened and shrunken
and drags the small intestine up towards its root, and
thus i; comes about that when fluid is present it is
most apt to collect towards the left side and lower
part of the abdomen. The mesenteric glands are also
enlarged, but not as a rule cheesy.
In these cases a certain amount of cirrhosis of the
liver may even be met with, or there may even be tuber¬
cles in the substance of the liver. The spleen also is not
uncommonly enlarged, either as the result of passive
congestion or hyperplasia, or in some cases from the
presence of tubercles. This adhesive form of tuber¬
culous peritonitis mayor may not be accompanied by
the presence of fluid, and where fluid is present it is
most often encapsuled, and there may be more than
one collection.
3. A third condition which may be present, and one
which is extremely grave, is that the tubercles run
together and form large masses which undergo case¬
ation ; the mesenteric glands are enlarged and caseous;
the omentum is often converted into a caseous mass,
and caseating masses form in the adhesions which
bind the intestines together. The contractions and
distortions of the intestine and the shrinking of
the mesentery and the other changes mentioned under
the second form are usually much exaggerated. This
condition is especially associated with intestinal
ulceration, and the intestine is usually thinned, and
may even be perforated. Collections of fluid are fre¬
quently present, most usually encapsuled and mul¬
tiple, and not uncommonly purulent. The pus may
present all the characters of ordinary tuberculous
pus, but in other cases it may be foul smelling, either
as the result of infection through the intestinal walls,
or as the result of actual perforation of the intestine.
In this form, in infants especially, the condition
may be most marked in the neighbourhood of the
umbilicus, and the pus may make its wav through
the abdominal wall at this point. Where this occurs
we find a sinus passing into the abdomen, and not
uncommonly a fsecal fistula is present as well. As
this faecal fistula is usually in the small intestine, and
often pretty high up, the child rapidly emaciates and
goes down hill.
Digitized by CjOOQle
600 The Medical Press. ORIGINAL COMMUNICATIONS. Dec. 27, 1899.
In both the second and the third forme the upper
S ort of the abdominal cavity may be healthy, the
isease being shut off above by the adhesion of the
omentum to the abdominal wall at the level of the
umbilicus. In other cases it may be still more cir¬
cumscribed, and form a limited patch with fluid
in the interior, this condition being most commonly
met with in the form of an irregular fluctuating
swelling in the left iliac fossa. Another local form is
where it is limited to the pelvic region, which occurs
especially in connection with infection from the Fal¬
lopian tubes; or, again, we may meet with a tuber¬
culous perityphlitis forming a mass in the right iliac
fossa, which has been mistaken for a malignant
tumour. These masses are usually secondary to
tubercle of the appendix or ca^um.
There are many intermediate forms and varieties
of these patholog : cal changes which it is impossible
to enumerate here, but these are the three chief types,
and they are of especial importance lrom the point
of view of treatment.
Symptoms.
The commencement of the disease is usually
insidious and slow, although in some cases
it may be rapid, and may then be mistaken for
typhoid fever, tuberculous peritonitis, etc. In most
cases the early symptoms are quite indefinite. The
patient has a feeling of malaise and weakness, he is
subject to headache, may suffer from thirst, does not
sleep well, and frequently has night sweats. He soon
begins to lose his appetite, feels out of sorts, and not
uncommonly has occasional vomiting. The bowels
are irregular, he frequently suffers from obstinate
constipation or from diarhoea, or again from alternate
constipation and diarrhoea. Bye-and-bye he begins
to have occasional abdominal pain, especially of a
shooting character, or, it may oe, only a feeling of
weight or pressure. In other cases there is no pain
at all; indeed, it is very seldom that pain is severe at
the commencement of the trouble. The pain if
present is increased by exertion. The temperature is
very variable; there is generally an evening rice, but
it may not be marked; in a good many cases there
is no rise at all. the temperature being normal, while
in others again, after it has been normal for some
time, it may suddenly commence to rise in the
evening and assume a marked hectic type. In
the early stage, except in the acute cases, the
patients are able to go about, or even follow their
employments, but from time to time they may have
to lie up on account of feeling out of sorts, or of
general weakness, or of increasing pain, and then,
after a few days’ rest, they are able to go about
again. After some weeks or months, however, the
patient has to give up work either on account of in¬
creasing weakness, or more commonly on account of
gradual swelling of the abdomen, a feeling of weight,
or more rarely severe pain, shortness of breath, «fcc.
As the disease goes on the general symptoms increase,
there is a rapid advance in the malnutrition and
emaciation, the skin becomes pale and sallow and dry,
the cheeks sink in, and the patient acquires the suffer¬
ing aspect of those with abdominal trouble In othere,
again, the symptoms are much more acute, and in a
considerable number of cases they have been mis¬
taken for those of typhoid fever.
On examining the abdomen the condition of
matters present depends on the pathological changes
already described, and to a great extent also on
whether there is or is not fluid, and on whether the
fluid is free or in loculi. Where there is much free
fluid present the abdomen is distended, somewhat
flattened at the sides, and the ribs everted. The
abdominal wall is stretched and shining, with big
veins running over it, and it ia usually so tense that
nothing can be felt through it. The pain is no
generally marked in these cases. Where the fluid is-
less the thickened omentum l <4 -eadily felt in the
form of a tumour-like mass of a sausage shape
generally running more or less transversely across
the abdomen about or just above the level of the
umbilicus, the omentum being thickened and rolled up
by the fluid and the distended intestines, and pressed
against and becoming adherent to the abdonimal walL
The percussion note is uncertain and atypical, fluctua¬
tion is not distinct, and the fluid as a rule only changes
its position slowly, owing to having to make its way
among the adherent intestines. Under other circum¬
stances, again, the fluid may be more or less com¬
pletely encapsuled and form definite fluctuating
tumours, which may be mistaken for ovarian or other
cysts. On the other hand, there may be little or no
fluid present; the coils of intestine become adherent,
the mesentery contracts, the omentum is thickened
and shrunken, and hard bands and thickenings are
found in the abdomen. Thus one may not only feel
the thickened omentum, but also definite patches of
hardness elsewhere, due to these bands and thickened
adhesions, or one may find more definite hard
tumours which are generally composed of masses
of glands or of thickened adhesions studded
with tubercles, or of small collections of encapsuled
fluid. The abdomen is uneven, owing to irre¬
gular distension of the intestinal cfils with gas.
There may be marked meteorismus, and, when the
intestine is kinked or in any other way obstructed,
the coils of contracted intestine may be seen through
the abdominal wall. In the latter case, of course there
would probably be other Bigns of obstruction. The
splenic dulneBs, if it can be made out, may be in¬
creased. The liver dulness is not commonly dimin¬
ished, but, on the other hand, the liver may be en¬
larged as the result of early cirrhosis or fatty infiltra¬
tion. There is often decrease in the quantity of the
urine, and not infrequently albuminuria. The stools
are frequently light in colour, due to imperfect diges¬
tion of the fat.
It is not uncommon for the disease to be asso¬
ciated with various complications, more especially
with intestinal obstruction due to kinking, bandB, or
narrowing of the lumen in connection with ulceration
or, on the other hand, perforation may occur, either
through the ulcer or above an obstruction ; or, again,
we may have inflammation and thickening around the
umbilicus, especially in children, which has been
already referred to, and which is pathognomonic of
tuberculous peritonitis. In bad cases belonging to
Type HI., where suppuration is present and emacia¬
tion usually rapid, there is generally considerable
fever, and the patient quickly goes down hill. It is-
not uncommon for the disease to be combined with
phthisis, or with pleurisy. Schreiber gives 26 cases,
of which 12 had already tuberculous pleurisy; and
Heintze in 25 cases had 20 with pleurisy. Although
not a8 a rule so frequently present, pleurisy is never¬
theless not at all an uncommon accompaniment; it
toay precede the peritonitis, or the two may begin
simultaneously, or more commonly the pleurisy cornea
on after it. It often sets in insidiously, and in any
case it is grave and increases the dyspnoea.
Surgical Treatment.
The value of surgical measures was found out
quite accidentally. In 1862 the late Sir Spencer
Wells, in operating on what he supposed to be an
ovarian cyst, found on opening the abdomen that he
had before him a case of tuberculous peritonitis. He
therefore at once closed the woand again, but u> his
surprise the patient soon began to improve, and ulti¬
mately got well, and was alive and well twenty-five
years later. As abdominal surgery became more and
more developed similar mistakes were frequently
made, and further, as exploratory operations were
D*c. 27. 1899.
ORIGINAL COMMUNICATIONS.
Th* Mkdical Pbiss- 661
introduced, tuberculous peritonitis was not un¬
commonly di covered. It was found that in a con-
s.derable number of cases after such mistakes or
explorations the patients rapidly got well, and bye-
and-bye it became clear that this could not be
regarded as a mere coincidence but that laparotomy
had a distinctly beneficial effect in a considerable pro¬
portion of cases of tuberculous peritonitis. Hence
surgeons began to perform laparatomy as a curative
measure in cases which were diagnosed as tuberculous
peritonitis, with results which have established it as
a highly successful means of treatment.
Prognosis of Laparotomy.
The prognosis of laparotomy naturally varies in
different cases. The most favourable are certainly
those belonging to the first group, with localised
ascites, and the next most favourable are those where
the fluid is diffused over the abdomen. I must con¬
fess that I have been surprised at the recovery in
some of these cases. On opening the abdomen one
finds tubercbe everywhere, the intestines protrude
from the wound and are seen to be red, inflamed, and
covered with tubercles, some of them sometimes of
considerable si/e, the abdorn inal cavity feels like a
bag of rice, and yet in these cases recovery may
follow. In two instances in which I gave a very bad
prognosis after the operation, on account of the size and
number of the tubercles scattered all over the intestine
and abdominal cavity, recovery took place rapidly and
apparently completely. The next most favourable
cases are those where there is no ascites and where we
have the fibro-adhesive form to a moderate extent as
described under headine No. II. Indeed favourable
results hive been obtained in this form even where
the adhesions were so great that the operator never
penetrated into the abdominal cavity. By some this
fibro-adhesive form is look ed on as a healing process,
and it is held that the operation proba bly merely
gives it a fillip in a good many cases. Where the
abdomen contains large caseating masses the pro¬
gnosis is much more grave, and as is evident from the
results mentioned above the successes are not nearly
so great At the same time they do occur, and I
myself had a successful result even when there were
large masses of caseating material. In this group
however it is rather the case of giving the patient a
chance than of any great probability of curing him.
It must also be borne in mind that it is in these cases
more especially that harm may be done by the opera¬
tion, for unless great care be taken the intestine may
be readily torn and a faecal fistula be established.
Indeed in some instances, even when there is
no apparent injury to the
fistula may result after
these cases it is not
that the scar breaks dow n
become infected with tubercle, but even in spite ol
this healing may ultimately occur in time where a
fecal fistula has also formea, provided always that it
is not large nor situated nigh up in the small
intestine.
Cases with slight phthisis also frequently improve
both locally and also as regards the lung alter opera¬
tion, but where the phthisis is extensive the result is
not good. Opinions differ as regards the effect of
pleuritic effusion on the results of operation, but as
a whole it is not looked on as a contra-indiction.
Cases with intestinal ulceration are particularly un¬
favourable, and it is a question there whether
laparotomy does any good. Spaeth also asserts that
cases secondary to tubal disease are not benefited by
laparotomy, even although the tubes are removed,
but this is contrary to the experience of Aldibert and
of a number of other observers who have obtained
good results even where the tubes were not touched.
The great risk of tuberculous peritonitis in these
intestines, a fecal
the operation. In
uncommon to find
subsequently, having
cases of tuberculous salpingitis, however, makes it
essential that where a diagnosis of tuberculous sal¬
pingitis is made the tubes should be removed at once.
Time for Operation.
From the evidence, I should say that in practically
all cases where improvement does not follow under
medicinal treatment after a reasonable time, say in
from four to six weeks in acute cases, to four to six
months in chronic cases, the abdomen should be
opened whether there be ascitic fluid or not. The
operation may do good in cases where it is least ex-
C ted to do so, and it is but seldom that it does any
m. Do not in any case allow the patient to go
down hill too much, otherwise one cannot expect good
results to follow, and it is fair neither to the
patient not* to the surgeon. It seems to me a
very questionable thing whether it is good for the
patient that the ascitic fluid should be absorbed
seeing that it contains toxins and bacilli, and therefore,
as I have said, where improvement does not follow
soon I believe that early laparotomy is best, and the
medical treatment can follow the operation just as
well, or better, than if it precede it.
On the other hand, it apparently does not do to
operate too soon. Where one operates quite in the
early stage, recurrence curiously enough is very apt
to take place, and the explanation of this I believe to
be that which I shall give presently in connec¬
tion with the modus operandiof the operation. How¬
ever it may be explained, it cei’tainly is the fact that
most of the cases wheie repeated operations for re¬
currence have taken place have been those in which
the first operation was performed quite at the com¬
mencement of the disease. On the other hand, it is
most important not to wait till the patient has gone
too far downhill. If the patient suffers pain from
bands, or from kinking of the intestine, or from
obstruction, operation is necessary, even although
much good may not result.
The Operation.
In operating, as has been before stated, it is well
not to attempt to carry the procedure to the extent of
attempting to remove any of the diseased tissues,
such as excision of an ulcer of the intestine, the re¬
moval of tubes, etc.: unless, indeed, one finds only
quite a commencing peritonitis at that part. The
removal of the tubes, for example, in cases of ad¬
vanced peritonitis would mean a prolonged and very
difficult operation, owing to the adhesions, in a peri¬
toneal cavity ah-eady very much inflamed, and one
which would almost certainly precipitate the patient’s
death from shock. On the other hand, if on opening
the abdomen one finds only slight commencing peri¬
tonitis around the tubes, then I believe they ought to
be removed so as to prevent further infection. Simi¬
larly, in the case of the appendix or caecum, while a
few cases have improved as the result simply of open¬
ing the abdomen, the best results have been obtained
in cases where the disease has been localised to that
region, and where the appendix or the caecum itself
has been resected. On the other hand, in cases with
intestinal fistula, operation is out of the question.
The patient cannot stand a proper operation for re¬
section of the fistulous portion, and the intestine in
the neighbourhood of the fistula is usually so thinned
and diseased that any attempt to stitch up the whole
without resection practically always fails, and such
attempts leave matters worse than the^y were belore.
Lastly, it may be said that if one is in doubt it is
better to operate than to leave things alone.
Some, thinking that the beneficial effects of
laparotomy were simply due to the evacuation of the
fluid, have concluded that the same result could be
obtained by aspirating the abdomen. This, however,
does not seem to be the case; good results have cer-
Digitized
662 The Medical Press
ORIGINAL COMMUNICATIONS.
Dec. 27, 1899.
tainly in a few cases followed puncture with evacua¬
tion of the fluid and injection of air, but simply
tapping the abdomen seems to be quite inefficacious.
Further, puncture of the abdomen is a procedure by
no means free from danger in these cases. It is not at
all uncommon for the intestine to become adherent
to the abdomen in the middle line, and cases have
occurred where it has been punctured by the trocar,
and the death of the patient has resulted. Hence,
partly on account of its inefficiency and partly on
account of its danger, puncturing the abdomen
should be given up as a means of treatment.
The operative procedure is very simple in most
cases. Where effusion is present without adhesions
it simply consists in opening the abdomen in the
middle line, below the umbilicus, allowing the fluid to
run out, aided by turning the patient on his side and
perhaps removing some of it by means of sponges,
and then stitching up the wound again. In former
days the abdomen was washed out with various anti¬
septic solutions, such as carbolic acid, sublimate, etc.,
some leaving the solution in, other flushing out the
abdomen afterwards with salt solution. Others again
very carefully dried the cavity as far as possible with
sponges and so forth. All this Beems. however, to be
unnecessary, and in reality inadvisable, for as good
results are obtained by simple laparotomy without
the introduction of any chemical substance at all, or
even without flushing out the abdomen or complete
removal of the fluid, as where these measures are
adopted.
Where adhesions are present, care must be taken
in opening the abdomen not to injure the intestine,
and if the adhesions are firm it is better to leave
them alone and close the wound than to try to force
one 8 way in, unless fluid be present.
In the dry fibrous form, unless the intestine is
becoming kinked or bound down by adhesions, it is
seldom advisable to try to separate the coils on
account of the risk of weakening the wall of the
bowel, and consequently leading to a fa)cal fistula. If,
however, obstruction is present it must be relieved or
an anastomosis must be made between the coils
above and below. Should a rent occur in the peri¬
toneal coat in the course of such an operation it
should be very carefully stitched up.
When pus is found it should be washed out by
salt solution, and it is then well to introduce a little
iodoform and glycerine emulsion into the cavity
before closing it.
The question of drainage has been raised in these
cases, but there does not appear to be any advantage
in drainage where the fluid is serous, and there is the
disadvantage that in some cases it has happened that
a tuberculous sinus lias been left at the seat of the
drainage tube. Even where pus is present, unless it
be foul-smelling, it seems best to t-eat it like a
chronic abscess elsewhere by washing it out tho¬
roughly, injecting a little iodoform and glycerine,
and closing the wound again.
An important point arises—namely, whether a
primary focus such as a tube or appendix, etc., if
found, should be removed. This, as I have already
said, depends very much on the extent of the disease.
If the whole peritoneum is infected, then no attempt
should be made to remove the primary focus, such
attempts having generally ended disastrously. On
the other hand, if the tuberculous peritonitis be
limited to the immediate vicinity of the tube or ap¬
pendix and caecum, the removal of the primary source
iB very important, and much better results are ob¬
tained by so doing than by simple laparotomy.
As regards the course followed after laparotomy, in
some cases immediate improvement begins, while in
others ten days or longer may elapse before any
noticeable effect is produced. In any case medicinal
measures should be superadded to the surgical as
soon as possible. In some cases the fluid reaccumu¬
lates, and there is then no objection to a subsequent
laparotomy; indeed, as has been already said, there
are some instances where several laparatomies were
performed and where cure was ultimately obtained.
OASTkIC ULCER;
PERFORATION—RECOVERY; ULCERA¬
TIVE ENDOCARDITIS—DEATH.
By W. H. CARTHEW DAVEY, F.R C.S.E.,
Hon. Surgeon, Boys’ Orphan Asylum, Liverpool.
Mrs. A., let. 22, married, two children, the youngest
child bora October 2nd, 1898, the confinement passed
off satisfactorily, and the recovery quite unevent¬
ful, the patient then left home for some time,
and I did not see her again till April, when I was
shocked at her appearance. From being a strong,
robust, healthy woman she was thin and wasted, and
complained of weakness and general debility, with
dyspeptic symptoms, flatulence, pain after food,
&c. (there was no vomiting). The case appeared to
be one of flatulent dyspepsia brought on by nursing
and worry and anxiety about the baby. The child
was accordingly weaned, and the dyspeptic sym¬
ptoms treated with soda and bismuth inter¬
nally, and a restricted milk diet. Matters im¬
proved very considerably under this treatment until
the evening of May 22nd, when the patient had eaten
somewhat heartily of supper. No discomfort was
felt at the time. She retired to bed at the usual
time feeling quite comfortable. At about 2 a.m the
patient was seized with violent abdominal pain and
vomiting. The husband, thinking it was an ordinary
bilious attack, did not send for me at the time, but
gave some brandy, This was promptly ejected. The
patient being no better I was telephoned for between
5 and 6 a.m., and on arrival found the patient in a
state of collapse and pain. (The vomited matter had
unfortunately been thrown away, but it was described
to me as quite black in colour.) On examining the
abdomen there was an area of tenderness and
dulne88 in the left hypochondriac region, no
general abdominal distension. I concluded we had
moBt likely a case of perforating gastric ulcer to deal
with. Now, how were we to deal with the case. Operate
at once, or opium and starvation. I chose the latter
treatment because I believed that the extravasation,
if any had occurred, had become localised owing to
old adhesions. I, therefore, injected morphia hypo¬
dermically, and commenced rectal feeding, nothing
allowed by the mouth. This treatment was continued
for ten days, the temperature during this period
remaining between 100 and 102degs.,until theeleventh
day it reached the normal point. A little peptonised
milk was now given, but we had a recurrence of pain
and rise of temperature. It was quite evident we
must again go back to starvation, and this was
accordingly done for another ten days, the patient
bearing her deprivation of food most kindly and with
great fortitude. We had now reached three weeks from
the primary attack, and felt justified in again attempt¬
ing nourishment by the mouth, peptonised milk was
again given, and no trouble arose from the venture :
the quantity was gradually increased, and at the end
of another week we were able to give a little fish and
chicken, and matters appeared to be shaping most
favourably (the dulness still remained in the left
hypochondriac region), the patient was able to sit up
and was hoping to get out in a few days, when the
temperature again began to rise, and parotitis of the
left gland came on. This was followed by the right
gland becoming inflamed; this gradually subsided,
but left facial paralysis remained. Another difficulty
Digitized by GoOgle
Dec. 27, 1890.
ORIGINAL COMMUNICATIONS.
The Mbdical Pkiss. 663
had been’overcome, when allonr hopes were shattered
by left’ hemiplegia presenting itself. It was now
pretty evident that we bad a case of septic poisoning
to deal with. It was most disappointing, one
trouble after another. Temperature during this
period oscillating between 99 and 103 degs.
The hemiplegia gradually improved, and the
case looked more hopeful, when we had another
hemiplegic attack, and about this time a very faint
murmur was heard over the aortic region of the
heart, and what we feared had occurred, the valves
of the heart had become involved in the general
septic poisoning, and the case was now hopeless, the
patient gradually got weaker, the wasting con¬
tinued, and in spite of all treatment, she died in the
middle of September after four months' illness borne
with great patience and fortitude.
ON THE EXAMINATION OF SICK
CHILDREN, (a)
By LANGFORD SYMES, F.R.C.P.I., Etc.,
Physician to the Orthopaedic Hospital in Ireland; Physician to the
Convalescent Home, Stillorgan ; Physician to the Homes
for Destitute Children, &c., Ac.
(AB8TBACT).
The clinical examination of sick children differs in some
respects from that of adults, and as their diseases, symp¬
toms, and treatment are in many ways diverse, it occurs
to me that it might be useful for us to consider to what
special points in their case particular attention should
be directed—what peculiarities strike the physician in
his visits to the children’s ward.
Young children never know the seat, nature, or cause
of disease. Their friends often mislead one, being them¬
selves in ignorance, and so its discovery is entirely
dependent on the physician’s powers of physical examin¬
ation. Hence it necessarily follows that every organ
should be examined.
The method or routine which I have been led to adopt,
and find useful, has this advantage at least, that once
the physician’s hands are laid upon the child the whole
examination can be gone through without their ever
being lifted off. In this procedure the child, if in bed,
must be stripped quite naked and rolled in a blanket;
and if in the out-patient department, for the first visit,
should be undressed by a nurse in the ante-room, and
sent in to the physician clothed only in a long flannel
dressing-gown. Before proceeding to examine any child
it is of great importance to know the history. The
following history is a rough sample of what should be
obtained from the mother or person in charge, for the
patient is quite unable to assist one. It differs in many
respects from that obtained from adult patients : —
History. —What the child has been brought for ? How
long ailing ? When last quite well ? Beginning, cause,
or progress of illness ? If born properly or prematurely ?
Particulars of labour and condition after birth ? (by this
inquiry premature birth, htematoma, visceral, or mucous
haemorrhages, asphyxia, obstetric paralyses, umbilical
conditions, septic infections, icterus, nostop, neonatorum,
tetanus neonatorum, or mastitis will be fully revealed).
How long fed at the breast, and when first given arti¬
ficial food ? How much ? How often ? How mixed ?
When weaned ? (by these questions we can often dis¬
cover the causes of some of the most fatal diseases of
children — marasmus and atrophy, rickets, scurvy,
diarrhcBa and dysentery, flatulent colic, and dilatation
of the colon). Commencement and progress of denti¬
tion? What previous diseases, and when (especially
we should inquire for thrush, rashes, snuffles, diarrhoea,
fits or convulsions, whooping-cough, mumps, diphtheria
or croup, rheumatism or growing pains, and infectious
diseases). How many other children living? Their
health ? Children lost (causes) ? Miscarriages (for
syphilis) ? Mother’s health and history (especially for
rheumatism, syphilis or tubercle) ? Father's health and
history (rheumatism, syphilis, tubercle), and, lastly, the
hygiene or sewerage of the house ?
All these particulars throw a vast amount of light
upon the case, and should be in writing on the note-
sheets at the head of each child’s bed, and obtained by
the clinical clerk on its admission from the mother or
friend before they are allowed to leave the hospital.
Examination. —The following order is recommended:—
I. “ Facies .”—The general appearance of the child is
to be first noted—pale and anaemic, florid, sallow or
jaundiced in complexion; fat and well-nourished, or
pinched and wasted; well developed or dwarfed; joy or
sorrow; pain or ease. The attitude, if at ease, distorted,
choreic, paralytic, or anywise' crippled. The gestures ;
how it receives objects, &c. Its sanity and intelligence,
and state of cerebration (idiocy, cretinism, moral
insanity, or mania will be evident). Conscious or coma¬
tose (drowsiness and stupor in children may result from
uremia, epileptiform convulsions, organic cerebral
disease—such as haemorrhage, effusion, abscess, or
tumour; bydrocephaloid condition in summer diarrheas,
ptomain or food poisoning, formerly called gastric
attacks, and sometimes from pneumonia, drugs, or
alcohol). If it cry or cough the voice will reveal its
pulmonary and laryngeal condition (for instance, it may
tell us of whooping-cough, diphtheria, laryngitis,
laryngismus, or pneumonia). Again, OBdema, cyanosis,
skin affections, or eruptions are at once obvious; also
the rashes of purpura, chicken-pox or infectious fevers.
Respiration is visible. The physiognomy alone often
reveals disease (e.g., chorea, pleuro-pneumonia, menin¬
gitis, “ hippocratic facies ” of impending death, adenoids,
Bright’s disease; wasting of diarrhcea, atrophy, or
marasmus, with Jadelot’s lines on the face; inherited
syphilis, with its rash, snuffles, fissures, or “ Hutchinson’s
teeth," Ac.). The state of the ocular muscles and pupils
are usually easily observed, and may reveal paralysis
from cerebral abscess, cerebral tumour, thrombosis of
sinuses, tuberculous meningitis, or diphtheritic para¬
lysis.
II. The child being now stripped next pass both hands
carefully over the head. Observe if sweating existB (as
in rickets). Note its size and shape—whether micro-
cephalic, hydrocephalic, rickety, or “natiform,” with
“bosses” or osteophytic nodes on the surface of the
bones. The sutures may be prematurely closed (micro-
cephalus), unduly patent (hydrocephalus, rickets), or
grooved. The anterior fontanelle, usually closing about
the eighteenth month, may be obliterated too early
(microcephalus); widely open, with resilient attenuated
edges (hydrocephalus, rickets, cretinism, achondroplasia,
formerly called foetal cretinism, and in some dwarfs) ;
tense and prominently bulging (meningeal effusion,
hydrocephalus, cerebral tumour, whooping-cough, pos¬
terior basal meningitis, bronchitis) : fiat or deeply sunken
and depressed (collapse, diarrhcea, cholera infantum,
“ hydrocephaloid ’’ condition, wasting diseases, malnu¬
trition), “ Craniotabes ” may be felt—i.e., thinning of
the occipital bones so as to yield under the pressure of
the finger (indicating syphilis, rickets, chronic hydro¬
cephalus). Measurements of the head are also neces¬
sary in some of its diameters in correctly estimating
mental capacity.
III. The hands now pass down from the head and
examine the entire frame, bones, and joints. The
shoulders, arms, hands, fingers, chest, ribs, hips, legs,
and feet. (Rickets, scurvy rickets, rheumatism with its
subcutaneous nodules, torticollis, clubbed fingers, de¬
formities, joint affections and bone diseases, sarcoma,
erythema nodosum, oedema, chilblains, and pseudo-
hypertrophic paralysis are thus at once observed).
IV. The reflexes are easily commenced next, as the
the hands are now touching the feet. Plantar, “ ankle
clonus,” knee-jerks, cremasteric, abdominal, epigastric,
facial irritability (for tetany), and ocular reflexes. The
reflexes are a most valuable index to the state of the
nervous system in infants, and neuritis, chorea, diph¬
theritic paralysis, infantile paralysis, Friedreich’s disease,
meningitis in its many forms, spastic paraplegia (cere¬
bral paralysis), birth palsies and hemiplegia can fre¬
quently be differentiated thereby.
Digitized by GoO^TlC
y y ^
(a) Bead before the Royal Academy ot Medicine of Ireland.
664 Th* Medical Pbbss.
ORIGINAL COMMUNICATIONS
Dec. 27, 1899.
V. The eyes should now be scrutinised—pupils,
ocular paralyses, vision, photophobia, nystagmus, &o..
The ears for otorrhma, &c., and the nose for snuffles (a
common sign of syphilis), ichorous dischargee, depres¬
sions, adenoids, &c.
VI. The glands are now commenced:—Parotid, cer¬
vical and submaxillary, thymus and thyroid, supra¬
clavicular, axillary and inguinal; showing perhaps
mumps, Hodgkin’s disease, tubercle, sarcoma or new
growth, syphilis, glandular fever, or with an atrophied
thyroid myxoedema or cretinism.
The hands will now lie upon
VII. The abdomen; the gentlest palpation possible
will alone reveal its true condition. First observing the
intestines we look especially for abdominal tubercle,
tuberculous peritonitis with bands of lymph, tuberculous
ulceration of the bowels, enlarged mesenteric glands or
tabes mesenterica, ascites, tumours, intussusception,
constipation or dilatation of colon. Next we measure
the liver by finger-breadths below the costal arch and
feel its ed^e. It is relatively larger in infants than in
adults, while its diseases are not so common. Then the
spleen may often be felt and measured. Enlarged spleen
in infants is common in splenic anaemia (a), rickets,
tuberculosis, and perhaps Byphilis. The kidneys should
also be sought for, and if felt some morbid condition ham
either enlarged or displaced them, as they should not be
felt in health, sarcoma, new growth, or cystic disease
here occur to the mind.
In connection with special abdominal diseases the
rectum must be examined, but as a routine practioe it is
not, perhaps, required.
VIII. The heart is now quite close; see its apex beat;
feel its impulse or thrill; map out its area of dulness.
Enlarged area of cardiac dulness in children occurs in
chorea, pericarditis, diphtheritic paralysis, rheumatism,
some cases of congenital heart disease, and whooping-
oough. In an epidemic of whooping-cough last spring I
found a remarkable increase in the cardiac dulness.
Appreciate its sounds, and detect its murmurs—
functional, organic, or congenital. Congenital heart
disease consists of patent ductus arteriosus ; patent fora¬
men ovale, or, most commonly, a deficiency of the ventri¬
cular septum. It will be known by cyanosis and
clubbing of the fingers ; loud, musical systolic murmur;
feeble apex beat, usually absence of thrill; and its
occurring in a child under three years old.
What is termed Eustace Smith’s sign may sometimes
be heard at this juncture— i.e., a murmur over the manu¬
brium on bending back the head, usually indicating
enlarged bronchial glands.
IX. The lungs are now beneath the hands—anterior,
superior, sides, posterior. Especially look for atelec¬
tasis or collapse, broncho-pneumonia, with its minia¬
ture patches of dulness so difficult of detection, and
empyema. Tuberculous lobular pneumonia is also a very
violent disease in children. Of all lung diseases, how¬
ever, one of the most peculiar is that known as “ Apex
Pneumonia,” very masked, resembling enterio fever,
with delirium, convulsions, and very little to show, it is
liable to be passed over. It was called from its delirium
“ cerebral pneumonia,” but as shown by Dr. Sturges it
is only because the other signs are less that the delirium
is more striking. The child will now for the first time
be sitting up, and when the posterior portions of the
lungs have been examined, glance next at
X. The spine. Test its curves, prominences, depres¬
sions, suppleness, or rigidity. Especially we must
beware of rickety curvature of the spine distinguished
from Potts’ disease—by forming a wide curve, disap¬
pearing on lifting the child, and by being unaccompanied
Dy pain or much stiffness. Also we must recollect para¬
lysis of the muscles of the back from diphtheritic para¬
lysis, tumour of the cord, or anterior poliomyelitis.
XI. The neck is an important part of the spine. It
(a) I would here remind you that splenic anemia was first cle-
E icted by an Irish observer, Dr. Francis Batters by, Siuxeon to the
nstitntion for Diseases of Children in Pitt Street, Dublin, who
published his careful observations in the “Dublin Quarterly
Journal' ' of May, 1819, as “ Tumefaction of the Spleen in Children.”
Continental and EmrUah observers liave since confirmed many of
his results. It occurs among the wealthy classes just as in poor
children.
reveals wasting in a child at once. Also rigidity of th» •
neck in children is a very striking symptom. It may
occur in tuberculous meningitis, purulent meningitis,
posteuor basal meningitis, cerebellar tumour, enteric
fever, diphtheria, apex pneumonia, wasting with dys¬
pepsia, tetany, retro-pharyngeal abeoees, oervical caries,
rheumatism, &c. When severe it produces retraction of
the head and “ oervical opisthotonos.”
XII. The mouth is now finally inspected. See the
lips, gums, teeth, tongue, cavity of the mouth, palate,
tonsils, and throat, and, if suspected, examine for
adenoids. A host of diseases previously unthought of
may be revealed in a child’s mouth—thrush, scurvy,
stomatitis, and cancrum oris; delayed or irregular
dentition from cretinism, rickets, syphilis, or retro- -
pharyngeal abscessalso follicular tonsillitis and diph¬
theria, laryngitis and laryngismus may have to be
differentiated.
This usually finishes the routine examination in
ordinary cases, and is generally sufficient to establish a
correct diagnosis, or at least, reduce the difficulty to one
of two alternatives. Thus in the passage of the hands
from the head twice down and up the body, the fullest
information can be quickly gathered from examination
of the various organs en route, while the hands are never
taken off the child.
XIII. Special investigation of the nervous system
must, however, be afterwards conducted if any suspicion
remains, or if the foregoing examination reveal any
nervous troubles.
The following are the chief points, being the same for
both adults and children:—
1. Motor phenomena— e.g., spasm, paresis, paralysis,
tremor—power of shutting eyes, whistling, laughing,
grinning or frowning; power of co-ordination, threading
needles, passing needle through a hole in paper, touohing
the nose, standing with eyes shut, etc.
2. Reflex phenomena, especially seeking for diphtheri¬
tic paralysis, infantile paralysis or neuritis.
3. Sensory phenomena— e.g., touch, pain, heat, cold.
4. Trophic phenomena, particularly regarding pseudo-
hypertrophic paralysis, juvenile muscular atrophy,
birth palsies, infantile hemiplegia, or spastic para¬
plegia.
5. Electrical phenomena.
6. Bladder phenomena; oontrol of sphincter. Incon¬
tinence of urine is often caused by stone, phymosis, uric,
acid, worms, or organic nervous disease.
7. Rectum phenomena, control of sphincter.
8. Mental capacity for feeblemindedness, idiocy or
imbecility, cretinism, moral insanity, mania, and even •
general paralysis of the insane (of seventy-two cases •
co. jK*ted under twenty years by M. Thiry, twenty-nine
were under fourteen years of age).
9. Speech, for backwardness, aphasia, nasal speech,,
stammering, idioglossia, or even dumbness.
10. Power of sitting, standing, walking, reading,
writing, or singing. It is remarkable that in some
cases ot cerebellar tumour in children they can sing very .•
well.
Some other points in clearing up the olinioal puzzles of
children’s diseases can be subsequently tested— e.g., the
urine, the rectum and anus, and alvine discharges (for
worms, diarrhoea, dysentery, prolapse or syphilis).
Blood estimation, the ophthalmoscope, vision, and colour¬
blindness, the weight to show nutrition, the height for
stunted growth, measurements of the head, further
investigation of the mental capacity, special electrical
reactions, and the use of the dynamometer, cesthesio-
meter, or other of the numerous pBycho-physical instru¬
ments.
Every physician must choose his own method of
examination; but the advantage of the above plan is,
that the hands, once placed upon the child, need never
be removed until the entire investigation is complete.
The recollection of these points as we enter the
children’s ward will materially assist us in our research.
It is, doubtless, frequently true in the practice of
medicine that we make mistakes, not because we do not
know, but because we do not examine, and in the diseases
of children this is eminently the case.
The medical examination of a sick child requires con- -
Die. 27, 1899.
CLINICAL RECORDS.
The Medical Press. 665
riderable dexterity. I do not wish to oonvey the idea
that the examination of an adult is an easy matter. Far
from it. But what I do wish to say is, that however
difficult the examination of an adult may be, that of an
infant is more so. Nay, more; I might say without fear
of contradiction, that there is no branch of the practice
of medicine in which clinical examination must be
brought to such a pitch of refinement as in the diseases
of children.
It forms, in my opinion, the very beet, although
severest, school for the clinical investigation of dipease,
and as a training ground for senior students it cannot
be surpassed—a study as instructive in education as it
is interesting in research, and useful in practice.
€lmical JUcorbe.
CA8E OF C.ESAREAN SECTION.
By Dr. G. Col* Bakes,
of Dublin.
I am enabled to bring before you a successful case of
Caesarean section in which I performed this operation
successfully, in August last, on a woman parturient for
the eleventh time. I believe that in this fact mv case is
unique, though Murdoch Cameron (Glasgow) has per¬
formed it on a nine-para, whose eight previous pregnan¬
cies had been terminated by craniotomy.
The history of the ten previous labours is somewhat
remarkable. The 1st, 4th, and 5th were terminated by
forceps. Result to the child:—1st stillborn, 5th died in
four hours, 4th alive, and now eleven years old. At the
2nd and 10th labours, forceps having failed, version
was performed, but in both cases the after-
coming head was only extracted by perforation and
craniotomy. The 3rd, 6th, 7th, 8th, and 9th labours ter¬
minated naturally, resulting as follows:—In the 3rd and
8th the children were alive, and are still living; the 6th
was stillborn, while the 7th and 9th both died a few
minutes after birth. Aware that the woman had had
living children, I allowed the pat’ent to remain in labour
for forty hours before I interfered, in the hope that the
head might mould and the child be extracted. At the
end of this time, however, as the mother’s pulse and
temperature were rising, the lower uterine segment
thinning out, and the contraction ring beooming marked,
the foetal heart sounds increasing in frequency, with a
“ caput" commencing to form without any symptoms of
moulding, I asked Dr. W. J. 8myly (ex-Master of the
Rotunda Lying-in Hospital) to see the case with me,
and we mutually agreed that the choioe lay between
Caasarean section and craniotomy. I chose the former.
I incised the uterus (longitudinally, and commencing as
near the fundus as possible) while still in the abdominal
cavity, and extracted the child by the feet. The incision
was through the plaoental site, and haemorrhage very
free for a few seconds, but was completely controlled by
Dr. Smyly, who slipped both his hands down on to the
cervix the moment the emptying of the uterus permitted
of its being lifted out through the abdominal incision. The
uterine wound, which was 6 ins. long, was begun with a
scalpel and completed with scissors, and from the time of
its commencement till the child was extracted was not
more than 90 seconds. The wound in the uterus was
closed with interrupted silkworm gut sutures passed
down to but not including the decidua. The patient
made a good recovery, was up on the twenty-eighth day
after the operation, having nursed her infant from the
second day after her delivery. Later I measured
the patient’s true conjugate with Skutsch’s pelvimeter,
and found it to be 6 centimetres only. It is difficult
to understand how a woman with such a limited
conjugate can have brought forth living children
per viat naturalee, except on the assumption that
she did not go to “ term ” on these occasions
and that the children were small. The child I
extracted was a female weighing 9 lbs. I do not
approve of craniotomy if the child be ascertained to
be alive, and I believe it to be no whit less dangerous
for the mother than Caesarean section in either im¬
mediate or ultimate consequences, while the child ia
sacrificed. Jardine (Glasgow) agrees with me on this
point. I do not think the child could have been de¬
livered alive in this case by the performance of
symphysiotomy, and, even so, I prefer Caesarean section
to that operation. In favour of this opinion I may
quote Charles Washburn (Boston), and Everke (Wien
Med. Woch., No. 51, 1898). Charles (in L’Obstetrique)
Bays : —“ Symphysiotomy is not less dangerous, as is
commonly supposed, than Caesarean section.” Everke
calls the suture of the uterine wound the “essential ”
feature of the operation. ' I agree with him, and
advocate three sets of sutures—fine silk (inter¬
rupted) for the decidua and submucoBa taken
together, strong silk (interrupted) for the muscular coat
taken alone, and a continuous fine cat-gut suture for the
peritoneum, inserted bo aB to cover in completely all the
silk sutures in the muscular coat. This is practically
the method of Lebedeff and J. Veit, and, in my opinion,
minimises friction due to respiration between anterior
uterine and parietal or visceral peritoneum, thereby
lessening possibilities of adhesion. I also advocate
Marcey’s manoeuvre of drawing down the omentum over
the incision as a good one—for adhesion of the uterus to-
the omentum would not be so undesirable, in the light
of a subsequent pregnanoy, as one of the uterus eithei
to the abdominal wall or to intestine. I think Schultze’s
method of artificial respiration the best for new born
infante, and I have never had any bad results, even after
employing the method for upwards of two hours.
CASES OF WHITE SWELLING OF THE KNEE. (<*>
By A. B. Judson, M.D.
Da. A. B. Judson, in introducing these cases rema-ked
that with the scientific progress of the day great changes
were taking place in our knowledge of dises se. Although
pathology took the precedence in medical studies she
was a fickle divinity. We learned, but with the prospect
of having to unlearn, and the all-wise, unwise public
sensed this, and, when in dire straits, went doubtfully
away, “trembling, hoping, lingering, flying,’ to fanes
where the divinities were not only fickle, but meretricious.
In white swelling of the knee, however.it was sufficiently
established the use of the inflamed joint aggravated and
prolonged the disease. Arrest of motion ana cessation of
weight-bearing necessarily followed as a part of rational
treatment. He described apparatus, ana presented the
following patients.
Cose I.—Seen in September, 1898. A girl, set. 61. Early
diagnosis. No pain. Slight musoular atrophy and swell¬
ing of the knee. Flexion 20 degs. to 170 degs. An asym¬
metrical gait had been noticed for about five weeks.
When told that a child was threatened with Pott’s
disease Dr. Taylor said: “ The house is on fire or
it is’nt on fire.” In the present case the occurrence of
signs whioh, though slight, were well defined, established
the diagnosis of osteitis. An ischiatic crutch for the
protection of the limb from the weight of the body was
applied. If resolution did not follow in a few weeks a
fixative brace would be added.
Cate II.— November, 1897. Boy, set. 4. Duration of
disease one year. Flexion 20 degs. to 125 degs. Ischiatic
crutch w is applied, and three months’ later a fixative
brace. Pott's disease appeared in the lumbar region and
a spinal brace was applied in December, 1898. Knee at
2 degs. or practically straight. Prognosis favourable.
Apparatus worn with ease and convenience.
Case III.—January, 1897. Girl, set. 5. Duration,
three years. Subluxation was present. Severe pain;
flexion 55 degs. to 125 degs. Apparatus applied, March,
1898. Abscess appeared, but had been absorbed. Sub¬
luxation persists, but the femur is super-imposed so far
over the tibia, that the stability of the limb would not be
impaired. Knee is at 6 degs. Prognosis good.
Cate IV.—August, 1895. Boy, one year, nine months.
Duration, a few weeks. Knee at 90 degs. Swelling and
severe pain. A year later destruction of the bone was
(«) Section on Orthopedic Surgery, New York Academy of
Medicine, October 20th, 1899.
Digitized by GoOgk
666 The Medical Iress. TRANSACTIONS OPI SOCIETIES.
far advanced with sinuses on all sides of the knee. Sub¬
luxation. The fixative brace was applied, with relief of
pain, and six months later the addition of the ischiatic
crutch restored the child to activity. Prognosis good.
Sinuses dosing. Knee at 10 degs.
Dr. W. R. Townsend said that thorough surgery
would do a good deal for the patient. The knee was
septic, and although children tolerated pus better than
adults, some day a general sepsis would appear and the
child would lose its life.
Dr. Judson said that long and frequent absences
from the dispensary had marked the history and had
delayed recovery. It was probable that other advice had
been freely sought. If the general condition was good
at the time it might have been said either that mechani¬
cal treatment should proceed or that an operation would
be well borne and would hasten recovery. If the con¬
dition had been bad, as it was at times in the extreme,
an operation might have been urged to save life or
postponed on the ground that the chance of recovery
was too small. The patient had escaped the loss of bone
by operation and the result would be recovery with
greater straightness, length, and stability of limb than
could be hoped for after an operation.
Case V.—January, 1889. Girl, set. 3 years 7 months.
Duration six months. Marked flexion. Fixative brace
and ischiatic crutch applied. Flexion entirely reduced.
Three absoesses appeared and in due time the resulting
sinuses cicatrised. In October, 1894. motion was
between hyperextension, 5 deg., and flexion, 30 degs., and
treatment was suspended. Four years later flexion
was found to have returned with motion 28 degs. to 48
degs. No symptoms. Fixative brace re-applied with
reduction to 10 degs., with prospect of complete reduc¬
tion. When the bones were mature their particular
surfaces would have adapted themselves to each other so
that the femur would rest securely on the tibia in the
straight position.
Case VI.—Feb. 1896. Girl, set. 10. Duration, three
years. Knee fixed at 35 degs. after excision. Fixative
brace applied. Flexion had been reduced to 20 degs., but
had relapsed to 30 degs. from a failure to inspire the
patient and her friends with enough confidence in the
usefulness of mechanical means to lead to the necessary
attention to the details of treatment.
Case VII.—Aug. 1895. Girl, set. 3. Flexion at 22 degs.
after operation on the bone. Fixative brace applied. 1
Flexion entirely reduced. Prognosis good.
Cast VIII.—January, 1893. Boy, set. 7 years 6 months. !
Duration 18 months. Previous treatment by a splint
protecting the limb from the weight of the body and a
plaster of Paris dressing. Fixative brace and ischiatic
crutch applied. Patient was presented to the Ortho-
pcedic Section, April 20th, 1894. Crutch removed Sep¬
tember, 1896, and brace January, 1897. Flexion 8 degs.
to 75 degs., with no defect in his ordinary gait.
Dr. Townsend said that synovitis was present with
effusion, and that he would continue to give support as
absorption, which was desirable, would be doubtful if the
boy was permitted to run about.
Dr. G. R. Elliott said that this case of chronic hydrops
presented quite as high a degree of atrophy as those in
which the bone was unquestionably involved.
Dr. Judson said that the presence of synovitic effusion
had been early recognised, but had not reversed the
diagnosis of osteitis.
Dr. Elliott said that the other patients ako presented
a high degree of atrophy above and below the joint.
The merest tyro was familiar with the sudden atrophy
of developing tuberculous joint disease, the cause of
which was still far from being demonstrated. How
could we differentiate atrophy due to disease from that
due to bone disease P Atrophy in the great number of
doubtful cases commended itself to us as a puzzling
sign, whose many expressions could not as yet be inter¬
preted.
Case IX.—March, 1891. Boy, set. 14. Duration since
infancy. Swelling and limitation of motion. Flexion
25 degs. to 65 degs. Two years after application of the
fixative brace the knee was straight, and 18 months
later hyperextendod 10 degs. Treatment was suspended
Due. 27, 1809.
January, 1896. Almost perfect ability in walking.
Flexion 0 degs. to 20 degs.
Case X.—February, 1885. Boy, tet. 8. Duration four
years. Marked subluxation. Flexion 30 degs. to 80 degs.
Sinuses. Thomas’s splint for protection, and a fixative
brace, March, 1885. Pre»ented to the Section, March 19th,
1886. An ischiatic crutch in plaoe of Thomas’s splint,
January, 1887. H yperexten ded 2 degs. Sinuses
closed. Ischiatic crutch removed March, 1890, and
fixative brace was occasionally worn until January,
1895 On presentation flexion was 25 degs., a result
due in large measure to failure to secure due attention
to treatment at home.
Dr. Townsend said that although there was consider¬
able deformity there was a useful limb. The absence
of motion was an advantage as, with motion, he would
not walk so well.
Dr. Judson said that gradual, painless, and complete
reduction of flexion should have been well within the
power of a simple lever such as the fixative brace, and
the ability of the limb to uphold the body would have
been thereby increased. Be did not object to the pre¬
sence of motion if the knee were capable of full exten¬
sion. In the absence of motion, ability to walk well
after recovery would be increased by raising the shoe
of the unaffected side by adding to its sole and reducing
the thickness of the sole on the affected side.
^ransactimtB ot Societies.
ROYAL ACADEMY OF MEDICINE IN IRELAND.
Section of Obstetrics.
Mkktino held Friday, November 24th, 1899.
The President, Dr. A. V. Macan in the Chair.
Dr. Pd refoy exhibited five myomatous uteri removed
by abdominal section recently in the Rotunda Hospital.
Dr. Kidd exhibited a myomatous uterus removed by
abdominal section.
Dr. Alfred Smith exhibited seven fibro-myomatouB
uteri removed by retro-peritoneal hysterectomy. In one
double salpingo-oophorectomy had been performed pre¬
viously in the hope that the haemorrhage would be
arrested. The operation was attended with more than or¬
dinary difficulty owing to the fact that bad adhesions had
formed. The tumour, though small, had caused great
loss of blood, and complete ablation of the ovaries had
failed to arrest haemorrhage.
dr. Glenn’s specimen—excision of cocctx for dis¬
location CAUSING 8EVERE COCCYGODYPIA OF MANY
YEAR8’ STANDING.
Dr. Kidd related three such cases. In one of his cases
union was so complete that the cicatrix could not be
seen. In two of the cases the pain was completely
relieved.
Dr. Glenn, in reply, said he now thought the
crepitus was a true crepitus, due to the rubbing
together of the ends of the bone. It was only three
weeks since the operation, and the pain had diminished,
but had not completely disappeared.
A CASE OF CA58AREAN 8ECTION.
Dr. G. Cole-Baker read a paper on a case of Caesarean
section, which will be found under “ Clinical Records.”
Dr. Kidd said the case he had reported differed in
many respects from Dr. Cole-Baker’s. His own opera¬
tion was performed in a condition where labour was
obstructed by a tumour which filled the lower part of
the pelvis, while Dr. Baker had operated for deformity
of the conjugate diameter. It was a common misfortune
to come down on the placenta, and, of course, if the
operator, in his hurry to gain entrance, incised the
placenta, it added to the danger of losing the mother
and child. The question of putting ligatures through
the mucous membrane of the uterus was important.
Where a local discharge, which had beoome septic, after-
1 wards occurred, he thought the passage of these sutures
Digitized by G00gle
Dec. 27. 1890.
TRANSACTIONS OF SOCIETIES. Tn Medical Pbub 667
into the cavity of the uterus would be an indirect means
to allow this discharge to get between the walls.
The President said that where there had been a long
labour the danger of Caesarean section was very great —
in faot, the operation was at times almost contra-indi¬
cated. Symphysiotomy was still permissible long after
the period for Caesaiean section had gone by. Dr.
Baker was to be congratulated on having such a success¬
ful result after a twenty-four hours' labour. He looked
on the elastic ligature as the great cause of asphyxia.
With regard to suturing the uterus, he would use
ordinary boiled silk, and rather than lose two seconds
over the operation, would include the mucous mem¬
brane.
Dr. Bakbb, in reply, said he failed to see that the
suture tracts passing through the decidua could in any
way conduce more to absorption from the uterus than in
the case of any other mucous membrane. The asphyxia
of the child was not due to pressure, as none was applied,
either with the elastic ligature or by the assistant, until
the child had been removed.
The President then read his address on " The
Significance of Pain in Gynaecology.”
The Section then adjourned.
8ection of Patholoot.
Meeting held Fbiday, December 1st, 1899.
The President, Professor A. C. O’Sullivan, M.D.,
in the Chair.
Exhibits.
SUICIDAL WOUND OF THROAT WHICH SEVERED THE
RIOHT COMMON CAROTID ARTERT AND PNEUMOOA8TRIC
NERVE, CAUSING IMMEDIATE DEATH.
Mr. Henry Gray Croly furnished the following notes
on above case J. H., set. 34, was admitted into the City
of Dublin Hospital on September 1st, 1899, suffering
from a bard fungating growth projecting through the
orifioe of the piepuce. The patient evidently had a
natural phymosis. The glands in the groin were much
enlarged. No direct history of syphilis could be
obtained. The patient was sent to me as a probable case
of epithelioma. The prepuce was slit and the foreskin
removed, and the growth shaved off the glans penis.
Mercury, with iodide of potassium,was administered. The
glands in the groin got much smaller, and were subse¬
quently excised. The patient, though dissatisfied at
the slowness of bis case, never showed any suicidal
symptoms. On November 4th, the man asked per¬
mission to go into the lavatory, and objected to the bed-
pan, He went to the bathroom after his dinner, locked
and bolted the door, and was found lying dead, with a
razor in his right hand. The floor was covered with
arterial blood. On examination the right carotid was
found divided, and its ends retracted about 1} ins. The
right pneumogastric nerve was also severed, and the
cartilages of the larynx severed in more than one place.
The penis was removed post-mortem, and on section was
found to be normal.
Dr. R. Charles B. Maunsell showed a varicose
aneurysm which he had excised from the right forearm
of a man, ®t. 42, who had received a punctured wound,
from a broken bottle, over the line of the radial artery
about 2 ins. above the wrist-joint. Pulsation and a sharp
thrill and buzzing sound were well marked before re¬
moval. The aneurysm had grown to the size of a walnut
in a fortnight.
Mr. M'Ardle demonstrated the case of a boy with a
peculiar form of eotopia vesicse (artificial marsupialisa-
tion); also the bones of forearm from a case of compound
fracture, and a collection of vesical calculi.
The President (Professor A. C. O’Sullivan) gave an
address on the mode of action and products n of Anti¬
toxin.
MALFORMATION OF KIDNEY.
Dr. Earl demonstrated this specimen, observing that
the right kidney and both suprarenal capsules were
normal as to position and vascular supply. The left
kidney lay on the brim of the pelvis-, it was tightly held
down by the peritoneum, and partly covered by the-
sigmoid flexure of tho colon. It was somewhat smaller
than the right, convex on its anterior surface, slightly
concave on its posterior surface. The inner margin was
more curved than the outer. The left ureter was 5} inn.
long, that on the right side being 10} ins. The hilum
was on the anterior surfaoe. It consisted of a deep de¬
pression near the lower end of the kidney, which was con¬
tinued upwards into two shallow depressions about } in.
apart, lying parallel to each other and to the long axis
of the organ. Each of these was about 2 ins. long. The
ureter divided near the kidney into two branches, one of
which entered at the lower part of the hilum, while the
other again divided into branches for the longitudinal
parts. The artery came off } in. above the bifurcation
of the aorta, and divided into three branches, two of
which entered the kidney at its inner margin near the-
upper end, while the third ran behind the kidney,
giving a branch to its posterior surfaoe. It finally turned
round the outer border, and, grooving the anterior sur¬
face, terminated in the lower part of the hilum. The
vein entered the vena cava in the normal position. A
little above the kidney it divided into two branohes,
which lie in grooves on the anterior surfaoe, and having
given branches to the longitudinal parts of the hilum,.
terminate in its lower part.
RECENT INVESTIGATIONS IN THE BACTERIOLOGY OF
BERI-BERI.
Dr. Percy Gerrabd's paper on this subject was
oommunicated by Dr. A. R. Parsons.
The President did not see, however, why, if an attack
of eiyBipelas would cur*, sarcoma, the streptococcus
should not cure beri-beri without a specific action.
Dr. J. A. Scott said that during the epidemic of 1894-
in the Richmond Asylum, Dublin, he made, with
Dr. Rambaut, some investigations into the condition of
the blood in this disease. A number rf attempted cul¬
tures remained absolutely sterile. In other oases, how¬
ever, colonies grew, and these were subsequently
separated. Some of the patients he observed were
always sure finds as regards cultures, whereas other
cases, equally as bad, were always sterile.
Dr. E. J. McWbeney said that the amount of material
Dr. Gerrard had operated on, a loopful of blood, was so
small that, if the cocci had really been in the blood, it
seemed to him there ought to have been no difficulty
in demonstrating them microscopically. With regard
to the improvement of the patients under anti-streptc-
coccic serum being co-ordinated with a growth of a
yellow colour obtained from the blood, he thought there
could be no connection, because the streptocoocus did
not produoe a yellow colour. The injection of th-*
serum, however, might have produced, as the President
had hinted, a general phagocytosis of a non-specific
character, but that state of affairs could not denote any
connection between streptococci and beri-beri. There
was such an extreme difficulty in sterilising the skin
that in his own work he would pay no attention to a
result got from a drop of blood that had been in con¬
tact with the skin. The method he employed success¬
fully was to extract ccs. of blood from one of the veinB
in the arm with a sterilised hypodermic or antitoxin
syringe. So few were the micro-o• gamsms in even,
violent septicaemia that unlee* they extracted a good
deal of blood they would not find any micro-organisms
at all. It was with these precautions that ne had
Buooeeded in getting the diplocoocus pneumoniae in a
case of ulcerative endocarditis coming on after acute
pneumonia.
Dr. Conolly Norman, referring to the micro-organ¬
isms described by Pekelharing and Winckler, said that
they found them in every patient’s blood ; but they also
found them in the blood of persons in Atjeh who had not
beri-beri, and similar cocci were also found in the air of
that place. Dr. Norman showed illustrations of cocci
found by other observers whioh were very dissimilar to
those of Pekelharing, bnt he (Dr Norman) pointed out
that these cocci were obtained from the dead body, and
he. therefore, considered them of little value. Pekel-
liaring’s and Winckler’s results were disputed by other
investigators, among whom was 8cbeube, who said
668 Thb Medical Press.
FEAN C E.
Dec. 27, 1899.
that their obeerrations were made on dirt, and that most
of the enimaln which they had injected experimentally
had died of septic poisoning. Glogner found parasites
in the spleen resembling those of malaria, and on that
fact had founded his theory, which had got a few
adherents, that beri-beri was identical with malar ia. At
Tuscaloosa, in the State of Alabama, cocci were found in
the blood of beri-beri patients, but they were not des¬
cribed in detail. One of the peculiarities of the disease
which Dr. Gerrard had remarked, and which he also had
noticed, was that patients frequently got relapses, and
often died rather suddenly after apparently getting
quite well. In a recent monograph on tne subject Grimm
laid it down that beri-beri always commenced with
slight initial fever.
D.\ Knott pointed out that Dr. Gerrard’s cases com¬
menced with fever and diarrhoea, and that one of his
cases was engaged in mining operations. He remembered
reading Borne years ago the theory that beri beri was
produced by the same parasite as produced Egyptian
chlorosie.
Dr. P arsons, in reply, Baid that most of the points
which had been raised had been already touched upon
by Dr. Gerrard in hiB paper. Bearing in mind Dr.
Scott’s notes, it was interesting to observe that several
of Dr. Gerrard’s cover-glass preparations had shown
distinctly diplocooci, and in many cases tetra-cocci.
Most of Dr. Gerrard’s patients were miners, and this
seemed to point to the poison being in the earth. In a
few cases the Anchylostomnm duodenale was found.
PRIMARY 8ABCOMA OF THB LIP.
Dr. Chablxs B. Maunbell read notes of a case of a
married lady, set. 32, from whose lower lip he had
removed a small prominent tumour. She was
suffering at the same time from well • marked
chloasma uterinum. On examination the tumour
was found to be a spindle-celled sarooma. Dr. Mannsell
drew attention to the rarity of sarcoma of the lip, and
• stated that so far he oould find no reference to it
in English works, but he had found a short notice of
two cases by Vidal and Lnttegast in “ Duplay and
Heel us’ Surgery.” Dr. Maunsell showed sections pre¬
pared by Dr. H. C. Earl.
D.*. E. J. McWkeney said that about a week ago a
specimen was given to him in hospital from the lower
lip of a child, a!ged ten years. The portion bore a growth,
slightly ulcerated, about the size of a pea, roundish in
outline, and snspected,by the surgeon who,had removed it
to be a sarcoma. On section it proved to be a mixture
of sarcomatous tissue, with dilated lymphatics and a
considerable number of minute newly-formed capillaries.
He reported it as being a lymphangio -sarcoma.
Dr. Maunbkll, in reply to the President, said that the
tumour was not pigmented.
The Section then adjourned.
EDINBURGH MEDICO-CHIRURGICAL SOCIETY.
Clinical Meeting held December 20th.
Mr. A. G. Milleb, President, in the Chair.
Db. Alexander Bbuck showed (1) a woman suffering
from progressive muscular atrophy of the peroneal-fore¬
arm (Charcot-Marie) type. There was complete foot-
drop following paralysis and atrophy of the peroneal
muscles, the muscles of the forearm and hand were also
affected, giving rise to claw hand and ulnar flexion.
Sensation was intact, but spinal curvature and difficulty
in artioulation had lately appeared owing to paralysis
of the muscles of the back, lips, and tongue. There was
also some mental weakness. The lesion was believed
to be a parenchymatous neuritis iwith affection of the
posterior columns of the cord. The case differed from
the ordinary Charcot-Marie paralysis in the age of
onset. 60, in the involvement of the muscles of the
trunk, and in the absence of an hereditary history.
2. A case of infantile paralysis affecting the muscles
of the hand. The left hand was smaller than the right,
all the intrinsic muscles were paralysed, and sensation
was unimpaired. The lesion here was a circumscribed
poliomyelitis at the level of the first dorsal segment.
3. A case of senile chorea of eight years’ duration in
a man of 50. There was neither mental impairment
nor hereditary history, so that the condition could not
be regarded as Huntir gdon’s chorea.
4. A case of paramyoclonus multiplex. The lower
limbs, especially the thighs, were most affected. The
movements were more or lees symmetrical, consisting of
sudden jerkings of muscles or groups of muscles. They
were most marked when the patient was at rest or when
he was excited; they diminished while walking and
were abolished during sleep. There was increased
mechanical irritability of all the muscles and exaggera¬
tion of the knee-jerks. The condition was probably
functional.
6. A case of injury to the lumbo-sacral roots. The
patient fell and struck the left buttook nine months ago.
Immediately thereafter he lost the power in the left leg,
and three weeks later the limb became aneesthtic.
Four months ago the right foot also became paralysed.
The anuesthetic area in the left leg exactly followed the
outline of the areas of the 4th and 5th lumbar, and the
1st sacral nerve roots. The paralysis of the right foot
was due to a euperadded alooholio neuritis.
Dr. Norman Walker showed (1) two cases of ichth} o-
s is in the same family, (2) a case of acne necrotica, and
(3) cases of lupus and favus, which had markedly im¬
proved under treatment with X-rays.
Dr. Allan Jamieson showed a case of papulo-anaes¬
thetic leprosy.
Dr. James showed (1) a child with post-hemiplegic
athetosis, and (2) a case of Jacksonian epilepsy with
weakness and increased reflexes on the right side. The
illness began with general convulsions four years pre¬
viously.
Mr. Stiles showed (1) an infant after operation for
acute ileo-caecal intussusception, (2 ) a boy after
M k ilicz’s operation for disease of the posterior tarsus ;
(3) a patient who suffered from acute thyroid cachexia
after excision of suppurating goitre. F^rty-eight hours
after the operation the patient became very sullen and
refused to reply to questions. She became jaundiced,
oomplained of general aching, and then twitching of the
muscles set in, the toes becoming pointed, and the
calves rigid. All the symptoms disappeared within
twenty-four hours of the administration of thyroid
tablets. (4) A patient after excision of a large lym¬
phoma of the neck. (5) Patient after avulsion of the
entire scalp, in whom repeated grafting had been tried
without benefit.
Dr. F. D. Boyd showed (1) a ca^e with some of the
signs of syringo-myelia. There was atrophy and
paralysis of the muscles of the hands and Bhoulder-
girdle, and complete loss of temperature sense in the
palms of the hands. There was, further, contraction of
the visual fields, anosmia, paralysis of the right half of
the palate, and loss of power of adduction of the right
vocal cord. (2) A oase of alcoholic neuritis with
paralysis of both facial nerves as well as slight paresis
of the motor division of both fifth nerves. (3) A case
of peripheral neuritis of pregnancy.
Dr. Gibson showed a case of pseudo-bulbar paralysis.
The following specimens were also shown: by Dr.
A. C. Sym. larynx and tongue from a case of angina
Ludovici; by Mr. Cotterill, tumour of the brain, urethral
calculi j by Dr. Gibson, specimen of myomalacia cordis;
by D»\ Purvis, exostosis of the femur.
Jrance.
[from our own correspondent.]
Pabis, December 24th, 1889.
Skiagraphy and Fractures.
At the last meeting of the Soctete de Chirurgie,
M. Tuffier remarked that for the last eighteen months he
examined with the radiograph all the fractures
Digitized by GoOglC
Dec. 27, 1899.
GERMANY.
The Medical Press. 669
observed in his ward, at first before redaction was
attempted, and then after the reduction. From the
several documents obtained, he was struck with the
frequency of the irreducibility of fractures, in spite of
- the employ of apparatus of contention to which had been
given entire confidence. More than onoe when he had
thought the co-operation of the fragments was perfect,
the radiograph showed that it was far from being
the case. However, he should add, that dt finite result
proved happily that it was not always neoessary to
•obtain perfect reduction in order to have satisfactory
function of the limb.
Coxaloia.
M. Meirard, recurring to the subject of the treatment
of coxalgia, said that resection of the hip had been
abandoned by many surgeons, because in certain
-countries an unjustifiable abuse was made of the
operation. One of his colleagues considered that the
persistence of pain constituted an indication for resection,
but such was not his opinion, for he had always found
that absolute rest ca used the pain to cease. As to the
treatment of abscesses he employed in 200 cases injec¬
tions of thymol and camphor, which were neither toxic
nor painful, and 1 per cent, cases were cured under their
influence.
In twenty-two patients who had remained refractory
to this treatment he resected the articulation and all of
them got well.
As to the orthopaedic results of that operation, they
varied evidently with the extent of the lesion. But in
a general way each time the cure was obtained in a few
months without necessitating further operations, the
length and attitude of the limb were very satisfactory.
Diuretic Action of Calomel.
Acoording to Dr. Bourgeon calomel acts as a diuretic in
heart affections accompanied by oedema. It produces
progressively increasing diuresis, but during its adminis¬
tration only. The quantity of urine varied from a pint
to two quarts or more. From four to eight grains are
given daily for from three to five days, but the kidney
should be watched as the calomel should be suspended
on the approach of albnmine.
Sudden Death in Infants.
The sudden death of children from a few days to a
few months old is an accident which but too frequently
provokes unjust condemnations, or. at least, unworthy
suspicions on the doctors or the nurses who have had
charge of them. Habitually, the accident happens
thus: An infant appearing to be in perfect health dies
suddenly in its bed, or on the knees of the nurse. The
autopsy reveals no cause which might explain the Bad
affair except a simple hypertrophy more or lees con¬
siderable of the thymus gland. Sometimes, however,
the death is preceded by a very short period
of dyspnoea. M. Berthold, who has written on th e
subject, cites the case of a nurse who was accused of
killing the child confided to her; fortunately, the post¬
mortem examination showed that the thymus gland
was considerably enlarged. Besides hypertrophy of the
above gland there are, according to the same author,
two other kinds of sudden death in children—spasm of
the glottis and brusque extension of the head back¬
wards. This latter accident is mainly observed in
ricketty children, in whom the head is relatively
•very large and increased in weight and who are in¬
capable from weakness of bringing back the head to the
normal position without the help of another person.
Impetigo.
The following I have found most useful in this
affection:
Salicylic acid, 3»-
Lanolin e, 3 iss.
Oxide of zinc, \ _ .
Starch, { ,jV ^'
6erm*ttg.
[from our own correspondent.]
BERLIN, December 23rd. I860.
At the last meeting of the Medical Society Hr.
Rothschild showed a kidney removed by
Nephrectomy
from a young woman of 27, in whom the operation was
perfectly successful, although the excretion of the urea
was only one half of the normal. The patient, although
no tuberculosis was present, had suffered for six years
with increased desire to micturate, pain on micturition,
feve.-. She was oonfined to bed, but up to lately had been
only treated by a “quack,” who had washed out the
bladder. On May 4th, 1898, she was admitted into
hospital in a pitiable condition. She was constantly
wet, day and night; sheceuld only press out a few drops
of purulent urine at a time. Her bladder was contracted
and only held 10 com.; the bladder walls were smooth.
The right kidney could be felt at the umbilical level,
slightly enlarged. By mechanical dilatation of the
bladder enough improvement was effected to allow of
the patient's return home. In September of the
present year she was re-admitted with the symptoms as
bad as before. Both kidneys could be felt. Distension
and washing out of the bladder were again carried out
until October 24tb, when a cystosoopic examination was
made under continuous irrigation. The left ureteral
opening normal, on the right side pain. The urea had
fallen to T3 per oent., but there were no ursemicsymptoms.
The patient, on account of the pain, requested operation
on the wanderitig kidney—the right. On operation
there was found to be total pyonephrosis on the right
side, the kidney containing no functionising substance
whatever. The patient made a good recovery, and the
quantity of excreted urea was increasing.
At the same meeting Hr. Lexer showed a man, set. 41*
from whom a
Mesenteric Tumour
had been removed in v. Bergmann’s Klinik. The
patient took ill of abdominal pain in April, 1899, and a
tumour was discovered, In October he was admitted
into hospital, the abdomen being then very prominent.
In the middle of the abdomen was a hard nodular
tumour the size of a child’s head. On relaxation of the
abdominal walls under an anaesthetic it was found to be
movable. The size and hardness of the tumour, its
great mobility, its position in the middle of the abdo¬
men, and the absence of bowel symptoms pointed to
mesenteric tumour. On opening the abdomen a loop of
intestine was found running over the tumour. The
chief mass of the tumour was attached by a pedicle to
the vertebral column. The pedicle was the radix
mesenterii. This was ligatured and severed without
Digitized by
Google
AUSTRIA.
670 The Medical Press.
bleeding. Resection of intestine was performed, with
lateral anastomosis of the ends by suture. Afterwards
it was found that over 6 ft. of intestine had been removed
at the resection. Reoovery was uninterrupted. In three
weeks the patient could get up, and he was at that time
(November 20th) quite well. Of the 29 cases of mesen¬
teric tumour hitherto reported, 15had died, 14 recovered.
The causes of the unfavourable course were shock
haemorrhage, peritonitis, when badly nourished ends of
intestine had been left, when not enough had been
resected or when lateral anastomosis had not been made.
The tumour was a hard fibroma with myomatous parts
(weight 4J lbs.).
Iodides of Sodium and Potassium in Hemorrhages.
In the Arch. f. Kl. Med., 63 to 66, Hr. A. Chelmouski
recommends the use of iodide in haemorrhages with
increased blood pressure. His recommendation is based
on several cases observed personally. Preference is given
to the soda salt, as it reduces the blood pressure at onoe,
whilst the potassium salt first raises it and then
slows the cardiac beat. The blood pressure sinks only
after one to two hours, and the cardiac activity
increases. The drugs were given in doses of 0 2 to 0-3 grm.
twice daily in half a glass of milk. The writer saw a
brilliant result in a case of hremoptysia in which all other
remedies that had been tried had failed. A good resul^
was also obtained in a case of excessive epistaxis occur¬
ring in a patient, tet. 39, with aneurysm of the aorta
After taking two doses only, the haemorrhage ceased and
did not recur. The potassium salt was given in this
case. In both cases the blood pressure had been high.
Asepsis and Antisepsis in Gynecology and
OB8TETBICS.
Prof. OlahauBen discusses the subject in a late
number of the Berl. lclin. Wochensch (45 99).
The high position held by Prof. Olshausen as first
professor of obstetrics and gynaecology in Berlin, lends
an added interest to the subject. He claims that
ssepticism and anti-Bepticism stand on a different footing
in his department of medicine to that they occupy in
general surgery. This is due to the abundant flora of
the vagina and to the very serious consequences of
septicity occurring in the genital tract. The dangers of
the vaginal flora should not be under estimated, and the
more so as the vaginal tube offers obstacles to suitable
disinfection A sterile field of operation here is scarcely
possible or at most very transient. Clinical experience
would point to a weakening of the virus of vaginal
germs. The fact known for years that g nococci that
produced no results before labour, after labour forced
their way through the tubes and set up peritonitis, was
most naturally explained on the hypothesis that changes
suddenly taking place in the vagina during the puerperal
state, produced such a nutrient soil for them as renewed
their original virulence. The conditions are similar in
regard to the other germs, and all this leads to the
great necessity of avoiding wound surfaces on the one
hand and of infective material on the other.
With regard to obstetric operations he has made out
a danger scale in the following order. The least dan¬
gerous operations are forceps extractions from the outlet,
especially in multipart. Next come perforation and
subsequent cranioclasis, and internal version. Then
comes high forceps extraction, mostly associated with
bruising and laoeration of the soft parts. Still more
Dec. 27, 1899.
dangerous is artificial premature labour. The moat'
dangerous of all operations, however, is the manual'
separation of the placenta. For this operation the Pro¬
fessor advises the use of D&derlein’s india-rubber glove.
For extraction at the outlet disinfection of the externa^
genitals is enough; for the high operation the vagina is
also disinfected in the University Klinik with carbolic -
acid or lysol, but he is of opinion that this disinfection
has its disadvantages as well as advantages. The cases-
entailing acute danger are such as demand speedy
operative delivery, or are complicated with haemorrhages ;
in gynaecology they are those of internal haemorrhage -
from ruptured ectopic gestation. In such cases
the danger arising from the state of the
patient is to be weighed against that of a changed and
shortened antiseptic preparation. The beginner is likely
to underestimate the latter, and to the prejudice of his
patient. In such cases when time does not allow for
boiling (and sublimate is not suitable for instruments),.
these should all l>e thoroughly disinfected by well rubbings
with alcohol. This can also be used for the hands after,
thorough use of soap and water.
In the case of rupture of an impregnated tube, the
danger is so great as to far outweigh that of infection..
Objective disinfection in such cases should be limited to
soaping of the body, shaving off the upper layer of
epidermis with the razor, and quick washing with
alcohol, and in extreme cases the latter only should be
waited for. A deep narcosis should never oe waited fsr,.
as patients are unconscious a few minutes before death
from haemorrhage. Hands and instruments should be
quickly washed with alcohol. Pressure forceps are
rarely required, and the abdomen can be open in less -
than ten minutes after operation has been decided on.
Technique should not be forced into the background by
disinfection, for it is a fact that danger of infection
increases with length of operation, and, it is too much,
disinfection that itself lengthens the operation.
Austria.
[FROM OUR OWN CORRE8 PON DENT. J
Vi EH HA, December 23rd, 18U9.
(Esophageal Cicatrix.
At the Gesellschaft der Aerzte Dorr showed a young
girl in whom the oesophagus was totally denuded of
mucous membrane for upwards of thirteen centimetres
in its length as proved by the microscopic examination.
In addition to this the circular and longitudinal mus¬
cular tissue was also absent.
The cause had been due to the girl swallowing nitric
acid by accident. In the literature of the subject we
have only eight cases recorded where total denudation,
has occurred, two of which ended fatally. This is not
due to inflammation of the submucosa and exfoliation
of the mucous membrane and tissue, otherwise the in¬
flammatory process would have been much more exten¬
sive and must have reached the mediastinum, which was
not so in the case shown ; also the microscopic examina¬
tion bore no testimony of such an inflammatory process.
He compared the mechanical loss of tissue to that exist¬
ing between uterus and placenta.
Stricture of Bowel
Schnitzler exhibited a female, ret. 27, who had'
Digitized by
Dec. 27. 1899.
THE OPERATING THEATRES.
The Medicxx Press. 671
suffered for the previous three yean with symptoms of
stricture in the bowel. In October last he per¬
formed laparotomy, and found three different stenotic
strictures in the small intestine, evidently tuberculous.
He concluded the operation with inter-anastomosis, with
perfect recovery. As in all other ca ses reoorded, the
results bore out the opinion that the increased peristaltic
action caused the pain and not the stenosis, as the
hypertrophied bowel was further strained by pressure
and the dilatation increased. Schr&tter remarked that
the stenosis was not of the typical tuberculous character,
as it is rarely the case that multiple tuberculous uloers
heal in the bowel. He would be inclined to
characterise Schnitzler’s multiple strictures as mechani¬
cal, due, probably, to some foreign body. Schnitzler
repelled this assumption on the ground of a circular
stenosis being rarely found from foreign bodies, while
there was no symptom or evidence in the history of such
a foreign body being present. As to the assertion of
multiple tuberculous stenosis not healing he was able to
bring forward evidence to the contrary with microscopic
specimens.
“ SP0NDYL08E RhIZOM ELIQUE.”
Schlesinger brought forward two patients under his
care with a rigid condition of the spine. The first was
a male, ret. 59, with the typical symptoms of Marie's
“Spondylose Rhizomelique." The pathological condi¬
tion is described aB a stiffening or hardening of the
binding apparatus of the vertebras, or possibly ankylosis
of the articulations. The clinical history of the disease
is described differently, and is often associated with
other joint diseases, such as arthritis deformans, gon-
orrhceic arthritis, or even chronic articular rheumatism.
The usual history is a progressive stiffening of the ver¬
tebra advancing to the hip, shoulder, and costal joints.
According to Schlesinger the disease often attacks the
hands, feet, and other joints, and is usually preceded
with great pain.
The second case was also a male, ret. 67, who had I
fallen fifteen years previously from a cart, in whom 1
afterwards the stiffening gradually increased. In this
case there was a distinct kyphosis in the cervical and
upper part of the dorsal vertebra with atrophy of the
shoulder muscles. Schwartz remarked that he recently
had an analogous case associated with pain where the
nerve roots had been interfered with by changes in the
bony structure of the vertebrae.
^kt (Dperating theatres.
MIDDLESEX HOSPITAL.
Splenectomy foe Rupture.— Mr. Kellock operated
on a man, ret. 40, who had been run over by a hansom
cab about three-quarters of an hour previously. On
examination the patient was evidently suffering from
loss of blood as the result of his injury; he was com¬
plaining of severe pain in the abdomen, chiefly referred
to the left hypochondrium and to the back. The abdo¬
men was very tender on manipulation and the walls
rigidly contracted, rendering examination very difficult;
there were no marks of injury or of bruise of the skin
of the abdomen. There was no evidence of free
fluid or gas in the peritoneal cavity, but the area of
splenic dulness was increased. There were marks of other
injury to the left elbow and to the left knee (acute-
synovitis of the latter). Urine had been drawn off
by a catheter and found normal. The man was anres-
thetised and an incision 5 ins. long made in the left
linea semilunaris. On opening the abdomen a fair
quantity of dark-coloured blood escaped ; on passing the
hand to the splenic region it was at once discovered that
the spleen was extensively lacerated. A short trans¬
verse incision was then made from the centre of the*
longitudinal one, and, the intestines being retracted
towards the middle line, the injured organ was brought
into view and blood was seen to be issuing from it. It
was brought forward, the pedicle being held between
the finger and thumb of the left hand; this last
was next transfixed and ligatured in two portions
with silk and the organ removed. It was found
that this proceeding had arrested all the bleeding. On
examining the place from which the spleen had been
removed it was found that a small piece of the organ
still remained attached to the peritoneum; this piece was
also removed without difficulty. No extensive examina¬
tion of the other abdominal organs was made; a large
quantity of blood clot was removed from the peritoneal
cavity by sponging, and the wound in the abdominal
wall closed all in one layer with silk sutures. Mr.
Kellock said that after such an accident the sym¬
ptoms the man presented were fully typical of
the condition which was subsequently found, and
the fact that there was no external mark
injury on the abdominal wall did not pre¬
clude serious internal damage. The man was evi¬
dently suffering from internal haemorrhage. He was
cold, pale, and restless; the fact that the urine con¬
tained no blood negatived injury to the kidneys or to
the bladder, the direction of the violence and the seat
of the pain were against the liver being the source of
the bleeding; there remained then the possibility of
ruptured spleen, ruptured intestine, or bleeding from
tbe mesentery or the omentum, but the fact that the
area of splenic oulness was increased led him to make
the incision in the situation beBt adapted to deal with
that organ. When it was discovered that the spleen was
the souroe of the hremorrhage, and that it was extensively
lacerated, no alternative was left but to remove it, in
doing which no great difficulty was experienced. The
isolated portion of the organ which was subsequently
removed, had evidently been completely broken away
from the spleen at the time of the accident. The souroe
of the hremorrhage having been discovered and dealt
with, and the patient evidently feeling the effects of loss
of blood rather severely, it was not, he said, thought
advisable to make an extensive examination of the
other abdominal organs on tbe chance of there being
other injuries. The condition found in the peritoneum
being quite an aseptic one no washing out was em¬
ployed, the fluid blood and clot being removed by
sponging, and as it was evident from the examination of
the pedicle that the bleeding had been effectually con¬
trolled, the wound in the abdominal wall was completely
closed without the use of a drainage tube. He pointed
out that the operation of removal of the spleen was quite
compatible with life, as had been proved not only by
operations similar to the present one but also experi¬
mentally ; moreover, removal of the organ was practi¬
cally the only way of arresting the hremorrhage which, -
Digitized by LjOOQlC
672 Th* Medical Press.
LEADING ARTICLES.
Dvc. 27,1899.
if left alone, must prove fatal. In the absence of other
undiscovered injuries, the prognosis, as far as the man’s
life was concerned, was, he thought, good.
On examination of the organ removed it was found
very extensively lacerated through its whole thickness,
and one small portion about the size of a walnut had
been completely torn off from the rest of it.
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“ 8ALU8 POP0LI 80PREMA LEX.”
WEDNESDAY, [DECEMBER 27, 1899.
THE UBIQUITOUS MICROBE.
Of recent years bacteria have assumed a posi¬
tion of first importance in the researches of scientific
medicine. Great, however, as the discoveries in that
direction have undoubtedly been, it is nevertheless
fairly certain that as yet hardly more than the fringe
of the subject has been grasped. The saving in
human suffering and in human life has already been
enormous, and it seems probable that when the
sanitary millennium descends upon this world of ours
its advent will be to a great extent due to our
knowledge of the natural history of the ubiqui¬
tous microbe. It argues a great deal for the
reasoning intellect of mankind that not a few of the
practical problems both of preventive and curative
medicine were successfully handled before the dis¬
covery of specific micro-organisms as a causa causans
of diseased processes. Indeed, so far as that goes,
we are still in the dark as to the pathogenic entities
answerable for such strongly marked infections as
small-pox, measles, and whooping-cough. Even
when a morbid reaction is traced to particular bac¬
teria the difficulties of the task for the medical atten¬
dant are by no means over. He may be able to
attack the symptomatic inflammation directly with
germioides if it be situated on the surface
of the body, as in the case of erysipelas.
Or he may combine external and internal reme¬
dies, as in diphtheria, in which the throat lesion is
treated with antiseptics while the blood is charged
with antitoxin. Into the wide question of serum-
therapy, with its vast field of potentialities, we do
not propose here to enter. There are a few points in
connection with local or snrfaoe infections of suffi¬
cient interest to warrant discussion, even when of the
brief and general nature entailed by the limits of an
article such as the present. The main difficulty in
the application of germicides appears to be physical,
that is to say, the mischief-working micro-organisms
are effectually shielded from harm by the cells of the
tissues and morbid excretions in which they flourish.
In this way the utility of sprays and powders and
other vehicles of antiseptic administration has fallen
far short of what was anticipated in theory. What
is wanted and what was earnestly sought after by
Lister in his earlier researches was a penetrating
antiseptic, and it was no doubt greatly owing to its
detergent qualities that carbolic acid became the
favourite agent adopted by that illustrious surgeon.
Tho ideal antiseptic, however, has still to be found,
notwithstanding that many excellent materials are
now available in every branch of preventive and cura¬
tive medicine. Incidentally, a flood of light has gradu¬
ally been thrown on various therapeutic measures.
Perhaps one of the most interesting recent observa¬
tions is the modem treatment of comeal ulcers, which
are now robbed of much of their danger. It was found
that touching the ulcer freely with pure carbolic acid
constituted a great advance on previous methods, and
nitric acid used in the same way has proved success¬
ful in other hands. Still more certain results have
followed the application of the actual cautery, heroic
though the plan may seem. It is hardly open to
doubt that the ulcer is caused by a microbial
invasion, and that the bacteria are directly de¬
stroyed by the heat. The action is comparable of
the cautery iron upon lupus patches on the skin,
although in the latter situation the further action of
phagocytosis is excited, a process that would occur
only to a limited extent in a structure that under
ordinary circumstances is non-vascular. Another
great advance in the rational antiseptic treatment of
eye diseases h*d been made by the abandonment of
nitrate of silver in favour of silver salts of greater
penetrative power, of which protargol may be taken
as a type. Purulent ophthalmia is due to the gono¬
coccus, an organism that invades the deeper layers of
the mucous and submucous coats of the conjunctiva,
where it is fonnd very commonly not only in an extra¬
cellular but also in an intra-cellular habitat. Nitrate
of silver rubbed into a mucous membrane at [once
coagulated the surface albumin, but failed to pene¬
trate into the deeper tissues. Indeed much of its
undoubtedly beneficial effect may safely be ascribed
to subsequent phagocytosis. The newer salts, on the
contrary, do not coagulate albumin; they possess
greater powers of penetration and do not cause
pain. These two instanoes of improved methods of
controlling local germicide action are of value as
types of what may be hoped for in a near future in
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LEADING ARTICLES.
Thb Mkdioal Psmi. 673
-other directions. The war against the bacteria is
likelj to last for many generations, although there
is no room to question that in the long run the in¬
telligence of man will secure him the victory. To
put to rout the single disease, influenza, would be to
confer a vast benefit upon the human race, and it
must be remembered that influenza is one of many
iocs that walk in darkness.
THE FEMALE NURSE IN THE ARMY.
The question of the employment of female trained
nurses in the field is just now very much the order of
the day, and as the army medical authorities of the
United States were confronted with the problem
during the war against Spain, their conclusions are
not without interest. Colonel Dallas fiache, Assist¬
ant Surgeon-General, recently published in the
Journal of the Military Service Institution of the
United States an instructive paper, in which he dis¬
cusses the make-up of the hospital corps in times of
peaoe. This organisation, though it may be trusted
to provide adequately for the care of the sick
under ordinary circumstances is, of course, quite
insufficient to meet the enormously increased strain
put upon the service in time of war. Difficulties at
once arose, it became necessary to provide additional
attendants, and, as might be supposed, the woman
nurse came to the front. Colonel Bache admits the
failure of the Medical Department to respond to the
demands made upon it with such suddenness, and
attributes it, or part of it, to the advent of the female
nurse. The Army Medical Department were obliged
to accept the services of a number of female nurses
for the simple reason that no other means were
available of obtaining trained persons to assist in
attending to the wounded, trained male nurses being
as rare as they are precious. Altogether upwards of
1,150 nurses found their way to the field of war, and
of these fourteen died of exposure or infection
The Colonel is reluctantly constrained to admit that,
in the absence of trained men, the female nurses
rendered great and immediate assistance, but he
evidently views them with distrust. He reproaches
them with hampering rapid movements and with
a distaste for the discomforts inseparable
from hastily constructed hospitals and quarters.
He holds very strongly that under no circumstances
ought the female nurse to be entrusted with duties in
division hospitals which require to be shifted with
great promptness as and when circumstances may
require. He is equally convinced that women should
not he employed on transports or hospital
boats or trains, and he maintains that the
nursing under such circumstances would be
better done by men. He is good enough to
admit that women may find a useful field of activity
in the permanent hospitals, where the “ discipline of
a marching column is not at stake.” The tenor Ot
the article is in favour of the organisation in time of
peace of a body of men trained to discharge minor
-medical functions, apparently something on the lines
•of our Medical Service Corps. Whatever may be
done in this direction, it may he taken for granted
that the services of women nurses will always be a
necessity under the stress of war. That the
change of environment may entail the abandon¬
ment of many existing notions of what consti¬
tutes feminine delicacy is possible, hut so does
hospital life under any circumstances. So long
as nurses can be made to work in groups and are not
left isolated we see nothing in their position that
differs in any essential respect from the conditions of
their ordinary work. Obviously they must not be
near enough to the front to run unnecessary danger
of injury from wayward shells, and they ought never
to be allowed to form part of a column which is liable
to sudden and unforeseen strategical movements.
Moreover, the standard of indispensable comfort for
women is, and must be, somewhat higher than for
men similarly engaged, specially in the matter of
Bleeping and hygienic accommodation. The advantage
of the woman nurse, on the other hand, is that she is
always available, without the expense and incon¬
venience of maintaining large bodies of men sys¬
tematically trained for this purpose, and the supply
is practically limitless. We doubt if any other
country in the world is as richly supplied with trained
nurses as our own, and indeed we have been the
pioneers in and the developers of this great move¬
ment. Even at the present time in no other country
are nurses so well organised and trained as here and
to attempt to exclude them from active service on
mistaken notions of propriety would be to incur not
only the risk, but the certainty, of a breakdown in
our army hospital service.
THE EFFECTS OF AN AESTHETICS UPON
THE KIDNEYS.
Some recent investigations by Kemp, of New York,
show that the physiological effects of the different
anaesthetics upon the kidneys have an important
bearing upon the employment of the drugs in certain
cases. In the first place, with respect to ether, the
results point to the fact that this agent “ pro¬
duces a special contraction of the renal arte¬
rioles, with a consequent damaging effect upon
the renal secretory cells similar to those which
follow clamping the renal artery. The kidneys
shrink in bulk, and this is succeeded by dimi¬
nution of secretion, marked albuminuria, and
finally suppression.'’ The author concludes, there¬
fore, that ether as an anaesthetic is contra-indicated
when renal disease is present, and when, with the
albuminuria, there i< associated a tendency to pul¬
monary oedema. It is, however, scarcely needful to
observe that renal insufficiency, especially albumi¬
nuria, is a most unfavourable complication with which
a surgeon.can meet in a patient upon whom he contem¬
plates attempting an operation. Moreover, in bad cases
of the kind he might even regard the renal disease
present as sufficient to contra indicate any interfer¬
ence upon his part, and under these circumstances
there would not be any danger of the symptoms being
aggravated by ether, and no necessity would arise for
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674 Thi Mkdicax Pbiss.
NOTES ON CURRENT TOPICS.
the use of a general antithetic. On the other
hand the author points out that his investigations
show that the effect of chloroform upon the kidneys
is nil. There is no interruption to the secretion
of urine during the administration of the drug, and
its physiological effects seem to be limited to
acting as a cardiac depressant. Again with
regard to the A. 0. E. mixture, the author
states that “ if this preparation is administered
more as ether is when used alone, then a study of the
carotid and kidney tracings shows clearly that we
hare both the cardiac depression of chloroform and
the renal derangement of ether combined.” Hence
an unfavourable opinion is expressed of this combina¬
tion of anaesthetic agents, and the author further
states his belief that all anaesthetic mixtures are
dangerous and of no advantage. Nitrous oxide
and oxygen are held to be the least dangerous
and the least deleterious to the kidneys. The
author draws attention to tho fact that in a series of
cases he found a marked increase of indican in the
urine after ether administration; and that this
increase was also noticeable, but to much less extent,
after the administration of chloroform and nitrous
oxide. In order to determine the precise physio¬
logical effect of an anaesthetic the urine should be
carefully examined and measured, according to the
author, for twenty-four to forty-eight hours before
the operation. Then the patient should be cathe-
terised immediately preceding the administration of
the anaesthetic, and catheterisation should be carried
out directly the administration is stopped, and the
urine in each case examined. By this means full
details may be obtained of the actual changes which
occur. The paper from which these results are
quoted is both interesting and instructive, the
J nquiry being one which deals with a most important
subject. However the practical application of the
teaching to which the investigations lead, clearly
points to the necessity of avoiding the use of ether as
an anesthetic in all cases in which renal insufficiency
is suspected. We believe that this precaution has
not claimed the attention of anesthetists generally.
4lot£B on torrent ‘topics.
What is an Accident ?
The prevalence of the popular practice of insuring
against accidents gives a special and practical interest
to legal definitions of what constitutes an accident,
and the difficulty experienced in arriving at a work¬
ing definition shows that the question i6 not as
simple as might be thought. A man in New York
recently sustained a perforation of the intestines in
consequence of having swallowed sharp fragments in
his food, and his representatives sought to recover
under his accidental policy. The company refused
to pay on the ground that, the cause of death
was not an accidental injury within the meaning of
the 'policy. Looked at merely as a question to be
decided on common-sense grounds, the company is
unquestionably in the wrong. If the man had injured
Dec. 27, 1899
^i* hand with some of the self-same fragments and 1
had died of blood poisoning, we presume it would
have been regarded as an accident, and unless the*
policy, which is the basis of the contract, distinctly
excludes internal injuries, these would necessarily
oome within its soope. Judicial decisions on this
point vary. In New York, for instance, it
has been held that swallowing poison by mistake
is an aocident within the meaning of the policy;
but in Illinois, on the contrary, the courts have
ruled exactly the opposite. The same points have
been raised from time to time in our own courts, and
in the case of accidental poisoning we believe we are
right in stating that the verdict has been unfavour¬
able to such claims. If the companies wish to restrict
the benefits of their policies to external injuries, they
must formally state their intention; but in the ab¬
sence of any specific exclusion, the widest interpreta¬
tion ought to be placed on the terms of the policy.
The Confectionery of the Future.
The official organ of the International Com¬
mission for the Suppression of Adulteration, the
British Food Journal, for this month calls
attention to an important, but somewhat delicate
question in respect of the employment of saccharin
in lieu of sugar in the manufacture of jams, confec¬
tionery, fruit syrups and the like. Sugar, it is pointed
out, is a food, which saccharin is not; indeed, the-
latter is of the nature of a drug to be employed
accordingly. It possesses antiseptic properties which,,
however valuable to the manufacturer of food stuffs,
may, in the long run, prove injurious when taken by
persons with normal digestions. Moreover, it enables
ingenious traders to give glucose the sweetening
power of cane sugar, thus defrauding the purchaser
who expects to get, not merely a delicacy, but a food.
As the law at present stands, we doubt the possi¬
bility of preventing this, the latest form of trade
adulteration. The manufacturer does not define
the nature of jam, he does not pretend that it
contains this, that or'the other substance except
perhaps the particular fruit by which it is described,
so that it would be difficult to bring home a charge
of fraudulent substitution Still, if our jam is not
real, where are we P It may come to pass, with the
progress of culinary chemistry, that not even the
fruit will be thought necessary. There are plenty of
synthetical compounds which may be trusted to give
the pleasing delusion of a given flavour, but we pity
the youngsters who are condemned to lard their slices
of bread with a compound of saccharised glucose,
coloured with aniline and ^flavoured with , jargonelle
pear, for instance.-
What is Medical Practice Coming to?
A correspondent, writing from a northern town
paints a dark picture of medical practice as a means
of gaining a livelihood. He says, “ It is really too
hard. A friend of mine, a practitioner of nearly forty
years’ standing, told me to-day that he had not
received a single new message in a week. The young
men Beein to get all the work. Each is a specialist, if
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Dec. 27, 1809.
NOTES ON CURRENT TOPICS.
Th* Malucal Paxes. 675
you please, or calls himself by some name or other, so
that, of course, he is the man for the time being,
the youngest being, of course, the most infallible ;
so on it goes, be in his turn yielding to the next.
I do not deny that the quality of the men who enter
practice is improving, but concomitantly with the
over-packing of the profession there is the greater
•power of the public to doctor themselves and the
combination of these two causes proves disastrous to
the Faculty. 1 observe that no local diseases now are
the local expressions of general states, indeed there
would seem to be no each thing. Yet I do not know
any cause of failure in practice and in giving relief
more disastrous than the dreadful habit of treating the
disease rather than the patient.” This is rather dole¬
ful newB especially for those practitioners who have
attained an age at which their experience might
be expected to secure the confidence of the public.
The immense improvement that has taken place in
the intellectual equipment of the modern practi¬
tioner undoubtedly tells heavily against those who
were educated on the old lines, hence the
preference displayed by a large section of the
public for comparatively young men. We have only
to compare the frame of mind of “ a practitioner of
forty years’ standing” with that of the bustling
young graduate, fresh from the hospital and the
laboratory, to understand that the self-confidence
and brand-new ideas of the latter must necessarily
impress those with whom he makes it his duty to
oome into contact. Experience is of value only so
far as it co-ordinates and develops previous know¬
ledge. It is not of itself knowledge, or, as it has
been often observed, the oldest among us would be
-the wisest quod abeurdum est.
Accuracy in Dispensing.
Judging from the evidence given before the
magistrate in some prosecutions recently undertaken
by the Fulham Vestry against chemists for selling
goods not of the nature, quality, and substance
demanded, the pharmacists had better set about
remedying their own shortcomings in the matter of
accuracy of dispensing instead of worrying about a
hypothetical proclivity to error on the part of the
.much-abused unqualified dispenser. The mixtures on
the analysis of which the prosecutions were under¬
taken proved to contain an excess of the active
ingredient —iodide of potassium—to the tune of from
7 to 15 per cent. According to Mr. Umney, who
was called as a witness for the defence, a prescription
must be considered to be accurately dispensed if the
excess or deficiency, as the case may be, does not
exceed 9 per cent. As the British Food Journal
points out, if the same latitude were permitted to
a grocer a pound of tea might contain any
.quantity between 141 and 17l ounces. This point
however, did not bear on the result, for the magis¬
trate, perhaps rightly, held that Section 7 of the
“ Sale of Food and Drugs Act,” is directed against
adulteration and not against inaccuracy, so that,
provided the drugs specified in the prescription are
contained in the medicine, the quantity does not
matter. If this be the law then everyone will agree
that the law requires amendment, but until we have
the pronouncement of a higher court on the matter,
we prefer to hold that the magistrate has misappre¬
hended the bearing of the Act. Perhaps it would be
too much to ask the Fulham Vestry to incur the
expense of an appeal, indeed, as the question at issue
affects the honour and integrity of the pharmacists
as a body, it would seem that the Pharmaceutical
Society is the proper body to take the matter in
band, but this we may be sure they will not do.
The Prince of Wales’s Hospital Fund
Distribution.
The report of the Executive Council of the Prince
of Wales’s Hospital Fund for the past year is more
favourable than that of the preceding twelve months.
A sum of £42,000—or £19,000 more than on the
previous occasion—has been distributed among
eighty-lwo institutions. In pursuing the list of the
latter and the awards, several matters worthy of note
become apparent. In the first place we are glad to
see that the Committee used commendable discretion
in refusing aid to those hospitals which did not
appear to be in need of funds. By adopting this
policy more funds were thus made available for the
needy institutions to whom financial assistance was of
the utmost importance. Again we note that
the Jubilee Hospital has failed to gain any oympathy
from the executive committee; the report concerning
it is as follows : This institution does not appear to
be a hospital in any sense of the word, and its
buildings are quite unsuitable for hospital purposes.”
This is probably the most scathing criticism which
this unfortunate institution has so far received. In
two cases—the London Ophthalmic Hospital and St.
Thomas’s —the awards are qualified with the recom¬
mendation to appoint an inquiry officer in order to
prevent the “possible” abuse by out-patients.
We have for some time been under the impression that
the inquiry system had not proved to be satisfactory
in the London hospitals. At one large hospital the
authorities found it to be useless. Upon the whole,
however, the report of the council just issued is, we
think, likely to give general satsfaction, aud to
inspire more confidence in the method under which
the fund is being administered. It is evident, how¬
ever, that the fund, by means of making its grant
contingent upon certain recommendations of the com¬
mittee being carried into effect, will eventually come to
exercise a good deal of control over the institutions con¬
cerned. In other words the likelihood seems to be
that in the future the fund will b9 able to ensure the
position of a “ Central Hospital board.” But whether
this will prove to be good or bad for the London
hospitals remains to be seen. Meanwhile there is no
doubt that any attempt to aggressively make use of
power conferred by the fund in regard to recom¬
mendations would be resisted by the hospital
authorities, So far, however, it may be said that no
• such aggressiveness has been exhibited.
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676 Th* Medical Pbsss. NOTES ON CURRENT TOPIC8.
D*c. 27, 189G.
The Salvation Shelter Decision.
On appeal to the Queen’s Bench decision the
London C ranty Council sustained its right to con¬
trol the semi-charitable night shelters of the Salva¬
tion Army. In the lower courts the decision given
by the magistrate was that these places did not fall
within the provisions of the Common Lodging
Houses Act. The contention of the local authorities,
on the other hand, was that they were in reality common
lodging houses, and should be registered as such.
The importance of sanitary supervision of such
shelters is obvious, especially in view of the nature of
the vagrant population attracted by their accommo¬
dation. The stringent rules laid down for common
lodging-houses are far more necessary for the shelters,
but as a matter of fact they have been hitherto
practically able to defy the authorities, and to carry
out cleansing, disinfection and other hygienic measures
at their own sweet will. This decision of the Lord
Chief Justice is, therefore, of first importance, dealing
as it does with a class of population difficult to control
under any circumstances from a health point of view.
We purpose entering into the matter more at length
in an early issue, and meanwhile would express our
approval of Lord Russell’s wish that as far as possible
the work of the Salvation Army should not be
hampered. Philanthropy, however |well intentioned
must not be permitted to block the pathway of
preventi re medicine.
What is Inebriety?
So far as the indecisive opinion of magistrates
can go it was ruled recently in the Brentford Ses¬
sions that the habitual taking of drugs is not in¬
ebriety within the meaning of the Act. An inmate
of a retreat for inebriates near Twickenham had left
the establishment and bought cucaine for injection.
If he had gone out to get drunk on whiskey this
would have been an offence against the law for which
the magistrates might have committed him, but it
was represented to them by the defending counsel
that neither cucaine nor any other hypnotic is men¬
tioned or indicated in the Act, and the magistrates
accordingly adjourned the case to enable the prose¬
cution to take further advice.
Sacculated Diverticula of the Gullet.
The curiouo and interesting abnormality of
oesophageal diverticula is rerely met with. It is most
commonly met with in the cervical region, where it
often gives rise to a visible swelling after a meal, and
at least one case has beenl recorded in which the
patient was able to empty the pouch of food at will.
One of the most prominent clinical symptoms is
dysphagia, which not infrequently developes to a
serious extent within a few months of the recognition
of the trouble! In some cases the obstruction to the
oesophagus has been so rapid and the difficulty of
swallowing so great that a malignant growth has
been diagnosed. In such a case emaciation is apt
to prove a fallacious sign, as it depends on the
difficulty of swallowing a sufficient amount of nourish¬
ment, and not on the cancerous cachexia. Curiously'
enough the irritation of the food retained in the
adventitious pouch sets up a pain that is not
infrequently referred to the stomach. No satis¬
factory explanation has hitherto been forth¬
coming as to the orgin of these abnormalities,
although it seems reasonable to suppose they are
connected with developmental reversions when
congenital, but the cause of the acquired condition
is unknown. For some unexplained reason these
pouches occur more commonly in man than in the
opposite sex. Although their occurrence is rare the
medical practitioner will do well to have a careful
note in his memory as to their chief characteristics.
Formaldehyde as a Preservative of Milk.
The discussion which has for some time been
taking place on milk preservatives lends additional
importance to experiments carried out for the pur¬
pose of testing the use of formaldehyde iu this regard.
The whole of the evidenoe bearing upon the matter
according to an American authority justifies the
following conclusions, namely, that formaldehyde,
used as a preservative, tends to impair the nutritive
value of milk, and disturb the processes of digestion,
while, in addition, if taken internally beyond a cer¬
tain dosage, the drug may produce dangerous if not
fatal results. We trust that the committee, now
sitting for the purpose of inquiring into the adul¬
teration of food products, will bear these facts in
mind, and not overlook the possibility of formalde¬
hyde being employed as a preservative of milk.
Slipshod Dispensing.
An inquest was held a few days since on two
inmates of the Crumpsall Workhouse Hospital who-
had died from the effects of poisonous doses of
strychnine administered in medicine by mistake
instead of Ditrous ether. As it is not the practice at
this institution for the dispensers to initial the labels,
there were no means of bringing home the respon¬
sibility to the careless member of the dispensing
staff, three in number. Perhaps this regrettable
accident will lead those responsible for the manage¬
ment of similar institutions to enforce rules which, if
they will not avert mishaps would at any rate enable
them to pounce on the delinquent. We may call the
attention of our friends the pharmacists to the fact
that this mishap occurred in the hands of qualified
dispensers, lest, for polemical purposes, they should
proceed to debit it to the persecuted “doctor’s
assistant.”
The Council Vacancy in the Royal College
of Surgeons, Ireland.
A meeting of the Council has been summoned for
January 8 to elect a councillor to the vacancy caused
by the death of the late Mr. Wheeler. As we have
already reported, the vacant seat is contested by Dr.
C. B. Ball, regius professor of surgery in the univer¬
sity of Dublin, and surgeon to Sir Patrick Dun’s
Hospital, and by Mr. Arthur Chance, surgeon to the
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Dec. 27, 1899.
N0TE8 ON CURRENT TOPTC8.
The MkDiCAI Pit 188. 677
Mater Miseracordite Hospital, both of these gentle¬
men hare already served as councillors. The voting
is'by ballot papers, so that all Fellows of the College,
within postal reach, can participate in the election.
The Surgical Treatment of Gastric Ulcer.
The intervention of the surgeon in cases of gastric
uloer has hitherto been limited to the treatment of
those cases where perforation of the organ has re¬
sulted from the uloeration. More or less success has
attended these attempts to save life under these
necessarily fatal conditions. But now it is recom¬
mended to deal surgically with another symptom of
gastric ulcer—namely, hsematemesis. Eisendrath
has recorded two cases in which he has operated
for this condition In one, that of a woman,
®t. thirty-eight, he opened the stomach, after
a second profuse haemorrhage, and found an
ulcer on the posterior wall. The uloer was drawn
out, a ligature applied at its base, and it was then
excised. The patient made a rapid recovery. The
seoond case was that of a man, mt. 36, for whom
gastrotomy was performed for the same reason, and
several small ulcers were found. These were treated
in the same fashion, and recovery followed. Symp¬
toms of gastric dilatation, however, subsequently
developed, for which gastro-enterostomy was per¬
formed, a Murphy’s button being used. But death
took place from peritonitis. Eisendrath thinks th«»t
repeated haemorrhages, or severe ones occurring
more than once, are the indications for operatin g.
The “ Internet ” Scandal at Pane.
The internes, or resident medical officers of the
Paris hospitals, are selected by periodical competitive
examination, and as the tenure of office is at least
three years, it can well be imagined that great
importance is attached to the results of the very
severe test to which candidates are subjected. At
the last examination in Paris, some misguided
individual, or individuals, obtained admission to the
Dean's room by burning out the lock with a thermo¬
cautery, and they then poured sulphuric acid into
the box containing the written papers, destroying
them for the most part. This scandalous proceeding
naturally gave rise to great commotion, and the
authorities have had some difficulty in making up
up their minds as to the best course to pursue under
the circumstanoes, and so far the police have not
been successful in tracing the delinquents. Along
with this scandal rumours have found currency in
the Press bearing on the prevalence of various illegal
methods of affording assistance to candidates desirous
of reinforcing memory, It has been decided to hold the
examination de novo, and in future the public will
be excluded from the examination hall, at any rate
during the written part of the competition. It is
surprising, indeed, to find that hitherto the public
that is to say, the friends of the candidates, have
been allowed free access to the room. It was almost
inevitable under the circumstances that abuses should
creep in, and it was high time to take steps to ensure
the fidelity of the test.
The Employment of Emmenagogues.
The fallacious importance attached in certain
sections of society to the action of emmenagogues
justifies an attitude of suspicion on the part of
medical men in regard to the use of this class of
agent. In the vast majority of instances the demand
for a drug of this class arrives from temporary
suspension of the menses under circumstances which
give rise to anxiety not exactly on account of health.
A woman whose periods cease for some reason other
than pregnancy to make their appearance at the
appointed date may quite possibly think it necessary
to consult a medical man, but in such case it is
merely because their cessation is associated in the
mind of the public with some grave preturbation of
health. Now amenorrhoea, apart from pregnancy,
occurs only in association with certain well-recog¬
nised conditions, anaemia chlorosis, ovarian disease
&c., in none of which would emmenagogues do any
good or indeed produce any effect whatever. This
leads one to ask under what circumstances the use of
these drugs is vindicated, if ever. Obviously not in
anaemic conditions, in which treatment must be
directed to the original affection; clearly also
not in diseases of the reproductive apparatus j
since their effect could only be to aggravate
the morbid state. It will of course be
alleged that they may be employed with advantage
in cases of functional paresis, that is to say, cases in
which there is no particular reason why menstruation
should not take place exoept a certain indolence on
the part of the organs concerned. But are there
such cases ? If the amenorrhoea be due to constipa¬
tion with consequent depreciation of health appro¬
priate measures will right matters without recourse ■
to an emmenagogue and the same mutatis mutandum
holds good with regard to the various other causes
classified by writers on gynaecology as entail¬
ing amenorrhoea. Either this medication is
useless or it is unnecessary as well as useless.
It may be assumed that the very general use of
these remedies is due to the quasti-necessity
of prescribing something when appealed to by
women suffering from amenorrhoea, and not to any
conviction on the part of the preacriber that the
medication is likely to be of any particular efficacy
for the purpose demanded. It is highly probable,
indeed, that in the cases of delayed menstruation
bread pills would produce much the same effect,
namely, to give an excuse for patience until such
time as the function reasserts itself.
The Growth of the Nails.
It has been stated that, as a general rule, the
growth of the nails progresses at the rate of about
one twenty-fifth of an inch per week, so that nails of
the average length, say about half-an-inch, would
take about a hundred days to grow, though other
authorities put the time at from 121 to 138 days. As
a matter of fact, the rate of growth varies, not
only according to the age of the subject, but also in
different subjects of the same age. Moreover, under
the influence of a variety of circumstances, the growth
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NOTES ON CURRENT TOPICS.
Dec. 27, 1899.
-of the nails may vary even in the same individual. A
-statistical crank who has taken the trouble to investi¬
gate the matter very closely notes that in a man
<of 21 the nail had grown afresh in 126 days;
while in one of 31 it took 159 days. In another
individual, only one year older than the latter, the
growth, however, took 88 days, in a man of 55 it was
110 days before the nail was reconstituted, and in a man
of 67, no less a period than 144 days was required.
The observer made this curious observation that the
instance of most rapid growth occurred in a tuber¬
culous patient suffering at the time from attacks of
haemoptysis. We are told that sea-air stimu¬
lates the growth of the nails, while, on the
other hand, grave emotions delay growth, and
may even lead to shedding of the nails. A
point that may possibly possess a certain diagnostic
value is his observation that while in diseases of the
. central nervous system the growth of the nails is
usually interfered with, nothing of the kind is observ¬
able in functional paralyses. Lastly, the occurrence
-of cerebral hiemorrhage is stated to put an end to
.the growth of the nails, but as to this we have our
-doubts.
The Operator’s Responsibility.
A suit will shortly come before the Courts in the
United States in which a certain well-known surgeon
-will have to defend himself against a claim for
damages based on the ground that he had caused the
. death of one of his patients by leaving a gauze plug
.inside the abdomen in the course of an operation.
The surgeon throws the blame on his head nurse,
whose special function it was to count the sponges
and plugs before and after operation. In this case
she assured the surgeon that the number was com¬
plete, and the surgeon declines any responsibility for
her error. Whether the tribunal will uphold this
delegation of responsibility is another matter.
Technically, the operator is responsible for every
. detail of the operation and from a professional point
of view qui s’ excuse s'accuse. Whatever may be the
practice in America, we believe that in this country
no experienced surgeon would leave a detail of this
capital importance to anyone. In spite of every pre¬
caution instances are on record in which the tearing
of a sponge in two, or an unsuspected addition to
their number has .led to a mishap.
Normal Arsenic.
At a recent meeting of the French Academy of
Medicine, Dr. Gautier described a method which he
had devised for the research of very small quantities
of arsenic in certain organs, a method which had
enabled him to discover in certain organs of the normal
organism a fixed quantity of this element. He finds
for instance that arsenic is always present in the
thyroid gland of animals, including man, and in
smaller, but still estimable quantities, in the thymus,
brain and skin, and probably also in the pituitary
body. Dr. Gautier explains the curative effect
■O arsenic in certain maladies on the assumption that
it is a normal and essential constituent of particular
organs and tissues. However this may be, if his
assertion be confirmed, the fact is one of considerable
interest to medico-legists.
Army Medical Dispensers.
The Department has found it necessary to desoend
from the qualification heretofore recognised for
compounders in the hope of attracting candidates.
Young men who have passed the “ minor ” of the
English Pharmaceutical Society are now accepted as
sufficiently qualified for the position if they have
served as dispensers for three years, and have a certi¬
ficate of character. They will receive, on appoint¬
ment, Is. 6d. a day with rations, kit, and free passage
out and home, and two months' pay as a gratuity
when the war is over.
Hospital residents, medical and non-medical, are
pecularly exposed to the infection of influenza, as
long and arduous experience has abundantly shown.
Last week, for instance, two of the house surgeons,
and two of the house physicians at St. Mary’s
Hospital, together with a large number of students,
were in the throes of this most undesirable malady.
PERSONAL.
Mr. Robert Cuff, M.B., M.R.C.S., honorary surgeon
to the Scarborough Hospital, has been appointed a
magistrate for the borough of Scarborough.
Professors William Osler and Howard Kelby, of
Baltimore, have been elected honorary members of the
Royal Academy of Medicine, Ireland.
Dr. John Macewen, a son of Professor Macewen of
Glasgow University, has volunteered for service as a
surgeon at the front, and started on Saturday for South
Africa.
Dr. A. Logan Turner, of Edinburgh, has been
awarded the prize of one hundred guineas by the
Council of the Royal College of Surgeons, Edinburgh,
for his essay on “ Racial Characteristics of the Frontal
Sinuses.”
The latest telegrams from the seat of war inform us
that Sir William MacCormac, Mr. F. Treves, and the
Principal Medical Officer, with several assistant sur¬
geons, were at the base hospital in attendance on the
wounded as they were brought in during and after the
battle on the lugela.
The Gold Medal presented to the Royal College of
Surgeons, Edinburgh, by Colonel William Lorimer
Bathgate, in memory of his late father, Mr. William
McPhune Bathgate, F.R.C.S.E., has been awarded,
after the usual written examination in Materia Medina,
to Mr. David Mitchell, student of medicine, of Broxburn.
The funeral of Sir Richard Thorne-Thome, late
principal medical officer to the Local Government Board,
took place at Woking on Thursday last, aad was
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CORRESPONDENCE.
The Medical Press. 679
-attended by Sir Dyoe Duckworth, representing the
fioyal College of Physicians of London, Sir Hugh Owen,
Dr Whiteley, from the Home Office, several officials
from the Local Government Board, and a large number
of medical friends.
Da. W. W. Ireland, Medical Superintendent of
Mavisbank Asylum, Midlothian, has been elected a
corresponding member of the Societa Freniatrica
Italian*, of which Professor Tambnrini (of Modena) is
president. -
A telegram has just reached Colonel Hughes,
C.B., C.M.G., of Guildford, from General Sir Redvers
Builer announcing the death of his son, Captain
Matthew Hughes, M.D., Royal Army Medical Corps, at
the battle of Colenso. General Builer adds, “ We had
all grown so fond of him.”
Mr. William Anderson, F.R.C.S., of St. Thomas’s
Hospital, and Mr. H. W. Page, F.R.C.S., of St. Mary’s
Hospital, were re-elected on Thursday last as members
of the Court of Examiners of the Royal College of
8ur,'eons, England, and Mr. Bernard Pitts, F.R.C.S. was
elected to fill the vacancy occasioned by the retirement
of Mr. Edmund Owen, F.R.C.S.
On the invitation of the War Department, Sir
William Stokes will proceed to South Africa as consult¬
ing surgeon to the forces as soon as he can make arrange-
ments for the journey. Sir William is the first Irish
surgeon whose services have been requisitioned by the
Government, and his experience as surgeon, formerly to
the Richmond Hospital, and now to the Meath Hospital,
fuliy justifies his selection by the Government to oocupy
a prominent position in the surgical work of the war.
Correspondence.
V.'e ilo not hold ourselves resimnsiblo for the opiuions of our
•corrrsi>ondent8.
THE CURE OF CONSUMPTION.
To the Editor of The Medical Press and Circular.
S'!*,—The only good sense expressed at the meeting,
reported in the daily journals on Tuesday, the 19th inst.,
wa« when Sir Samuel Wilks seconded the resolution,
pressed bv the Duke of Northumberland. It seems
now that we are not to regard consumption as a disease
solvly due to the influence of a special bacillus as
scsilatina, variola, and other infectious maladies, and
upon which theory tuberculin was founded, but as de¬
pendent as much or more on the conditions of the
atmosphere that surround the individual. Hospitals
may be necessary for one class of maladies but for con¬
sumption it certainly would be impossible to secure
fresh and pure air for the treatment of a disease which
runs no definite course and has no resemblance to these
fevers. What are we to think then of those who follow
the Prince of Wales and at the same time support con¬
sumptive hospitals ? When the Earl of Derby said that
“ tno remedy for the ignorance which prevailed on
this subject was . . . light and air,” it ap¬
peared as if he thought a great discovery had
been made. There is no doubt but that his lordship
muat have been speaking from personal feeling and ex-
pei ience, and if it has been discovered that ignorance
can be cured by light and air it is something to be proud
of. We think that some of those who have gone before
us held pretty much the same views, centuries back, as
we are discovering reasons for doing to-day. Those who
Anew anything of the history of medicine will find that
-whenever there has been a rush by the public aft e
a remedy it has generally, we may say always, turned
out to have been a delusion. 8ociety is in a certain
hysterical state when it rushes after soienoe in any form.
We do not »ee how this new theory can find any reason
for “ appealing to the public for the means of establish¬
ing new hospitals.” It seems difficult to support the
hospitals we have, and we fear that Charity is finding
other objects, and will do so for some time than hospitals,
for the treatment of snoh diseases as consumption, which
are generated in the evil conditions of crowded cities,
and which are cured by that life in the country which
makes men better fitted to be soldiers and active
workers. The kind-hearted men who are supporting the
Prince of Wales both io this move for cure of consumption
and in other matters of medical interest would do well
to be careful lest their work bring no result but dis¬
appointment.
I am, Sir, yours truly,
A Sympathetic Critic.
THE IRISH COLLEGE OF PHYSICIANS AND THE
APOTHECARIES’ HALL, IRELAND.
To the Editor of The Medical Press and Circular.
Sir,— I observe in an article in the Medical Press
and Circular of the 21st inst., referring to my statement
at the last meeting of the General Medical Council of the
reasons why the Royal College of Physicians in Ireland
declined to enter into a conjunction with the Apothe¬
caries Hall of Dublin, you say that “ the representative
of the Irish College of Physicians raised, for the first
time, certain technical objections.” This is a mistake;
these objections have been urged over and over again.
Not only at the meetings of the College from time
to time to my knowledge for the past forty years, but also
at conferences, with deputations from the Council of the
College of Surgeons in 1889, and subsequently, and
lastly, a tabulated statement of them was printed and
laid before the General Medical Council by me at the
meeting of the Council, November, 1895.
I am. Sir, yours truly,
Dec. 24th, 1889. Lombe Atthill.
[It does not seem to be a matter of much importance
whether these objections were publicly raised by Dr.
Atthill’s College, now, or at some previous time ; but as
he questions our accuracy, we may say that we have
searched the volume of minutes and reports of the General
Medical Council for 1895, and can nowhere find a state¬
ment on behalf of Dr. Atthill’s College, of these objec¬
tions. We know that a printed statement as to the
deficiencies of the ‘‘Hall ” examinations was circulated,
but we cannot recollect that any statement of these
objections was contained in it. The incident may pass,
inasmuch as we have not, for the present, questioned the
validity or force of Dr. Atthill’s objections.—E d.]
■ (Obituarg.
MR. WILLIAM CADGE, F.R.C.S.
The death is announced, at the ripe old age of 75, of
that veteran surgeon, Mr. William Cadge, F.R.C.S., at
Lowesroft. His name, it may truly be said, has been a
household word in the counties of Norfolk and Suffolk for
nearly half a century, and as a correspondent observes,
no surgeon has been held in higher estimation than him
since the death of‘‘old ” Crosse of Norwich. Mr. Cadge
was educated at University College Hospital, just at tne
time when Robert Liston was at the apogee of his reputa¬
tion as an operating surgeon. Mr. Cadge became a
member of the Royal College of 8urgeons in 1845, and
forthwith became Liston’s private assistant, and he
remained such until Mr. Liston’s death in 1847. He
was subsequently appointed demonstrator of anatomy
in University College, and assisted Morton in producing
his anatomical plates. In 1848 he became a Fellow of
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LITERATURE.
)kc. 27. 1899
the College of Surgeons, and in 1860 he was appointed
Assistant Surgeon of University College Hospital in suc¬
cession to Mr. Erichsen. This appointment, however,
Mr. Cadge did not hold long, for two years later, a
vacancy occurring at the Norfolk and Norwich
Hospital, he returned to his old home and began
practice in Norwich. There he carried on for
many years a most successful and lucrative prac¬
tice, being the recognised consultant for the eastern
counties. As an operator, particularly in the
operations for stone in the bladder, Mr. Cadge soon
achieved a great reputation, and the museum at the
Norwich Hospital contains innumerable trophies of his
skill in this department. Mr. Cadge married the sister
of the late Sir Richard Quain, but had no family, and
his wife predeceased him. He took an active interest in
municipal matters, and was on one occasion Sheriff of
Norwich. He was a liberal supporter of his hospital,
having on two occasions presented the charity with the
munificent donation of .£10,000. When he retired from
the active duties of the staff, he was elected consulting
Burgeon with the right, which he occasionally exercised,
to occupy a few beds with his patients. Mr. Cadge was
elected a member of the Council of the College of
Surgeons of England in 1880 and held office for 18 years,
and was Hunterian Professor of Surgery in 1886, when
he chose for his subject lithotomy and lithotrity.
DR. W. N. THUR8FIELD, OF SHREWSBURY.
Da. W. Nealor Thursfield, whose death occurred
on Wednesday last at his residence, Kingsland, Shrews¬
bury, was bom in the same county in which he lived
for 69 yearB and died. He was educated first at Marl¬
borough College, following his medical studies at King’s
College, London, and subsequently at Edinburgh
University; passing Mb membership examination of the
Royal College of Surgeons, England, in 1861, and next
year he took his M.D., degree at Edinburgh. He
then commenced practice at Wellington, Salop, where
he was appointed medical officer for the town, and soon
built up a large private practice. It was, however, as
medical officer of various rural districts in the county
of Salop that he was best known. Since 1873 and up
to a year or two ago he held the position of medical
officer of health for the Shropshire combined sanitary
district. In addition, he was medical officer for several
sanitary districts that either overlapped the county
boundary or were entirely outside. It is probable there
was not another medical officer in England who covered
so much ground as medical officer as Dr. Thursfield did.
About two years ago he was appointed to the newly
constitu ed position of med cal officer of health for the
county of Salop. Failing health, however, led to his
taking steps for relinquishing the position, and it was
only at the last meeting of t he County Council that his
resignation was received. Paralysis was the immediate
cause of death.
literature.
GILLESPIE ON MODERN GASTRIC
METHODS (a)
The hope of the author that this work may serve a
useful purpose is certainly fulfilled when the description
of the methods employed is based on his personal
acquaintance with the processes to wMch a careful perusal
points as those that have particularly engaged Dr.
Gillespie’s attension. The first few pages are devoted
to a well-made precit of modem views on healthy gastric
conditions which is followed by details of the methods
for obtaining and examining the oontents of the
stomach, evidently derived from practical experience
and familiar knowledge of the means employed, espe¬
cially in regard to the chemical examination of the
fluid removed (from the stomach for the purposes of'
diagnosis.
There is no doubt that careful description of actual
practice in the use of instruments, tests and calculations,
used to foster greater precision in our estimate of the
conditions on which disorders of gastric digestion may
depend, must prove interesting to those who are engaged
in the 6tudy of this particular subject; while for
practitioners of medicine who may not have facilities for
carrying out the chemical examinations necessary to
enhance diagnostic accuracy, the directions given by
the author for the performance of lavage and the
simpler clinical tests which do not involve the possession
of apparatus and laboratory accommodation are clearly
and succinctly set forth.
In tMs connection, however, we do not always find,
ourselves in agreement with Dr. Lockhart Gillespie’s
advice and opinions. We have not found that the
lubrication of the stomach tube with the small quantity
of glycerine required has caused more irritation of the-
pharynx than when its use has been omitted, especially
if the capital plan of sucking a cocaine pledget, as
advocated by the author, is carried out before the
passage of the tube. It is no small reduction of the
discomfort at first experienced by the subject of lavage
to be reassured by a suggestion of easy sliding over his
rising gorge, which the careful anointing of the tube
conveys to Mb mind.
8ince this book teems with useful detail and prac¬
tical hints, we are surprised to read the author’s direc¬
tions for dealing with the tube after its removal, and
should expeot remonstrance from the intelligent patient
in these days if we used unsterilised water, and failed tu
sterilise the tube before passing it into the stomach for
the purpose of lavage.
The chapters on chemical examination are most care¬
fully written, and contain original recommendations not to
be found elsewhere. The author’s method of estimating
total acidity, acidity after evaporation, and volatile
acidity appears to be an excellent substitute for the more
complex plan of Hayem and Winter, and the simple¬
way of determining the digestive power of the stomach
contents after removal and filtration advocated on page
98, also deserves attention. Within the limits set by the
author it would not be reasonable to demand
equality of treatment for the various means
employed in modern gastric diagnosis; but we hope
that the views of Stein on the absorption of
salol from the Btomach may not be accepted without
further confirmation. Dr. Lockhart Gillespie has not
apparently employed the X-rays in combination with
Einhorn’s stomach bucket for the recognition of the
position and motility of the organ, nor does he appear
to have any acquaintance with the use of massage in
combination with Gunzberg’s capsule and the salol test,
when we believe it is valuable as an aid to diagnosis.
The improvement on Torek’s irrigator by Herschell, and
the use of the phonometer in the diagnosis of gastric
size and position, will doubtless be noted in the second,
edition of this book, which is sure to oreate a demand,
for more information from the same souroe.
DEMOOR, MARSART, AND VANDERVELDE ON
EVOLUTION BY ATROPHY, (a)
We learn from the preface that this treatise was com¬
piled in connection with a scheme for research work in
general sociology elaborated in June, 1894, and was pre¬
sented to the Institute of Sociology in Brussels. The
subject is discussed under three main headings: Part I.,.
The Universality of Degenerative Evolution; Part II.,.
The Path of Degenerative Evolution; Part III., The-
Causes of Degenerative Evolution. The authors argue-
that degeneration and progress are really only two
aspects of evolution, that is to say, that all progress
must, necessarily, be attended by degeneration. The
first part of tho work is ohiefly taken up with tho
marshalling of examples in the animal and vegetable
J a) “ A Manual of Modern Gastric Methods, Chemical, Physical*
I Therapeutical/’ By A. Lockhart Oillespie, M.D., F.R.C.P.E.*
F.BS.E. 175 page*. 15 illustrations. Edinburgh: Oliver and
Boyd. 1899.
(ai “ Evolution by Atrophy in Biology and Sociology." By Jean-
Demoor, Jean Maraart, Emile Vandervelde. Translated by Mrs-
Chalmers. The International Scientific Series. Vol. LXXXVEL
- Mitchell. London: Kegan Paul, Trenoh, TrQbner ft Co., I.td_
899.
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Dec. 27, 1899.
LITERATURE.
The Medical Pews. 681
kingdoms of departures from the known forms. In the
second pa»t, the question is fully discussed as to whether
retrogression is a tracing backwards of progression, and
the application of this law to sociological phenomena is
reviewed. In the third part, which from a medical
aspect is the more interesting, many points are discussed
and instances given in relation to the production of
degeneration by the atrophy of organs and parts, and a
somewhat remarkable chapter is added on the “ atrophy ”
of institutions from lack of use. Any one interested in
the subject of sociology and its discussion from a
scientific aspect will find in this book much that is
instructive and original.
MURRAY’S ROUGH NOTES ON REMEDIES, (a)
We are not surprised to find this useful and suggestive
little book now in its third edition. In the present day,
when the practitioner is overwhelmed by the host of new
remedies that are continually poured in upon him to
live their little day and then give way to others, it is
quite refreshing to read the experience of a physician who
has a good robust faith in the curative powers of calom-1,
blue pill, arsenic, and last, but by no means least, good
liqueur brandy.
Of more modern remedies we find nothing said, except
a wise caution against the use of chloral in pneumonia.
Though the use of arsenic in the treatment of chorea
and asthma is by no means new, yet it is not everyone who
will venture to give to a child such a dose as 15 to 20
drops of Fowler’s solution three times a day, for the cure
of chorea.
Nevertheless, we have in this book undoubted proof
of the singularly curative power of this large dose, while
at the same time wise advice is given as to how long it
is safe to continue its administration, in view of the
occasional grave results of arsenical poisoning of
medicinal origin.
The chapters on the ubo of belladonna in various
spasmodic diseases, and of mercury in heart disease aie
full of sound practical advice, and aie thoroughly in
accord with our own experience.
'I he last chapter on the restorative powers of liqueur
brandy shows that the author fully appreciates the value
of alcohol as a therapeutic auent. His insisting, by no
means needlessly, but strongly, on the purity of this
remedy as seen in good liqueur brandy would make
many a patient say “ Dr. Murrav is the man for me.”
The book iB one that cannot fail to commend itself to
the busy practitioner as abounding in useful advice drawn
from extensive and well-used experience.
ECCLES ON DIFFICULT DIGESTION (5).
Any contribution upon the physiological and clin lca I
aspects of massage from the pen of Dr. Symons Eccles
would claim attention, but in the work before us the
author his succeeded in materially enriching the litera¬
ture of the subject by throwing much light upon points
which are little known and little understood. However,
he is careful to state in the preface that his volume is
merely a collection of notes on some cases of difficult
digestion due to displacements of certain abdominal
viscera, and is not in any rense intended to assume the
character of an exhaustive treatise on the subject of
enteroptosis. Th s explanation seems to be necessary,
inasmuch as it is elsewhere remarked that only matters
are dealt with which have come under the author’s
personal notice. Thus the work, in providing a clear
and detailed account of Dr. Ecclea’s own methods of
treatment and clinical experience, gains both in concise¬
ness and value—as a matter of fact no treatise has been
published upon the subject of enteroptosis since Glenard's
work appeared in 1885, and for this reason, if for no
other, the present volume is likely to supply a want. A
detail of some importance is the method of examination
resorted to in patients suffering from visceroptosis, and
S " Rough Notes on Remedies.” By William Murray, M.D *
C.P.Lond. Third Edition. 8ro., pp. 142. London: H. K -
Lewis, Gower Street. 1896.
(b) “ Difficult Digestion Due to Displacements.” By A Symons
Eccles, M.B., M.B.C.S. London: Bailliere, Tindall and Cox,
1899. Price 4e.
in this regard the author describes a special apparatus-
designed by him for the purpose. It consists of a
movable frame, swung on two uprights ; this is so con¬
structed as to be adjustable to any position, and when a
patient is reclining on it the effect is to cause relaxation
of the abdominal muscles, by which the abdominal
examination is greatly facilitated. The book is rich in
detail regarding the clinical examination of the abdomen,
and reflects the author’s ample experience in this special
branch of his subject. There are chapters on gastro-
ptosis, movable kidney, general enteroptosis.and prolapse
ot the sigmoid flexure, and, with respect to the latter,
the author relates three cases in which carcinoma of the
rectum succeeded this condition He attributes the
development of the malignant disease to the irritation
of the bowel set up by the prolapse—a clinical observa¬
tion, the possibility of the correctness of which should be
borne in mind. In conclusion, we can only say that the
perusal of Dr. Eccles’s w ork has convinced us that as a
personal record of clinical experience and facts in con¬
nection with the comparatively little known subject of
enteroptObis the volume before us is both valuable and
instructive. A word of praise is due to the publibhers
for the excellent ‘ get-up ” of the work.
CAMPBELL ON THE NERVOUS SYSTEM (o).
The aim of the author is brevity and simplicity, and
in this he has been successful. He has not been
tempted, like bo many writers on neurological medicine,
to give a copious anatomy and physiology, too often a
mere paraphrase or reprint of what has appeared before,
rather doei he confine himself to elementary
outlines, clear, precise, and freshly interesting. The
chapter on the general structure of the central nervous
system, for example, is well conc-ived, and the idea of
the neuron is clearly conceived, without superabundant
references, and the illustrations though few. are quite
sufficient, and serve their purpose fully. The illustra¬
tions of brain cells in Fig. 2 are interesting and helpful,
in view of modern histological teaching. The Becond
and third chapters deal with the sensory and motor
systems respectively, and are equally characterised by
clearness »nd directness. They are sufficiently informa¬
tive for the average medical man; indeed, this may be
said of the book generally. The method and arrange¬
ment throughout are very good, and by means of
practical tables of comparison, graphic diagrams, and
many excellent photographs the reader is provided with
as quick a means of getting at some of the leading facta
of the nervous system and its diseases as we can
remember ever having seen. Much, of course, is left
out, even in the way of leading facts, and we should
havo preferred to see a few chapters devoted to
systematic descriptions of nervous diseases; but so far
as it goes the book is well done, and worthy the
attention of those who are on the threshold of
neurological study.
CABOT’S SERUM DIAGNOSIS. (6)
We have read with interest Dr. Richard C. Cabot's
“ Serum Diagnosis of Disease,” and can strongly recom¬
mend it to those who wish to become acquainted
with this method of investigation. In the case of
typhoid fever the extreme value of aids to diagnosis is
universally admitted, and a very practical applica¬
tion of ita utility was afforded during the Spanish-
American war. Fevers were rife among the
troops in Cuba and Porto Rico, but until the
serum diagnosis threw light on the cases it was •
impossible to distinguish with certainty between typhoid,
malaria, yellow fever, and dysentery. Dr. Cabot himself
went to Porto Rico in the hospital ship. Bay Stati, and
at Ponce he found hundreds of oases treated for malaria,
which Widal’s reaction proved to be typhoid. The
author shows that the principle is capable of almost
(a) “An Introduction to Diseases of the Nervous System." By
H. Campbell Thomson, M.D. London: Bailliere, Tindall & Cox r
1899. Price 4s ^ v *
(b) "The Serum :Diagnosis of Disease.’ By Bichard C. CaDot,
M.D.. Massachusetts. Price 7s. 6d. London: Longmans, Green.*
and Go., 1899.
Digitized by V^OOgle
682 The Medical Press.
LITERATURE.
Die. 27, 1899
unlimited extension, and that it is applicable to
the diagnosis of a variety of diseases, including
S anders, Malta fever, yellow fever, cholera, bubonic
ague, anthrax, pneumococcus, streptococcus, bacillus
CoH and other infections, tuberculosis, diphtheria,
relapsing fever, &c. Perhaps he rides his hobby too
far, though we admit that he makes out a case for the
U66 of the method in the diagnosis of Malta fever,
cholera, and relapsing fever. In the case of non-motile
organisms the specific reaction is indicated by a pecu¬
liarity of growth of the organism. As might be antici¬
pated, most attention is given to the Widal reaction in
typhoid fever, and very full and clear instructions are
given for performing the test. Regarding the time
limit and dilution the author sums up, “ One to forty is
a proper dilution with a time-limit of one hour, one to
ten is equally reliable with a fifteen-minute limit. Out
of 5,978 cases of typhoid, a positive reaction was found
in 97‘2 per cent.; and out of 849 cases tested before the
eighth day, the reaction was present in 93 per cent.
The compilation of the work entailed a vast amount
•of research into recent medical literature, and the only
fault we have to find with the very complete bibliography,
is that no attempt is made to separate the wheat from the
chaff.
YEAR-BOOK OF PHARMACY (a).
It has been for a long time recognised that the
medical art in its broadest sense has become too
extended to be embraced in all its rfages by any one
life or intellect, that it is necessarily breaking up into
specialities ; and that not the least of these is the com¬
plete and scientific study of practical pharmacy, by
which alone can we hope to ultimately secure a national
or better still an European international pharmacopoeia
of completeness, accuracy (and, let it be added), with a
general rejection of old and exploded remedies, and
worthy to take rank with the general advance of medical
science. There are few more useful contributions
towards this end than the Year book of the Pharmaceu¬
tical Conference, which after so many years has become
quite an institution, and which now appears with its
usual commendable promptitude. The central pivot is
of course the 'July meeting at Plymouth, which was 1
opened by the inaugural address of the President, Mr.
J. C. C. Payne, of Belfast, in which he gave an interest¬
ing account of the progress of pharmacy and of the |
history of the foundation of the Pharmaceutical Society
of Ireland, and also of the legislation for the regulation
of the sale of poisons. In the course of his address he
mentioned an interesting fact which is not known as I
generally as it might be, viz., that so far back as 1760
the Royal College of Physicians of Ireland endeavoured
to make a regulation that all poisonous remedies should
be dispensed in three-cornered bottles, and innocuous
ones in round phials; that effort this college was still
m.iking during the present year, and it is likely now to
be accomplished ; but we do not like to think how many
rueful lives would have been saved had legal difficulties
not intervened during the past nearly a century and a
half to retard this vital reform. The President gave
also an interesting history of the various local pharma¬
copoeias, which are now remembered by the older »chool
only ; and which culminated in the adoption of the first
British Pharmacopeia; remarking that the Dublin
Pharmacopoeia of 1850 was the first to use the English
language, and to employ avoirdupois weights instead of
the old Troy ones.
The papers on practical pharmacy were very valuable
indeed, and the discussions, in which Professor Attfield
and other eminent experts took part, were as interesting
as the papers themselves. There was a series of papers
on the Ipecacuanha compounds of the last edition of the
B.P., in which the question of ascertaining the standard¬
ised strength of preparations was very judiciously
handled. There was a very good communication on the
(o) ‘‘Hie Ytar-Ecok of }hammer, comprising abstracts of
apers relating to PIidi uiaoy, Materia Medica and Chemistry, from
une, 1698, to July, 1699. Further, the transactions of the thirty-
sixth annual meeting of the British Pharmaceutical Conference,
held at Plymouth during July, 1899.” London : J. and A. Churchill.
8vo, pp. 517.
best plans of determining the percentage of pure iron in
ferrum red actum, and another on Jaborandi and Pilo-
carpin, and on the determination of low percentages of
diabetic glucoBe. The paper on “suggested standards of
purity for foods and drugs” was listened to with much
interest:the writers justly remarked that in addition to
the classes of pure and of adulterated food there might be
a third class of “ specimens of inferior quality, but not
necessary adulterated.” “They also properly remark
that we have no legalised standards at all, except in
the case of spirits, and in the case of a few articles of
food, the limits adopted by the Inland Revenue authori¬
ties are Inown ( as in the case of milk ) and are probably
used by most Aimlysts.” To this they might have added
tobacco, our fiscal authorities showing the most con¬
scientious care in insuring the purity of this article.
No one will doubt the absolute necessity for
such legalised standards of every species of food,
where such is possible; it would protect the
public and the trader as well; and would put an end
to those unseemly squabbles between the experts of
prosecution and of defence, who too often contradict
each other flatly in our Courts, to the scandal of science;
and the worst of it is that these experts on both sides
are generally both honest and competent, but con¬
tradict each other on oath because their standards of
purity are different; on the percentage strength of a
sample of whiskey they would be sure to agree. It seems
to us that the test standards of the B.P. are sufficient for
public protection, as regards drugs ; the writers seemed
to desire something more. Most unfortunately this
paper was not discussed on the ground of “ want of time,"
but more probable was the reason put forward by another
speaker that “ on some of these points they would be
touching on rather tender ground, and that the sub¬
ject would be much better discussed in the Press than
in that room, where the temperature, already fairly
high, would probably rise rapidly.” Ihis matter, how¬
ever, mu3t be faced, and the problem legislatively
solved.
The year book of pharmacy (the first part of the
volume) i3 divided into th>ee sections, viz.: 1. “Che¬
mistry ”; 2. “ Materia Medica and Pharmacy ” ; and
3 “ Notes and Formulre.” These consist of short ab¬
stracts and extracts, taken from the Journals of the
whole world, of matters of interest and of novelty on
these important subjects ; this department is most care¬
fully and efficiently carried out by the accomplished
editor, Mr. Louis Siebold ; it contains such a mass of use¬
ful details for everyday work that it would be impossible
to summarise it; our only advice to our readers is, get
the book and read it. A very complete index enables
the reader to lay his hand at once on any point, or to
investigate any department.
MEDICAL ANNUAL SYNOPTICAL INDEX, (o)
Fob the past twelve years Wright’s “ Medical Annual ”
has furnished its readers with a well digested summary
of the progress of medical science. Each volume was
furnished with a good index, and the matter was, as a
rule, arranged alphabetically; thus reference was
facilitated to the utmost.
But the busy practitioner found as years went by and
the goodly row of the “Annual” filled his shelf that
searching indexes was too great a tax on his time and
patience—the something he sought escaped him ; and
he regretted that he had not a handy volume giving an
index for the whole twelve volumes.
The want has been met—met in the best and most
praiseworthy fashion by the synoptical index. A perfect
gem of an index, with cross references, a supplemental
index, and a synopsis of each article arranged chrono¬
logically.
Every fact likely to be wanted in every-day practice
on disease, its therapeusis, and on new remedies is in¬
cluded, and so helpful is the volume that we think prac¬
titioners who do not possess the Annual for years past
(a) “The Medical Annual Synoptical Index to Remed : ea and
Piseases. For the Twelve Years, 1887 to 1899.” Bristol: John
Wright and Co. 1899.
Digitized by
D*c. 27. 1899.
MEDICAL NEWS.
Th* Medical Press. 683
cannot make a better investment than in securing a copy
of the Index, and those just entering on practice will at a
glance find in its pages the moet approved methods of
treatment.
The arrangement of the book into sections on (1)
remedies; (2) diseases; (3) alterations in the 1898 BP.);
(4) test types; (6) memoranda; and (6) a supplemen¬
tary index, is exoellently carried out.
The multitude of facts compressed into the small
compass of its four hundred pages make the book one
of permanent value, both to students and practitioners of
medicine.
^Hcbical <ikto6.
The Queen’s Colleges in Ireland.
The recent very undignified and unpleasant distur¬
bances at the visitation of the Queen,s College, Cork,
arose chiefly from the judgment of the visitore that it
is impossible, under existing circumstances, to establish
a professorate of Pathology in the College School. The
Belfast College students have followed the lead of their
Cork brethren, and it is not surprising that they should
do so considering that pathology is, according to present
day opinion, one of the most important subjects of the
student’s education. The only obstacle in the way of the
establishment of such a chair is the parsimony of the
Treasury which, in this case is ridiculous, hair splitting.
We ofier to the students of the Queen’s Colleges our
sympathy with their very reasonable demand.
We have not the same sympathy with the complaint
of the Belfast school that their teachers are not
appointed, in due proportion, as examiners in the Royal
University. According to our old-fashioned ideas the
examinations of a great university ought to be conducted
by examiners totally independent of school interests,
though we well know that an examinership is a valuable
asset for a medical school, and we hold very strongly
that an educational institution humiliates itself when
it allows itself to be made the creature of any medical
school on religion or politics.
The “ Purser ” Testimonial.
The movement set on foot by the pupils of Pro¬
fessor Purser, the Professor of Physiology in
the University of Dublin, to present to him a testi¬
monial on the occasion of the completion of his
twenty-fifth year of Professorship, has resulted in
the foundation of a Medal in the Trinity College School.
The subscribers to the fund have arranged that the
occasion shall be celebrated by a dinner to the Professor,
which will be held at the Shelboume Hotel, Dublin, on
the 2'.'th inst. Dr. Kirkpatrick of 23, Lower Baggot
Street, Dublin, is the treasurer in charge.
The Vacant Surgeoncy of the City of Dublin Hospital.
It is announced in our advertising columns to-day
that applications for the Surgeoncy vacated by the
death of Mr. Wheeler, will be received up to the 5th of
January, but no day for the election has yet been fixed,
nor can it be bo until the Medical Board has decided
upon the applicants whom they will recommend to the
Governors. The list of candidates which is published
by a contemporary is therefore entirely speculative
and unauthorised, nor does it contain the names of all
the gentlemen who are currently named as likely to
compete.
Vital Statistics.
The deaths registered last week in thirty-six great
towns of England and Wales corresponded to an
annual rate of 22 0 per 1,000 of their aggregate popula¬
tion, which is estimated at 12,786.832 persons in the
middle of this year:—
Birkenhead 14, Birmingham 22, Blackburn 17, Bolton
16, Bradford 20, Brighton 20, Bristol 21, Burnley 16,
Cardiff 19, Croydon 20, Derby 14, Dublin 38, Edinburgh
17, Glasgow 22, Gateshead 16, Halifax 17, Huddersfield
9, Hull 22, Leeds 20, Leicester 22, Liverpool 26, London
23, Manchester 18, Newcastle-on-Tyne 19, Norwich 16,
Nottingham 19, Oldham 19, Plymouth 27, Portsmouth
30, Preston 25, 8alford 23, Sheffield 21, Sunderland 20,
Swansea 24, West Ham 15, Wolverhampton 24. The
highest death-rate per 1,000 living, as measured by last
week’s mortality, were ;—From measles l - 2 in Liverpool, -
1-4 in Sheffield, 18 in Birkenhead, 2 0 in Swansea, and
81 in Preston; from scarlet fever 1‘1 in Bradford; from
whooping cough 1*0 in Leicester, 1*2 in Blackburn, and
1*4 in Norwich and in Salford. In none of the large
towns did the death-rate from fever or from diarrhoea
reach 10 per 1,000. The 128 deaths from diphtheria in¬
cluded 55 in London, 16 in Leeds, 11 in Sheffield, 8 in
Portsmouth, 5 in Leicester, 5 in Liverpool, 4 in Norwich,
3 in Brighton, and 3 in Birmingham. Twelve deaths
from small-pox were registered in Hull and 1 in London,
but not one in any of the other large towns.
PASS LI8TS.
Royal College of Surgeons in Ireland.
The following candidates having passed the necessary
examination have been admitted Fellows of the College :
—Mr. J. T. Abbott, Mr. R. J. Coulter, Mr. T. Gilcriest,
Mr. R. D. Joyce, Mr. D. A. McCurdy, and Mr. H. W.
Dulton.
University of London.
The following is the official list of successful candi¬
dates who passed the necessary examinations during the
present month:—
M.D. EXAMINATION. MEDICINE.
Alford, Cyril Wolrige Hodgson, Corts. Bawstliorne
Armitnge, Frances, B.S. B.S.
Ash win, Richard Hamilton H order, Thomas Jeeves, B.Sc.
Bunting, Cecil, B.S. Horner, W. Ernest L., B.S.
Benliam, Charles Henry Houfton, Ernest Henry
Bostock, Eustace Bernd., B.S. Huggins, Sydney Penrose
Bo::. Stanley Longliurst Jenkins, John David, B.S.
Bruce, Harold Wilson, B.S. Leon, John Temple, B.Sc.
Buckley, Charles William Maxwell, James Laidlaw, B.S.
Burn. Alfred Mayston, Robert William
Cleveland, Arthur John Nubarro, David Nunes, B.Sc.
Cornish, Sydney, B S. (Gold Medal.)
Coutts, John Morton 8im Norman. Richard Henry, B.S.
Cunliffe, Thomas Varley, B.S. Perry Sidney Herl^rt
Currie, John Pugh, John WiHmmson
Fielder, Frederick John. B.S. Rotertson, Frederick W., B.S.
(Jotfe, ErnBt. Geo. Leopold, B.8. Slater, Geo. Nathan Oscroft
Greeuwood, Frank Reumayne Starling, Hubert John
Gullan, Archibald Gordon Stoney, Florence Ada, B.S.
Harris, diaries Poulett Williams, Percy Glyn S., B.S.
Hibbert, Joseph Coote
STATE MEDICINE.
Gully, Boliert Cullum. M.D. Weir, Arthur Nesham. B.Sc.
Jackson, Herbert William
B.S. EXAMINATION.—FIRST DIVISION.
Bucknall. Thos. Bupt. H., M.D. Trotter, Wilfred B.L . M.D.
Rol-erts. Adeline Mary Ttirnbull. Jane Holland
Stevenson, Mabel Geraldine Turner, Philip, B.Sc.
SECOND DIVISION.
Anderson William Maurice Meachen. George Norman
Andrews, Hy. Russell, M.D. Meakin, Etliilda Budgett M.
O-irter, Arthur Hunton Murrell, Christine Mary
) Chadbnrn, Mand Mary, M.D. Sayer, Ettie
. Dobson, Joseph Faulkner 8prawson, Cuthbert Allan
Ferris, William Stewart, Mary Ariel
Hilton, C deb Thomas Stewart, Walter Urahame
Howell. John Strange, Robert Gordon
lies. Mary Muriel Griffin Vernon, Ethel Miller
Martin dale, Louisa Watts, Eliza Turner
M.S. EXAMINATION.
Bonney, Wm. Fras. Victor, Handley, Wm. Sampson, M.D.
M D. Milton, William Taylei
Boyal College of burgeons, Edinburgh.
After having passed the requisite examinations the
following candidates were, at a meeting held on Decem¬
ber 15th admitted Fellows of the College :—
Hugh Bennett, M B., C.M.Edin., Captain, Indian Medical 8ervice;
Charles William Booker, M.RC.S.Eng., John Clark M.D.Edin.,
William Henrv Cooke, M.B.C.S.Eng., Charles William Dean,
L. R.C S.E., William Evans, M.B.C.S.Eng., Alfred Joseph Mar-
tineau, M.B.C.S.Eng., Alexander Glen Park, M.D.Glasg., David
Bichard Rowlands, M.B., C.M.Glasg., Robert Basil Stamford,
M. B.C.S.Eng., and James Whitton, L.R.C.S.E.
Society of Apothecaries, London.
The following candidates passed during December in
Surgery : T. B. Haig, Section I. ; J. B. Hall, Section II. ; T. E.
Holman; C. Johnson, Section I.; G. G. Meml-ery. Section II.,
O H. Rogorsou, Section II.; M. J. Evan ; O. C. Sibley; H E,
Weston, Section I. " _
Medicine: G. H. Bedford, Fcotion II.: W. F, C. Bennett, Section
II.; E. Grunge: K. Urube; H, N, Horton, Section 11.: G. G,
Membery, Section II,: O, H. Bogerson, Sections I and II,; G, M.
Watson.
Forensic Medicine : Dady, F. C. H., Elios, F., Grange, E.,Grube,
K. Bogerson, O. H., Watson, G. H.
Midwifery : Amos, C. B. S., Brooks, C- E., Cox, W. A. C., French,
W I)., Furness, J. C., Lucas, G. R., Roberts, W.. Bogerson, O. H.,
Smith, C. V.. Worts, C. C.
The Diploma of the Society was granted to the following candi¬
dates entitling them to practise Medicine, Surgery, and Midwifery :
Messrs. G. H. Bedford, C. E. Brooks, F. Elias, J. B. Hall, G. G.
Membery, O. H. Bogerson, O. C. Sibley, and C. C. Worts.
Diq
2 d by
.oogle
684 The Medical Psebr
N0TICE8 TO COBRERPONDENTS.
Dec. 27,
4totice« to
ClorrespoDbents, Short Ipettcrs, &t.
■ & Correspondents requiring a reply in this column are par¬
ticularly requested to make use of a distinctive lignature or
initially and avoid the practice of signing themselves “ Reader,”
*• Subscriber,” “Old Subscriber,” 4c. Much confusion will be
■pared by attention to this rule.
Local Reports and News.— Correspondents desirous of drawing
attention to these are requested kindly to mark the newspapers
when sending them to the Editor.
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 passed through
the post.
Original Articles or Letters intended for publication should
be 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.
BKrRiNTS.— Authors of papers requiring reprints in pamphlet
form after they have appeared in these columns can have them, at
half the nsnal cost, on application to the printers before the type is
■broken up.
THE SWEETENING POWER OF SUGAR.
According to the N.Y. Medical Becord, the sweetening powors of
sugar in powder are decidedly inferior to those of the coarsely crys¬
tallised article. In the process of pulverisation it is surmised that
the heat or electricity transforms part of thesugar into glucose; the
sweetening effects whereof are only about a third of saccharose.
M. E. Seirs.— We ore not aware of any concerted measures
having for object the destruction of sewer rats, nor, indeed, unless
-with some special object in view, such as the prevention of plague,
do we think their wholesale destruction is a thing to be aimed at in
■view of the usefulness of their role as garbage consumers. In certain
foreign seaports attempts have been made to asphyxiate these
rodents by chemical means, but we are unable to say with what
amount of success.
M.R.C.8.—Dr. Mayer’s abortive treatment of tonsillitis consists in
the hourly administration (to begin with) of teaspoonful doses of
the following mixture: sulphate of morphine, gr. I; tincture of
green hellebore ldr. water 4oz. Dr. Mayer states that retrogression
of the symptoms of acute tonsillitis often follows this medication
within twenty-four hours. Should this not be the case, it is useless
to persevere.
CASE OF EXTENSIVE SUPPURATION OF THE
ABDOMINAL WALL.
To the Editor of The Medical Press and Circular.
Sir.—I n your journal of December 6th (p. 580) I am represented
as having reported that in a case of extensive suppuration of the
abdominal wall “ the body of the uterus had disappeared. ” This is
a mistake. If you will permit me I will send you the notes of the
case, a very remarkable one of perforation of the uterine wall,
though not quite so remarkable as you have reported it, and you
may possibly think them worthy of publication.
I remain, yours obediently,
C. B. Keetlet.
■ 56, Grosvenor Street, W.
Dec. 20th, J.809.
[We shall be glad to receive Mr. Keetley’s notes.—E d.]
'Exeter. —You are quite right in giving a guarded prognosis in the
case. It not infrequently happens that in the earliest stages of pul¬
monary tuberculosis, tubercle bacilli may not be detected in the
sputa. Indeed they are not discoverable until some breaking down
of the lung tissue has taken place. In view of the family history, to
advance an adverse opinion was a hazardous step. In any case you
have taken the proper scientific attitude and may calmly await the
issue of events.
•An Edinburgh Student.— You are a little out in your data
Galileo mode his discovery of the isochronous oscillations of the
pendulum when a student at Pisa at the age of eighteen, applying it
soon after to determine the beat of the pulse—still an expedient in
everyday medical practice; and he constructed a pendulum for the
S orpose, giving it the name of pulriloffium. He invented the
tiermometer fifteen years later, in 1597, and microscope in 1600.
M. G.—A marked feeling of fatigue and lassitude on rising, in the
absence of a specific cause, is, or may be, the first signs of incipient
.neurasthenia. Before _ regarding it in thiB light, however, it is
necessary to exclude visceral and other causes, because, though the
Significance of the symptom is the same, its importance from the
point of view of diagnosis and prognosis varies according to the
physical basis which has given rise to it.
AMBIGUOUS I
The New York Medical Record mentions that a new book by Dr.
Weiss Mitchell is on the point of publication, with the suggestive
title “The Autobiography of a Quack.”
Dr. Rand.—T he distressing phenomena occasionally induced by
thyroid medication may, it is stated, be averted by administering
srsenic at the same time. There is sufficient clinical confirmation
of the statement to warrant a trial, at any rate, and possibly your
difficulty in the case referred to may thereby be obviated.
Bennett, W. F. C., L.B.C.P., L.R.C.S.Edin., Assistant House Sur¬
geon to the Rotherham Hospital and Dispensary.
Collier, James, M D„ M.R.C.P., K.Sc., Registrar to the National
Hospital for the Paralysed and Epileptic, Queen Square,
London.
Elliman, A. C. L.R.C P Lond., M.R.O.S., Medical Officer by the
St. Saviour's Board of Works, London, pro tem.
Greensill, J. H., M.R.C.S., Medical Officer of Health for the
Mnrtley Rural Sanitary District.
Hates, G Constable, F.R C.S.,Eng., Assistant Ophthalmic and
Aural Surgeon to the Leeds Geueral Infirmary.
Lunt, D. C M., L.R.C.P.Ire., L.R.C.S.Edin , M.B.C.S., Medical
Officer of Health for the Lvinm Urban Sanitarv District.
Ma. Callan, A F., B.A., M.B., B.C., F.R.C.S., L.B C.P.. Junior
House Surgeon to the Roval London Ophthalmic Hospital.
Newbt, T., M.D.St. And., M.R.C.S., Medical Officer of Health for
Great Grimsby Town Council.
Parsons, W. Brock, M.RC.S., L.R.C.P.Lond., Resident Medical
Officer to the North-West London Hospital.
Pugm. R . M.B., Ch.B.Edin., Senior Assistant Medical Officer for the
Birmingham City Asvlum.
Roberts, C Hubert, M.D.Lond., F.K C.S., M.R C.P., Physician to
Out-patients, Queen Charlotte’s Lying-in Hospital, Txmdou.
Russell, C. H., L R.C.P.Lond., M.R.C.S., D.P.H., Medical Officer
to Great Yarmouth.
Smith, W. E., M.B., C.M.. Senior House Surgeon to the Royal
London Ophthalmic Hospital.
Stanwell, St. John. M.B., M.C Edin , M.R.C.S., 8urgeon to the
Stamford and Rutland General Infirmary. Stamford.
Ttrrell, F. A. C., B.A., M.B., B.C., M.R.C.S., L.R.C.P., Junior
Surgical Officer to Out-patients, Royal London Ophthalmic
Hospital.
Dacanties.
Bristol Royal Hospital for 8ick W'omen and Children.—House Sur¬
geon. Salary £100 per annum, with rooms and attendance (not
board).
Bristol City and County.-Medical Officer for the Workhouse.
Salary £250 per annum. Apply to the Clerk to the Gurrdians,
St. Peter’s Hospital, Bristol.
City of York.—Medical Officer of Health. Salary £400 per annum.
Apply to the Town Clerk, Guildhall, York.
East Sussex County Asylum. Hayward’s Heath.-Third Assistant
Medical Officer. Salary £175 a year, without board or lodging.
Leicester Inflrmap’.—House Physician for 12 months. Salary £100
per annum with board, apartments and washing.
Lewes Dispensary and Infirmary and Victoria Hospital, Lewes.—
Resident Medical Officer. Salary £100 per annum, furnished
apartments, board, coal, gas, and attendance.
Middlesex Hospital, W.—Assistant in the Cancer Research Labora¬
tories. Salary £100 per annum, with an honorarium of £50,
after his second year of office.
Nottingham General Dispensary.—Assistant Resident Surgeon.
Salary £120 per annum. Special arrangement for board, Ac.
Seamen’s Hospital Society, “ Dreadnought,” Greenwich.—Senior
House Surgeon for the Branch Hospital, Royal Victoria and
Albert Docks, E. Salary £75 per annum, with board and resi¬
dence, and an additional £25 per annum conditionally.
St. John’s Hospital for Diseases of the Skin, 40, Leicester Square,
London. — Honorary Assistant Medical Officer. Apply to
Secretary.
St. Morylebone General Dispensary, London, W.—Resident Medical
Officer. Salary 100 guineas per annum, with furnished apart¬
ments, attendance, coals, and light
Teignmouth Hospital, South Devon. House Surgeon. Salary £50
a year, with board, lodging, and washing. No stimulants sup¬
plied, but in lieu thereof £6 per annum allowed.
Three Counties Asylum, near Hitchin.—Second Assistant Medical
Officer. Salary £150 per annum, with board, apartments, wash¬
ing, and attendance. Apply to the Clerk, St. Neots, Hunts.
Crawford.- On December 21st, at 71, Harley Street, London, the
wife of Raymond H. P. Crawfurd, M.D., of a sou.
Bell.— On December 19th, at Higher Broughton, Manchester, the
wife of Wm. Bruce Bell, M.B., C.M.Edin., of a daughter.
Faichnie. —On December 22nd, at 14, Strathray-gardens, London,
the wife of Norman Faichnie, Capt. B.A.M.C., prematurely of a
son, stillborn.
Mackat.— On December 19th, at The Cloisters, Knaresboro, the
wife of Ian l>. Mockay, M.B. and C M. of a daughter.
Roberts. —On December 19th, at Kingsdown, Forest Hill, 8.E., the
wife of Francis Henry Roberts, M.R.C.S., L.R.C.P.Lond,, of a
son.
Seaiha.
Brodir.—O n December 16th, at 5, Woodside Place, Glasgow, John
Ewan Brodie, M.D., Brig.-Snrg. iC.V.LB. and S.M.O. Clyde
Defences,
Flint.- On December 13th, at Orford, Suffolk, Frederick Saver
Flint, L.R.C.S., L.R.C.P , aged 31.
Pope.—O n December 23rd, at Woodnding, Pinner, Mary, widow of
John R. Pope, M.H.C.8.. L.S.A.
Waring.—O n December 12th, at 8, Eaton-road, Hove, Dr. Francis
John Arthur Waring, Retired Surgeon R.N., deeply mourned.
Google
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Printed on Thin Paper for Foreign Postage.
anil Cirrnlar. (fisfsfr. isa»
N^IS!S,'loi: LXVliljNo-SlW WEDNESDAY, DECEMBER 27, 1899. {STlS^ <*d.
SUMMARY O
THK HARVKIAN LKCTURR8.—
On the Surgical Treatment <>f
Tuberculous Diseases. By
W. Watson Cheyue, M.D.,
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Medical Press, King William Street, Strand.
WILLIAM MATHER, Limited,
MANUFACTURER* Of '
India Bubber, Medicinal, Adhesive, Porous, Bunion,
Com, Court, Kid, Leather, Mustard, Boll, Spread
Pharmaceutical and Surgical
FLAISTHRS
of every description, iu the most approved form.
Quality First Importance. Every Article Warranted.
SAMPLE* AND PRICES ON APPLICATION.
MARKING FLUID for LINEN—" NIGRINE."
No Warm Iron or Heating required.
WILLIAM MATH£R, Ltd., Dyer St, Holme, Manchester.
Loudon, Wholesale and Export Agents—
Mown. MACE ft HALDANE, 94 Milton 8treet, E.C.
“UNDOUBTED PURITY AND STRENGTH.”
MEDICAL MAG AX INS.
“IN THE FRONT RANK OF REALLY VALUABLE FOODS.”
ocoa
FAVOURED BY THE HOMES AND HOSPITALS OF
GREAT BRITAIN.
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Dec. 27,1800
"The Lancet 22 nd July, 1899 , says:—
“This brandy shows excellent features on analysis while the evidence 01 iaste is distinctly in favour k
the description that it is an old matured grape spirit. It possesses that ethei ial fragrance due to the peculiar
ethers of wine. Our analysis yielded the lollowing resultsAlcohol, by weight 41-00 per cent., by volume
48-43 per cent., equal to proof spirit 8487 percent. ; acidity expressed as acetic acid, 0-033 per cent.; ex¬
tractives 0*69 per cent.; mineral matter, nil; alcohol in volatile ethers, two grammes per to litres. The
MARTELL’S
is soft and mellow and ihe aroma is char¬
acteristic of a sound and mature wine-derived
spirit. In view of these analytical and general
evidences this brandy may be described as par¬
ticularly suitable for medicinal purposes.”
THREE STAR
"The Medical Press,” 9 th August, 1899 , says:—
“ We have carefully examined a sample of this well-known
spirit by the usual tests, and the results obtained by analysis
fully warrant our recommending it for medical and dietetic pur¬
poses. The analysis gave the following figures:—
BRANDY.
Alcohol (as proof spirit)
Extractives .
Ash .
Acidity.
Ethers (as alcohol)
86 5 per cent.
•68 „ „
Nil.
“ We analysed this product some ten or more years ago, and finding that it still maintains its exception¬
ally high character, we are consequently in a position to speak highly of it as a genuiue old brandy made
from wine, well matured, and free from all compounds which might detract from its value'as a medicinal agent.”
AS SUPPLIED BY SPECIAL WARRANT TO THE QUEEN.
IDRIS
ROYAL
TABLE
WATERS.
\DRIS & CO*, LTD , j C london , T £m 5 J!' And at Southampton and Liverpool.
MILNE’S ANTISEPTIC LICATURES.
Catgut, Silk
and
Horae Hair.
Silkworm Out
_ and Sulpho-
l- J Chromic Out.
These mostreliable and convenient Ligatures are protected by Royal Letters Patent, and
Surgeons should see JOHN MILNE’S name on every package so as to avoid
purchasing cheap and inferior imitations.
JOHN M ILNJEs m aU^iANUFACTIJRINC CO., LTD.,
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Dec. 27, 1899
The Medical Press and Ciroular Advertiser. yi!
Taller man's Hot Air Treatment.
NOTICE .
On the 24th June, 1899, an Action was instituted in the High Court
of Justice by Mr. Louis A. Tallerman and the Patents and Manufacturers
Development Company, Limited, against the Dowsing Radiant Heat
Company, Limited, and on the hearing of such Action in the Court of Appeal,
on the Dowsing Radiant Heat Company, Limited, undertaking not to print,
publish, issue, or circulate any pamphlet, notice, circular or advertisement
which contained any Press notice, testimonial or other document, or any
extract therefrom originally written in favour of the Plaintiffs’ Hot Air
Treatment and agreeing to pay the Plaintiffs £2 5 on account of their costs
in the Action, an Order was made that all further proceedings in the Action
should be stayed, and that the Defendants, The Dowsing Radiant Heat
Company, Limited, do pay to the Plaintiffs, Louis Abraham Tallerman and
The Patents and Manufacturers Development Company, Limited, the sum of
£25 for their costs of the Action.
Dated 23rd December, 1899.
SOLD WHOLESALE BY
GEO. NELSON DALE & CO., Ltd., 14 DOWGATE HILL, LONDON, S.C.
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LONDON, 1884. ADELAIDE, 1887. MELBOURNE, 1888.
BENGE R'S FOOD.
|FOR INFANTS, INVALIDS, AND THE AGED.
This delicious, highly nutritive, and most easily digested food is
specially prepared for Infants, and for those Adults whose
digestive powers have been weakened by Illness or age.
THE FOLLOWING LETTER Is PUBLISHED by SPECIAL PERMISSION of THE RUSSIAN COURT;-
“BALMORAL CASTLE, SCOTLAND.
“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."
Published by Permission of HER ROTAL HIGHNESS PRINCESS ALEXANDRA YON HOHENLOHE:—
“SCHLOSS, LANGENBURG, WURTEMBURQ.
“ Sirs,—I thought you would like to hear how the little Prince of Hohenlohe is getting on. I have
fed him entirely on ‘BENGER’S FOOD ’ since he was two and a half months old, and now he is eight
months. He is the finest and strongest child I have ever had charge of. He really is a splendid boy,
$iid always so good and happy. He has already four teeth, and has cut them without any trouble.
“I remain, Sirs, yours truly, MARY GALLOWAY
“(Nurse to the little Prince Gottfried v. Hohenlohe).
“ Dec. 5th.
“ I Asii be very pleased to have my letter printed, or any portion of it you wish. I have the permission
of Her Royal Highness Princess Alexandra von Hohenlohe. H.R.H. is very delighted with your food."
The Lancet describes it as “ Mr. Benger’s admirable preparation."
Thb 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 saysBenger’s Food has by its excellence established a reputation
of its own."
The Illustrated Medical News saysInfants 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 fortnight 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
oonsider Benger’s Food incomparably superior to any I have ever prescribed.”
A Ladu 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.” _ _
BENGER’S FOOD ia sold in Tins of various sizes by Chemists, &c., everywhere.
Wholesale of all Wholesale Houses and Shippers, or of the Manufacturers,
F. B. BENGER & CO., Ltd., Otter Works, Manchester.
Tbliqraphic aadpbks :—** ManoheBtsr."
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Deo. 27, 1890
The Medical Press ana Circu’ar Advertiser.
lx
m “Allenburys” foods
A Progressive
Series of Foods.
% Infant
feeding.
T HE “ AVIknburys ,f A\HK Food? so closely approximate in composition
to the natural food as to supply an artificial diet almost identical with,
and in practice found, when intelligently used, to be a reliable substitute
for the mothers milk. So much so in this the case that an infant can take these
Foods and the breast alternately without any disturbance to its digestive organs.
All ordinary substitutes for the mother’s milk fail in some important attribute
thus the usual substitute, cow’s milk, differs materially in composition, which no
amount of mere dilution can correct, being deficient in fat, albumen, and lactose,
whilst the casein is in excess. Further, as obtained in towns, cow’s milk invari¬
ably swarms with bacteria, many of which are pathogenic to the alimentary canal
of the infant.
THE
“Allenburys” Milk Food No. 1,
for use from Birth to Three Months ,
Affords, when prepared for 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 form it keeps
perfectly and requires the addition of boiled water
only to furnish a pure and easily digested food suit¬
able for infants during the first three months of life.
THE
“Allenburys” Milk Food No. 2,
for use from Three to Six Months,
This No. 2 Food contains all the elements of human
milk in proper proportions. To this is added a small
proportion of the soluble products of the action of
malt upon wheat, i.e. Maltose, Dextrine, and Soluble
Phosphates. These ingredients are a valuable adjunct
to the increasing needs of the infant economy, yet the
Food is readily and easily assimilated, there being no
unconverted starch present. This No. 2 Food is
designed for children between three and six months
of age.
THE
“Allenburys” Malted Food No. 3
for Infants of Six Months and upicards.
This is a 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 albuminoids. Being a fari¬
naceous Food, it requires the addition of fresh milk
in its preparation. This food should be given from
six months and upwards.
The “Allenburys” Foods should be given as
directed and not continued beyond the time indicated.
Thus the No. 1 Food should only be given during the
first three months of life, the No. 2 between the third
and the sixth month, and the No. 3 Food after the
child is six months of age.
Note.— When infants ire reared artificially it is
strongly advised that some fresh elements of diet
be given . Eminent authorities have recommended
that a little raw meat-j»ice, grape, or sweetened
orange juice , be given to or three times a week
after the first three or four months. Full
directions as to this are issued with each tin of
food.
Cbe “Allenburys” feeder.
This bottle has the nipple at one end and a valve-stopper at
the other, so that, both being removed, it can be readily 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. Price 13 each.
Allen & Hanburys Ltd., Lombard Street, London.
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X
Dec. 27, 1809
The Medical Press and Ciroular Advertiser.
Established 1700.
BOILEAU & BOYD, Limited,
Wholesale Druggists, Manufacturing Chemists,
ST. BRIDE’S LABORATORY, DUBLIN.
Special attention to all Beqnlrementa of Medical Prac titioners. Ask for Quarterly Price list.
THE BEVERAGE OF HEALTH,
Purveyors
to
H. R. H.
The
Prince of
Wales.
%S;clib SODA
lUv 1 )Y Ol )V/0 Medals A warded.
Works-DUBLIN AND BELFAST.
When
Ordering
see that
you get
the
“ CLUB.”
Prof. CAMERON, Superintendent Medical Officer of Health, and Vice-President of the College of Surgeons, Ireland,
■ays:— “ ‘Club Soda’ neutralizes the lactic acid in the blood which gives rise to rheumatism and other affections. 4 Club Soda
an antidote to acidjdyspepsia. ‘Club Soda’promotes digestion. 4 Club Soda’ is the most wholxsomk daily beverage that can be taken.
Mineral Water Manufacturers, Contractors to the Nile Expedition.
DUBLIN Sc BELFAST, who have been awarded 31 Gold and Prixe Medala,
When obdibutg THE " CLUB,” an that tou get rr.
Always Trustworthy.
« T has been proven by clinical tests that Bromidia is the best
and safest hypnotic yet known to the profession.
It is always of the same strength, and hence 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:—O ne-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 ft CO., 8t Louis, Mo.. U.S.A
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V/V/V/V/ \jfyjf\jfyjfyjf'
AAAAAAAAAAAAAA,
he taaicai Press and Circular Advertiser.
VVW v /VWW v/v/wva/V'/\a/va/ v , / VV
AAAAa w \Aa \AAAAAAAAAAAAA a
SCOTT S is the
Best Emulsion.
Because it contains the largest nercentage
of cod-liver oil.
Because the oil is the best medicinal
Norway oil.
Because the oil is in the most perfectly
emulsified form.
Because glycerine is combined with the oil.
Because sugar is not used to sweeten it.
Because the hypophosphites of lime and
soda add greatly to its medicinal
value, and
Because Scott’s Emulsion is not only the
most palatable of all forms of cod-
liver oil, but it can be absolutely
relied upon.
Scott’s Emulsion retains its form and
sweetness indefinitely. It does not grow
rancid, and it is tolerated by patients
continuously.
The best test of Scott’s Emulsion is
the practical test. Patients like it, and it
does them the most good.
SCOTT & BOWNE, Ltd., Manufacturing Chemists, London, E.C.
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AAAAAAA^
x(i
The Medical Press and Giroular Advertise-
Dec. 7, 1899
H ITHOUT offending the palate
or disturbing the diges¬
tion, ‘Kepler’ Solution en¬
sures the absorption of
cod liver oil to an extent
hitherto impossible. No
plain or prepared oil is so
acceptable to fastidious invalids and young
children or so easily assimilated as this
intimate incorporation of the finest Nor¬
wegian God Liver Oil in ‘Kepler’ Malt
Extract. It is the best preparation of malt
And oil which can be produced from the
finest materials by the latest and most
original methods under the control of
experts who have devoted many years to
studying the subject. ‘Kepler’ Solution is
supplied in small and large bottles.
Burroughs Wellcome & Co
LONDON and SYDNEY.
i?:;'r:rf
I
i
(oorrmQMT]
H 171
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Dec. 27, 1809
The Medical Press and Circular Advertiser
XV
Grateful Mothers
LIFEBUOY
A Spennymoor, Durham, Lady writes
“My baby has been washed with LIFEBUOY SOAP since she was
two weeks old. She is now six months, and the picture of health.”
A Bristol Lady writes
“A few weeks ago my little boy had a ringworm on his face. 1 gave
him hot baths at night, using LIFEBUOY SOAP freely. When doctor
saw the child’s face a short time afterwards he was astonished at finding
that the ringworm was so quickly removed.”
A Pendlebury Lady writes
“ My little girl recently suffered from eczema. I used LIFEBUOY
SOAP constantly, and she is now well and healthy and as fair as a lily.”
A Leytonstone, Essex, Lady writes
“ My daughter recently suffered from an attack of eczema in her hands.
For two years she attended a hospital, but she was not cured. At last she
tried your LIFEBUOY SOAP, and is now quite well.”
A London Lady writes
“ My baby was washed with LIFEBUOY SOAP when it was born, as
my doctor recommended it.”
LIFEBUOY Royal Disinfectant SOAP is a powerful disinfectant and
exterminator of the various germs and microbes of disease; is made of
absolutely pure materials; is free from injurious chemicals, and, in use, is at
once safe, sure, simple, and economical.
(Manufactured by
LEVER BROTHERS LIMITED,
Soapmakan to the Queen.
Port ftunMarht, Cheshire.
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fh« Medical Ppps« and Circular Advertiser.
Dec. 27, 1899
R A Y f R ’ Q PHARMACEUTICAL
PH I Ln J SPECIALITIES.
A new silver preparation, highly efficacious in the treatment of gonorrhoea (acute : injec¬
tions of i to 2 per cent.; chronic : injections up to io per cent.).
Most strongly recommended as a wound healer (either in powder form, or as an ointment
of from 5 to io per cent.), especially for suppurating wounds, ulcers and burns.
PROTARGOL contains 8'3 per cent, silver, and is easily soluble in cold or warm water,
is non-irritating, and possesses a better penetrating effect on the tissues than any other known
silver preparation.
PROTARGOL is a chemical compound of silver and a protein substance. Its solution is
not precipitated by albumen, chloride of sodium, or diluted hydrochloric acid.
PROTARGOL possesses high bactericidal properties. An eminent English surgeon, in
The Practitioner for March, 1898, confirms, so far as his experiences go, the favourable opinion
expressed by Professor Neisser, the discoverer of the gonococcus, especially with reference to
the powerful antibacterial properties of Protargol.
PROTARGOL has been used with the greatest success in ocular therapeutics (blepharitis,
dacryocystitis, etc.;, in solutions of 5 to 20 per cent. ; and recently in Rhino-Laryngology
(brushing with solutions of 5 to 10 per cent.).
PROTARGOL has also been highly recommended as a prophylactic for gonorrhoea (In¬
stillations of a trituration of 20 parts of Protargol, with 10 per cent, of glycerine, mixed with.
70 parts of water).
(Acetic Ether of Salicylic Acid.)
A perfect substitute for Salicylic Acid and its salts. It does not irritate the mucous-
membrane of the stomach. In consequence of its slow tendency to decompose it passes
through the stomach unchanged, being split up into component parts only in the intestinal
alkaline fluids. It does not cause any disturbances of the stomach or loss of appetite. More¬
over, it possesses an agreeable slightly acid taste, which favourably contrasts with the repug¬
nant sweet taste of the Salicylates. Aspirin causes none of the unpleasant after effects which
so frequently attend the use of Salicylic Acid and its salts.
Extensive clinical trials have proved that Aspirin is equally effective as a therapeutic agent
with Salicylic Acid and its salts, whilst it possesses at the same time the great advantage of
having absolutely none of the drawbacks which prohibit at times the use of the latter.
TRIONAL, IODOTHYRINE, TANNOPINE, SALOPHEN, LYCETOL, CREOSOTAL,
DUOTAL, HEROIN, PROTARGOL, ARISTOL, EUROPHEN, TETRONAL, ANALGEN,
LOSOPHAN, IRON SOMATOSE, MILK SOMATOSE, PHENACETINE-BAYER,
SULFONAL-BAYER, PIPERAZINE-BAYER, SALOL-BAYER.
Samples and Literature willingly supplied on application to the Wholesale Depot for
all BAYER’S Specialities.
THE BAYER CO., Ltd., 19 ST.DUNSTAN’S HILL, LONDON, E.C..
Alii at 20 Booth St, Morlej St, MANCHESTER; *2 Bothnll St, 8U8B0M; 4 4B Ticarajo taao, BRABFORO.
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Deo. 27, 1899 _The Medical Press and Circular Advertiser. xvii
FOR TRADE MARK.
BRIN’S OXYGEN
ADDRIM— •>»■•. •[
BRIN'S OXYGEN CO., Ltd., 34 Victoria 8t. Works: 69 Horseferry Rd., LON DON. [Telephone, 31111
BIRMINGHAM OXYGEN CO., Ltd., 8altley Works, BIRMINGHAM. [Telephone, 2687].
MANCHESTER OXYGEN CO., Ltd., Great Marlborough St., MANCHESTER. [Telephone, 2538]
SOMATOSE
SOMATOSE is acknowledged by eminent Medical Authorities at
home and abroad to be
An Ideal Food for Invalids
and Convalesconts.
SOMATOSE contains nearly 80 per cent, of Meat Albumen, is
invaluable iu wasting diseases, puts life and strength into the
weakest invalids, as well as those whose condition precludes the use
of ordinary food.
SOMATOSE also acts directly as a tonic, and speedily increases the
appetite.
SOMATOSE is an almost tasteless and odourless powder,
easily tolerated by the most delicate stomachs.
SOMATOSE is not a Patent Medicine or a drug, but a Thera¬
peutic Food in a form which has never before been obtained. It
is easily soluble in water, milk, soup, coffee, cocoa, &c.
SOLI) BY ALL LEADISG CHEMISTS A XI) STORES.
SAMPLES AND ALL PARTIf'l LARS FROM-
The BRITISH SOMATOSE CO., Ltd.,165Queen Victoria St.,London, E.C.
ANTITOXIN SERUMS ( Tetanus,
Streptococcus.
& QVDHJOIZQ Koch’s Tuberculin
01 nlllUCO ' Coley’s Fluid, etc.
FANNIN A CO., Ltd., keep in Stock all the above, and can despatch, per first rail or post,
immediately on receipt of telegram.
ALSO
OXYGEN GAS AND INHALERS.
(Address for Telegrams: “FANNIN,” DUBLIN.)
FANNIN & GO., Ltd., Manufacturers of Surgical Instruments and Appliances,
ARTIFICIAL LIMB MAKERS, CHEMISTS,
41 GRAFTON ST., DUBLIN. 88 WELLINGTON PLACE, BELFAST,
On Sundays or at Night send to FANNIN’S, No. 1 North Frederick Street, Dublin.
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The Medical Press and Circular Advertiser.
Deo. 27, 1899
r\| A D |_ 1X0 VAN ABBOTT’S GLUTEN BREAD, BISCUITS, AND FLOUR.
UIMDU I COa VAN ABBOTTS S07A BREAD, BISCUITS, AND FLOUR.
And various other Biscuits and Bread from Bran, Almond Nut, and Meat Flour.
O-. t taw ABBOTT < 8 e BOM’S, 104 WIGMORE STREET CAVENDISH SQUARE, LONDON W
Purveyor! to H.M. Naval, Military, and Principal London, Provincial, and Colonial Hoepltala. Established 1869. Agents for
DublinRetail—W. H. Bowers A Co., Great Brunswick Street. Wholesale—H unt A Co., 17 Westland Row.
LIQUOR PEPSINS [LONG’S]
(From the original Formula of Dr. E. LONG. A.D. 1869.)
Sss. to 3 j. for a dose, at or immediately after meals.
THE M08T CONCENTRATED AND EFFECTUAL PREPARATION OF PEP8INE KNOWN.
IT IS SWEET AND PALATABLE EVEN FOR CHILDREN.
A drachm with 15 minims of muriatic acid, and 1 oz. of water will dissolve 700 grains of moist fibrine at 100 degrees Fahrenheit.
The Strength of each batch it carefully tested. Vide Medical Press and Circular for October 13th, 1869.
H. L. & Co. are warranted by the approbation of Medical Men in recommending this preparation with oonfidenoe.
Manufactured by HAMILTON, LONG & CO., Limited , State Apothecaries, dee
8 LOWER 8ACKVILLE 8T., and GRAFTON 8T., PUBLIN. RATHMINES and KING8TOWN.
DR. J. COLLIS BROWNE’S
0 H L O R O D YjjN E
THE ORIGINAL AND ONLY GENUINE.
--♦-
From Symes & Co., Chemists, Medical Hall, Simla, January 5 , 1880 .
To J. T. Davenport, Esq., 33 Great Russell 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 Hindoetan, but 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 there 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 as general sedative, that have occurred under our personal observation during many years.
In Choleraic Diarrhoea, and even in the more teirible 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 Collis
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.,
His Excellency the Viceroy’t Chemists.
Sole Manufacturer, J. T. DAVENPORT.
37 GREAT RUSSELL STREET, BLOOMSBURY SQUARE* LONDON.
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Dec. 27, 1899
The Medical Prees and Circular Advertiser.
r -
"THE LANCET »„
VAN HOUTEN’S COCOA,
JULY 3rd, 1897.
“In a recent analysis
“ which we have made, the results
“ distinctly indicate the advantage of
“VAN HOUTEN’S PROCESS of manu-
“ facture. Thus this Cocoa yields
“ a decoction containing a maximum
“ proportion of the valuable food con=
“ stituents of the bean, and what is
“ of more importance still, these are
“ presented in a condition more easy
“ of assimilation and digestion than in
“ Cocoa not so prepared.”
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XX
__ 'The Medical Press and Circular Advertiser. Deo 27 , 1899
BEWLEY & DRAPER’S
GINGER WINE
■May be obtained of all Grocers and Wine Merchants.
Manufacturers, BEWLEY & DRAPER, Limited, DUBLIN.
CARLSBAD
NATURAL Mineral Waters, Salt, &c.
THE WATERS FROM THE
SPRUDEL, MUHL and SCHLOSS Springs
are largely prescribed in cases of
CHRONIC GASTRIC CATARRH, HYPEREMIA of the LIVER, GALL-STONES,
DIABETES, RENAL CALCULI, GOUT, DISEASES of SPLEEN, &c.
The NATURAL SPRUDEL SALT is now prepared from the Mineral
Water in the form of Pwoder (“ Pnlvorformig ”), and contains all the constituent* of the Spriidel
Spring. It has the great advantage in not being afFected by change of temperature or exposure
to the atmosphere, therefore in this form is the most reliable, and best adapted for EXPORT*
A SAMPLE of tbe SALT in POWDER FREE to MEMBERS of the MEDICAL PROFESSION on application to the Sole Importer!
for the United Kingdom and Colonies,
EAST PAUL’S WHARF, 26 UPPER THAMES ST., LONDON.
19 South John Street, LIVERPOOL, and Bath Bridge, BRISTOL,
To avoid imitations, please see that THE WRAPPER round each bottle of SALT bears our Signature
SALMON’S ABDOMINAL BELT. BRITISH CALF VACCINE
F..r Ilia hfffur-ff and nft.«r uccoiK'hfttnent. and for all cases of ahdnmi- ■■■WWBUfci
For use before and after accouchement, and for ill cases of abdomi¬
nal weakness, affords a more complete lifting support than any hither-
m to made, as it effectually raises
/I the lower part of the abdomen.
Air pads are fitted to It for
//IIIMIIM1 1 Hl!lil,l' \1'\ i \ cate of hernia prolacsus and
'If HI 1 ^ ■ —A moveable kidney wheureuuired
.i i -uii Prices from 26a. to 60s. Ladies
0 can address to Mrs. Salmon.
HENRY R. STTMON,
42 BEAUMONT 8T., UPPER WIMPOLE ST.,
" _(Established 1861.)
DR. RENNER’S ESTARLISHMENT
TOR
VACCINATION with CALF LYMPH,
186 MARYLEBONE ED., LONDON, N.W.
The Oldest Original Calf Vaccine Institution in this Country
priors or Calf Ltmph.—(Glyckrinated).
, Large ... 2s. each or 3 for 6s.
Tubes J Small .. Is. each or 3 for 2s. 6d.
■' ) „ .. sufficient for one Vaccination only ; 2 for Is or 6
' for 2s. fid.
Squares .. _ .. 2s. fid. each.
Registered telegraphic address- 1 ' Vaccine,” London.
Sent on receipt of remittance addressed to the Manager of the
establishment or the appointed agents
1 Russell Villas, Willoughby Road, Twickenham,
RICHMOND BRIDGE.
Director—W m. FAULKNER, M.R.C S.
® GLYCERINATED CALF LYMPH
guanmteed of exceptional pure
Put up In tin cases, containing 1 large
Tube (2-4 Vacclnations) .. per oaae L-
Put up In tin cases, containing 6 large
Tubes (2-4 each) .. .. peroS 6/-
Sent vost free on receipt of Pottal Order or
UN8AT18FAOTORY TUBES KXOHAKORD ran
Or OHARO*.
Specially packed for Export at same
_ prices. Postage extra.
Sole Wholesale Depot
BURGOYNE, BURBIDGES, & CO.,
COLEMAN STREET, LONDON E.C.
Tale graphic Address “ Cyrf ax London "
POOR LAW MEDICAL OFFICERS—LOCUM
TENENS — Medical Officers seeking temporary substitutes, or
practitioners willing to act as such, are requested to make application
to the Locum Tenens - Registrar, Dublin Office of the Fun
19 Lincoln Place, Dublin. ’
Digitized by
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Dec. 27, 1889 The Medical Press and Circular Advertiser.
THE MOST ECONOMIC, CONVENIENT, &
PORTABLE FORM OF SOUP.
mt
THESE SQUARES ARE PREPARED IN 13 VARIETIES (WUL IGATAWNY, JULIENNE, GRAVY, &C.) AND
SHOULD FIND A PLACE IN EVERY STORE-ROOM. BEING INVf LUABLE FOR MAKING SOUP AT SHORT
NOTICE OR IMPROVING STOCK. THEY WILL KEEP GOOD «f'Y REASONABLE LENGTH OF TIME AND
ARE PACKED IN NEAT BOXES CONTAINING 8 A 12 SQUARES.
ONE 6° SQUARE
cat? aaiatp
SOLD BY ALL THE LEADING GRCCERS & STORES.
Should any dilliculty be ex|>ci iuicc-d in obtaining the Square-', |i!c.i-e «■ aimmi, ate at once with tin- Manufacturers,
E. LAZENBY & SON, L TD 18 JTr in ty St aj LONDON. S.E.
Nisnrs
kf
co
geo
ii
L
The Richest in 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-FAT.
Sample Tin sent free to the Medical Profession on application to HENRI NESTLE,
4* Cannon Street, London, E.C.
Digitized by AjOOQle
if'xxii
The Medical Press and Ciroular Advertiser.
Dec. 27, 1880
COWTREXEVILLE. DAMMTnM
Moat Effective in the
Treatment of
GOUT, GRAVEL, ARTHRITISM.
«»«■« wm. (Diuretic, Tonic, Digestible)
Samples free to Members of the Medical Profession on application to INGRAM A ROYLE, East Paul’s Wharf, 26 , Upp. Thames st. London, E. C.
SPECIALITIES FOR INVALIDS.! N
s is
(Strongly Recommended by the Medical Faculty.
REAL TURTLE SOUP
teed made from the live Turtle only),
lOa. Od. per pine.
CONSOMME DE VOLAILLE.
3a. pax* pine.
And all KINDS of LIGHT COMESTIBLES.
SUPPLIED BY
V. BENOIST,
36 PICCADILLY, LONDON, W.
Purveyor by Special Appointment to HER MAJESTY THE Ql'EEN
and H.R.H. THE PRINCE OK WALES.
Particular * on application.
DISPENSING BOTTLES.
SPECIAL NOTICE. REDUCED PRICES.
8 and 4 ounce, plain or graduated, 8a. per groat.
Sand 8 „ „ „ 9a. „
The above can be bad Washed and Corked ready for uae la. per
gToaa extra. They are the improved ahape with rounded edges
WHITE MOULDED PHIALS.
Plain or graduated teaspoons, best quality.
4 ounce, 3a. id. per groat. I 1J ounce, 4a. 8d. per groat
GLASS BOTTLE MANUFACTURERS,
106 Midland Road, St. Pancrag, LONDON, N.W.
Banker*—L oudon & WtsnoNsm Bank. EaUbllahed 60 Year
MR. MARTIN’S PURE RUBBER BANDAGES
(REGISTERED TRADE MARK.)
For the radical Cure of ULCERS and other Diaeaaea of the Legs, are
far superior to any of the numerous imitations.
No. 8a 6 ft. by 2$ in., No. 24 wire gauge, price 3a. 8d.
No. IB 101 ft. by 3 in., No. 28 wire gauge, „ 6s. 6d.
No. 8 14 ft. by 3 In., No. 28 wire gauge, „ 7a. 6d.
No. 9B 21 ft by 3 in., No. 28 wire gauge, ,, 10a. 6d.
No. 1A 101 ft. by 3 in., No. 24 wire gauge, „ 7a. 6d.
No. 7 14 ft. by 8 In., No. 24 wire gauze, „ 9a. 6d.
No. 9A 21 ft. by 8 in., No. 24 wire gauge, ,, 18s. 6<L
CAUTION.—Please Orde the Genuine Martin’ 8 Bandages, each
No. IB 10i ft. by 3 in., No. 28 wire gauge, „ 6s. 6d.
No. 8 14 ft. by 3 In., No. 28 wire gauge, „ 7a. 6d.
No. 9B 21 ft by 3 in., No. 28 wire gauge, ,, 10a. 6d.
No. 1A 101 ft. by 3 in., No. 24 wire gauge, „ 7a. 6d.
No. 7 14 ft. by 8 in., No. 24 wire gauze, „ 9a. 6d.
No. 9A 21 ft. by 8 in., No. 24 wire gauge, ,, 18a. 6<L
CAUTION.—Please Orde the Genuine Martin’ 8 Bandages, each
. being stamped with Dr. Henry A. Martin's
JJO A // 1 Signature. All others are spurious imitations.
fU Mfi. U mIhkHm- Complete Price List, also Dr H. A.
tOn Martin s Pampnlet, post free from the Sole
/ European Agents,
V XSOHVE * BB8BXANN,
Surgical Instrument Makers,
Duke St., Mancheater Sq., W. & 241 Whitechapel Road, London.
f VOR 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. Like wise a strong low-priced
article for Hospitals and the Working Classes.
ABDOMINAL SUPPORTING BELTS, those for
Ladies' use, before and after accoachement, are
admirably adapted for giving adequate support with
EXTREME lightness— a point hitherto little attended
to.
Instructions for Measurements and prices on ap¬
plication, and the articles sent by post from the
Manufacture™
POPE & PLANTE,
Hosiers by appointment to the Queen.
Removed to 39b OLD BOND ST., LONDON, W.
The Profession, Trade and Hospitals are supplied.
BILLING “NON-MANTLE
INCANDESCENT CAS LIGHT
WITHOUT MANTLES.
BRILLIANT AND ECONOMICAL.
Price 5s. 6d. each.
By-pass Is. 6d. extra.
Postage: Inland, 6d.; Foreign, Is.
Hundreds of Testimonials. rj'* rj Jl||
' Grest saving in Gas. Easily fixed to any •»'
fittings. Illustrated Catalogue post free.
Lasts for years. Nothing to renew. wgs PgPjp D
Not affected by vibration or j | f
draughts.
Billing’s Burner Syndicate,
LIMITED,
180 WARDOUR STREET, LONDON, W.
INSURE - YOUR
HORSES AND CATTLE.
With the
IMPERIAL ACCIDENT, LIVE STOCK AND GENERAL INSUR¬
ANCE COMPANY, LIMITED,
Established 1878.
Head Offices: 17 PALLJIALL EAST. LONDON. 8.W.
Carriage, Saddle, Farm, and Trade Horses; Hunters, Stallions
and Infoal Mares Insured against Death from Accident
or Disease.
Claims Paid exceed glM.MB.
Prospectuses and particulars post free.
AGENTS WANTED. B. 8. ESSEX, Manager.
THE RETREAT PRIVATE ASYLUM,
Near Armagh.
(Established 1824.)
Licensed for the reception of ladies and gentlemen of the upper and
middle classes suffering from
MENTAL AND NERVOUS DISEASES.
(Voluntary Boarders and Inebriates admitted). This establishment
lias lately undergone many structural alterations and improvements,
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 added.
For further information, apply to the Medical Superintendent Dr.
J. Gower Alleh, J.P., or Mr. Joseph Allen, Clonallen, Armagh.
Digitized by LjOOQie
l)#o. 2ft, 1809
The Medical Press and Ciroular Advertiser.
xxiii
“ 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,
Professeur aja Faculte'de Medecine, Paris; Medecin honoraire des Hupitatu
Mcmbrc de VAcademit de Mcdccinc.
APENTA
THE BEST NATURAL APERIENT WATER.
Sole Importers: THE APOLLINARIS COMPANY, Ltd., LONDON.
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XXIV
the Medical Press and Circular Advertiser.
Deo. 27, 1899
CAMBRIDGE UNIVERSITY.
PATHOLOGICAL DEPARTMENT.
I.ONli VACATION COl'HSK, 1900.
Hi is Course will commence on Friday, July Utb, and will end on
Friday, August 17th, 1900.
Classes will he held as last year, but further arrangements are being
made for Advanced Classes.
The Laboratories will be open as usual for original work.
ARMY MEDICAL SERVICE.
A N EXAMINATION of CANDIDATES for
THIRTY COMMISSIONS in the ROYAL ARMY MEDICAL
CORPS will be held at the Examination Hall, Victoria Embankment,
W.C.. on 2 nd February, Hkhi, and following days.
Applications to c mipetc should bo made not later than the 22nd
January, on which date the list will be closed.
The following is the scale of pay, stated in annual amounts
Lieutenants and Captains .. .. £200 to £279 15s. nd. a vear.
Majors . £3«n to £410 12s. (id.
Lieut.-Colonels. £456 to £ti01 15s. tkl.
Colonels . £730. ,,
Surgeon-Generals. £1,003 15s.
Exclusive of quarters, fuel, servants, Ac., or allowances in lieu.
GRATUITIES AND PENSIONS.
After 10 years'service.gratuity of £1.25<i
„ 15 „ „ . „ £1.-0 >
,, IS „ „ . ., £2,500
20 ,, „ .. .. annual pension of £305
.. 25 ,, ,, . ,, £410 to £500
Colonels, after 3 years'service as such .. .. about £040
Surg.-Generals „ ., ,, .... ,, £730
Idle necessary forms, together with regulations and all further in¬
formation, can Ik 1 obtained from the Director-General, Anuy Medical
Service, 18 Victoria Street. S.W.
(Signed), J. JAMESON,
War Ottiee, Director-General.
27th November, 1899.
INDIAN MEDICAL SERVICE.
INDIA OFFICE, 2nd December, 1899.
A N EXAMINATION FOR EIGHTEEN
APPOINTMENTS TO HER MAJESTY'S INDIAN MEDICAL
SERVICE will be held in London on 2nd February, limO, and follow¬
ing days.
Copies of Regulations for the Examination, with information regard¬
ing the Pay and Retiring Allowances, Ac., of Indian Medical Officers
nmv lie obtained from the .Military Secretary, India Office, London,
S.W.. to whom applications for admission to the Examination, with
the necessary certificates, should lie sent so us to reach him not later
than the 22nd January, 1900.
E. STEDMAN, Major-General,
MHilary Secretary.
MEDICAL DEPARTMENT OF THE NAVY,
ADMIRALTY,
Northumberland Avenue, W.C.,
14 th December, 1399.
A N EXAMINATION of CANDIDATES for
entry into the MEDICAL DEPARTMENT of the ROYAL NAVY
will be held on the I9th FEBRUARY’ next and following days at
Examination Hail, Thames Emliankment.
Not less than sixteen Commissions as Surgeon will be offered for
competition.
The forms to be filled up by Candidates will be supplied on applica¬
tion to this Department.
H. F. NORBl'KV, Director General.
LONGFORD UNION
HAMPSTEAD, GLASNEVIN, FOR
GENTLEMEN,
HIGHFIELD, DRUM00NDRA, for LADIES,
NEAR DUBLIN.
Telephone No. 1082.
Licensed, under the Government Inspectors Supervision.
As Hospitals for the Medical Care and Treatment of Patlenta of the
Upper and Middle Classes suffering from
MENTAL AND NERVOUS DI8EA8E8.
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 the Resident Medical
Superintendent, 1IY. MARCUS EUSTACE, M.D., any time at the
above addresses, or at his office, 41 Grafton Street, Dublin,
on MONDAYS, ")
WEDNESDAYS, ^ 2-3 p.m.
FRIDAYS, )
STRETT0N HOUSE, CHURCH STRETT0N,
SALOP.
A Home for Insane Gentlemen.—Established 1853.
Church Stretton Is in the Shropshire Highlands, 600 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. 1943, o r apply
fully illustrated prospectus to RESIDENT MEDICAL OFFICER.
Telegrams— CAMPBELL HY8LOP, Church 8tretton.
BLOOMFIELD, M0REHAMPT0N ROAD,
DUBLIN.
(A Home for the Insane).
THIS PLEASANTLY - -SITUATED RESIDENCE, with extensive
gardens and grounds, for the reception of persons 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., 45 Mcrrion Square, East. HENRY* T. BEW'LEY, M.D.
F. R.C.P.I., 26 Lower Baggot Street, Medical Attendant
For terms and other particulars, application to be made to the
Superintendent at the Institution, or to the Hon. 8ec., JOHN EVANS,
L.R.C.8.I., 49 Dawson Street.
THE INEBRIATES’ ACTS, 1879-98.
BUNTINGFORD HOUSE RETREAT,
HERTFORDSHIRE.
For the Treatment and care of Gentlemen suffering from Inebriety
and the abuse of Drugs. Nine Acres of Grounds. Healthy employ¬
ment and recreations Workshops, Poultry Farm, Cricket Ground,
Tennis, Billiards, >Vc.
Terms-from 25s. to 45s. a Week. No Extras.
For Prospectus and Vacancies apply—
NORMAN DAVIS, M.D., Medical Superintendent.
SHAFTESBURY HOUSE, F0RMBY-BY-
THE-SEA, near LIVERPOOL.
Recently erected with all the latest Improvements, upon place
approved by the Commissioners in Lunacy, and licensed for ladies
ana gentlemen mentally afflicted. Bach Sitting-room, Dormitory,
and Corridor Is warmed and ventilated by special means, besides the
ordinary fireplace. The building Is surrounded by ten seres of
ornamentally laid out pleasure grounds. Lawn tennis, cricket, and
carriage exercise. Private suites of rooms U required. Terms moderate
Aoply to STANLEY A. GILL. B.A.. lf.D. M.R-C.P.Lonl.
TRAINED NURSE Wanted for the Fever Hospital, •|Uulilir-! accord¬
ing to the requireinentn of the Local Government Board. Salary £50
a year, with rations and apartments.
Applications, with testimonials and eertilleale of training. Ac., to
lie sent to the Clerk, on or before FRIDAY, the 5th of JANUARY,
next.
HARRY M. t'ANN, Clerk of the Union.
lbtli December, 1899.
CITY OF DUBLIN HOSPITAL,
UPPER BAGGOT STREET.
PRIVATE HOME FOR LADIES
MENTALLY AFFECTED.
Only a very limited number received.
Experienced Medical Treatment, supervised by Physicians, who
are famed for recoveries of Mental cases. Apply to
THE PROPRIETRESS,
ELM LAWN. DUNDRUM, Co. DUBLIN.
xarnBRixiT'S'.
A VACANCY’ at present exists in the SURGICAL STAFF of tile
nbovo Hospital. Application- shoiihl lie -cut on or la-fore JAN*. 5,
limn, to the lion. Sec, Medical Board. Mr. G. Ja.MK.-on Johv-Ton.
F.R.U.s.l.. from whom all pin liculais can lie had.
CONSULTING ROOMS TO LET.-
- TO MEDICAL AND OTHER PROFESSIONAL GENTLEMEN
Small Residence to Let on Portniau Estate, No. 1 Bickenhull Mansions.
Central and unique position for Consulting Rooms or other purposes.
Rent £180.—Apply at Offifces, 3 Bickenball Mansions, Gloucester Place,
Loudon, W.
DALRYMPLE HOME, Rickmansworth, Herts.
For the treatment of gentlemen, under the Act and privately.
Terms— 2 to 5 guineas weekly. 4( acres charming grounds on the
bank of the river Colne. Cricket, Tennis, Billiards, Concert Boom,
Workshop, Photographic Studio, <fcc.
Apply to the Medical Sdpkrintkndkkt
MEDICAL LOCUM TENENS. — Medical
Officers and Applicants are Invited to send particulars of their
wants to Medical Press, 19 Lincoln Place, Dublin. No charge beyond
It for registration.
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Deo. 27. 1809
_ Tha Medloal Press and Circular Advertiser. _ tut
CONTINENTAL HEALTH RESORTS AND HOTELS.
WIN T E'R RESORT for Consumptive Patients;
A R C O ■ NERVOUS COMPLAINTS;
(South Tyrol. Austria).
and CONVALESCENTS.
INNSBRUCK,
lUiulrattd Pamphlet tent free on application.
“An Ideal Winter Home.'* Invigorating. Dry. Suuuy. 1,920 feet Altitude.
Sheltered from North ami East Winds. Equable Temperature. Free from fogs.
For Health, Pleasure, and Educational Advantages this Town Is unique.
University; Schools; Medical < 'oil eg*; English Church; Theatre; Military Music
and Balls, Skating Kink ; Curling ; Toltogganlng ; Sleighing; Numerous Excursions.
PQANfl IlflTfl CIIDflDC Every Home-comfort. Electric-Light. Lift,
unnpu qUICL cui\urc. Hath*. Conversation, Reading, & Smoking8alons.
A. HANKBIOH, Proprietor.
Very moderate Pension-Terms for Famines and for Winter-Keddenoe.
Winter Resort for Convalescents, Nervous Disorders,Ac.
R
rwn
First-Class Family Hotel.
(South Tyrol, Austria).
Large Garden. Best Situation. Lift. Electric-Light.
Bugllalx Ohuroh.
HOTBL OONTINUNTAZi.
Superb Central Situation. Exquisite Panorama of Bay, Islands, and Mountains. Most
Comfortable Winter Home. Electric Light in every room. Ascenseur. Unquestionable
■Sanitation. Moderate Terms. Special Pension Terms Nov. to Jan. Uth.
Renovated throughout this Season ; and now re-opened under the personal Management of
the new Proprietors, Mr. and Mrs. OESCH-MULLBK, of the popular RUGEN-HOTEL,
Jungfraublick, Interlaken.
CANNES
TTT
81xteen hours Rail from Paris (P.L.M. Line). Carriages direct from Paris to Hyhres. Two English Churches.
English Banks, Libraries, Reading-Rooms, etc.
English Physicians.
By its unique position Hyeres enjoys an UNRIVALLED CLIMATE ; SHELTERED
by the Maures Mountains from the COLD ALPINE winds, and by the hills around
Condon, Faron. and Toulon from violent MISTRALS. The mean WINTER Tempera¬
ture of Hyeres is 50 ° to 59 " Fahrenheit in the shade, and 68 ° to 77 0 Fah. in the sun.
The many Hotels, Pensions, Apartment-houses, Villas Mid Cottages, enable Visitors to live (as each may prefer) luxuriously or comfortably
yet very economically. Hyeres is the most Southerly Riviera Winter Resort.
BRIGHTON.
Tan GRAND BOTH
The most comfortable. The most moderate in chargee.
JL. D. SHOOK, M
NATURAL MINERAL WATERS
(STATE SPRINGS)
VICHY
O m Xa m fll TT X W S .-For Diseases of the Kidneys, Gravel, Gout, Rheumatism, Diabetes, etc.
GRAHTDIl-ORIDDD. -For Diseases of the Liver and Biliary Organs, eto.
35C O X* X V Jk. Xa . — For Stomaoh Complainte.
VIOHY.KTAT PASTILLES. VIGHY-^TAT OOM PRIMES.
or 8 Pastilles after each maal facilitate digestion. For Instantaneously producing an effervescing alkaline water.
Samples and Pamphlets free to Members of the Medical Profession on application.
CAUTION.—Bach bottle from the STATE SPRINGE bears a neck label with tlmwords “ VICH V-1TAT • and the name of the
SOLE AGENTS:-
INUK A Id & RQYLE, Ltd., East Paul's Wharf, 26 Upper Thames Street, 1.0.
And at Liverpool, and Bristol.
Digitized by LjOOQle
The Medical Press and Circular Advertiser.
B.P. 1898.
Deo. .27, 1899
CHOCOLATE-COATED TINCTURE TABLETS
CON VENIENT. A CC UR A TE. RE LI A BL E.
We are prepared to supply the following— .
No.
Per
1000
Per
500
Per
100.
220 Aoonite Tinct., 1 min.
. 36
110
-/8
Physiologically tested.
222 Belladonna Tinot., 1 min.
... ..." 3 6
1/10
-; 8
223 tBelladonna Tinot., 5 min.
. 4-
2/2
-/8
224 Camphor Comp., Tinct.. 2 min.
. 3,6
1/10
-,8
226 “Camphor Comp., Tinot., 6 min.
. 4/8
2/6
-/9
226 tCamphor Comp., Tinct., 15 min.
. 7/8
42
1/-
227 Camphor Comp., Tinot.. 30 min.
. 11/9
6/3
1/6
228 Cannabis Indioa, Tinot., 5 min.
. 6/-
3/2
-/IQ-
Physiologically tested.
229 tCannabis Indica, Tinct., 15 min.
. 9/3
4/10
1/2
230 fCapsicum Tinct., 1 min.
. 3/-
18
-.7
231 Capsicum Tinct., 5 min.
. 5/-
2,8
-/9
232 Cinchona Tinot., 30 min. ..
. 11/9
6/3
1/6
233 Colohioum Seed Tinot.. 5 min...i
../a. 6/-
3/2
-110
234 fColohicum S$ed Tinct-., 15 min
. 9/3
4/10
1-2
236 Digitalis Tinot., 1 min.
3/6
1/10
-'8
Physiologically tested.
236 fDigitalis Tinot., 5 min.
. 6/-
3/2
-10
237 tGelsemium Tinot., 5 min.
. 6/-
3/2
-110
238 Geleemium. Tinot., 15 min.
. 8/10
4/8
111
fGinger Tinct., 5 min. (240) ...
. 3/6
1/10
-IS
Ginger Tinct., 30 min. (260)
. 48
2/6
-10
239 tHyoecyamus Tinct., 15 min. ...
. 7/8
4/2
11-
240 Hyosoyamus Tinct., 30 min. ...
. 11/8
6/1
1/6
241 Nux Vomica Tinot., 1 min. ...
... 3/6
1/10
-/a
242 t-Nux Vomica Tincl., 5 min. ...
. 4/8
2/6
• -/9
243 Opium Tinct., 1 min .
. 4/8 ..
2/6
-19
244 Opium Tinot., 5 min.
- —.
3/2
-/10
245 tOpium Tinot., 15 min .
. . li/-
5/8
1/3
246 Opium Tinct., 30 min .
. 17/9
9/-
2/-
Paregoric, see Camphor Comp.
247 Strophanthus Tinot., 1 min. ...
!
v. 6/6
3/6
-10
Physiologically tested.
248 t8trophanthus Tinot., 5 min. ...
. 11/-
5/8
1/3
249-250 See Ginger.
251 Stramonium Tinct., 6 min.
... ..... 6/6
3/6
-/10
Formulas marked thus (t) will be sent when choice between two or more similar
combinations is not Indicated on order.
PARKE, DAVIS & CO., LONDON, W-
’Muted for the P* >prletor and Published every Wednesday iimiulng by Aibkht Alkrkd Tindall, King WiL'iam Street, Strard Londou.
iiMin : A. H. J aoob, 19 Uncoln Place.
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